The ethical work of expressive research : Revealing the remoralising power of pathic action

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The ethical work of expressive research
Revealing the re-moralising power of pathic action

• Peter Willis, University of South Australia
• Sally Borbasi, Griffith University

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SECTION ONE

• PART A. PATHIC ACTION AND REMORALIZATION IN
  HUMAN SERVICE
• PART B. EXPRESSIVE NARRATIVE RESEARCH

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The gnostic and pathic hand

• The touch of the gnostic hand palpates and
  explores the body looking to discover signs of
  pathology and of healing it seeks knowledge
  linked to diagnosis, attempting to explain the
  symptoms in terms of an illness consistent with
  them.
• But (outside of the highly technologized
  intensive care, the nurses hand is a pathic
  hand the patient still expects that primarily
  this is a healing hand, a caring hand which does
  not only touch the physical body, it also touches
  the self, the whole embodied person.. Van Manen
  (1999p.28)

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DEMORALIZATION AND REMORALIZATION

• Arthur Frank spoke of demoralization which means
  the tendency of patients (or human service
  clients more generally) to be reduced to an
  object, a part in the hospitals story of
  scientific diagnosis and healing.
• Remoralization means a dialogic process by which
  people regain their humanity and occupy their own
  story.

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PART B. EXPRESSIVE NARRATIVE RESEARCH

• Second part of the first section looks at the
  nature of expressive narrative research in
  contrast to explanatory paradigmatic research.
• It draws on work of, Jerome Bruner, Peter Reason,
  Max van Manen and later work by Elliot Eisner and
  Tom Barone

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Explanatory and narrative inquiry

• Scientific (or paradigmatic) research tends to be
  concerned with generating explanatory statements
  about human activities and events such as what
  kind of a thing is it and what caused it?
• Narrative research seeks to explore the storied
  nature of human experiences. It questions human
  activites and events in search of the meanings it
  has for the person experiencing it What
  happened? What was it like? What did you make of
  that? What did it mean?
• It uses different textual forms for reporting and
  portraying

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Report and expressive textual forms of
narrative research

• Report form (accounting for meanings)
• Attempt to provide an ordered account of the
  meanings of some event or phenomenon.
• Expressive form (portraying an experience)
• Expressive narrative research seeks to present a
  vivid portrayal of what such events were actually
  like.

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THE EXPRESSIVE FORM

• An expressive portrayal needs to hold the
  attention of the listener on the experience
  itself, rather than the meanings given it by the
  person experiencing it. It uses aesthetic
  strategies like metaphor and dramatic
  representation.
• It has to get it right and walks the knife edge
  that routinely surrounds and threatens aesthetic
  projects.
• It draws on a phenomenological foundation

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Expressive research criteria

• Verite Does it ring true?
• Integrity Is the expressive piece well
  structured?
• Verisimilitude Is it lifelike?
• Aesthetic capacity Does it capture the
  imagination and move the heart?

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THE REVELATORY POWER OF EXPRESSIVE RESEARCH

• Expressive narrative research of this kind can
  have a strong ethical and prophetic function in
  its capacity to reveal the valuable remoralising
  effects of pathic action and the deleterious
  effects of its absence.

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SECTION TWO

• PORTRAYING PATHIC ACTION

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II. PORTRAYING PATHIC ACTION

• The prelude Cue-ing the audience
• The dramatic performance the film clip
• Constructing the expressive text
• Depicting N re-tells Hanas story
• Distilling N Reports on the phenomenon
• Drafting The researchers craft the text
• Nursing in action poetic prose
• Display Producing the final texts
• Nursing in action poetic verse

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Constructing the expressive text

• Two researchers now take the role of Hana (N)and
  an interviewer (I).
• They seek to construct a multi layered reading
  and re-reading of the lived experience of the
  pathic action of the nurse presented in the film
  clip from depicting to distilling to drafting and
  display

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Depicting Hanas story

• I Hi Hana. What happened in there?
• N That badly burnt patient, I had been nursing
  in the ambulance truck was brought in by
  orderlies and placed on a bed in one of the less
  damaged rooms. They were as careful as they could
  be but I could see he was nearly out of it with
  the pain and the jolting on the truck.
• After they left, I set out to make the place
  livable and to get myself as clean and trouble
  free as possible.
• Later on I brought him some plums I had found in
  the garden. Because he had trouble chewing, I bit
  off a piece and removed the skin and placed a
  small piece into his mouth. To my delight, he
  tasted and chewed almost in wonderment and then
  said that it was very plummy plum.
• I returned to attend to the patient who was lying
  on the bed with the sheets and supplies beside
  him. I brought pillows I had found from other
  rooms in the house and lifted his head gently to
  place them under him.
• I managed to get the undersheet onto the mattress
  with him lying on it by rolling him to one side
  and then the other while I spread the sheet out
  on the side he wasnt on. Then I tucked the ends
  in under the mattress. All this time the patient
  was silent and stiff and seemed inattentive to
  what was happening to him. At one point when I am
  getting him to roll back, he said to me in a kind
  of wonder with his cultivated English voice "Why
  are you so determined to keep me alive?" I
  answer while I was leaning over him, holding him
  on his side so I could complete the arrangements
  of the bed, "Because Im a nurse." He didnt ask
  anymore.

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Distilling the experience

• I What was that nursing moment like?
• N It was about getting it right an embrace as
  if my music had found a resonating instrument It
  was like being let into a special sunlit space in
  winter.
• I Can you think back to what it appeared to you
  as a bodily experience
• N It was the converting body, intimate
  experience. My nursing body holds him against me
  while I unroll the sheet. My nursing body
  experience is mobile going to immobile, warm to
  cold, accepting the beginning of softening, trust
  generating holding going to painful immobilised
  and in pain. It is busy and intimate loving and
  distant. The plum goes from my mouth to his
  almost like a holy communion
• I What was it like as a spatial experience?
• N This nursing experience was centred on the
  patient lying in the bare room. As a spatial
  experience, nursing is coming in going behind,
  moving under and lifting, covering and
  uncovering. It is like coming to him from many
  angles and focusing on him in all places in the
  room.
• I What was it like as an experience in time?
• N Nursing was like a powerful now that held my
  attention on him and his precarious condition. He
  could die any minute nursing in this time was
  like each moment was the first and last.
• I What was it like as a social relations
  experience?
• N Nursing was like being more mother than
  sister intensely intimate but initiative taking
  waiting for response body openness and no false
  modesty. Nursing was being openly non-intrusively
  intimate.
• I How did you feel?

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Drafting Nursing in action

• At the villa, nursing appears to Hana as coming
  in close to her patient for comfort and healing
  It is like being hit by small joys, cheerful
  making and amplifying small happinesses. In the
  intimacies of her practiced and skillful nursing
  it comes to her as feeling her touch getting
  through.
• This is the quintessential pathic hand. For her
  the nursing experience is like makeshift
  materials becoming perfect like colluding in
  aliveness and cheerful courtesy. There are also
  those times when the nursing experience lifts for
  her so that it is like dancing beautifully with
  her partner under the music of her own orchestra
  like defenses crumbling into peace. The communion
  of the plum is one such moment.

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Display The poetic verse

• Nursing
• My arms know what to do,
• Hold you up as you turn in pain
• on the clean, rough sheet
• Im spreading out for you.
• I watch as you let go,
• Feel my work take hold
• As you surrender, yield back
• on the pillows I found for you.
• I bite a piece from a plum,
• Separate skin from pulp

• in my mouth, then take
• and place a piece
• between your wounded lips.
• You chew and taste,
• commend the plums plumminess
• I watch you, as we eat together.
• Out of your sight,
• I weep my own pain
• And then I hear you moving,
• lift my head, move lightly,
• attentive to your need.

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PROFESSIONAL AND ETHICAL IMPLICATIONS

• If the pathic is really an integral part of
  remoralizing human services then in what ways is
  this encouraged in training and provided for in
  time allocation?