Chapter 22

The Ripple Effect: A Story of the Transformational Nature of Narrative Care

The Later Story, page 354-365

政大圖檔所 陳勇汀

2013, May 23

Could a narrative approach be the key to effecting deep, transformational change in a variety of context?

「敘說生命故事」是否能夠成為影響、改變各種情境的關鍵呢？

活動策劃：「讚揚我們的人生 (Celebrating Our Stories)」

── a narrative program at York Care Centre (老人看護機構)

• 計畫目標

• 藉由人們的聆聽與記錄，來讚揚住戶的人生故事
• 在了解住戶真正的想法之後，讓機構相關者(職員、志工等)能夠改變對老人的刻板印象。

• 預期影響：藉由敘說的力量

• 讓人能從不同觀點來看待他人
• 激勵社群：讓每個人都有“aha” moment。因此計畫將居民自身與有興趣的人都培養成「記錄者」(biographer)

• 核心價值：關係 (relatonship)

• 促進不同人之間的新關係
• 改變記錄者與家人對居民的既有關係

• 流程

1. 記錄者組成：每4個月組成一班約4-6位記錄者，包含不同的職員與志工
2. 記錄者訓練：半天的訓練，包含敘說實作練習、記錄工具教學、訪談與編撰技巧、倫理與情意面的訪談經驗
3. 成品產出：將特色故事與照片製成15到20分鐘的投影片(slide show)
4. 成果展示：每個月都舉辦「故事分享會(narrative ceremony)」，邀請家人與朋友、職員與志工等來觀看他們的故事。
5. 成果彙整影片：每年的投影片都會製成DVD，給其他職員及典藏到圖書館。

漣漪效應 The Ripple Effect

• 影響對象：居民、家人、記錄者、職員/志工、機構社群
• 影響面向：意義建構與成長(Meaning-Making and Growth)、互動(Connectedness)、賦權(Empowerment)

意義建構與成長 Meaning-Making and Growth

• 對於居民（受訪者）：講述完他們的生命故事之後，傷痛的人比較能夠感到釋懷
  He was visibly able to put it to rest and move on in his story
• 對於家人：

• 知道受訪者的完整故事，並且重新認識他
  Many expressed gratitude that it had allowed them to see their loved one as a whole being once again.
• 學習到記錄生命故事的重要性，並持續記錄下去
  After their loved one's story was completed, some went on to continue the story of their family by contacting others in different areas of the province and the world.

• 對於記錄者：經歷記錄居民的生命故事之後

• 他們也開始講述自己的故事
• 記錄自己家人的生命故事

Many have been inspired to begin telling their own stories and to connect with members of their family to further this process.

• 對擔任志工的職員：認識到新的觀點，對於個人跟專業都有所成長。

• 護士：從醫護看顧到有機會認識居民的故事
  “I do not always have the opportunity to know and to understand residents beyond their medical conditions and daily living needs....This program has been a rewarding and exciting opportunity for me to connect to the residents I interact with on a daily basis.”

• 對於機構社群：成果發表之後，受到影響的人們越來越重視生命故事的記錄

• 促進更多記錄者加入計畫
• 自主記錄自己家人的生命故事

互動(Connectedness)

• 居民->記錄者：soul-to-soul connect
• 家人->居民：更進一步認識受訪者
• (！) 家人->記錄者：信任記錄者。當居民去世之後

• 家人相信記錄者能夠感同身受
  They felt I (biographer) truly understood what they were experiencing at that moment.
• 激發記錄者負起責任作些什麼
• 生命故事的成品將可以讓家人感到與所愛有所聯繫
  Indeed, the project continued to feed them and help them through the dying and grieving process, and kept them feeling strongly connected to their loved one.

• 記錄者->居民與家人：如同居民與家人對記錄者的互動一樣，他們的關係越來越深刻(run deep)
• 社群中的互動：促成觀點的改變

• 職員不只看到居民的「現在」，還能看到他們「個人」
  Members of our community have developed an ability to see the residents beyond the "now" of everyday life… There have been countless testimonies such as these, all passionately illustrating the changing perspectives of each person who observes a resident's lifestory.
• 因此越來越少用「吹毛求疵」、「很多要求」的標籤來看待居民了。

• 與其他領域的互動：其他人也開始學習並使用敘說記事在他們的領域上，包括社工(social work)、加護看護(acute care)、安寧看護(palliative care)、信仰看護(pastoral care)等等。
  People from all walks of life social work, acute care, palliative care, pastoral care, and other fields are talking and learning together about the transformative impact of a narrative approach.

賦權(Empowerment)

──原本無法做到的事情，透過這個計畫而可以去做的事情

• 居民的賦權：分享生命故事並留下記錄 (”showing off” their stories)
  A resident with no children of her own and very few surviving family members expressed happiness over being able to leave a legacy behind her: "This book. .. that will let them know about me."
• 家人的賦權：
• 參與看護活動
• 向外推廣計畫，教育他人記錄生命故事的重要性
• 記錄者的賦權：

• 有自信能夠照顧他人
• 有能力能夠真正地了解他人
  in their own ways they have become confident in their ability to relate to others on a truly human level

• 機構社群的賦權：

• 因為更了解社群的成員，因此以身處這個社群為傲
  "It has made me very proud to be a part of the York Care Centre family."
• 提昇看護品質，聚焦於人性的看護
  It puts more focus on the human side of care giving and [we] certainly need more of this.

對於規劃敘事活動的建議

• 愛它 Love it：相信敘事計畫可以改善我們的文化。
• 別太急躁 Go slowly：準備工作需要大量的時間，包括建立敘事活動、發出通知、建立穩固的支援輔助。計畫開始之後就要專注於改善它，而不是繼續宣傳計畫的重要性。
• 全心投入 Be dedicated："say no to nothing."
• 享受它Enjoy it：累的時候，回頭看一下已經完成的生命故事，再次為自己作過的事情感到驕傲吧。