Nursing Health Assessment Using Storytelling

The current ANS featured article reports a project that demonstrates how storytellng as a means of assessment has the potential to expose the complexities of health experiences that are not readily uncovered using standard assessment approaches.  The article is titled “Narrative Inquiry Into Shelter-Seeking by Women With a History of Repeated Incarceration: Research and Nursing Practice Implications,” authored by by Amanda Marie Emerson, PhD (English), PhD (Nursing), RN.  Dr. Emerson shared this information about her work:

I had the enormous good fortune during my PhD program in nursing (2017,

“The Sexual Health Empowerment (SHE) for Cervical Health Literacy and Cancer Prevention study team, December 2017: (Back row) Katherine Gwynn, Amanda Emerson, Molly Allison, Brynne Musser. (Front row) Joi Wickliffe, Megha Ramaswamy (PI), Shelby Webb. Used by permission.

University of Missouri-Kansas City) to become part of an interprofessional team (RNs, public health professionals, health educators, medical residents, social workers, a sociologist, and even a historian!) doing cervical cancer prevention research led by Dr. Megha Ramaswamy (PI) at the University of Kansas Medical Center, and my mentor Dr. Patricia Kelly (Co-I) (UMKC). The Sexual Health Empowerment (SHE) study, funded by the National Cancer Institute, sought to learn whether a interactive, trauma-informed, small-group intervention centered on cervical health literacy and feminist principles would increase up-to-date Pap screenings among women detained in county jails. We implemented the program with successive cohorts of women over 2 years beginning in 2014 and have been following up for 3 years. In addition to my role in the intervention itself, I took part in an ethnographic sub-team that conducted interviews and participant observation with a group of volunteers in the community after their release.

The Advances in Nursing Science article reports on a series of particular interviews I conducted with those women. We were initially impressed by the variety of strategies women used in highly challenging circumstances (i.e., poverty, physical and emotional abuse, child separation, even during incarceration) to get and give social support to one another. In my analysis of the interviews—a course of coding, reiterative reading for themes, memoing, discussion with team members—a particular set of stories coalesced. Almost to a woman, the participants in our follow-up research struggled to find secure housing when they returned to the community. This basic need drove many of the stories they told, organizing how they perceived and interacted with others and impacted how they understood choices related to their health and safety. It bears noting that I have a background in literature as well (PhD, 2004) where I learned to recognize the power of stories to give form to versions of self and other, to shape feeling and motivate behavior. The stories about shelter-seeking told by women with histories of repeated incarcerations in this study were not long, but they were rich in implications for the women’s health. The analysis I present in this narrative inquiry maps a couple key trajectories the stories about shelter seeking take and serves as a call to nurses who work with women in the community who may have backgrounds involving incarceration. I urge nurses to listen up, to make stories part of the assessment. As my analysis illustrates, those narratives can carry otherwise unavailable information about threats to health and safety and open up valuable opportunities for nurse-led education and advocacy.