Finding Meaning and Sensemaking in Hospital Nursing Teams: The Promise of Narrative Medicine

Purpose. Narrative medicine is an innovative field that has provided meaning and increased communication between health care providers and their patients. This study explored the significance and nature of the practice of Narrative Medicine and what impact this had with NICU nurses on their team interaction with respect to team functioning, sense-making, and vocational understanding. This study seeks to provide nursing teams another tool to find meaning in their work and strengthen their teamwork. Using Narrative Medicine and the theory of phenomenology, this is a new approach that may bring nurses to draw on fresh ways to engage their work and each other. This has the possibility to demonstrate how the work of Narrative Medicine creates clarity and lucidity for nurses. This study asks the question of how meaning is constructed discursively in the practice of nursing. Method. In this study, 11 NICU nurses participated in the practices of narrative medicine. This included 3 group sessions, one individual interview, and observation of each participant for 3-5 hours. Participants examined and discussed the ways they viewed their work in terms of functioning, sense-making, and vocation. Field notes were read by myself and coded for emergent themes in the phenomenological theory tradition. Results. Patterns of communication and teamwork were complex and nuanced. Participants reported building stronger relationships as they grew more aware of each other’s stories and had the opportunity to reflect on their work among their coworkers. This led to an intensified individual and team understanding of their roles as healthcare professionals. Participants responded in the group, individual, and observation time about how this process positively contributed to their individual and shared identity, value, and meaning as a nurse. Conclusions. Conversations in the Narrative Medicine exercises, individual and observational time demonstrated how the influence of these practices assisted to remove barriers so that relationships were enhanced. This positively contributed to team practices of asking for and offering help to other teammates, increased trust, team task functioning, sense-making, and increasing a sense of their “call” or vocation in the practice of nursing

National survey of indigenous primary healthcare capacity and delivery models in Canada: the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) community profile survey

Background: There is a significant deficiency of national health information for Indigenous peoples in Canada. This manuscript describes the Community Profile Survey (CPS), a community-based, national-level survey designed to identify and describe existing healthcare delivery, funding models, and diabetes specific infrastructure and programs in Indigenous communities. Methods: The CPS was developed collaboratively through FORGE AHEAD and the First Nations and Inuit Health Branch of Health Canada. Regional and federal engagement and partnerships were built with Indigenous organizations to establish regionally-tailored distribution of the 8-page CPS to 440 First Nations communities. Results were collected (one survey per community) and reported in strata by region, with descriptive analyses performed on all variables. Results were shared with participating communities and regional/federal partners through tailored reports. Results: A total of 84 communities completed the survey (19% response rate). The majority of communities had a health centre/office to provide service to their patients with diabetes, with limited on-reserve hospitals for ambulatory or case-sensitive conditions. Few healthcare specialists were located on-site, with patients frequently travelling off-site (> 40 km) for diabetes-related complications. The majority of healthcare professionals on-site were Health Directors, Community Health Nurses, and Home Care Nurses. Many communities had a diabetes registry but few reported a diabetes surveillance system. Regional variation in healthcare services, diabetes programs, and funding models were noted, with most communities engaging in some type of innovative strategy to improve care for patients with diabetes. Conclusions: The CPS is the first community-based, national-level survey of its kind in Canada. Although the response rate was low, the CPS was distributed and successfully administered across a broad range of First Nations communities, and future considerations would benefit from a governance structure and leadership that strengthens community engagement, and a longitudinal research approach to increase the representativeness of the data. This type of information is important for communities and regions to inform decision making (maintain successes, and identify areas for improvement), strengthen health service delivery and infrastructure, increase accessibility to healthcare personnel, and allocate funding and/or resources to build capacity and foster a proactive chronic disease prevention and management approach for Indigenous communities across Canada. Trial registration: Current ClinicalTrial.gov protocol ID NCT02234973. Registered: September 9, 2014