How to write your clinical narrative

Don't underestimate the power of this document

Patricia Benner, PhD, RN, believes that evaluation of practice is best done through narratives because they describe the practice within a context. The quality of care delivered is best judged with knowledge of the circumstances surrounding that care. The goal of a narrative is to visualize nursing practice.

With that in mind, the following dialogue was developed to assist you in writing your own narrative.

What is a clinical narrative?
A clinical narrative is a written statement of actual nursing practice. It is a story of how you provided care for a patient and family. This could be how you prepared a patient and/or family for something that changed their lifestyle when they return home, such as an amputation. Or it could be how you helped a young couple prepare for the eventual death of their two-year-old with leukemia.

Your narrative is the story of a patient care situation that is meaningful to you. It is one that caused you to reflect on your practice, and may continue to influence your practice as you confront similar situations. It is a good example of how your care made a difference in the outcome of a particular patient/family. You might say that you have grown in your professional practice as a result of this experience, that the relationship and interventions you shared reinforced what you already believed.

What is the purpose of a clinical narrative?
Simply stated, the purpose of a clinical narrative is to articulate nursing and to make your practice visible. The purpose is also to see the growth and development you have made over time. This narrative assists you in reflecting on your practice.

What should I write about my practice?
Often nurses are not aware of their contributions to the care of the patient and family. They may not see missed opportunities or ways a situation could have been handled differently.

By writing about an experience and sharing it with your peers, you can see your own growth as a professional. You also receive direction for broadening your clinical practice. Writing about your clinical practice helps you reflect on that practice and relate experience to patient care situations in the future. It also brings to light the skills you currently possess.

How do I begin to write this clinical narrative?
Think of your most recent group of patients (maybe a primary patient). What did you do that you remember? This can be a patient that you cared for yesterday, last week or within the past year. How did you interact with that patient? Your narrative does not have to be one that involved a life-threatening situation. Choose one that involves your relationship with a patient and family. What did you and the patient plan for his or her care? Why did you make the choices you did? Write as though you are trying to have someone understand your practice.

Should I write my narrative using the word “I”?
Yes. This must be a first person narrative. It is always difficult to write about ourselves, but to describe your practice you have to think in terms of yourself. You are the one who made the difference, so talk about it and use the word "I."

What should I do after I select a patient to write about?
Sit down in a quiet place and write your story:

  1. Set the scene – let the reader visualize your patient and the situation. Write one or two opening paragraphs.
  2. Involve yourself early on in this scene.
  3. Tell what you did, what you thought about and why you made the choices you did. Write two or three sentences. The assessment should be ongoing, based on feedback during the intervention with the patient and family.
  4.  As with any story, there is a beginning and an end. The reader should know what happened as a result of your intervention, and what this whole experience means to your practice or says to you about your practice.

As you proceed with the story, talk about your role with this patient, your assessment of the care that was needed, the care you gave (your intervention), how you involved the patient and family and the advocacy role you played with the patient. Include the reason(s) why you made the choices you did. What was your thought process? Talk about how you mobilized your resources or extended your intervention outside the hospital. As you write the narrative, you will realize how your care influenced the patient's outcome.