An integrated narrative nursing model: towards a new healthcare paradigm.

In the traditional biomedical model of clinical practice, which assumes a medicine focused on disease, diseases are considered as biological or psycho-physiological universal entities. This explanation, although necessary, is not enough. Several authors have recently become interested in the use of narrative practices in the medical care setting, underlining the increasing importance of "a patient-centered approach", a "relationship -centered care" and "narrative medicine". Even in Nursing, the challenge was to combine two models that seemed incompatible: the Evidence-Based Nursing Model and the Narrative-Based Nursing Model. The first one is based on the disease and is capable of reaching measurable objectives. It is marked by rationality, objectivity, determinism, unilateralism and linearity, and its methods emphasize logic, control, measurement and deduction. The second model is based on a global approach, resulting in a psycho-social perspective which stresses the importance of individuality, interpersonal relationship, and the illness and sickness as significant parts of healthcare. Through a short examination of different narrative models in medicine, we underlined some principles which can be used in nursing practice and we suggested a new healthcare paradigm based on integrated narrative nursing. It represents a groundbreaking new normative approach, deriving from different epistemological (positivist paradigm and interpretive paradigm) and methodological approaches that integrate quantitative data already normally detected on the patient, with subjective information obtained from the person and his family, and by the social impact that the disease causes. The integrated narrative nursing makes use of quantitative (e.g. scales and scientific evidence) and qualitative tools (e.g. narratives, autobiographies, therapeutic emplotment and patient's agenda). This approach, based on holistic comprehension, hermeneutic dialogue and a high degree of narrative skill, produces different ways of understanding and offering cure, care and assistance. This could allow a targeted assessment, a precise diagnosis and a personalized education. The benefits coming from the use of this paradigm are several, as for example, to disseminate a personal experience in a perspective of humanization, to improves quality of life and to create a positive effects on patient care outcomes.