26th February 2021

Book in Focus

How Nurses Can Facilitate Meaning-making and Dialogue

Reflections on Narrative and Photo Stories

By Jan Sitvast

The following is based on an adapted version of Sitvast J., “Person-Centredness in Mental Health Care, a Contextual Framework for Nursing Aimed at Promoting Shared Decision Making and Self-Management”. IJCMCR. 2020; 5(1): 005

We assume that shared decision-making, co-creation, and self-management will be important concepts within the healthcare system in the next decade. To realize shared decision-making and self-management in practice, collaboration is necessary, especially between the healthcare professional and the patient, between the healthcare professional and the family and informal networks around the patient, between healthcare professionals from various backgrounds, and between institutes. The vehicle for facilitating all this will be found in narrative medicine, or, more precisely, in narrative nursing, which is the focus of this book.

Underlying narrative nursing is the concept of health as ‘positive health’. We no longer follow the concept of health as a state of complete physical, mental and social well-being as this concept (formulated by the WHO in 1948) implied that many people must be classified as ‘ill’ even when they coped with their disease very well and they themselves would not describe themselves as such. ‘Positive health’ is defined differently:

“Health is the capacity of people to adapt and direct their coping with adversities of life against the background of physical, emotional and social challenges. Being healthy means to be able to adapt to disruptions, show resilience and maintain a balance or re-find this balance physically, mentally and socially.” (Huber et al., 2011)

The coping behaviour that is assumed here poses demands on how health professionals should facilitate this. The role of nurses in supporting this process becomes more and more important as we move into an era of personalized health care with treatment ‘tailored’ to the specific individual needs of the patient.  These needs will often depend on where the patient stands in the transition stage from health to illness (and vice versa) and the incurring consequences this can have for daily life. Transition moments concern turning points in the life course or in the career as a patient with a necessity to reorient oneself regarding one’s past, the present situation and the future still to come. Meaning must be found in a new situation, losses must be integrated into one’s life, a new balance must be (re-)es­tablished, and a new identity may even be desired. According to Meleis (2000), it is the task of nurses to support patients during transition moments and pay attention to essential aspects in­herent to the experience of this transition: awareness, engagement, time span, the relevance of critical points and events, and how these are experienced. Here the patient narrative comes in: how do self-awareness and the experiences concerning illness and recovery enter the life-story?  The vitality (or lack thereof) and the strength to move on to a new phase in life depend on the answer to this question. With a positive narrative, the patient’s resilience and capacity for self-management will be strengthened and quality of life will improve (Huber & Staps, 2016). In mental health care, the re-establishing of control over one’s life, (re)finding a positive identity, and starting living according to one’s values are often called ‘recovery’.

The issue now is how nurses in mental health care can deal with all the demands that are made on their competences, from the perspective outlined above. This book offers suggestions on the direction to take in answering some of the questions that are involved with nurses’ competences. When applying these competences to our core themes, shared decision-making and self-management, then we may formulate the following critical questions:

In the book, we postulate that the central issues in promoting self-management are awareness and goal-readiness, and show that professionals could contribute to them by:

  • Having a keen understanding of what awareness and goal readiness takes;
  • Adopting a person-centred approach;
  • Being narrative-orientated;
  • Being relation-oriented;
  • Assessing needs and risks;
  • Coaching skills (how to cope with a disease).

One example of nurses assisting patients in creating awareness and goal readiness is described more extensively in the book, namely using photography as a therapeutic medium. In this approach, patients will take photographs supported by assignments, before being invited to reflect on these photographs and make them part of a visual narrative. The focus here will be on how to live a valued life with an illness or disorder and what this means for illness management, lifestyle decisions, and spirituality, among others. The photo-instrument, developed by the author, is one intervention that has been researched regarding the degree to which it inspires patients to set goals in the context of self-management and shared decision-making.

Jan Sitvast was educated as a historian, before becoming a nurse in mental health care, bringing with his fascination with the narratives of ordinary people. He trained as a nurse practitioner (2003) and worked as such for a couple of years before becoming a researcher working in a mental health institute. His PhD thesis explored the therapeutic application of photography and visual narratives for patients in mental health care. He has published a number of articles and books on empowerment photography, self-management, nursing and narrative.


Huber M., Knottnerus J.A., Green L., Horst H.V., Jadad A.R., et al. (2011). How should we define health? BMJ 343: d4163.

Huber M., Staps S. (2016). Self-management for health and environment: Time for a new approach-position paper. Louis Bolk Instituut en Institute for Positive Health White Paper.

Meleis A.I., Sawyer L., Im E.O., Messias D.K., Schumacher K. (2000). “Experiencing transitions: An emerging middle-range theory”. Adv Nurs Sci 23: 12-28.

How Nurses Can Facilitate Meaning-making and Dialogue: Reflections on Narrative and Photo Stories is available now in Hardback. Enter the code PROMO25 at the checkout for a 25% discount.