Strategies and effectiveness of narrative medicine in renal patients: a literature review. Part 1

Abstract

Strategies and effectiveness of narrative medicine in renal patients: a literature review. Part 1 Introduction: This paper on narrative-based medicine (NBM) is divided into two articles. The concept of NBM has been developed over the last decades to bring the biomedical aspects of illness and treatment closer to the psychosocial aspects and life experiences related to illness. Purpose: To identify and summarize the evidence and concepts of NBM in nephrology. Methods: Review of studies based on a literature search in 6 databases. Results: Thirty-five papers were included in the review, none of which were quantitative. Discussion: The narrative approach applied to a nephrology context seeks to shed light on the life experiences related to kidney disease by collecting, through structured and semistructured interviews, stories from patients, caregivers and health care providers. Some of the main topics emerging in the first article are the lack of a "disease identity" that allows patients to identify with the specific status of kidney disease; uncertainty as a dominant feature of living with an illness characterized by continuous progression and regression; the "unspeakable", referring to all those aspects for which there is no room for expression in the care relationship, such as living with the risk of dying, experiences that are difficult to put into words, and everything related to mystery, faith and the inexplicable. Conclusions: This review shows the importance of exploring the disturbing aspects of life for patients with chronic renal failure. Knowledge of these aspects can help health care providers improve the quality and effectiveness of the therapeutic relationship and ensure that the patient will not feel isolated but at the center of the care process. Narrative medicine, as will be highlighted in the second article, is also aimed at health care providers in order to investigate their experiences, which are often characterized by situations of suffering and discomfort. The narrative approach in nephrology could be supported by further research into the therapeutic abilities of narration in the care relationship. Keywords: Narration, Narrative medicine, Narrative nursing Indirizzo per la corrispondenza: Mariangela Mettifogo Dipartimento di Nefrologia, Dialisi e Trapianto renale Ospedlae San Bortolo -ULSS 8 Berica Viale Rodolfi, 37 -36100 Vicenza mariangela.mettifogo@gmail.com rizzano l'orientamento. Nei primi studi ermeneutico-fenomenologici, la medicina è stata considerata un sistema culturale i cui significati simbolici modellano il vissuto del malato (1), e la narrazione la modalità con cui la persona attribuisce significato agli eventi e si orienta rispetto alle azioni e alle scelte da intraprendere. Secondo l'approccio ermeneutico la condivisione della pluralità dei significati che emergono dall'incontro tra sanitario e paziente può contribuire a una co-costruzione di senso dell'esperienza vissuta. La narrazione da parte del malato della propria storia e l'ascolto di chi si prende cura di lui, gli pe...

Narrative interviews to assess quality of life in Peritoneal Dialysis

“…Selon les théories narratives [5], le but du récit est de « clarifier le sens de l'expérience de la maladie en donnant un ordre aux événements ». La médecine narrative a montré son intérêt dans le domaine de la santé [6], en néphrologie [7,8] et auprès de patients dialysés [9]. Nous n'avons pas pour idée de comparer la qualité de vie des patients selon les différentes techniques de dialyse adoptées, mais de leur proposer un temps d'échange pendant lequel ils peuvent s'exprimer librement sur leur propre ressenti vis-à-vis de la maladie rénale chronique et de la dialyse.…”