Narrative analysis: how students learn from

stories of practice
Edwards, Sharon Lorraine . Nurse Researcher (2014+) ; London  Tomo 23, N.º 3,  (Jan 2016): 18.

Enlace de documentos de ProQuest

RESUMEN
 
Aim To describe and recommend a variety of data analysis methods when engaging in narrative research using
story as an aid to nursing students' learning.
Background Narrative research methodology is used in many nursing research studies. However, narrative
research reports are generally unspecific regarding the analysis and interpretive process.
Discussion This article examines the qualitative analytical approaches of Lieblich et al 's ( 1998 ) narrative
processes of holistic content and analysis of form, incorporated as overarching theories. To support these theories
and to provide a more rounded analytical process, other authors' work is included. Approaching narrative analysis
from different perspectives is recommended. For each cycle of analysis, it is important to conceptualise the
analysis using descriptors drawn from the initial literature review and the initial text. Rigour and transparency are
foremost, and tables are generated that reflect each stage of the analysis. The final stage of analysis is to clearly
report, organise and present findings to reflect the richly varied and diverse potential of stories.
Conclusion Engaging in narrative research and then dealing with the large quantities of data to analyse can be
daunting, difficult to manage and appear complex. It is also challenging and rewarding. With clear descriptors,
examining the data using multiple lenses can serve to develop a greater level of insight into understanding nursing
students' learning from their clinical experiences, presented as stories, when involved in the care of individuals.
Implications for practice There are many approaches to narrative analysis in nursing research and it can be
difficult to establish the main research approach best suited to the study. There is no single way to define
narrative analysis and a combination of strategies can be applied.

TEXTO COMPLETO
 
Introduction
Narrative research can be used to make what is tacit more explicit and organise experiences so that they can be
explored, understood, analysed and critiqued. It can also be used to explore a situation where little is known about
what is being studied. It is a method for tapping into the contextual learning that takes place in nurses' clinical
practice.
There is a dearth of nursing literature about narrative research, but what does exist ( Traher 2011 ) usually focuses
on results with only brief descriptions of analysis. The purpose of this paper, which is part of a larger study to
explore story as an aid to learning, is to provide an interpretive guide to some of the analysis techniques that are
available. These are not presented as linear or iterative (even though this can be applied to story data) but through
many different lenses, filtered to prevent distortion. To ensure a more comprehensive understanding and take
advantage of its full potential, story data has to be analysed from all perspectives, although this can be seen as
complex.
This paper discusses the use of narratives to explore learning. It focuses and expands on the two-stage approach
developed by Lieblich et al ( 1998 ), that is, the holistic analysis of content and then form. Methods are exemplified
using a study involving stories written by nursing students, to explore their use as a potential aid to learning from

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clinical practice.
Learning and stories in narrative research
Narrative research is an approach that is plausible, flexible and open-ended, encouraging a researcher to search for
novel insights. It is highly suitable for nursing education research, which seeks to make the classroom and
practice environments places where students are more likely to learn ( Fairbairn and Carson 2002 ). Nurse
education students can use narrative and story to describe the world of clinical practice from their perspectives
and in their own language. Their stories can show nursing 'as it really is' ( Carson and Fairbairn 2002 ) or, at least,
as the individual nurse perceives it.
Nursing is about practice and the research covered in this paper was concerned with the potential for students to
learn from their clinical experiences of practice represented as stories. More exactly, it explored students' learning
from their stories of situations of clinical practice.
There is more than one approach to the study of narrative ( Holloway and Freshwater 2007 ). Narrative research
can be interpreted in many different ways and qualitative researchers can build their own 'narrative
methodologies'. This study used written stories, participants as researchers and focus groups.
Story may well be an integral part and a vital element of narrative enquiry. The notion of story is used in many
ways in the illustrative research example. Table 1 shows the overlap between the function, purpose, nature and
value of story, and why the concept of story might be so difficult and complex to unpick, interpret and
consequently analyse. The importance of Table 1 is that it shows the variety of roles that story can play and how
they can be brought together through narrative research.
Table 1 The notions of story used in the illustrative research example Functions Purpose Nature Value * Self-
evaluation
To find meaning
To give voice
Temporal elements
Show humanity
Represent experience
The story becomes more meaningful
Emotional experiences
What is their intention?
Improve relationships between students and teachers
Can be shared
The story is special to the individual
How stories come into being - a reason for them for the individual
How stories grow and take shape
Bringing to the fore the embodied nature of story
The consequences of story
To show change or progression
Characteristics of story
Bringing to the fore the embodied nature of story
Consequences of the story's use and an outcome - the difficulty is how these are arrived at
Can be shared
Story can itself be regarded as narrative research. 'Narrative' and 'story' have different meanings ( Frid et al 2000 ):
a narrative is an account of events experienced by the narrator, while story is the repeated telling or reading of an
account by people other than the narrator ( Edwards 2014 ). However, 'narrative' and 'story' can be used
interchangeably in research and legitimately combined ( Carson and Fairbairn 2002 ).
Participants in the study
The 55 participants were all nursing students from a university in London, in their second or third year of an

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undergraduate nursing (pre-registration) course or on a postgraduate course at degree or master's level but with a
number of years' experience as a qualified nurse.
Following ethics approval for the study, pre- and post-registration nurses were asked to volunteer to take part in
the research. The volunteers were given an information sheet and consent form, and invited to write down a story
of their practice (a 'student story') and identify what they had learnt from it (a 'student learning account'), following
the process in Table 2 .
Table 2 The stages of learning related to data collection Stages of personal learning Data collection Data
generated 1. Remembering Give out the research information to help students recall a story of a patient's journey
or an aspect of clinical practice 2. Writing Write down the story * Student stories
Learning accounts from 55 participants
Written stories and learning accounts from 55 participants
Understanding of stories
Contribution to learning
Possibility of using the process in the future.
Mind maps from students' discussions
The researcher's notes from discussion
Narrative data analysis procedures
Reports of narrative research are generally not specific about analysis or interpretation ( McCance et al 2001 ,
Elliott 2005 , Whiffin et al 2014 ). Well-defined accounts of how to analyse narrative data are scarce, with no
standard approaches or lists of interpretative procedures available. This is probably what makes narrative analysis
particularly difficult and complex.
Narrative researchers generally use several different approaches and models, to describe and understand
participants' experiences ( Freeman 2003 , Keats 2009 ). In this study, an attempt was made to differentiate,
elucidate and give structure to the various approaches that could be used. It was useful to divide the narrative
analysis into four stages, each giving a different perspective of the same data. Table 3 provides a summary of the
procedures and processes used. The four stages of analysis in Table 3 are not presented as a continuum (
Riessman and Quinney 2005 ), but as a cyclical process, analysing the story through multiple lenses ( Chase 2005
).
Table 3 A summary of the approaches to narrative analysis Analysis structure Analysis type Results generated
Literature used 1 Participants as researchers * Learning accounts generated by participants from their written
stories
General overview of data - genre/types of stories
Categories and sub-categories arising from stories
Addition of focus groups
Searching for patterns and connections in the category analysis
Individual learning arising from the story process, development of case studies
Evidence of learning through time
The process of learning analysis: searching for structure
Reviewing all evidence collected, from the analyses of content and form
Stage 1: participants as researchers
The first stage, which is not required but often included in analyses of narrative research, is the involvement of
participants in the analysis ( Reason 1994 , Aranda and Street 2001 , Tsang et al 2011 ).
Nursing needs to develop a method of enquiry that directly involves practitioners in the enquiry ( Kim 1999 ), and
narrative research can incorporate and engage practitioners (Squire 2009). However, study results are often biased
towards researchers' perceptions ( Gilbert 2008 ). Participants can be inhibited and their disclosure of personal
information overshadowed by the researchers' interpretations ( DePoy and Gitlin 2010 ).
Faulkner and Thomas ( 2002 ) argued that in educational research, qualitative methods can only be complete when

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they include the subjective experiences of students. Some qualitative researchers believe that researcher-
participant interaction is the best way to develop a deeper understanding of people's experiences ( Casebeer and
Verhoef 1997 , Aranda and Street 2001 , Burns and Grove 2011 ).
Students in higher education are sometimes excluded from being researchers, because they do not know enough
about the topics being investigated ( Martin 2002 ). By such means, academia maintains power over students.
However, the researcher must not assume a superior position over participants and should have a relationship of
'congruence' ( Holloway and Freshwater 2007 ). More generally, Reason ( 1994 ) proposed that a participative
methodology involves research being conducted with people rather than on people, becoming a mutual enquiry
into experience and practice.
Inviting students to become participant-researchers enabled teaching practices and research ethics to come
together to inform the investigation, conforming overall to the ethical stance of the researcher. By including the
students as researchers, the researcher could empathise with and, hopefully, respect the participants.
Using participants as researchers in this study also gave the best representation of their ideas about what they
had learned from their stories. The student learning accounts were a vital aspect of the narrative analysis, and to
avoid predetermining the students towards any particular view of learning, they were given no information about
learning theories or styles, or examples of the type of learning that might emerge from their stories.
The researcher transcribed the stories and learning accounts and could have (if appropriate) returned them to the
participants for integrity, to allow for confirmation, change, modifications or additions; this was not achieved in
this study, as student story confidentiality would have been broken.
Unlike some other research methodologies, narrative research does not require researchers to express their
preconceptions or theories at this stage.
Stage 2: reading the stories and learning accounts
Reading the students' stories and learning accounts many times helped to gain insight into their experiences and a
sense of the emerging descriptors that helped define the main categories. Narrative analysis often begins with
reading the participants' stories, which here represented descriptions of past events in the students' lives. The
purpose of first reading just the stories as they were presented was to get a feel for them as they were told and to
gain a sense of their narrative power.
The general approach of initially reading through the stories initially was adopted by Koch ( 1998 ) and
Maivorsdotter and Lundvall ( 2009 ). They did not analyse the story material they had gathered but still reached
significant findings that, ultimately, brought about change in the areas they investigated. The stories presented by
Koch ( 1998 ) are 'good human stories' ( Squire 2008 ) and relevant action resulted once the stories were made
public. Similarly, Orland-Barak and Wilhelem ( 2005 ) illustrated how nurses' stories, without any layer of
interpretation, can help with the practice of nursing.
Reading through stories can give an idea of the types that are being shared. Riessman ( 1993 ) suggested applying
genres from film, theatre and literature to the stories - for example, horror, war, action or science fiction. In some
stories, the student becomes the hero, and the teacher, manager, mentor or doctor is the villain. The stories are
often horror stories, with 'war' the power struggles between healthcare professionals; 'action' stories emerge from
students' experiences of emergency care; the use of invasive technology in patient care can be seen as 'science
fiction'; the passion nurses have for their role can be seen as 'romance'; stories can be funny and thus 'comedies';
the suffering, pain and maybe death of a patient can be likened to a 'tragedy'; a story can even be a 'detective
story', in which a patient's condition is unknown and has to be investigated.
This way of looking at stories, using the concepts of type and genre, was helpful in identifying what the
participants were encountering in clinical practice. The stories and the student learning accounts were carefully
read through, and an overview given using genre and type. They were then analysed as objectively as possible,
using holistic analyses of content and form.
Stage 3a: holistic analysis of content
The third phase of analysis was to find meaning in the participants' stories and learning accounts. This was done

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using holistic content analysis, identifying categories and searching for related or recurring patterns arising in the
categories, to determine if students were connecting the categories in any way.
Identifying categories Sorting the content of stories into categories, aided by learning accounts, was necessary to
determine the possibly significant patterns or connections between what the students could be learning (a later
part of the content analysis). Even though the participants were self-selected in response to an open invitation, the
differences and similarities among their stories invited categorisation.
Using Lieblich et al's ( 1998 ) ideas about categorical content analysis, appropriate sections of the text were
highlighted. These sections were extracted and placed in the emerging categories. Category descriptors ( Koch
1998 ) were devised and acted as exemplars, leading to salient excerpts from the data from which common
themes emerged. Researchers should use their own experiences and knowledge to assign content into categories
( Linde 1993 ). Largely, the categories were not imposed on the story and learning accounts but were suggested by
the texts.
Focus groups can elicit a multiplicity of views and emotional processes around understanding stories ( Davidson
2004 ). In addition, group interaction can widen the potential contribution of a story by reminding participants of
forgotten details of the shared experiences.
The final judgements about the categories were bolstered by the results of three focus groups. Students were
placed into self-selected groups of three to five people, where they could share their understanding of learning
from their stories and make comments, which stimulated discussion and conversation with each other. After
considering others' views, the participants formed opinions and as a group, came up with some consensus about
the learning that can take place when stories are used. This all took place without interruption from the researcher,
who took notes.
After 20 minutes, students were invited to document the parts of their dialogue that took place in their groups and
write what they were willing to share in a mind map on a flip chart ( Buzan and Buzan 1996 ). It was important that
group members were asked to share only those aspects of their stories and learning that they felt comfortable
exposing.
All the repetitions of the same expressions were used when developing the categories to determine the learning of
importance to students. The most important categories were clustered under 13 headings. Each story and learning
account was then examined and related to the descriptors for each category. A table was constructed for all
categories, which varied for each individual story and learning account.
Lieblich et al ( 1998 ) stressed the importance of paying special attention to individual sentences and paragraphs,
which might help to illustrate sub-categories emerging in the broader frameworks. Therefore, along with the
category analysis, evidence for sub-categories - labelled 'further dimensions' - was drawn from each category. The
objective behind creating further dimensions was to discover whether there were additional elements of learning
that had not showed up in the first study of content.
Identifying patterns in and connections between the categories This analysis looked to uncover patterns in and
between the category data ( Lieblich et al 1998 , Elliott 2005 ) using Lieblich et al 's ( 1998 ) idea of looking for
patterns in the data by reading them several times, until patterns significant emerged.
Narratives can forge links between the exceptional and the ordinary ( Bruner 1990 ) and sometimes, although there
were few or no clear patterns of similar categories emerging from the stories and learning accounts, the students
made connections between the categories related to their clinical experiences. This is what Polkinghorne ( 1988 )
referred to as linking diverse happenings together and identifying the effect one event has on the other.
To acknowledge connections between the categories, it was especially noted when students mentioned two or
more connected categories or related issues in one or two sentences or paragraphs. These were placed under the
joint headings of the participants' learning, in the words written by the student.
Stage 3b: holistic analysis of form
This stage was looking for differences in the ordering of events in stories (their structure) and the way connections
between them are made, to identify what might be judged important features of individual learning, learning

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through time and the way stories can be mapped against potential stages ( McDrury and Alterio 2002 ), a plot (
Polkinghorne 1988 , Mishler 1995 ) or templates ( Bailey 1996 , Bailey et al 2004 ). Riessman ( 1993 ) argued that
researchers need to avoid simply looking for content analysis, and instead advocated the examination of individual
narratives' subjective dimension observed in the nature and value of the story (see Table 1 ). This can be done
through the holistic analysis of form ( Lieblich et al 1998 ).
Lieblich et al ( 1998 ) did not give a clear definition of what they meant by holistic analysis of form, but they
assumed that rather than be cut up into pieces and simply assigned to themes, stories should be analysed as a
whole. The lack of guidelines meant it was necessary to attempt to use the interpretations of other narrative
analysis theorists ( Polkinghorne 1988 , 1995 , Bruner 1990 , Riessman 1993 , Elliott 2005 , Squire 2008 ) and other
researchers ( Labov and Waletzky 1967 , Nelson 1993 , Koch 1998 , Clandinin and Connelly 2000 , Maivorsdotter
and Lundvall 2009 ) in Lieblich et al 's ( 1998 ) framework.
Individual story analysis Elliott ( 2005 ) said that it is important to obtain a story that reflects the interpretations
and values of the individual. On this basis, a number of students' stories and learning accounts could be analysed
in detail, something Polkinghorne ( 1995 ) proposed, as it provides commentary on a selection of narratives,
transforming them into case studies. McCance et al ( 2001 ) said it would be unrealistic and difficult to provide
case studies for all narratives with commentary on each, and Polkinghorne ( 1995 ) supported this, suggesting
choosing about six narratives for individual commentary.
Eight student stories were chosen, based on the richness of the data they provided and the sense in which they
seemed to be unique and illustrative of different kinds of experience. The students' accounts of learning were
uniquely detailed and scrutinising them had the potential to provide a more differentiated understanding of what
the students were learning. In the written commentary on individual student stories and learning accounts, it
became apparent that students were gaining a variety of different, very individual learning from their stories. This
process helped the researcher become attuned to participants' stories and learning accounts as the genuine
products of individual 'self-learners'.
Learning through time Story can be used to link past, present and future, and is an accessible way to make such
links explicit rather than tacit. Lieblich et al ( 1998 ) do not mention time in their holistic analysis of form, but do
make reference to the 'individual's personal construction of evolving life experiences'. They also described the
plots of stories as developing gradually over a period of time. This emphasises that some form of learning through
time is an important element in the analysis of stories. Squire ( 2008 ) used the term 'reconstruction of story
across time and place' and Elliott ( 2005 ) referred to story as being temporal.
The concept of continuity is often used to denote the passage of time ( Dewey 1938 , Clandinin and Connelly 2000 ,
Elliott 2005 ), linking past, present and future. Polkinghorne ( 1988 ) discussed the centrality of sequencing or
ordering in stories, and commented on how this operates along a temporal dimension. Clandinin and Connelly (
2000 ) discussed 'looking backwards into the past', 'looking in the present' and 'looking forward into the future', as
terms to help search for temporal patterns in data.
Incorporating these terms, with descriptors for each ( Table 4 ), analysis was applied, selecting sentences and
paragraphs that related to the interpretations of learning through time. This revealed that potentially, our
experiences are 'tinged with time', students learning to become nurses over time, perhaps as part of a lifelong
learning process. Nevertheless, data in this study tended to focus on nurses' engagement with a patient in the
present: what appears to be fulfilling to students is the here and now.
Table 4 Descriptions of analysis through time Through time elements Interpretations of learning through time
Looking backwards into the past If students: * Detailed in their stories or learning accounts published documents,
research, literature or policies
Used the past tense (for example, 'when I worked', 'past experience' or 'previous knowledge', 'I recalled', 'I have
encountered', 'past incidences' or 'previous placement')
Were looking at a patient's past medical history
Detailed how their learning would influence 'future care'

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Used terms such as 'in the future' or 'do further' 'expanded', 'if the situation arises again', 'I need to gain', 'I realised'
Mapping stories This aspect of analysis explored the qualities of the stories and learning accounts, looking for
actual events. Elliott ( 2005 ) used the terms 'regressive', 'progressive' and 'stable' to categorise stories: a
regressive story refers to a deterioration or decline and is seen as negative in tone; a progressive story gives an
account of advancement, achievement or success, and is deemed to be positive; and a stable story demonstrates
no evidence of decline or progression and is neutral. Using this categorisation, stories can be conceptualised as a
series of chapters, characterised by the direction of a plot.
In this paper's research, the researcher attempted to explore the features and characteristics of learning from story
using the terms 'pre-narrative', 'remembering', 'writing', 'sharing' and 'learning'. Placing individual stories and
learning accounts relative to a sequenced or staged account provided a practical tool for a 'chronological
structure' ( Labov and Waletzky 1967 ), which may help in understanding the wider impact of the story.
Stage 4: organising and presenting findings
The researcher's role is not just textual reporting, but also organising and presenting findings, which adds an
additional layer of analysis. This draws on earlier analysis, but does not just report results from these earlier
stages, as this would not fully reveal the richly varied and diverse potential of stories as data in narrative research
methodology and as resources for learning ( Figure 1 ). It summarises the central themes, refines the analysis and
joins all analysis processes together, from which recommendations can be drawn. This also enables the narrative
researcher to meet the research's aims and answer research questions in a way that lets the stories and learning
accounts 'speak for themselves' as far as possible.
In this study, final qualitative analysis was given with interpretative comments that incorporated students'
judgments, and was informed by the analyses of content and form.
The three overall findings were: story content's revelatory role, which clarifies often hidden aspects of what is
happening in the clinical setting; the exploratory role of stories, revealing what the priorities of nursing care are for
this particular group and to identify what their main concerns might be; and story as a more direct aid to learning,
in more ways than so far considered.
Conclusion
Narrative data analysis takes a number of forms, beginning with the participants and reading of the stories and
other data, and ending with the linking together of all the interpretative comments to demonstrate the varied and
diverse roles story can play as an aid to nurses' learning. Analysing stories in a narrative research methodology is
not simply about content category analysis and then reporting the themes.
The approach recommended by this paper for narrative analysis constructs a more sophisticated, multi-layered
analytical challenge and demonstrates the complexity surrounding people's experiences and actions. There are
many approaches to narrative analysis in nursing research and it can be difficult to establish the main research
approach best suited to the study. This article suggests there is no single way to define narrative analysis and a
combination of strategies, such as those presented in this paper can be applied.
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DETALLES

Identificador / palabra narrative methodology narrative analysis narrative research data analysis nursing
clave: students learning stories multiple lenses

Título: Narrative analysis: how students learn from stories of practice

Autor: Edwards, Sharon Lorraine

Título de publicación: Nurse Researcher (2014+); London

Tomo: 23

Número: 3

Primera página: 18

Año de publicación: 2016

Fecha de publicación: Jan 2016

Editorial: BMJ Publishing Group LTD

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 Lugar de publicación: London

País de publicación: United Kingdom, London

Materia de publicación: Medical Sciences--Experimental Medicine, Laboratory Technique, Medical Sciences--

Nurses And Nursing

ISSN: 13515578

Tipo de fuente: Scholarly Journals

Idioma de la publicación: English

Tipo de documento: Journal Article

DOI: http://dx.doi.org/10.7748/nr.23.3.18.s5

ID del documento de 1784940483

ProQuest:

URL del documento: https://search.proquest.com/docview/1784940483?accountid=37408

Copyright: Copyright: 2012 (c)2012 RCN Publishing Company Ltd. All rights reserved. Not to be
copied, transmitted or recorded in any way, in whole or part, without prior permission
of the publishers.

Última actualización: 2016-04-28

Base de datos: ProQuest Central

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