Academic journal article International Public Health Journal

Translating Stories of Clinical Practice into Narratives for Critical Reflection

Academic journal article International Public Health Journal

Translating Stories of Clinical Practice into Narratives for Critical Reflection

Article excerpt

Introduction

As clinician, narrative therapist and researcher working in sexual health and HIV, I am interested in helping health care workers translate their local stories of clinical practice into narratives for critical reflection. This research sits within the language based tradition of qualitative interpretive human science, hermeneutic phenomenology, ethnography and poststructural narratives. It picks up Alfred Korzybski's dictum the 'map is not the territory' where the map provides an abstract schema and the territory provides the experience (1). Clinicians frequently utilize maps of technical data, knowledge and skill to perform evidence based practice, whereas, this research is located in the experiential territory of health care workers as a socially constructed experience.

Translation is the process of communicating an idea using specific language and it began with the appearance of writing. The Latin term translatio, or trans- and fero, together mean 'to carry across', while the Ancient Greek term for translation, μ[varepsilon]τ?υρασιsfgr; (metaphrasis) means 'to speak across' (2). This research is about translating what health care workers say about their service.

The paper introduces translational research as a speaking across process using narrative ideas. Qualitative human science methodologies, narrative and local stories show how this research is useful in developing health services, because it explores what health workers say they do in practice. A case study about universal antenatal Chlamydia screening by midwives in a rural hospital provides an example how stories are translated into narratives for critical reflection. In complex health environments this research offers a way to reformulate how knowledge is implemented by drawing on local stories of clinical practice.

Qualitative interpretative human science and hermeneutic phenomenology

Qualitative interpretative research is a broad term of the human science paradigm used to capture human experience and includes many domains: discourse analysis, ethnography, phenomenology, grounded theory, case studies and action research (3). Interpretative research aims to express human knowledge, experience and meaning held by informants in their social context - this information adds flesh to the bony structure of quantitative data.

This research begins with hermeneutic phenomenology and includes a socio-cultural narrative to explore dominant ideas, minority views and things that are excluded. Hermeneutic phenomenology offers a way to richly describe lived experience, where hermeneutic ideas were originally articulated by Dilthey (4) to provide a way to interpret 'the written records of human existence'. Phenomenology uncovers themes present in every human phenomenon by bringing the experience into light where it can be seen, described and understood. A major assumption in hermeneutic phenomenology is that language is the reservoir of human existence as it transmits individual life expressions, which leads Manen (5) to conclude this research 'is essentially a linguistic project.'

Ethnography

The research example about midwives screening for chlamydia has a unique ethnographic quality: I studied midwifery in this hospital with these midwives 25 years ago, and also have 18 years full time clinical experience in sexual health screening and treatment. Ethnography investigates the commonsense meanings held by members of a sociocultural system and includes three broad types - classical, critical and poststructural ethnographies (3).

Ethnography data is collected about the social context, shared beliefs and attitudes, economic and political organisation, language, customs, rituals, events, behaviour and actions. Classical ethnography is more functional. The researcher adopts a neutral, reflective and interpretive role to document with minimal intrusion in the setting. The researcher attempts to gain a social view through rigorous observation over time, while generating a theoretical position based on reasoned analysis. …

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