Valuing narrative in the care of older people: a framework of narrative practice for older adult residential care settings.

AIMS AND OBJECTIVES: To report on the development of a framework of narrative practice, in residential care settings for older people.

BACKGROUND: Residential care settings for older people provide care for people who are no longer able to live in their own home. To date, the impact and structure of nursing practice on care provision in these settings has proved difficult to conceptualise within a specific nursing theory framework.

DESIGN: A hermeneutic approach incorporating narrative methods was used.

METHODS: Forty-six narrative interviews with older people in residential care were secondary-analysed for key themes through a three-stage process: by the first author, four focus groups of 12 clinical nurse managers and two independent experts. Themes were also derived from a focus group of eight residents who explored person-centredness and narrative. Finally, the combined findings were used to derive a single set of themes.

RESULTS: The secondary data analysis process led to the development of a framework of narrative practice for the care of older people in residential settings. The framework is influenced by narrative enquiry, person-centred practice and practice development. It has four pillars, prerequisites, care processes, care environment and narrative aspects of care. To operationalise the framework of narrative practice, three narrative elements, narrative knowing, narrative being and narrative doing, need to be considered. Working with the foundational pillars and the narrative elements would enable staff to 'work in a storied way' and provide person-centred outcomes and a narrative informed philosophy of care for older adults in residential care.

CONCLUSION: This framework provides nurses with a template that confirms the identity of the older person taking account of their biography.

RELEVANCE TO CLINICAL PRACTICE: The framework outlines an approach that provides staff with a template on how to provide person-centred care in a narrative way.