Narrative competence: a neglected area in undergraduate curricula

According to many inter-disciplinary scholars, including, notably, Alasdair MacIntyre and Jerome Bruner, human action and accounting for such action draws on and is shaped by available cultural narratives. Nursing is no exception to this truism, which makes the development of narrative competence in nursing a pressing curricular imperative. At a broad level, narrative competence refers to a finessed, ethically-charged respect for human lived and storied experience. At the level of professional development, it demands that nurses must constantly strive to improve on their abilities around listening, hearing, absorbing, interpreting, and intelligently responding to the stories of people in their care (Bach and Grant 2015). Doing so facilitates empathic, and trustworthy practice through sensitive attunement to existential qualities such as inner hurt, despair, hope grief, and moral pain. All of these qualities accompany, and sometimes constitute, the health problems that patients experience, and are of course more fundamentally inscribed within the human condition.
On the basis of our experience and scholarship in this area, we thus find the relative neglect of narrative competence in nursing educational policy, undergraduate nursing curricula, professional and educational literature, and related teaching practice surprising. Such neglect is made all the more remarkable in the light of recent very promising conceptual and practice developments in this area of healthcare. The contemporary turn towards fostering a more ‘narratively competent’ healthcare practitioner has been recently illustrated in the work of promoting narrative medicine (eg Charon 2006), narrative psychiatry (Thomas 2014), and narratively competent evidence-based nursing (Bach and Grant, 2015).
From the perspective of nurse educational policy in the UK and Ireland, the important skill of listening to patients and attending to what is said by them is predominantly addressed in its communication and interpersonal skills curricular elements (Bach and Grant 2015). Such competence is articulated as an essential requisite required for professional registration in Ireland and the UK. However, it is arguably complacent of nurse educators to assume that attainment of these competencies reflects and reaches the necessary educational depth required for skilled narratively competent practice. We make this assertion on the basis of our respective lived, academic experiences of many nursing students in our own and other universities, and their qualified colleagues in practice, who seem ill-prepared to adequately understand, interpret and respond to the distress stories of people in their care.