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INTRODUCTION

Your clinical narrative should be a first-person “story” about a clinical event or situation that holds some special meaning for you. Your narrative should be an honest reflection of your current clinical practice.

CHOOSING A TOPIC FOR YOUR NARRATIVE

Your narrative can be based on one or more of the following:

  • A situation in which you feel your intervention really made a difference in the patient’s outcome—for example, you recognized a change in the patient’s condition or an opportunity to intervene.

  • A situation that you commonly confront in your practice—for example, ethical concerns or a rapidly changing clinical situation.

  • A situation that was particularly demanding—for example, caring for a dying patient or a situation of conflict.

  • A situation that you think captures the essence of your discipline—for example, when you leave work and say, “I was at my best today. I made a difference.”

WRITING YOUR CLINICAL NARRATIVE

In writing a clinical narrative, you should include the following:

  • Information about yourself, such as your name, title, unit, and length of time in practice

  • The context of the clinical situation: where it took place, time of day, shift, existing conditions

  • A detailed description of what happened

  • Why this clinical situation is important to you

  • What your concerns were at the time

  • What you were thinking about as the situation was taking place

  • What you were feeling during and after the situation

  • What, if anything, you found most demanding

  • Important conversations you had with the patient, family, and members of the healthcare team or other relevant parties

The following tips will help you write your narrative:

  • Present your story as a first-person account.

  • Change the patient’s name and any other identifying information in order to protect confidentiality.

  • “Tell” your story into a tape recorder and then transcribe the tape and edit it, tightening it and filling in any needed details.

  • Tell the complete story first and then edit it to include the essential details.

EDITING YOUR CLINICAL NARRATIVE

After you’ve written your initial narrative, it’s important to take the time to edit it:

  • Review your story with a colleague who has also cared for the patient. This may help you capture the description you want.

  • Have someone read your narrative who doesn’t know the patient to see if there are questions or if you missed information. An outside reader can help you fill in familiar information you may have taken for granted.

  • When you edit your narrative, avoid vague summary statements or general phrases that do not communicate what actually occurred. Examples include:

    • “I analyzed the possible dangers to the patient and took action.”

    • “I gave emotional support.”

    • “The patient’s improving.”

  • More specific ways of stating what occurred include:

    • “The blood pressure was dropping ...

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