Story TheoryStory TheoryA Middle Range TheoryA Middle Range Theory

Donna H BrownDonna H Brown

UNC GreensboroUNC Greensboro

April 20, 2010April 20, 2010

What theory should be…What theory should be…

• ““Enthusiastic discourse that that fits the Enthusiastic discourse that that fits the description…a place where people work description…a place where people work at the very edges of their abilities, at the very edges of their abilities, constantly pushing each other’s thinking constantly pushing each other’s thinking into new territory, giving names to into new territory, giving names to things that have gone unnamed, things that have gone unnamed, dreaming of better ways, describing dreaming of better ways, describing common ground and finding ways to common ground and finding ways to realize shared dreams” realize shared dreams”

Belenky, Clinchy, Goldberg, & Tarule Belenky, Clinchy, Goldberg, & Tarule (1996).(1996).

BackgroundBackground

• First published 1999 as “attentively First published 1999 as “attentively embracing story;" simplified to story embracing story;" simplified to story theorytheory

• Mary Jane Smith, PhD, RN:Mary Jane Smith, PhD, RN: Professor Professor and Associate Dean, Graduate Academic and Associate Dean, Graduate Academic Affairs, West Virginia University School of Affairs, West Virginia University School of NursingNursing

• Patricia R. Liehr, PhD, RN:Patricia R. Liehr, PhD, RN: Professor Professor and Associate Dean for Nursing and Associate Dean for Nursing Scholarship, Florida Atlantic UniversityScholarship, Florida Atlantic University

What is Story Theory?What is Story Theory?

• Ontology:Ontology: “story is an inner human “story is an inner human resource for making meaning” (Reed, resource for making meaning” (Reed, 1999).1999).

• Epistemology:Epistemology: “middle range theory “middle range theory bonds research and practice in a method of bonds research and practice in a method of knowledge development” (Reed, 1999). knowledge development” (Reed, 1999).

• Smith and Liehr share the belief that story-Smith and Liehr share the belief that story-telling has healing potential; this theory telling has healing potential; this theory development was driven by the desire to development was driven by the desire to bind practice and research in nursingbind practice and research in nursing

PurposePurpose

• Stories as a part of human experienceStories as a part of human experience• Stories bind people and timeStories bind people and time• Stories as expressions of who we are, Stories as expressions of who we are,

where we have been and where we are where we have been and where we are goinggoing

• Story theory = context for nurse-person Story theory = context for nurse-person health promoting processhealth promoting process

• Structure to guide nursing in practice and Structure to guide nursing in practice and research by collecting stories about health research by collecting stories about health situations that are important to the personsituations that are important to the person

Storytelling in the Storytelling in the LiteratureLiterature

• Foundations from Parse, Rogers, Reed, Foundations from Parse, Rogers, Reed, Peplau, Watson, Newman, Benner, Chinn, Peplau, Watson, Newman, Benner, Chinn, KramerKramer

• Understanding culture, meaning of Understanding culture, meaning of events in the lives of individuals, events in the lives of individuals, understanding the impact of emotions, understanding the impact of emotions, ways of healing and repair, sharing in ways of healing and repair, sharing in artistic form, rediscoveryartistic form, rediscovery

• Growing phenomenon; qualitative Growing phenomenon; qualitative researchresearch

Assumptions Assumptions • People change as they are interacting People change as they are interacting

in relationship with their world; this in relationship with their world; this change is found in connected change is found in connected dimensions that are in constant motiondimensions that are in constant motion

• People live in their expanded present; People live in their expanded present; this state is due to the transformation of this state is due to the transformation of past and future events into the here and past and future events into the here and now experiencenow experience

• People experience meaning through the People experience meaning through the “creative unfolding of human potential.” “creative unfolding of human potential.”

Theoretical ConceptsTheoretical Concepts

•Intentional dialogueIntentional dialogue•Connecting with self-in-Connecting with self-in-

relationrelation•Creating easeCreating ease

Theoretical ModelTheoretical Model

Creating Ease

NURSE PERSONIntentional Dialogue

Complicating health challenge

Developing story-plot

Movement toward resolving

Smith, M.J., & Liehr, P.R. (2008). Middle Range Theory for Nursing, 2nd ed. New York: Springer

Research and Story Research and Story TheoryTheory

• Adolescents living with obesity and Adolescents living with obesity and pregnancypregnancy

• Increasing sensitivity to Appalachian Increasing sensitivity to Appalachian culture in APNsculture in APNs

• BP changes when adding story-BP changes when adding story-centered care to diet and exercise centered care to diet and exercise regimen of patients with stage 1 HTNregimen of patients with stage 1 HTN

• Energy resources for caregivers in Energy resources for caregivers in oncologyoncology

• Drinking and drivingDrinking and driving

Using Story Theory in Using Story Theory in Nursing PracticeNursing Practice

• Setting aside life burdensSetting aside life burdens• Expressing disagreement through Expressing disagreement through

behavioral messagesbehavioral messages• Theory for mutual timingTheory for mutual timing• Understanding the meaning of voiceUnderstanding the meaning of voice• Health care decision making from Health care decision making from

gathering storiesgathering stories

7 Phases of Inquiry7 Phases of Inquiry

1.1. Gather the story about a health challengeGather the story about a health challenge

2.2. Compose restructured storyCompose restructured story

3.3. Connect challenge and current literatureConnect challenge and current literature

4.4. Refine name of health challengeRefine name of health challenge

5.5. Describe developing story plotDescribe developing story plot

6.6. Identify energy/motion directed to Identify energy/motion directed to resolvingresolving

7.7. Collect additional stories about this Collect additional stories about this challengechallenge

Possible Uses for My Possible Uses for My ResearchResearch

• Narrow the age group to children OR Narrow the age group to children OR adolescents (Story path has been used adolescents (Story path has been used and worked well with adolescent groups)and worked well with adolescent groups)

• Introduce your story in the way you Introduce your story in the way you frame your topic in an introductory letter frame your topic in an introductory letter to participantsto participants

• Calm, quiet environment and interviewerCalm, quiet environment and interviewer• Familiarize with additional articles on Familiarize with additional articles on

story theory to gain more insight with story theory to gain more insight with adolescent groupsadolescent groups