Illness Narrative Assignment Deepens Understanding and Strengthens Writing Skills

by Pamela Cangelosi, Nursing

Based on her 2006 WAC Conference presentation at Clemson University

In today's fast-paced and content-laden educational environment, it is essential to identify teaching strategies that assist students in understanding essential information and its application to their future careers.  One way to accomplish this is to integrate teaching strategies that reinforce the vital content of the course and also provide opportunities for student growth beyond the objectives of the course.  Important for all disciplines, integrated teaching is critical in the health sciences where lack of knowledge can mean the difference between life and death.

In a pathophysiology course, nursing students in an accelerated one year program wrote an illness narrative that helped them learn disease concepts and understand how pathophysiological processes affect all aspects of a person's life.  An illness narrative differs from a case study in that a case study focuses on the medical facts and responses to treatment. The illness narrative, however, seeks to capture the individual's perspective of living with the illness with all of its emotional, psychological, spiritual, and physical components. 

The Task
Each student was assigned to interview a person of her or his choosing who had a chronic disease, such as arthritis, diabetes, or heart failure. The purpose of the interview was to enhance the student's understanding of the individual's illness experience by encouraging the interviewee to recall in rich detail the lived experience of the illness in question.  The person who was interviewed for this assignment could not be a client in the clinical practicum or a classmate.  Consenting adult friends, relatives, or neighbors were the only individuals eligible to participate. 

By eliminating the involvement of clients from the clinical sites, students were forced to extend their knowledge of nursing practice beyond the acute care realm and into the community where much of today's nursing is performed.  This stipulation was also intended to help students recognize the challenges their chronically ill, acute care individuals face when discharged home. 

Students were instructed not to include diagnostic tests and other medical data in the paper unless these topics were of concern to the interviewee.  Focusing on narratives required the student to gather data from the individual, creating an understanding of what the illness experience means to that person.

Based on their interviews, the students were assigned the task of writing a paper in which a brief, one-paragraph definition of the disease was first stated.  The majority of the paper was to consist of a description of how this disease has affected the interviewee’s everyday living and perspective on life.  The students were encouraged to write an assessment from the individual's viewpoint and to include the individual's own words whenever possible.     

The Outcomes
Knowledge of pathophysiological processes was an expected outcome of this exercise.  While the focus of the paper was not on the description of the disease process, the students had to thoroughly research the disease in order to understand the individual's comments in the interview and to know how to prompt the person to dialogue about how the disease was affecting everyday life. 

Through the interviews, students learned the meaning of polypharmacy, medication interactions, and comorbidity.  The writing of the narrative also helped the students better understand the influence of culture, the social and ethical implications of illness, and the role of scarce community resources in the management of chronic disease. 

Students’ Feedback
One student noted when handing in her paper:

I didn’t really know these neighbors very well, but I knew the grandfather had diabetes.  I interviewed the grandfather and his daughter who helped him a lot, and I found out so much about how their Hindu faith affects their healthcare practices and feelings about death.  I never knew any of this before.  I learned that I can help them, even if my beliefs are so very different.

Unsolicited student comments also suggested that this assignment strengthened their writing skills.  Limiting the length of the paper to three to four double-spaced pages challenged the students to compose succinct papers containing only the information vital to understanding how the chronic disease was impacting their interviewees' lives.  Even references to their research course surfaced when deciding what information the individual said was "really qualitative data."

Some students obtained large quantities of information while some only gathered a scant amount.  They learned the importance of skillful interviewing for assessment purposes, quality versus quantity of information, and professional reporting of essential information.  Credit was given for proper grammar and spelling and correct documentation of any references was enforced. 

As a student stated:

It is hard to figure out what to include when you have so little space to write.  I can go on and on when I write, but the page limit made me really think about what had to be included.  This helped me look at my writing in clinical.  You can’t write everything, or you would be writing forever, and no one would take the time to read it.  You have to determine what HAS to be included.

Some Essential Skills
At first, students were reluctant and bewildered to carry out a writing assignment in a science class, preferring to focus on information in the text, which they see as the authority on the disease. 

As they talked with their respective individuals, however, they came to realize that it is not enough to know the pathological process of a disease.  Through the writing of an illness narrative, students learned the essential skills of integrating and succinctly reporting information from the person living with the disease with the knowledge gained from their courses, and were brought to a deeper understanding of how a disease impacts a life.

For more information about writing in nursing, see the Guide to Writing in the College of Health and Human Services.