Clinical Recognition: Describing Practice Through Clinical Narratives

Institute for Patient Care Clinical Affilations Program

What is a clinical narrative?

A clinical narrative is a first person "story" written by a clinician that describes a specific clinical event or situation. Writing the narrative allows a clinician to describe and illustrate her/his current clinical practice in a way that can be easily shared and discussed with professional colleagues. In addition, the narrative can help clinicians examine and reflect on their clinical practice or analyze a particular clinical situation.

This document describes the essential components of a clinical narrative. It also offers suggestions on how to write a narrative that will effectively illustrate your current level of practice. Narratives written by clinicians from a range of disciplines are included as examples. If after reading this guide you would like more help in writing a narrative, speak to the clinical leaders in your area. They can share their own expertise and can identify other MGH clinicians who are experienced in writing narratives and who are available to coach others.

What should the narrative be about?

Narratives written as part of a clinicians portfolio for Clinical Recognition, must describe a clinical situation occurring in the six months prior to submission where they were the accountable clinician caring for the patient.

Some examples include:

A clinical experience with a patient or family that illustrates how your intervention made a difference in patient outcomes
A clinical experience that was particularly demanding
A clinical event or situation that you think captures the essence of your discipline
A clinical situation that you commonly confront in your practice and that gave you new insight into your role as a professional clinician

Often, a single event shares several of these characteristics and can serve to illustrate multiple aspects of your practice.

What information should a clinical narrative include?

When writing a narrative, be sure to include details and information that help the reader visualize the situation and understand its context. Remember that the reader may be unfamiliar with your clinical role and overall approach to patient care. Use the narrative to describe you and your role and to illustrate how you approached a challenging patient care situation.
Some elements to include in your narrative:

Information about yourself including your name, title, unit, and length of time in practice
Information that allows the reader to put the situation in context such as a description of where the event took place, the time of day and shift on which it occurred, a description of special conditions on the unit, and details about the patient’s background
A detailed description about what happened
Statements about what concerned you at the time
Descriptions of your thoughts and feelings during and after the situation
Discussion about what, if anything, you found most demanding
Important conversations you had with the patient, family, members of the health care team, or other relevant parties
Reflections on why this clinical situation is important to you

Writing the narrative

The following "tips" will help you write your narrative:

Present your story as a first person account. Change the patient’s name and any other identifying information in order to protect confidentiality.
"Tell" your whole story into a tape recorder. Then, transcribe the tape and edit it, removing unnecessary detail and adding any missing elements. Your story should be 1 – 3 pages in length.
Review your story with a colleague who also cared for the patient. This may help you identify additional details and information that should be included.
Have someone who doesn’t know the patient read your narrative to see if you missed information or left questions unanswered. An outside reader can often help you identify details that you took for granted and inadvertently omitted.
Avoid vague summary statements or general phrases that do not communicate what actually occurred. Instead, state what happened in specific terms. This will help the reader better understand the situation and appreciate your actions. For example:

Don’t say: "I analyzed the possible dangers to the patient and took action."

Instead, say: "The blood pressure was dropping and the pulse rate was rising. I sensed the patient was going into shock. I immediately called the intern."

Don’t say: "I gave emotional support."

Instead, say: "I sat and talked with the patient about how to tell his family about the diagnosis."

Don’t say: "The patient is improving."

Instead, say: “The patient is able to sit independently, transfer out of bed with assistance, and is progressing with gait activities on the parallel bars and with a walker."

Be sure to include descriptions about what concerned you and what prompted you to take a particular action. This type of information gives readers a window on your thought process and the way in which you make clinical judgments. For example, "I thought the patient would be resistant, so I decided to…."

How is the narrative used in the Clinical Recognition Program?

Because it provides insight into an individual’s current clinical practice, the clinical narrative is an important component of the recognition process. Clinicians seeking recognition at the Clinician level are asked to write a narrative that they review and discuss with their director. Those seeking recognition at the Advanced Clinician and Clinical Scholar levels must include a narrative in the portfolio they submit to the Clinical Recognition Program Review Board.

Sample Narratives

Nursing
Occupational Therapy
Physical Therapy
Respiratory Therapy
Social Work
Speech, Language and Swallowing Disorders & Reading Disabilities