RES EA RCH M ETH ODO LOG Y : D ISCUSS ION

PAPER – MET HOD OLO GY

Narrative in nursing research: an overview of three approaches

Briege Casey, Denise Proudfoot & Melissa Corbally

Accepted for publication 19 November 2015

Correspondence to B. Casey:
Narrative in nursing
C A S E Y B . , P R O U D F O O T D . & C O R B A L L Y M. ( 2 0 1 6 )
e-mail: [email protected]
research: an overview of three approaches. Journal of Advanced Nursing 72(5),
Briege Casey EdD MSc RMN 1203–1215. doi: 10.1111/jan.12887
Lecturer
School of Nursing and Human Sciences, Abstract
Dublin City University, Ireland
Aim. The aim of this paper is to present and discuss three popular narrative
Denise Proudfoot DoH MSc
research approaches which have been successfully used by the authors in nursing
RPN Lecturer research. Examples of each approach are offered to illustrate potential application
School of Nursing and Human Sciences, in healthcare contexts.
Dublin City University, Ireland Background. The creation, function and interpretation of narratives are of
increasing interest to nurse researchers worldwide. Currently a variety
Melissa Corbally DProf MSc of narrative research approaches are used to explore how people make sense of
RGN Lecturer experience. While this diversity adds to the richness and scope of the
School of Nursing and Human Sciences,
methodology, practitioners new to narrative research may struggle in determining
Dublin City University, Ireland
which approach best suits their research purposes and contexts.
Design. This discussion paper presents the philosophical basis, methodology,
strengths and challenges of the following three commonly used narrative
approaches: Murray’s Narrative Framework, the Biographical Narrative
Interpretive Method and Arts-Based Narrative Methods.
Data sources. Data sources dating from 1934–2014 were used. These included
seminal texts and articles from nursing and social science journals on narrative
and narrative research found in the CINAHL, Medline and PsycInfo databases.
Implications for nursing. This discussion offers clarity and guidance to nurse
researchers who are considering/ using narrative research methods to enquire into
the storied nature of human experience and sense making processes.
Conclusions. Employing a specific narrative research approach requires close
attention to the ‘fit’ of the research question/context with the particular method
under consideration. While sharing some narrative commonalities, each of these
three methods enables the emergence of unique analytic and interpretive
perspectives about stories relevant to nursing practice.

Keywords: arts-based narrative methods, biographical narrative interpretive

method, Murray’s narrative framework, narrative methods, nursing research,
research exemplars

© 2016 John Wiley & Sons Ltd 1

B. Casey et
al.
In healthcare contexts internationally, stories about ill-
Why is this research or review needed? ness and caring are shared at shift handovers, at bedsides,
• Narrative research is a method of inquiry that is of grow- in corridors, offices, cars and staff rooms. McAllister et al.
ing relevance and value for nursing knowledge and prac- (2009, p. 157) claim that in the sharing, narratives of ill-
tice. ness and caring have communicative, sense-making and
• A variety of narrative approaches exist, which can result in transformative potential and that ‘these benefits are crucial
methodological confusion. Therefore, greater for an applied profession such as nursing’. Many contempo-
understanding is required in nursing research about the rary nurse researchers, including Holloway and Freshwater
affordances and uses of a range of narrative research (2007) and Gregory (2010) argue that the phenomenologi-
approaches. cal insights generated through the analysis and sharing of
• The three narrative methods discussed: Murray’s Narrative
narratives advance nursing knowledge and research prac-
Framework, the Biographical Narrative Interpretive
Method and Arts-Based Narrative Inquiry exemplify a
tice. Narrative research in nursing has flourished in recent
commonly used and varied range of narrative research years and there has been a corresponding proliferation in
practice. approaches to understanding and exploring storied
accounts. McCance et al. (2001) propose that nurse
What are the key findings? researchers new to narrative approaches can experience
some confusion as to the selection and use of particular
• While sharing some narrative commonalities, each of the
methods to suit their purposes. This paper presents a broad
three methods outlined in the paper enables the emergence
of unique analytic and interpretive perspectives about sto- overview of the main philosophical foundations underpin-
ries encountered in nursing practice. ning narrative research and offers examples of three narra-
• Employing a specific narrative research approach requires tive approaches used by the authors which reflect this range
close attention to the ‘fit’ of the research question/context of theoretical positions. Common features and unique char-
with the particular method under consideration. acteristics across these approaches are described with the
• The three narrative approaches presented in this paper con- aim of informing potential narrative researchers in their
firm the usefulness and richness of this research methodol- choices of appropriate narrative methods to suit specific
ogy for nurse researchers wishing to enquire into the research questions and contexts. We will begin by dis-
storied nature of human experience and sense making. cussing some of the common overarching premises of narra-
tive research.
How should the findings be used to influence
policy/ practice/research/education?
• The findings will increase awareness of the important func- Background
tion of narrative processes in enabling patients and practi-
tioners to make sense of complex and often traumatic life Narrative research encompasses a broad range of
experiences. This heightened awareness should inform pol- approaches which are focused on gathering, analysing and
icy, practice, research and education. presenting storied texts or personal accounts with the pur-
• Nurse researchers should familiarize themselves with the pose of establishing a rich description of the meaning of an
affordances and practices of various narrative research individual’s experience (Riessman 2008). Exploration of
approaches and engage confidently with a range of narra- narrative generally embraces one of the following two main
tive inquiry methods. positions; however, it is important to note that these are
not perceived as mutually exclusive and elements of both
Introduction can be found in various studies.
Nursing is largely an oral narrative culture (Sandelowski
1994, Wolf 2008, Adamski et al. 2009). We are immersed
Position 1: Narrative is a human sense-making process
in stories; our own nursing stories and the stories of people which is essential for configuring lived experience
in our care. We order our life experiences into stories with
temporal and logical sequences and this narrative mode of This position owes much to three philosophical origins: the
thinking helps us to organize and make sense of disparate first is phenomenology which is concerned with meanings
life events (Bruner 1990). This narrativizing process is of lived experience as encountered from the subjective or
invariably employed to re-configure experiences of illness first person point of view (Van Manen 1997, Merleau-
and trauma (Frank 1995, White 2004, Williams 2009). Ponty 1999). The second is cognitive psychology, particu-
larly the work of Bruner (1990) and Sarbin (1986) who (Labov & Waletzky 1967/1997). An example of this struc-
regard narrative sense making as an integral component of tured approach is Wengraf’s (2001, 2008) Biographical
configuring often complex life experiences. The third philo- Narrative Interpretive Method (BNIM) which is discussed
sophical origin is social constructivism (Vygotsky 1978); later in this paper. Recent studies by nurse researchers using
the belief that meaning is created in the individual in the structured approaches are MacLellan (2015), who uses
context of a social world. Articulated narrative is regarded Labovian analysis to explore childbirth stories on the Inter-
as an expression of individual reality; however, there is net and Ramvi (2015) who uses Wengraf’s (2001, 2008)
acknowledgement that narrative configuration is influenced BNIM in a case study examining a nurse’s self- understand-
by social contexts and through time. Using a naturalistic or ing in the context of her professional practice.
realist approach, the narrative researcher is particularly The focus on the socially mediated nature of narrative is
concerned with the content and the ‘what’ of the story; also influenced by poststructuralist concerns such as those
what experiences participants have had and what those of Foucault (1980) and Blumenreich (2004), about the nat-
experiences have meant to them. These experience centred ure of knowledge and power in social contexts and how
approaches (Patterson 2008) generally adopt a hermeneutic these forces are enacted through culturally agreed interpre-
approach to analysis; the researcher moves back and forth tations of narratives (grand narratives or meta-narratives).
between stories, developing themes and aiming at full inter- Poststructuralist narrative approaches explore the interac-
pretation and understanding. Examples of experience cen- tion between self and environment as we enact our narra-
tred narrative approaches in nursing research include tives (Carolan 2005); there is increasing interest as to how
Overcash (2004) who explores the quality of life of older personal and cultural narratives; (the personal and the
women with breast cancer and Law et al. (2015) who political) interact and rub up against each other (Wilson &
examine the experience of learning to speak up among Crowe 2009, Casey & Gordon 2010). Poststructuralist
newly graduated registered nurses. Later in this paper, an thinking also highlights language as already embedded with
example of an experience centred approach (Murray’s Nar- pre-scribed, socially sanctioned meanings which require
rative Framework 2000, 2008) will be discussed in more close attention and deconstruction (Taylor 2003). Given
depth. these perceived limits of language, poststructuralist
approaches are interested in divergent ways of apprehend-
Position 2: Narrative is a tool of social construction; ing and communicating experience, for example, the nature
reality and meaning are configured through telling and of embodied experience and the affordances/characteristics
sharing stories using the medium of language of arts-based narrative research (Stickley et al. 2007,
Lapum et al. 2012). Arts-based approaches contain ele-
This position is influenced by postmodern and social con- ments of both phenomenological and social constructionist
structionist thinking (Sparkes & Smith 2008, Gregen philosophy; which Riessman (2008) terms the ‘what’ and
(2009). Rather than viewing the process of construction of the ‘how’ of narrative. There is interest in what the lived,
meaning as residing in the individual, social embodied, personal experience feels like for the person and
constructionists contend that meaning and reality are also a focus on how this experience is constituted by and in
configured through social processes; through the turn constitutes the social milieu. An example of arts-based
performance and interpreta- tions of stories in social narrative approach developed by Edgar (2004) will be dis-
domains. (Calvert 2014). Accord- ing to this position, cussed later in the paper.
narratives also reveal much about social life or culture, as
aspects of culture are conveyed through the story.
Researchers using social constructionist approaches are Data sources
more interested in the ‘how’ of the narra- tive; how the The CINAHL, Medline and PsycInfo databases were
story has been configured and how it is com- municated, searched using terms relevant to the three methods under
how the account presents self and (life) story and how the discussion. These terms were: nursing, narrative research,
personal story transmits wider social and cul- tural Murray’s Narrative Framework, Arts-based Narrative
meanings. It follows then, that such a close examina- tion Research and Biographical Narrative Interpretive Method.
of the narrative as product or text demands a highly The terms narrative research and narrative inquiry were
structured analytic approach. Here, examination of lan- used as synonyms. This search, as expected delivered a
guage goes beyond its referential content and the researcher large, often undifferentiated volume of research articles per-
studies the use of particular modes of speech, metaphors taining to narrative research. This was useful for some of
and language that is nuanced by particular perspectives

© 2016 John Wiley & Sons Ltd 120

the more general discussion about narrative research in cal element establishes how stories relate to cultural/societal
nursing. A more intensive search by each author in relation contexts and identifies social representations in the narra-
to the three research methods discussed was also required tives. The focus on the personal interpretation is common
and contemporary examples of these approaches were gen- to all experience centred approaches as previously dis-
erated through this process. Seminal texts were also cussed. The interpersonal, positional and ideological explo-
accessed as these illuminated the philosophical foundations rations in Murray’s Framework acknowledge the influence
of social constructivism, cognitive psychology, social con- of dialogical and societal forces on interview context and
structionism and poststructuralism. Therefore, material story creation; however, narrative sense making is viewed
dated 1934–2014 was reviewed. This discussion paper is as occurring in the consciousness of the individual. In nurs-
also informed by our own experiences as researchers using ing contexts this approach generally involves interviewing a
these methods small number of participants who share a lived experience
for example; people living with the experience of long-term
Discussion illness (McMahon et al. 2012).

This paper considers three common narrative approaches, Methodology

each of which exemplifies the premises of the philosophical This approach employs semi-structured interview where the
positions discussed above. These are; an experienced cen- participant is asked to recount a story related to the topic
tred narrative method i.e. Murray’s Narrative Framework of inquiry. The analysis of narratives adopts a hermeneutic
(Murray 2000, 2008), used by Proudfoot (2014), a struc- approach using the four ‘lenses’ previously described;
tured narrative approach i.e. The Biographical Narrative exam- ining transcripts and identifying key events/experiences
Interpretive Method (Wengraf 2001, 2008), used by Cor- to gain understanding of personal experiences, the narrative
bally (2011) and Arts-based Narrative Research with a par- tone and the narrator’s use of imagery and metaphors. The
ticular focus on Imagework (Edgar 2004) used by Casey interpersonal analysis explores how the accounts are co-
(2009). The aim of this discussion of exemplars is to share constructed by the narrator and the researcher by examin-
research experience by demonstrating how each approach ing conversation flow in the narrative while taking account
facilitated the authors to explore and understand health of the interview context. The positional level extends the
experiences. It is further hoped that this discussion paper intrapersonal level to consider differences between the
will provide clarity and guidance to nurse researchers con- researcher and the narrator and how this influences the co-
sidering/ using narrative research methods. construction of the narratives. In health research, examining
the positional level can be important if the balance of
Murray’s narrative framework power lies with the health professional/researcher (McMa-
hon et al. 2012) which can inhibit the narrator telling their
Background and theoretical/philosophical basis story. The ideological level explores how the participant
The first research approach, Murray’s Narrative Framework perceives their experiences in relation to broader sociocul-
(Murray 2000, 2008) is an experience centred narrative tural norms associated with their health condition for
research method which aims to gain insight into the example, stigma and mental illness.
meanings of lived experiences. Squire (2008) posits that
experienced centred narrative research is based on the Strengths and challenges
phenomenological assumption that through stories, experi- The main strength of Murray’s framework is that it
ences become part of consciousness. Narrative performs a enables in-depth exploration of personal lived experience as
transformative function enabling sense-making concerning created and recounted through narrative. The hermeneutic
a particular experience. Murray’s narrative framework analysis allows for the understanding of health and illness
exami- nes storied experiences focusing on four specific experi- ences from different perspectives through detailed
elements of the narratives; personal, interpersonal, explo- ration of the meaning in the collected stories.
positional and ideo- logical (Murray 2000, 2008, Shelton & Murray’s framework goes further than some other
Johnson 2006). The personal element is concerned with experience centred narrative approaches in that it also
how an individual describes their own experience. The considers the effects of interaction with the social
interpersonal and posi- tional examine the interaction and environment and co-construction on the creation and
power relations/positions between the participant and the articulation of the narrative. There is an interest in the
interviewer and how the narrative evolves during the language and metaphor used in the narra- tive which also
interview. Finally, the ideologi- extends this method. Given that broader
social processes affect many aspects of an individual’s expe- narrative approach is an option for nurse researchers who
riences of health and illness, this approach has much to are interested in lived health/illness experiences in a rela-
offer nursing and healthcare research particularly when tional and social context. A more structured narrative
attempting to appreciate a person’s experience of illness approach is The Biographical Narrative Interpretive
(Holloway & Freshwater 2007). Method (BNIM) and the next section considers its use in
In her critique of experience centred approaches, Squire health research.
(2008) argues that there is a tendency towards homogeneity
(through fitting diverse and possibly contrasting
experiences into themes and typologies) and researcher Biographical Narrative Interpretive Method (BNIM)
empiricism in that there are a priori expectations as to the Background and theoretical/philosophical basis
format and content of experience stories and these
BNIM is concerned with the exploration of subjective expe-
expectations can guide the conduct of the research and
rience in historical and social contexts and examines life
analysis. Squire (2008) also contends that because of the
narratives in a structured way. Through case-based analysis
unproblematic and dominant focus on experience, the
BNIM facilitates systematic and retrospective exploration
significance of language can be overlooked and that this
of the person’s whole life story (Biography) and how they
can contribute to misinter- pretation of the related
tell it (Narrative) while appreciating that narratives are sub-
narratives. However, Murray’s ana- lytic approach
ject to social and historical configuration and interpretation
incorporates language features including metaphors and the
(Interpretive) (Wengraf 2008). BNIM follows social con-
tone of the narrative and this considera- tion reduces the
structionist philosophy (Berger & Luckman 1966) concern-
possibility of misinterpretation of collected stories.
ing the social nature of knowledge and reality construction,
about narrative as vehicle by which socially mediated
Use of Murray’s narrative framework in health research
knowledge becomes manifest. BNIM research is interested
Murray’s narrative framework has informed a variety of
in the structure of the life narrative and how these histori-
health related studies, Shelton and Johnson (2006) used this cal and socially mediated meanings inscribe the narrative.
method when exploring mothers’ subjective experiences of Accordingly, close examination of language and text struc-
delayed motherhood. Murray’s approach supported them in ture is an important component. The generation of case
exploring how the women negotiated social expectations accounts using BNIM is characterized by a particular inter-
of mothering in their personal narratives. More recently, view style and a comprehensive, formulaic analytic method.
it was used in studies about the experiences of breast cancer In addition to social constructionism, this method is
(Murray 2009) and those living with fibromyalgia (McMahon informed by other theoretical orientations, including bio-
et al. 2012) and provided insight into the multi-dimensional graphical approaches (Chamberlayne et al. 2000), literary
impact of these conditions which is useful to nurses criticism/ linguistic analysis (Labov & Waletzky 1967/
involved in their care. Proudfoot (2014) drew on this 1997) and grounded theory (Glaser & Strauss 1968).
framework in her doctoral research exploring the mothering
experiences of HIV positive women. In this study, partici- Methodology
pants described significant events since diagnosis and this BNIM in practice uses a unique interviewing technique to
research revealed the complex interrelationships between elicit an uninterrupted story from participants. This is
mothering stories and HIV stories. For example, some called the Single Question Aimed at Inducing Narrative
mothers prioritized their children’s care by deliberately min- (SQUIN) (Wengraf 2001) and always underpins the first
imizing the negative aspects of being HIV positive; they interview session. A typical example of a SQUIN is as fol-
invested more heavily in their mothering role. Using Mur- lows: ‘I would like you to tell me your life story, all the
ray’s framework to analyse these narratives allowed for a events and experiences which were important for you. Start
broader understanding as to how being a mother influences wherever you like. Please take the time you need. I’ll listen
the HIV experience and vice versa. Importantly, Vallido first I won’t interrupt, I’ll just take some notes for after-
et al. (2010) argue that healthcare professionals (including wards’. Up to two additional sub-sessions can follow
nurses) rarely acknowledge the influence of being a mother depending on the nature of the research but any subsequent
on illness/treatment attitudes and behaviour; through using questions must relate to material arising from the SQUIN
Murray’s framework Proudfoot’s (2014) study made (Wengraf 2001).
visible this previously overlooked dimension of the The BNIM analytic strategy uses a structured approach
women’s experiences and narratives. Murray’s to explore the individual’s life history or life story (case). If
experience centred
BNIM is used to its full capacity, nine stages of analysis are cal and cultural contexts (Gubrium & Holstein 2009,
used per case with a tenth stage comparing across cases Gunaratnam & Oliviere 2009). According to Lomas (2012)
(Jones 2001, Corbally & O’Neill 2014). Typically sample and Ofri (2015) the contemporary forces in nursing of
sizes are small given the intensity of analysis. A more in- bureaucracy and cost-effective healthcare management
depth discussion of the intricacies of BNIM can be found in often render the individual life story invisible. BNIM
(Corbally & O’Neill 2014). There is also a very active acknowledges the processes of change, time, culture and
online support network for BNIM users (https://www.jiscmail. history, and the lived texture of lives and the appreciation
ac.uk/cgi-bin/webadmin?A0=BIOGRAPHIC-NARRATIVE- of structure and agency in those lives (Meares 2007). Case-
BNIM [accessed 2nd April 2015]. Here, Tom Wengraf (the based methods are particularly useful in discovering
champion of BNIM in the UK) and many others offer individualized reactions to life altering challenges such as
timely support for scholars using this method) which is use- serious illness, disability or as in the study undertaken by
ful. The following diagram outlines what is involved in the Corbally (2011), intimate partner violence. The formulaic
various stages of BNIM analysis (Figure 1). structure of BNIM provides narra- tive researchers with a
clear and rigorous structure to inten- sively analyse life
Strengths and challenges stories from a small cohort of participants.
The focus on participants’ biographies allows nurse One of the challenges with BNIM and other highly struc-
research- ers to consider people as historically and socially tured narrative analysis approaches is that strict application of
formed actors whose actions are only fully intelligible in the formulaic approach can decontextualize narratives by
their histori- ignoring interactional and contextual factors (Bornat

Track 1 – llved
life analysis
1
Biographical data
chronology
2
Lived life
interpretive panel
analysis
3
Biographical data
analysis

Track 2 – told
story analysis
4
Text structure
sequentialisation
5
Told story
interpretive panel
analysis
6
Microanalysis
Merging lived life and told story 7
8 Thematic field
Comparing lived life with told story analysis
9
Construction of a case account

10
Cross case theorization
(Comparison and analysis across other cases subjected to 9 stage analytic process)
Figure 1 Stages of BNIM analysis.
2008). In this approach, the influences of the research envi- representation of narratives (Leavy 2009). Some contem-
ronment and researcher participant relationships/interac- porary writers (Rogers 2007, Schick Makaroff et al.
tions are not considered, yet according to Atkinson and 2013) have highlighted the limits of language in commu-
Silverman (1997), these elements can also influence story nicating the ‘unsayable’; that is experiences, particularly
formulation. of trauma, that are beyond language and thus difficult to
The specific interviewing and analysis processes involved narrate. Frosh (2004) and Leitch (2006) posit that arts-
in BNIM demands some level of skill and training on behalf based research extends traditional practices of narrative
of the researcher. Jones (2003) also contends that using the inquiry in that it retains the conceptual framework con-
full rigour inherent in the ‘classic’ BNIM method may cerning the narrative mode of configuring experience, but
result in excessive and/or overly complex data generation and goes beyond the limits of language or prosaic conscious-
analysis processes depending on the phenomenon of study. ness through the use of arts-based methods that give
Although Corbally (2011) used all ten stages of the ‘classic’ access and expression to embodied, ‘felt’ knowing. Thus,
BNIM method, it can be modified to incorporate less ana- engagement with narrative shifts from the story as
lytic stages depending on the nature of the research ques- received and interpreted to the story as created and/or
tion (O’Neill 2011). performed. In the process of creating and performing, ten-
tative, ambivalent and previously unvoiced perceptions
Use of BNIM in health research and meanings are grappled with and articulated in evoca-
BNIM has been used in a variety of health research pro- tive ways (Barone & Eisner 2012). Philosophies influenc-
jects. For example O’Neill (2011) studied end of life care ing arts-based narrative research straddle phenomenology
decisions about older people in hospitals, Nicholson et al. (Gadamer 1989), aesthetics/art as experience (Dewey
(2013) examined older persons’ narratives about frailty 1934), social constructionism (Gergen & Gergen 2012)
and Garratt (2014) explored the working lives of indepen- and poststructuralism (Foucault 1972/1969); there is inter-
dent midwives and their perceptions of the mother-midwife est in both the internal, individual narrative configuration
relationship. Corbally (2011) used the classic BNIM of experience (often embodied) and habitually performed,
approach in examining men’s stories of female perpetrated socially inscribed narratives.
intimate partner violence (IPV). IPV is mostly understood
as a problem experienced by women. Therefore, men who Methodology
are being abused by women frequently feel that their abuse Arts-based Narrative Research may involve the use of any
experiences are ‘unbelievable’ Corbally (2011). BNIM art form(s) at any point in the research process, whether for
enabled exploration of the tensions between the men’s generating, interpreting and/or communicating knowledge
lived lives and their told stories of abuse and how the con- (Knowles & Cole 2008). Additionally, arts-based methods
text of their lives as men in a patriarchal society made it may be combined with more traditional research
very difficult for them to make sense of their experiences approaches at any stage of the research process. For
of IPV. This approach also proved useful in creating con- example, Wright (2006) and Lapum et al. (2013) gathered
textual interpretive case accounts and in highlighting par- data on healthcare issues through participant poetic writing
ticular narrative strategies men used to talk about IPV. and analysed the poems using traditional thematic analysis
Another narrative informed research method that is con- and textual discus- sion. Alternatively, Edwards (2015)
cerned with silenced stories is Arts-based Narrative incorporated poetry at a later stage of her research process
Research and this method is discussed in the next section. by gathering data through qualitative interviews and
transforming the findings of her research into poetic form.
Arts-based narrative research For the purposes of this paper, an example of a specific
arts-based narrative research method used by Casey (2009)
Background and theoretical/philosophical basis will be described. This is a visual arts- based method
Arts-based Narrative Research is an umbrella term refer- (Imagework) developed by Edgar (2004).
ring to approaches which employ some art form as part Edgar’s (2004) Imagework approach involves asking peo-
of the narrative research inquiry (Finley 2011). In health ple to create a mental image that reflects the situation being
research contexts, a range of arts-based practices – visual considered. For example in healthcare contexts,
(video, photography and painting), performative (drama, participants, individually or in groups may be asked to
dance and music) or literary (poetry, fiction) are used to visualize scenes or objects that are connected to
facilitate divergent ways of inquiry, meaning making and experiences/narratives of being given a diagnosis or
navigating a health issue. Articulation and exploration of
these mental images are facilitated
through asking the person to make an external picture or unvoiced narratives. Similarly, research audiences are
drawing of their mental image. The participant creates the drawn closer to the lived stories through this aesthetic evo-
picture or drawing of the mental image and subsequently cation. With its focus on apprehending experience through
describes the process of constructing their art piece and divergent, aesthetic ways of knowing (Carper 1978, Leight
what they aimed to convey about their experiences. This 2002), arts-based research troubles relationships between
session is recorded and transcribed and the completed knowledge and power and challenges traditional forms and
images are pho- tographed (with participant consent). Edgar institutionalized, habitual ways of thinking (Mitchell et al.
(2004) provides a framework for analysis which focuses on 2011).
the participants’ stated process, meanings and subsequent However, there are also some challenges in using these
personal or group responses about their created art methods. Knowles and Cole (2008) highlight that this work
narrative. demands a high level of self-directed methodological
rigour, creativity and innovation on the part of the
Strengths and challenges researcher. Arts-based researchers are less likely to avail of
Jonas-Simpson et al. (2012) suggest that the strengths of ‘off the shelf’, structured templates (Raingruber 2009),
using arts-based approaches lie in their capacity to enable therefore, Barone and Eisner (2012) advocate that this
articulation and analysis of previously under-explored, research needs

Table 1 Illustration of the main components of Murray’s Narrative Framework, BNIM and Arts-based Narrative Research.
Characteristics Murray’s Narrative Framework BNIM Arts-based Narrative
Research
Theoretical/ Phenomenology Biographical methods Phenomenology
philosophical Cognitive psychology literary criticism/linguistic analysis Aesthetics
basis Social constructivism Social constructionism Social constructionism
Social constructionism Grounded theory Post structuralism
Key contributors Murray (2000, 2008) Fischer-Rosenthal and Rosenthal Edgar (2004), Knowles and Cole
(1997), Chamberlayne et al. (2000), (2008), Leavy (2009), Barone and
Eisner (2012)
Wengraf (2001)
Methodology/ Semi-Structured interview Initial unstructured interview (single Participants facilitated to create art
methods of question aimed at inducing (individual or group) based on area of
data collection narrative (SQUIN) – followed by inquiry or more traditional data
and analysis semi structured follow up. collection method used and data
analysed and translated into art form
Hermeneutic analysis of 10 stage formula (9 on individual Visual analysis of visual
categories across narratives case and 10th stage cross-case art/photographs, narrative analysis of
comparison)Interpretive panels language based data and contextual
used (3 panels per case) discussions.
Analysis may be researcher
Strengths In-depth exploration of personal Facilitates understanding of led/ participatory
lived experience as created individual life story within Goes beyond limits of familiar language
and recounted through historical and cultural context usage, facilitates previously ‘unvoiced’
narrative through narratives, challenges meta-narratives.
multi-level analysis of biography,
lived life, told story.
Hermeneutic analysis using Provides clear and rigorous structure Participatory, Embodied, Evocative
4 ‘lenses’ allows for the to intensively analyse life stories
understanding of health and from a small cohort of participants.
illness experiences from different
perspectives
Challenges Tendency towards homogeneity Formulaic – can decontextualize Difficulty in establishing agreed
(through fitting diverse and narratives by ignoring evaluative criteria to judge the merits,
possibly contrasting experiences interactional/ power/situational qualities and rigour of arts-based
into themes and typologies) factors in narrative production and narrative research
sharing
Significance of language could be Risk of over complex data generation High level of self-directed research
overlooked ethics, rigour and innovation required
Examples of Murray (2009), McMahon et al. O’Neill (2011), Corbally (2011), Casey (2009), Boydell (2011), Carter
use in health (2012), Proudfoot (2014) Nicholson et al. (2013), Garratt and Ford (2013)
research (2014)
to be underpinned by a strong and continued awareness of refers to. Murray’s framework, with its experience cen-
the research questions/aims and ongoing reflexivity as to tred approach could be considered a more traditional
the selection and fit of particular arts methods. Researchers narrative method, whereas arts-based narrative
need to have ongoing sensitivity to ethical issues that arise approaches might be regarded as extending customary
in the field and issues of voice, representation and research narrative approaches through innovative, creative prac-
purpose. The question of developing evaluative criteria to tices. BNIM contributes to this diversity with its more
judge the merits, qualities and rigour of arts-based research structured focus on the narrated biographical particulars
has also provoked much debate with some researchers argu- that Chase also alludes to. Accordingly, although all
ing that current qualitative research evaluation criteria are methods clearly share a narrative thread, there are
based in positivistic paradigms and are therefore not appro- nuanced differences in each in terms of particular narra-
priate for arts-based research (Finley 2011). However, tive focus and interpretive lens. Table 1 provides an
scholars such as Finley (2011), Lafreni`ere and Cox illustration summarizing the main components of each
(2013), Archibald et al. 2014) have worked at formulating of these three approaches.
criteria that reflect the aesthetic, methodological and ethical Rarely is a research method developed from a unitary
required standards for this work. epistemological base and the above table illustrates how
similar and diverse epistemological positions can influ-
Uses of arts-based narrative approaches in health research ence the development of novel research methods. The
Health care and the Arts have a common interest in narra- fact that social constructionism is a shared assumption
tives of the human condition. In nursing research, arts- among all three illustrates a commonality across these
based methods of enquiring and re-presenting are becoming narrative approaches. Equally, elements of diversity and
more frequent, across a range of populations and contexts. uniqueness are apparent, for example, in the varying
Some examples include; the work of Mitchell et al. (2006) emphasis on realism and social construction between the
in creating a drama based on the experiences of living with approaches and variations in methodological practice in
dementia, Carter and Ford’s (2013) examination of arts- data collection, analytic techniques and representation of
based participatory approaches in researching children’s findings.
health experiences and Casey’s (2009) exploration of the
identities and sense making processes of student nurses
Implications for nursing; how can understanding of
through their art-making. In Casey’s (2009) study, arts-
narrative research methods enhance nursing research
based participatory methods (poetry, visual art, drama,
and practice?
dance) enabled the exploration of the previously unvoiced
narratives of student nurses, facilitated collaborative inquiry For nurses considering narrative approaches in research/ to
about some of the unquestioned assumptions adopted enhance understanding in nursing practice, the decision as
through the nursing socialization process and offered pow- to which narrative method one adopts can be complex
erful ways of enquiring into student nurses’ perceptions, and needs to be informed by the research question,
motivations, biographies and identities as nurses and care research/practice context and the affordances and con-
givers. straints / limits of each method. One way to explain this
is to consider how each narrative approach might be used
to explore, for example, stories of chronic pain. A
Comparison of approaches
researcher/enquirer adopting Murray’s method to explore
When one considers the multiplicity of approaches that are chronic pain for instance will be interested in the personal
used in narrative, Chase’s (2005 p. 651) sentiment has clear experiential account of pain, the metaphors and language
resonance: the person uses to describe their pain, the person’s social
story and the part that pain plays in that context. This
“Contemporary narrative inquiry can be characterized as an amal-
approach is useful if the researcher wishes to consider the
gam of interdisciplinary analytic lenses, diverse disciplinary
lived experience of pain and its influence in the person’s
approaches and both traditional and innovative methods – all
wider lived context. Additionally, the researcher recognizes
revolving around an interest in biographical particulars as narrated
the part that s/he plays as audience to that account and
by one who lives them”.
will engage in a reflexive process considering the interper-
The approaches presented in this paper provide useful sonal and positional relations between researcher and
exemplars of the methodological amalgam that Chase researched; in this case possible power differentials and
the researcher’s own experiences and attitudes concerning As outlined in this paper, narrative research encompasses
pain. a range of approaches which take as their central focus the
A nurse researcher using BNIM, to explore chronic pain construction, articulation and interpretation of storied
narratives will be interested to a greater extent in how this accounts. However, each approach will provide a slightly
story has been constructed and shaped over time and con- different lens on the story under inquiry and the modes of
text through tellings and re-tellings. For example, in this accessing, exploring and re-presenting these stories may dif-
case, how at different times the narrator may present self as fer depending on which approach is adopted. The complex-
a victim of chronic pain or as a survivor. The researcher ity of contemporary research contexts, particularly those
will also be interested in the dynamics between the story as involving experiences of illness and distress, demands
told and the actual lived experiences of the narrator and research approaches that ‘catch and care for the sparkle of
the analysis will systematically focus on uncovering some of moments of beauty, of reverence, of joy or personal pain’
these dynamics. Generating insights into the differences (Mair 1989 p63). The choice of approach will depend on
between lived lives and told stories is of great benefit to the research questions and the unique characteristics of the
nursing interactions and interventions given that nursing research context. Consequently, the three narrative
work involves the appreciation of complexity and ambiva- approaches presented in this paper confirm the usefulness
lence in peoples’ perceptions and responses. and richness of this research methodology for nurse
Arts-based narrative approaches might be used in the researchers wishing to enquire into the storied nature of
exploration of the physically embodied experience of human experience and sense making.
chronic pain. An arts-based enquirer may argue that con-
ventional words are not sufficient or possible to express the
pain narrative therefore painting, dance or poetic form Funding
might facilitate this articulation and bring the audience/ This research received no specific grant from any funding
viewer closer to the actual experience. The art-making pro- agency in the public, commercial, or not-for-profit sectors.
cess may also enable the researcher to uncover/discuss
other experiences related to the pain narrative for example
body image, body agency, treatment, impact of surrounding Conflict of interest
cul- tural attitudes to pain. These concerns can be discerned No conflict of interest has been declared by the authors.
through the choice of metaphors or composition of the art
piece.
It is clear that while there are philosophical, interpretive Author contributions
and analytical variations, all three approaches work to gen- All authors have agreed on the final version and meet at
erate insights about the stories people tell concerning their least one of the following criteria [recommended by the
lived experience. The insights achieved are nuanced and ICMJE (http://www.icmje.org/recommendations/)]:
informed by the approach taken.
• substantial contributions to conception and design,
acquisition of data or analysis and interpretation of
Conclusion data;
Using narrative processes to configure life experiences, par- • drafting the article or revising it critically for important
ticularly those of trauma or illness is an essential human intellectual content.
sense making activity. Implicit in nursing work worldwide,
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