People in the palliative and end-of-life phase undergo numerous and varying experiences along their life trajectory. It is important that some of these experiences are expressed as often as possible. There could be a number of ways that healthcare professionals and community nurses can facilitate this process, particularly when care is delivered in the home setting. Storytelling plays a unique part in the provision of palliative care. This process enables patients to tell their story while listening to others', which can act as a means of support and assist patients in coming to terms with their situation or terminal condition. While telling their story, there is also the opportunity to reflect and evaluate their situation, with a possible benefit to overall wellbeing, leading to enhanced quality of life. Storytelling has the potential to preserve self-identity (Youell and Ward, 2016) and boosts confidence, allowing people to connect with others. Self-identity comes from feelings of being valued, being acknowledged as a person first and then as a patient. The process of storytelling affords the teller a sense of autonomy, as they are in control of what they share.
While the storytelling process could pose its own problems (eg the inability to articulate the story clearly), the end goal should be to create a platform for a person to express and share their experiences, with a view to processing difficult emotions while fostering a sense of togetherness with those listening. Therefore, it is important that listening becomes a central element of this process, even where issues of articulation are apparent, and accompanied with encouragement to the storyteller to keep sharing their experiences.
In a workshop focusing on storytelling, conducted by the Sharing Stories for Wellbeing organisation and evaluated by Youell and Ward (2016), one participant captured the essence of storytelling for them:
‘… you think about things that you haven't thought about in a long time, and that gives you some pleasure … you can pass them onto future generations of the family.’
‘You sit and think about it a while and you think “at least I did something with my life”.’
It can be argued that storytelling has the advantage of encouraging individuals to express themselves while reducing the social isolation often experienced towards the end of life (Gunaratnam and Oliviere, 2009). However, with any process that involves divulging inner emotion, there is a need for skilled guidance by healthcare professionals, so that the patient's disclosures end up being cathartic rather than traumatising, energising them to view their life as worthwhile and reinforcing their self-identity.
Therefore, it is essential that proper training in the facilitation of storytelling is provided to community nurses, so that they are confident in supporting patients and families express their experiences and emotions. Certain skills, such as asking the right questions to allow people to share their most intimate stories and listening intently while managing time during home visits, are crucial for all community nurses. Sharing Stories for Wellbeing is one organisation offering such training to healthcare professionals in partnership with Hospice UK. More details can be found at the following links:
- www.sharingstoriesforwellbeing.co.uk
- https://professionals.hospiceuk.org/what-we-offer/courses-conferences-and-learning-events
In a time where a health condition threatens a patient's wellbeing, usurping their independence, it is sensible to conclude that offering patients a platform for storytelling can be a welcome intervention. Within the palliative care phase, storytelling has the potential to inspire patients and help them to come to terms with their terminal condition. Storytelling offers an opportunity to introspect, evaluate their circumstances and undergo reflection with some therapeutic value, which leads to enhanced quality of life (Synnes, 2015). Synnes (2015) goes on to suggest further benefits, including the reinforcement of the patient's sense of identity, leading to a reduction in episodes of low mood. With such reported and demonstrated benefits, alongside many others not mentioned here, those working in healthcare should cultivate the skills, courage and dedication to enable and facilitate storytelling among all the patients we care for. Supporting these patients can also help their families and friends retain positive memories as they undergo bereavement and the grieving process.