Narrative Utilization Ecosystem for Person-Centered Care

Abstract: Person-centered care is proposed as a principle that values each care recipient as an individual (Kitwood et al. 1992). In nursing care, it is necessary to provide high-quality individualized care based on a deep understanding of the narrative, which is the life story of each care recipient, including their life background and values (Guendouzi et al. 2015). However, it is not easy for busy care workers to practice individualized care according to the person-centered care principle. Fragments of narratives are typically gathered during initial assessments when users start using nursing care services and through daily conversations. Unfortunately, these narratives are often underutilized in actual care practices. This issue arises from various factors, including challenges on the care recipient side, such as difficulty in self-disclosure due to dementia and inadequate rapport, and challenges on the care worker side, such as heavy workloads and variability in communication skills among care workers.Our goal is to collect and structure narrative fragments from care recipients, organize their life background, values, and characteristics related to their thinking and behavior, and then develop tools to effectively utilize this information in caregiving settings. This paper proposes a narrative utilization ecosystem to enhance the quality of nursing care services by implementing and disseminating these tools to care workers. By incorporating narratives into care services, we aim to improve the rapport between care workers and care recipients, encourage further self-disclosure from care recipients, and facilitate the collection of additional narratives. This approach is expected to create a virtuous cycle within the ecosystem. In this paper, we will describe the components of this ecosystem, including the aspects where care workers can leverage their interpersonal skills and the areas where technologies such as AI and robots can enhance efficiency in the future.In this study, to collect narrative fragments, we conducted an experiment in which a person with dementia walked and talked with a care worker in familiar areas where he had lived or visited in the past. During the experiment, we gethered narrative fragments by asking him to recount past episodes based on the scenery he saw while walking and the questions posed by the care worker. In this case study, we, along with the care workers, analyzed narrative fragments from the conversations during the experiment, generated interpretive stories, and attempted to understand his past episodes. Through this analysis, we uncovered his memories of his father, who was a train driver, from the narrative fragments shared at the site of the railroad tracks. Additionally, from the narrative fragments shared while looking at the river scenery, we understood his memories of playing in the river and his recollections of his mother, who was a good swimmer. In this paper, we also analyze the reasons why narratives are not effectively utilized in nursing care settings and discuss the requirements for providing better care services as a team by sharing narratives among care workers.Kitwood, T., Bredin, K. (1992). Towards a theory of dementia care: Personhood and well-being, Ageing and Society, 12(3), 269-287.Guendouzi, J., Davis, B., Maclagan, M. (2015). Expanding Expectations for Narrative Styles in the Context of Dementia. Topics in Language Disorders. 35. 237-257. 10.1097/TLD.0000000000000061.

Keywords: Narrative, person-centered care, ecosystem

DOI: 10.54941/ahfe1005834

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