Narrative Process Research Articles

Peritext in the Picturebook: Can It Be Metanarrative?

This paper focuses on how peritexts function in communicating a picturebook's narration and what impact they have on reading comprehension or interpretation. Based on modern narratological theory and research findings of metanarration, this study analyses the metanarrative function of peritexts in three picturebooks: Chester by Mélanie Watt, Black and White by David Macaulay, and Keine Angst vor gar Nichts by Gudrun Likar with illustrations by Manuela Olten. The findings of this study reveal that peritexts in picturebooks display metanarration at both a verbal and a visual level; they reflect the act or process of narration, highlight the book's narrative features, and affect the reader's reception of the picturebook.

Introducing reflective narrative for first-year medical students to promote empathy as an integral part of physiology curriculum.

Guided reflective narratives facilitate deeper understanding and learning. The study was aimed at exploring the scope of guided reflective narratives on early clinical exposure, for first-year medical students, in promoting empathy. Strengths and limitations of the process of reflective narratives were also explored. First-year medical students (n = 150) were exposed to guided reflective narrative writing following each of the three "early clinical exposure" sessions integrated into a physiology curriculum. A feedback on the entire program was obtained through a semistructured questionnaire. The contents of the reflective narratives and feedback on the program were analyzed. Students empathized with the situation and needs of patients and caregivers and could relate to responsibilities and challenges faced by members of health care team. They realized the importance of cooperation from patients and caregivers and work efficiency, communication, behavior, and teamwork from members of healthcare and thereby emerged with the idea of the coordinated effort in patient care. Students opined that reflective narratives made them reflect and empathize with people and situations. Too many narrative writing sessions and hesitation to share their thoughts were some of the suggested limitations. The process led to emergence of a working model for guided reflections to promote empathy. Guided reflective narratives made students reflect and relate to people and situations. While promoting empathy, the reflections also gave them an idea of holistic approach to patient-centered care. Inferences led to a conceptual model for guided reflections to promote empathy among medical students.

Impact of deep learning-determined smoking status on mortality of cancer patients: never too late to quit

BackgroundPersistent smoking after cancer diagnosis is associated with increased overall mortality (OM) and cancer mortality (CM). According to the 2020 Surgeon General's report, smoking cessation may reduce CM but supporting evidence is not wide. Use of deep learning-based modeling that enables universal natural language processing of medical narratives to acquire population-based real-life smoking data may help overcome the challenge. We assessed the effect of smoking status and within-1-year smoking cessation on CM by an in-house adapted freely available language processing algorithm.Materials and methodsThis cross-sectional real-world study included 29 823 patients diagnosed with cancer in 2009-2018 in Southwest Finland. The medical narrative, International Classification of Diseases-10th edition codes, histology, cancer treatment records, and death certificates were combined. Over 162 000 sentences describing tobacco smoking behavior were analyzed with ULMFiT and BERT algorithms.ResultsThe language model classified the smoking status of 23 031 patients. Recent quitters had reduced CM [hazard ratio (HR) 0.80 (0.74-0.87)] and OM [HR 0.78 (0.72-0.84)] compared to persistent smokers. Compared to never smokers, persistent smokers had increased CM in head and neck, gastro-esophageal, pancreatic, lung, prostate, and breast cancer and Hodgkin's lymphoma, irrespective of age, comorbidities, performance status, or presence of metastatic disease. Increased CM was also observed in smokers with colorectal cancer, men with melanoma or bladder cancer, and lymphoid and myeloid leukemia, but no longer independently of the abovementioned covariates. Specificity and sensitivity were 96%/96%, 98%/68%, and 88%/99% for never, former, and current smokers, respectively, being essentially the same with both models.ConclusionsDeep learning can be used to classify large amounts of smoking data from the medical narrative with good accuracy. The results highlight the detrimental effects of persistent smoking in oncologic patients and emphasize that smoking cessation should always be an essential element of patient counseling.

Narrative coaching – Part 4: Redesigning the GROW model as the 4th generation coaching for people and the planet

This paper reflects and reviews the formulation of the GROW model in relation to narrative coaching in response to the climate change crisis, the socio-cultural and technological paradigms. It proposes a new coaching model by redesigning the GROW process and integrating it with narrative coaching process. It argues that the new model called ROGWin can be regarded as the 4th generation coaching (4GC) in terms of the evolution of coaching psychology as a professional discipline. Its implications to future research, practice including the technological impact such as artificial intelligence (AI) and wider role in the world and environment are discussed. Keywords: AI; climate change; fourth generation coaching; 4GC; coaching psychology; GROW; environment.

Brain Structure and Functional Connectivity Correlate with Psychosocial Development in Contemplative Practitioners and Controls.

Jane Loevinger’s theory of adult development, termed ego development (1966) and more recently maturity development, provides a useful framework for understanding the development of the self throughout the lifespan. However, few studies have investigated its neural correlates. In the present study, we use structural and functional magnetic resonance imaging (MRI) to investigate the neural correlates of maturity development in contemplative practitioners and controls. Since traits possessed by individuals with higher levels of maturity development are similar to those attributed to individuals at advanced stages of contemplative practice, we chose to investigate levels of maturity development in meditation practitioners as well as matched controls. We used the Maturity Assessment Profile (MAP) to measure maturity development in a mixed sample of participants composed of 14 long-term meditators, 16 long-term yoga practitioners, and 16 demographically matched controls. We investigated the relationship between contemplative practice and maturity development with behavioral, seed-based resting state functional connectivity, and cortical thickness analyses. The results of this study indicate that contemplative practitioners possess higher maturity development compared to a matched control group, and in addition, maturity development correlates with cortical thickness in the posterior cingulate. Furthermore, we identify a brain network implicated in theory of mind, narrative, and self-referential processing, comprising the posterior cingulate cortex, dorsomedial prefrontal cortex, temporoparietal junction, and inferior frontal cortex, as a primary neural correlate.

There and Back Again? Exploring the Real-Time Cognitive Journey of Narrative Transportation

Prior research has produced seemingly conflicting indications of whether or not audience members who are transported into a narrative leave themselves and the real world behind. This study proposes that a dynamic perspective can help resolve that conflict. Both traditional static post-exposure and real-time dynamic measures were used to examine four cognitive processes: attention, presence, self-referencing, and real world-referencing. Participants ( N = 118) were randomly assigned to view one of two television dramas. They provided continuous rating responses during viewing, as well as post-exposure measures of the overall viewing experience. Post-exposure measures indicated that self and real world-referencing were strongly positively correlated with transportation. The dynamic approach to understanding narrative processing, while exploratory in nature, likewise indicated links between the self, the real world, and the narrative world. Presence in the narrative predicted real world-referencing, and self-referencing predicted attention to the narrative, suggesting that when audience members link story content to their own lives, transportation may be enhanced rather than diminished. Strengths, limitations and future directions are discussed.

Relational victimization and depressive symptoms: The interactive role of physiological reactivity and narrative processing

Although previous studies have documented that relational victimization serves as a risk factor for depressive symptoms across developmental periods, heterogeneity in effects highlights the possibility that some individuals may be especially vulnerable. This study examined two factors that may influence the link between relational victimization and depressive symptoms: physiological reactivity and narrative processing during the recounting of a past victimization experience. In a sample of 200 college students, we examined narrative processing (i.e., use of disengagement coping strategies, positive resolution, and primary control coping strategies) and respiratory sinus arrhythmia (RSA) reactivity, assessed during a standard laboratory interview, as moderators of the link between self-reported relational victimization and depressive symptoms. Although relational victimization was associated with increased rates of depressive symptoms, a combination of RSA activation and high disengagement coping appeared protective for individuals high in relational victimization. Similarly, a combination of RSA activation and high levels of positive resolution appeared protective against depressive symptoms among individuals high in relational victimization. The findings shed critical light on the interaction of physiological and cognitive processes in coping with relational victimization.

Integrative Developmental Model for Narrative Supervision

ABSTRACT This article introduces a combined supervision model, the Integrative Developmental Model for Narrative Supervision (IDMNS), which incorporates the Integrative Developmental Model and Narrative Supervision Model. This model provides concrete guidelines for supervisors to incorporate narrative processes in clinical supervision while attending to supervisees’ developmental needs. Specifically, the proposed tenets of the model include multicultural awareness, supervisory relationship, and narrative facilitation. The benefits and the limitations of the model are identified along with a case study of the IDMNS in practice. Implications for future research are discussed.

Narrating ambiguous loss: Deficiencies in narrative processing and negative appraisal of consequences.

To compare narrative coping with physical and psychological ambiguous loss (AL) and definite loss in terms of distancing (vs. narrative immersion), meaning-making, and subjective biographical consequences. Thirty adults who had lost a parent to death, to going missing, or to Alzheimer disease (N = 90, 67 females; mean age 36.73 years, SD = 7.27; mean time since loss 9.0 years) narrated two loss-related and three control memories. Individuals with AL were not more immersed in the loss experience, but less successful in finding meaning and in evaluating the loss and its consequences positively compared to those with a definite loss. These group differences were not due to differences in depression, posttraumatic stress disorder, and protracted grief. Ambiguity of loss renders meaning-making and coherently narrating loss more difficult, leading to more negative affect, suggesting interventions that help narrating loss coherently in a self-accepting way.

The Painter of Rural Life: Narrative Complexity and Imaginative Sympathy in George Sand and George Eliot

This article explores the concept of liminal homodiegeticity in George Sand’s La mare au diable (1846) and George Eliot’s Adam Bede (1859). Both authors use the brief, chronologically distanced incursion of the novel’s narrator into the storyworld to embody an ethics of sympathy. By portraying rural, working-class characters whose lives are valorized through the narrator’s reconstruction of their stories from later conversation, Sand and Eliot aimed to shift public opinion toward expanded sympathy for their real-world counterparts. The distinctive, complex narrative process involved reveals the importance of modeling sympathy in Sand’s and Eliot’s aesthetics. Both narrators appear in sections of the novels that are structurally liminal: in the case of La mare au diable, the first two chapters and the appendix; in that of Adam Bede, the much-discussed chapter 17. The self-conscious marginalization of the embodied narrator’s role tests the limits of the distinction between homo- and heterodiegeticity in narratology from Genette to more recent work by Wolf Schmid. The oblique insertion of the narrator implies that the ethics of sympathy rely on a logically implausible plenitude of narrativization. As a result, the reader is urged toward an equal measure of sympathy for the narrator as for the rural characters they describe.

Relating the Past with the Present: Information Integration and Segregation during Ongoing Narrative Processing.

This study examined how the brain dynamically updates event representations by integrating new information over multiple minutes while segregating irrelevant input. A professional writer custom-designed a narrative with two independent storylines, interleaving across minute-long segments (ABAB). In the last (C) part, characters from the two storylines meet and their shared history is revealed. Part C is designed to induce the spontaneous recall of past events, upon the recurrence of narrative motifs from A/B, and to shed new light on them. Our fMRI results showed storyline-specific neural patterns, which were reinstated (i.e., became more active) during storyline transitions. This effect increased along the processing timescale hierarchy, peaking in the default mode network. Similarly, the neural reinstatement of motifs was found during Part C. Furthermore, participants showing stronger motif reinstatement performed better in integrating A/B and C events, demonstrating the role of memory reactivation in information integration over intervening irrelevant events.

Escitalopram enhances synchrony of brain responses during emotional narratives in patients with major depressive disorder

One-week treatment with escitalopram decreases amygdala responses to fearful facial expressions in depressed patients, but it remains unknown whether it also modulates processing of complex and freely processed emotional stimuli resembling daily life emotional situations. Inter-subject correlation (ISC) offers a means to track brain activity during complex, dynamic stimuli in a model-free manner.Twenty-nine treatment-seeking patients with major depressive disorder were randomized in a double-blind study design to receive either escitalopram or placebo for one week, after which functional magnetic resonance imaging (fMRI) was performed. During fMRI the participants listened to spoken emotional narratives. Level of ISC between the escitalopram and the placebo group was compared across all the narratives and separately for the episodes with positive and negative valence.Across all the narratives, the escitalopram group had higher ISC in the default mode network of the brain as well as in the fronto-temporal narrative processing regions, whereas lower ISC was seen in the middle temporal cortex, hippocampus and occipital cortex. Escitalopram increased ISC during positive parts of the narratives in the precuneus, medial prefrontal cortex, anterior cingulate and fronto-insular cortex, whereas there was no significant synchronization in brain responses to positive vs negative events in the placebo group. Increased ISC may imply improved emotional synchronization with others, particularly during observation of positive events. Further studies are needed to test whether this contributes to the later therapeutic effect of escitalopram.

Narrativas e infâncias: tecendo fios de sensibilidades pela arte e cultura

Este artigo destaca as narrativas infantis entremeadas em linguagens-expressões da arte e da cultura – material e imaterial, apresentando metodologias nas quais a educação pelo sensível se torna imprescindível no percurso formativo da criança. O objetivo foi o de criar e experienciar uma Oficina Estética, tendo a arte e as culturas locais como propulsoras de sensibilidades. Este trabalho é um recorte de uma pesquisa a nível de Pós-Graduação, realizada em uma escola pública rural com 19 crianças do 2º ano do Ensino Fundamental l, no município de Garuva, Santa Catarina. A abordagem metodológica foi a narrativa, pois a coleta e a produção de dados se pautou nas vozes infantis, permeadas pela arte e expressões culturais. A análise fundamentou-se na observação e interação dos professores-pesquisadores e nos processos de produção e narrativas das crianças. Os resultados indicaram que a arte e as culturas mobilizam a imaginação, a criação e o sentimento de pertencimento dos envolvidos.

Self-initiated expatriation and older women: composing a further life

PurposeResearch into self-initiated expatriation (SIE) has increased exponentially, although the focus of these investigations has been on professional workers, and little has been gender specific. The purpose of this research therefore is to explore the career and personal motivations for SIE through the novel lens of older women. In this exploratory study, SIE and socio-emotional selectivity motivation theories (SSTs) are used, in addition to the Kaleidoscope Career Model (KCM), to understand the reasons these women have taken this path.Design/methodology/approachThe paper employs a qualitative methodology, drawing on in-depth life story interviews with 21 women aged 50 or more who had taken a SIE. A five-step narrative process using a story-telling approach was the method of analysis.FindingsThe findings show important contradictions to the extant literature. Career dissatisfaction and escape are key motivations for these women. Further, contrary to SST, these women were seeking novelty–new places and new experiences. These women were also seeking authenticity as suggested by KCM, but also challenge was to the fore–not in the career domain, but in the personal domain. Their motivations for SIE extend beyond the current evidence base and understanding of the phenomena.Originality/valueThe contributions include new insights into the motivational drivers for SIE for these older women and the importance of timing as facilitators of SIE. The SIE nomenclature is broadened through the inclusion of older women and beyond professional spheres. An initial framework of a more integrated model is developed from this exploratory study and presented as a basis for beginning to understand the phenomenon of older women undertaking SIE.

Double trouble: Therapists with low facilitative interpersonal skills and without training have low in-session experiential processes

ABSTRACT Objectives: This study examined the combined effect of therapist Facilitative Interpersonal Skills (FIS) and Training Status on experiential processes within therapy sessions. In this randomized trial of FIS and Training Status, we predicted that in-session experiential processes would be highest for the high FIS and trained therapist group and lowest for the low FIS and untrained therapists. Methods: Forty-five clients were selected from 2,713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists were selected for their level of FIS (high vs. low) and Training (trainee vs. untrained) and each were assigned two clients for seven sessions each. Two different coder teams independently rated experiencing and narrative process from the third therapy session and computer analysis identified affect words from transcripts. Results: FIS×Training Status significantly interacted on the set of experiential process measures. Relative to all others, therapists who were in the low FIS / no training group had lower experiencing and reflexive content, but higher external content. Conclusions: The findings highlight the importance of therapist characteristics within therapy sessions. Therapists without training and with low interpersonal skills have sessions that are nearly devoid of content that focuses on client experiential processes and emotion.

Trauma as a Provocative Pattern in Restoring and Rebuilding the Identities of Characters in Lan Cao’s Monkey Bridge

The current paper attempts to identify the theoretical aspects of the post-traumatic stress disorder upon the characters in Lan Cao’s Monkey Bridge. It endeavors to examine the characters’ possibilities to restore their identities by remembering their past myths and homelands. Throughout analyzing the thematic and formal representations of experiences of the war trauma, it raises the questions of whether those traumatized individuals can formulate their personalities to incorporate to the new homeland. It examines the individuals’ behaviors that are portrayed throughout the process of digressive narration to explore the effect of the traumatic experiences of war upon their personalities, and recognize their different responding. It aims at adopting specific cultural methods to reconstruct the characters’ personalities in their conformation of trauma and re-building new identities by acclimating new language and values.

Control rooms in publicly-funded health systems: Reviving value in healthcare governance

BackgroundAs part of reforms in 2015, the Ministry of Health and Social Services in Quebec, Canada mandated the national implementation of control rooms, making health system actors accountable for implementing value-based performance management. ObjectiveTo explore how do organizational actors appropriate control rooms as managerial tools to influence value-based performance in health systems. DesignMulti-site organizational ethnographic case studies (N = 2) and narrative process analysis of triangulated qualitative data collected through non-participatory observations (179.5 h), individual semi-structured interviews (N = 34), and document review (N = 143). ResultsThe process of appropriating control rooms plays a crucial role in achieving value-based performance management. Appropriating unfolds along three paths (cognitive, structural, technical) over three phases (implementing, testing, adapting). Implementing control rooms both produces and emerges from improvement capacities within healthcare organizations. Testing tools reveals that incompatibilities between tools, structures and values give rise to value-driven distributed clinical leadership. Adapting tools relies on the adaptability of organizations towards the value system driving the tools, rather than on the adaptability of tools to organizational design. ConclusionThere is no “one-size-fits-all” framework to design and support the successful appropriation of control rooms towards achieving value-based performance. However, we believe that consideration for the three distinct phases of appropriation and leveraging the right mechanism to support each phase is a first important step in reviving value in healthcare governance.

The dynamic construction of brand storytelling

ABSTRACT Branding literature has long recognized storytelling as a powerful tool to provide meaning to the brand, and to build relationship between customers and brands. In the literature, there has been a lot of focus on consumer behavior and narrative process, but only a few studies have investigated storytelling from a managerial or strategic branding perspective. This paper aims to bridge this gap by using a single case study based on 18 semi-structured interviews with brand and communication managers. Building on the stakeholder’s co-creation of brand meaning perspective, this research makes use of an in-depth case study in an effort to understand, from the inside, how brand storytelling is implemented and embedded in the communication process, as well as how the new digital ecosystem may challenge the brand storytelling. It provides detailed insights into the dynamic construction of brand storytelling and extends the scope of the brand meaning’s co- creation from consumers to intra-organizational stakeholders.

Job-Related Problems Prior to Nurse Suicide, 2003-2017: A Mixed Methods Analysis Using Natural Language Processing and Thematic Analysis

Background Nurses have a higher rate of suicide than the gender-matched general population at baseline. Quantitative data from the Centers for Disease Control and Prevention National Violent Death Reporting System have been previously analyzed to reveal that nurses have more known job-related issues prior to death by suicide. However, no known study has focused on the context of those job-related problems prior to nurse suicide. Purpose The aim of this study was to provide context to job-related problems experienced before nurse death by suicide. Methods Cases were selected either because they were coded as having a job-related problem prior to death or the words “job” or “work” appeared in the case investigation narrative. Natural language processing and thematic analysis of free-text medical examiner and law enforcement investigation narratives were performed to better describe nurse deaths by suicide in cases with known job-related problems prior to death. Results Narratives from a total of 203 nurse deaths from between 2003 and 2017 were included in this study. Very little was reported regarding the actual work of being a nurse. Job-related problems of these 203 deaths focused on substance use, mental health problems, chronic pain, or job loss due to investigations for substance use or diversion of medication. Conclusions Nurses who lose a nursing position or leave the profession because of substance use, mental health issues, or chronic pain are at risk for nurse suicide. Alternative-to-discipline programs for nurses with substance use disorder need to be improved and standardized. Earlier or more complete treatment for mental illness may help prevent suicide in this population. Nurses have a higher rate of suicide than the gender-matched general population at baseline. Quantitative data from the Centers for Disease Control and Prevention National Violent Death Reporting System have been previously analyzed to reveal that nurses have more known job-related issues prior to death by suicide. However, no known study has focused on the context of those job-related problems prior to nurse suicide. The aim of this study was to provide context to job-related problems experienced before nurse death by suicide. Cases were selected either because they were coded as having a job-related problem prior to death or the words “job” or “work” appeared in the case investigation narrative. Natural language processing and thematic analysis of free-text medical examiner and law enforcement investigation narratives were performed to better describe nurse deaths by suicide in cases with known job-related problems prior to death. Narratives from a total of 203 nurse deaths from between 2003 and 2017 were included in this study. Very little was reported regarding the actual work of being a nurse. Job-related problems of these 203 deaths focused on substance use, mental health problems, chronic pain, or job loss due to investigations for substance use or diversion of medication. Nurses who lose a nursing position or leave the profession because of substance use, mental health issues, or chronic pain are at risk for nurse suicide. Alternative-to-discipline programs for nurses with substance use disorder need to be improved and standardized. Earlier or more complete treatment for mental illness may help prevent suicide in this population.

영화 〈여판사〉를 통해 본 소문의 서사화 과정

이 논문은 우리나라 최초의 여판사 ‘황윤석’ 변사 사건이라는 실제 사건과 소문을 모티브로 한 영화 〈여판사〉(홍은원, 1962)의 서사화 과정을 고찰한 논문이다. 이 사건은 사건의 발생 단계에서는 자살이냐, 타살이냐 하는 죽음의 원인을 밝히는 것에 대중의 관심이 집중되어 있었다. 그러나 점차 사건의 원인을 여성의 사회 진출에서 발생하는 가정 내 갈등으로 추측하는 소문으로 서사가 재구성되었다.<BR> 소문을 전유한 영화 〈여판사〉는 가정 내 갈등을 드러내는 ‘폭로의 서사’가 아닌 ‘해결의 서사’로 구성되면서 서사의 비대칭성을 보인다. 소문과 영화의 가장 큰 변별점은 실제 사건과 소문에서는 죽은 ‘여판사’가 영화에서는 살아서 직접 사건을 해결함으로써 사건의 피해자가 아닌 해결자의 역할을 수행한다는 점이다. 이는 실제 사건에서 소거된 피해 당사자의 목소리를 법정이라는 공적인 장소에서 발화하게 하여 가족갈등을 법정이라는 공론화 장으로 끌어들인다. 이처럼 영화 <여판사>가 소문을 영화화하는 과정은 여판사의 죽음을 대중의 흥밋거리가 아닌, 사회문제로 인식하게 하면서 1960년대 여성의 사회진출에 대한 가능성과 불안을 반영하고 있다.<BR> 〈여판사〉의 서사화 과정은 실제 사건의 콘텐츠 기획 단계에서 실제 사건과 영화 서사의 유사성에 주목하기 보다는 그 과정에서 의미를 끌어내는 방식에 따라 서사를 재구성하는 것이 필요하다는 점을 보여준다.