Abstract
In research, statistics tell most of the story. A statistical test reveals a trend between patients who use positive language in their writing and objective physical therapy measures. A correlation exists between patients who articulated a goal in writing and achieved that goal. Keeping a positive outlook and writing about it can lead to healing. When the authors conducted a research study, they discovered potentially groundbreaking implications for the fields of patient education and health education. They learned lessons and their findings will continue to educate adults about health issues. However, statistics don't tell the entire story. The field of narrative inquiry examines qualitative stories in addition to the quantitative data. In this chapter, the authors discuss what they learned about patient education, as well as the stories of the moments that made this research process a memorable journey.
TopPrologue: Narrative Experiences
We plan to give examples of various stories that happened during the research process. Narrative inquiry involves living a story and telling that story. The retelling of the story leads to additional insights, ideas, and perspectives. The official narrative of the research follows our research project from the initial idea to the final statistical analysis. The unofficial narrative of the research illustrates all the moments that cannot be captured in a statistical table. Why did a physical therapist and his former patient, an English professor, decide to stay in touch and do research together after her treatment for neck pain? How did the physical therapist feel about grading writing rubrics? What did the English professor learn spending time in a physical therapy clinic as a researcher instead of a patient? When were the moments of success and the moments of trying not to feel discouraged? Who have both of them become as a result of going on this research journey? Where is this research going to lead next to continue to enhance the field of health education? We will answer the questions, share stories, and provide information of what we learned about adult patient education.
Writers live stories once, and relive the stories when writing about them. Or as Goldberg (1986) states, “writers live twice” (p. 48). Life is a series of stories. At the end of our lives the line between the year of birth and the year of death represents each individual’s collection of stories. If we write about our stories, future generations will know what we did with the line between the years we lived.
In a world where people write their stories, it is our dream that students in every classroom and patients in every physical therapy clinic will have a journal to write about their experiences as well as have the support of understanding teachers and clinicians to read the stories. The qualitative research theory of narrative inquiry embodies the sharing of stories.
One of the themes of adult education is that life situations create the need for adult learning. Lifelong learning can contribute to health, fulfillment, and the desire to create positive change in the world. But sometimes within the context of our busy lives, we don’t realize our teachable moments and learning experiences when they happen to us. Writing can help us process life events that occur so we comprehend our learning needs and cope with inevitable changes in life. Sometimes we must look back to move forward. Writing helps us do this by setting any locked up feelings free so that we don’t have to constantly carry them. Cameron (1998) explains, “because writing is a practice of observation as much as invention, we can become curious as much as frightened in the face of change. Writing about the change, we can help it along, lean into it, cooperate. Writing allows us to rewrite our lives” (p. 31). Carrying upsetting feelings, just like carrying a heavy bag, can create tense muscles and lead to physical pain. Cameron continues, “our bodies are storytellers” (p. 58). She elaborates, “your body will speak to you. It will tell you your own needs. It will tell you the cost of your life as well as what is priceless to you. Images and memories will arise at the touch of a finger. Muscles will unlock to whisper your pains and your dreams” (pp. 58-59). Writing, such as creating a pain journal of symptoms, can provide information about the story the body tells.
As the character of Nick memorably reflects in the novel The Great Gatsby (Fitzgerald, 1925), “so we beat on, boats against the current, borne back ceaselessly into the past” (p. 180). Retelling our stories through writing helps the writer own them and while memories of stories often pull us back into the past, they don’t define our future. Cameron (1998) believes, “valuing our experience is not narcissism. It is not endless self-involvement. It is, rather, the act of paying active witness to ourselves and to our world” (p. 50). By writing, we witness our experiences as we retell them and thus relive them. We learn from our experiences so we can move forward. As adults, we may no longer sit in a classroom, but our collection of stories provides the texts we use for lifelong learning.
Key Terms in this Chapter
Artistic and Technical Writing: English teachers often design rubrics which incorporate both artistic and technical writing when evaluating student essays. Artistic writing focuses on the writer’s tone of word choice, also known as voice, while technical writing focuses on the writer’s specificity of word choice.
Wanner-Bird Healing Survey for Pain Recovery: An original survey designed by Dr. Eric Wanner and Dr. Jennifer Bird. This survey features both numerical subjective questions, where patients are asked to respond to statements by circling a number from 1-5, and written subjective questions that score patients’ written responses on a rubric with a score of 1, 3, or 5. The rubric incorporates both the technical and artistic dimensions of writing.
Journal Writing: The process of a person responding to prompts and writing about his or her thoughts and feelings. While journal writing is typically associated with writing classrooms, writing teachers including Julia Cameron, Natalie Goldberg, and Donald Murray advocate that journal writing can be done by anyone, anywhere. Journal writing can be adapted to create pain journals, where patients record the level of pain felt and the actions which caused the pain. Pain journals can subsequently be shared with medical professionals to enhance the healing process. Students in an English classroom, patients in a physical therapy clinic, and readers of this chapter in their living rooms can pick up a pen, paper, and just write.
Physical Therapy Outcome Measures: Tests used by physical therapists to measure the progress a patient makes, such as such as the DASH (Disabilities of the Arm Shoulder Hand), LEFS (Lower Extremity Functional Scale), NDI (Neck Disability Index), and Modified Oswestry (for back pain). Physical therapists choose which outcome measure to use based on the body part where the patient experiences pain.
Writing Voice: Voice in writing describes how a writer uses word choice and tone to compose a journal entry or other written composition that reflects the personality of the writer. Just like each person has a unique speaking voice, each writer has a unique writing voice.
Story-Truth and Happening-Truth: Happening-truth is an objective factual account of events which occurred. Story-truth, sometimes referred to as emotional truth, is a subjective reflection of a person’s thoughts and feelings about the same event when retelling that story. Writers such as Tim O’Brien, Natalie Goldberg, and Anne Lamott believe in the power of emotional truth that enables writers to switch back and forth from objective observations to subjective emotions when sharing a story.