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Advances in Social Sciences Research Journal – Vol.8, No.1
Publication Date: January 25, 2021
DOI:10.14738/assrj.81.9577. Willis, K., & Marzilli, C. (2021). Conceptualizing Narrative Health in Human-Facing Professions to Develop Cultural Competence and
Improve Communication During the COVID-19 Pandemic. Advances in Social Sciences Research Journal, 8(1) 32-36.
Conceptualizing Narrative Health in Human-Facing Professions to
Develop Cultural Competence and Improve Communication During
the COVID-19 Pandemic
Kent Willis, PhD, Colleen Marzilli, PhD, DNP, RN
University of Texas Health Science Center, Tyler, Texas, United States
Colleen Marzilli, PhD, DNP, RN
University Of Texas At Tyler, Tyler, Texas, United States
ABSTRACT
Narrative health is a technique that healthcare professionals can use to
connect with patients. The events of 2020, including the global severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have
identified that patient care is largely dependent upon relationships
within the healthcare environment. Relationships in the healthcare
environment are established through a trusting exchange between the
patient and provider, and one technique to develop this relationship
and trust is through narrative health. Narrative health provides the
exchange of information between patient and provider in a discussion- like manner, or narrative health. This strategy promotes cultural
competence amongst the healthcare professional team and improves
communication between the patient and provider. Narrative health is an
important concept for healthcare professionals to understand, and
narrative health should be a part of any healthcare professional’s
toolbox, especially in vulnerable times like the COVID pandemic. The
inclusion of narrative health in practice has the potential to improve
patient outcomes and empower healthcare professionals and patients.
Keywords: COVID-19; narrative health; cultural competence; improved
communication
INTRODUCTION
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease
2019 (COVID-19) pandemic exposes critical communication and information gaps that contribute
to health disparities among vulnerable populations [1]. Narrative health in human-facing
professions, like medicine and nursing, is a professional approach in healthcare and a strategy
focusing on optimizing relationships, adequate communication, effective patient care, and
professionalism. It relies on engagement, cooperation, building relationships with stakeholders, and
reflection on the inspiration that drove the individual to choose the healthcare profession. Narrative
health aims to enhance human relations and the environment of care through collaboration,
boosting motivation, and dedication through inspiration to ensure the best possible outcomes. The
narrative approach to health and medicine may help develop cultural competency by improving
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Willis, K., & Marzilli, C. (2021). Conceptualizing Narrative Health in Human-Facing Professions to Develop Cultural Competence and Improve Communication
During the COVID-19 Pandemic. Advances in Social Sciences Research Journal, 8(1) 32-36.
URL: http://dx.doi.org/10.14738/assrj.81.9577 33
communication, enhancing interaction, and inspiring authenticity in human relations among people
from different walks of life. Humans use narratives to make sense of life [2].
IMPROVING COMMUNICATION
Health communication practitioners recognize the positive benefits of storytelling as a narrative
approach to convey health information between healthcare professionals and patients [3]. Namely,
one of the primary focuses of the narrative approach is to enhance communication in healthcare.
The narrative approach seeks to develop careful listening, observation, and speaking skills critical
for the adequate delivery of the services that health professionals provide, and careful reading and
speaking skills are important to consider in the process of narrative health [4]. Training individuals
on narrative approaches occurs by engaging in different communication scenarios to analyze and
practice these critical skills. They practice observation, attentive listening and engagement,
appropriate response, developing connections and trust, and all other aspects of effective
communication in the training sessions [4].
Emphasis on the need for critical analysis and evaluation of communication is vital to improve
outcomes in healthcare. Promoting narrative health training is the best strategy to help providers
improve communication and interactions. The trainees are also equipped with other critical skills
like empathy, accommodation, and understanding to enable better communication and interaction5.
The narrative health strategy is a professional approach to developing essential skills at the
professional level to facilitate teamwork between the health providers and the patient to determine
the most effective treatment.
When these critical skills are developed in training sessions, it helps facilitate acquisition of the
narrative approach. Trainers can help human-facing professions develop the narrative skills. While
training is helpful for developing the narrative approach skills, it is not essential to develop these
skills. Human-facing professionals, like physicians and nurses, that wish to engage in a narrative
approach to care can use listening and discussion to engage the patient in a dialogue to develop a
narrative that will enhance trust and adherence to the healthcare plan.
AUTHENTIC HUMAN RELATIONS
The narrative approach focuses on collaboration among different health professionals, patients,
families, and other relevant parties to enhance service delivery. Solidifying high-quality care is
dependent on the effective engagement and participation of stakeholders, and it is another benefit
of narrative health. More importantly, the need for highly developed narrative health competencies
among human-facing professions facilitates a relationship between provider and patient that
addresses cultural differences and concerns. Healthcare professionals must have the human
relation skills to handle cultural differences and maximize interactions as this is paramount for trust
between provider and patient6. Therefore, the healthcare provider must develop and consciously
improve their narrative health and collaborative skills to actively implement collaboration as they
work with the interprofessional team in the delivery of care for the patient. Critical expertise to
handle challenges like language barriers, religious beliefs, practices, resistance to care,
noncompliance, family participation, professional differences and others that inhibit collaboration
results in improvements in health outcomes [5]. The narrative approach helps to build cultural
competence and understanding of differences and the way those in the human-facing helping
professions develop relationships with patients for a trusting and collaborative approach to care.
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The narrative approach also places emphasis on collaboration in healthcare settings. It requires
consultative decision-making among different health experts and the engagement of the patient and
families in the process. The approach is enabled by discussions, meetings, personal communication,
negotiations, and consultations. This ensures engagement and trust to share experiences, and this
further develops an awareness about the difference [5]. Such a thorough process enhances
understanding of differences and perceptions of individuals and their healthcare practices. A
narrative approach promotes accommodation and collaboration, and it leads to the achievement of
high-quality care. These are all important tools for building relationships that focus on
understanding through a narrative health approach. Narrative health allows the patient to be an
active participant in their health journey through feelings of empowerment that place the patient in
an active role in their health.
RELATIONSHIP DEVELOPMENT
The narrative approach also emphasizes the importance of professionalism, effectiveness, and
growth that can only be achieved through best practices and collaboration. It identifies the need for
enlightenment and learning to build competence and expertise throughout the life of the healthcare
provider. Those in the human-facing helping professions develop critical competencies like
professional conduct, accountability, consultation, communication, and interaction that then helps
to enhance the relationship with the rest of the stakeholders. The strategy then enables the
improvement of skills to enhance collaboration with other health stakeholders in the delivery of
health services [6]. A narrative health approach leads to the realization that success depends on the
ability to collaborate and work with others, and this leads the individual to focus on developing the
narrative competencies to promote health and wellness in patients. In turn, this facilitates the
improvement of relationships between provider and patients and improves healthcare.
The narrative approach emphasizes the need for application-based training and not just abstract,
classroom-based instructions. Practitioners participate in practice exercises where they directly
engage potential peers and clients to develop, implement, and improve critical competencies. The
training session should promote engagement by including diverse environments, and this ensures
that healthcare providers gain expertise and skills to handle patients from diverse backgrounds.
The strategy ensures that those in human-facing helping professions exercise accumulated
knowledge, and this enhances skill development [5]. Once done with initial training, healthcare
professionals embark on the process of developing skills to enhance their effectiveness. The
experience healthcare professionals with diverse skills to develop relationships with people from
different cultures.
The narrative approach builds cultural competency through effective communication, human
relationships, and relationship development. It requires the development and application of critical
communication skills like attentiveness, listening, observation, and appropriate response. However,
it also mandates collaborative working through engagement and joint decision-making, and this
promotes interaction and understanding of essential differences. Even more critically, the narrative
approach encourages continuous engagement and development of skills to enhance competence to
work in human-facing professions like healthcare. Joint collaboration between patients and
healthcare providers is the best approach to interact with and understand others to develop cultural
competence, essential for a narrative approach.
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Willis, K., & Marzilli, C. (2021). Conceptualizing Narrative Health in Human-Facing Professions to Develop Cultural Competence and Improve Communication
During the COVID-19 Pandemic. Advances in Social Sciences Research Journal, 8(1) 32-36.
URL: http://dx.doi.org/10.14738/assrj.81.9577 35
Conceptualizing the term narrative health through the exploration of theoretical linkages is
fundamental to the process [7]. Exploring the qualitative research underpinnings that investigators
use in the study of health concepts and experiences provides awareness with the recognizable
benefits of narrative approaches in health messaging and communication These benefits include:
1. The interrelationship between health and life issues;
2. The benefits of good health that people take for granted;
3. Coherence or lack relating to good health as a norm;
4. Temporal issues;
5. Health as a moral practice.
NARRATIVE HEALTH AND CULTURAL COMPETENCE
Cultural competence is an important aspect of health, and a lack of cultural competence is related
to health disparities and poor patient outcomes. Cultural competence means that health
professionals accept the individual and embrace humility that may exist as a result of cultural
differences. It is a complex phenomenon, and all those involved in health care are charged with the
task of providing culturally competent care with colleagues, patients, and families [8]. It is
important to realize that approaching health from a narrative perspective is a powerful tool to
develop relationships with patients and engage in a culturally competent manner with patients.
COVID-19 AND THE PANDEMIC
COVID-19 and the pandemic has caused undue stress to the healthcare system that permeates all
aspects of care. From patients having limited visitors and companions during crucial appointments
to requiring face masks for all visits, these changes have served to isolate the patient during crucial
health appointments. This approach has made healthcare seem less patient-centered and has
alienated many patients from being an active role in their health journey. Healthcare professionals
using a narrative approach can help restore the humanistic component of healthcare back to the
equation. Narrative health is a tool that all healthcare professionals can use in their practice. It is
free, it does not take that much time, and it goes a long way towards empowering patients.
CONCLUSION
In conclusion, the narrative approach to health and medicine derive from qualitative research and
have promise for improving outcomes. The primary benefits of narrative health and medicine
include improvements in communication, empathy, collaboration, teamwork, and relationship
building. Improving interprofessional skills between providers and dialogue between providers
and patients establishes a foundation for understanding cultural competence.
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