Zocher Ute, Bertazzi Isabella, Colella Elvira, Fabi Alessandra, Scarinci Virginia, Franceschini Alessandro, Cenci Cristina, Cognetti Francesco, Cercato Maria Cecilia
Free Lance/Collaboratrice per l'Istituto Robert Koch, Berlino.
UOC Oncologia Medica 1, IRCCS Istituto Nazionale Tumori "Regina Elena", Roma.
Recenti Prog Med. 2020 Mar;111(3):154-159. doi: 10.1701/3315.32857.
Narrative medicine makes explicit the experience of disease and enhances the subjective view in the cure. In addition, the narrative approach involves personal experience and emotional resonances of the health care professional leading him to redefine the values in terms of health and disease. The IMPERO study aims to explore the personal "life experience" of health care professionals involved in studies exploring a new methodological clinical approach: the use of a digital narrative diary in collecting and integrating theme-oriented narration in clinical practice.
Qualitative study based on the interviews of three health care professionals (two oncologists and one nurse) involved in the AMENO study. The main topic of the interviews was the "perceived" and the intimate experience of each health care professional, particularly on the meaning and the role regarding their personal and professional experience while coping with patients narration. The analysis of data focuses on three aspects: a) the health care professionals' point of view using the diary as a tool for narrative-based medicine; b) the work environment as a framework for the use of the digital diary; c) the mental construction concerning the meaning of the tool and its preliminary use in clinical practice.
The diary is appreciate as a tool for the application of narrative-based medicine; the reading/writing format is considered of high quality and suitable for clinical practice processes. The narration drives a change in the patient-health care professional relationship: the patient is valued as an "individual". An atmosphere of empathy and greater intimacy is created. The perceptions developed over the years of clinical practice, which reflect personal and professional concepts (knowledge and individual believes in illness, health, healing, etc.), influence the perception of the narrative instrument and its clinical use. The work context influences the use of the diary, limiting its potential. Narrative medicine is a way of reorganizing the criteria that contribute in defining the quality of patient care by focusing on the patient-health care professional relationship.
The approach of narrative medicine must be reviewed in the light of the relational systemic theory which allows us to understand several aspects: the training in narrative medicine itself, the acquisition of professional skills by practitioners, and the organizational development of the institutions (the organizational structures but also the values and professional culture of work).
叙事医学使疾病体验变得明晰，并增强了治疗过程中的主观视角。此外，叙事方法涉及医疗保健专业人员的个人经历和情感共鸣，促使他们重新界定健康与疾病方面的价值观。IMPERO研究旨在探索参与一项新的临床方法学研究的医疗保健专业人员的个人“生活经历”，该临床方法是在临床实践中使用数字叙事日记来收集和整合主题导向的叙述。
基于对参与AMENO研究的三名医疗保健专业人员（两名肿瘤学家和一名护士）的访谈进行定性研究。访谈的主要主题是每位医疗保健专业人员的“感知”和内心体验，特别是在应对患者叙述时他们个人和专业经历的意义及作用。数据分析聚焦于三个方面：a）医疗保健专业人员将日记用作叙事医学工具的观点；b）将工作环境作为使用数字日记的框架；c）关于该工具意义及其在临床实践中的初步使用的心理构建。
日记被视为叙事医学应用的一种工具；阅读/写作形式被认为质量很高且适合临床实践过程。叙述推动了患者与医疗保健专业人员关系的改变：患者被视为“个体”而受到重视。营造了一种共情和更亲密的氛围。多年临床实践中形成的观念，反映了个人和专业概念（对疾病、健康、治愈等的认识和个人信念），影响了对叙事工具及其临床应用的认知。工作环境影响日记的使用，限制了其潜力。叙事医学是一种通过关注患者与医疗保健专业人员的关系来重新组织有助于界定患者护理质量的标准的方式。
叙事医学的方法必须根据关系系统理论进行审视，这使我们能够理解几个方面：叙事医学本身的培训、从业者专业技能的获取以及机构的组织发展（组织结构以及工作的价值观和专业文化）。
