The nurse who uses storytelling to connect with patients
Clinical nurse specialist Jess Wilson says oral storytelling can help to develop a therapeutic relationship in mental health settings. She trains other staff in how to use storytelling to ease patients’ stress, reduce anxiety and calm volatile situations
Jess Wilson is a clinical nurse specialist in storytelling, perhaps the first nurse ever to hold such a title.
Mental health nurse Ms Wilson has landed the position as part of a unique secondment to mental health services in Abertawe Bro Morgannwg University Health Board in Swansea.
She has trained nurses and support workers at forensic psychiatric units in England and Wales in oral storytelling as it helps distract patients from stressful situations, reducing anxiety. It is also used to de-escalate volatile situations.
‘Traditional oral storytelling provides a tool that meets patients wherever they are on their journey to recovery’
Ms Wilson says: ‘Violent and aggressive behaviour can have an impact on the nurse-patient relationship, yet that therapeutic relationship is the cornerstone of care delivery. Nurses have found that traditional oral storytelling provides a tool that meets patients wherever they are on their journey to recovery.’
Watch: Mental Health Award finalist Jess Wilson describes her highly commended project
Nurses and support workers say that simply by telling a story they can create a positive atmosphere and significantly improve their relationships with patients.
The technique can be used in pre-planned groups or spontaneously with an individual needing one-on-one support.
It is used to engage patients being cared for in isolation, and nurses say it can de-escalate volatile situations, avoiding extra medication or the use of physical interventions, and also improve nurses’ confidence and self-awareness.
Being creative in nursing
Ms Wilson, who works for Elysium Healthcare, a private provider of mental health services, was highly commended in the mental health category of the RCNi Nurse Awards 2017 for her work.
After the awards, she was asked if she was interested in a hospital director post.
‘It was not in my trajectory,’ she says. ‘I was interested in storytelling and being more creative in my nursing. But a couple of months later the regional director asked again, saying to induce me they would let me give one day a week to the health board in Swansea, where I had done a secondment. There my new title is clinical nurse specialist for storytelling.’
Elysium Healthcare chief nurse Keith Barry says: ‘We are very proud of Jess and her storytelling. She is a truly compassionate, motivated and dedicated nurse.
‘As chief nurse I have watched Jess develop storytelling over the years and seen its success. Patients find it non-threatening and even patients who are the most difficult to engage have participated, which can then open doors to other interventions.’
‘The secondment role was created especially for Jess so that we could retain and support her. It was recognised that storytelling was something Jess wanted to commit to, so we were keen to enable her to combine her hospital director role with her storytelling specialty.
‘Her work provides an exciting and innovative way of connecting with and supporting people’
‘Jess’s practice benefits in that a passionate and capable nurse is able to develop in the way she wants. By allowing her the flexibility to keep her interest in storytelling going alongside her hospital director role, we retain a highly recognised staff member. We also benefit from the recognition her work achieves and through networks she makes.’
Ms Wilson will be working across all the board’s mental health services, in the community and with older adults as well as forensic units.
Nurse director of the board’s mental health and learning disability delivery unit Hazel Powell says Ms Wilson's work provides an ‘exciting and innovative way of connecting with and supporting people’.
‘We are very lucky to be able to make use of Jess’s skills and expertise to make a positive difference for people. I am looking forward to seeing how this work develops and have no doubt that she will be an incredibly valued member of the team.
For Ms Wilson it makes perfect sense. ‘Elysium wanted to work more collaboratively with the NHS,’ she says. ‘I will learn things that I can take back to Elysium Healthcare.
‘Why can’t we share best practice? They are the same patients. Innovation is happening all over the place. We should not stay in our health silos.’
From destructive to spellbound
Jess Wilson first realised what oral storytelling could bring to the therapeutic relationship while working as a staff nurse on special observations with a patient in a forensic hospital.
‘No one seemed able to develop a therapeutic relationship with her,’ says Ms Wilson (pictured). ‘All she wanted to do was destroy everything – herself by self-harm, others by assault, the environment by smashing it up, and any meaningful relationships by being hostile and confrontational.’
She sat on the floor and said to her nurse: ‘I’m bored. What are you going to do about it?’ On impulse, Ms Wilson said: ‘I could tell you a story.’
‘As soon as the words came out of my mouth I regretted them, thinking she would feel patronised, causing an escalation in aggression and hostility,’ says Ms Wilson. ‘But I was wrong – she stayed cross-legged on the floor and said, “go on then”.’
Put on the spot, Ms Wilson frantically searched her brain. ‘I started with the way that I know stories start – “Once upon a time” – and told her a fairy story I vaguely remembered from my childhood. And I told it more like a list of events, but when I finished with “happily ever after” she asked me to tell her again.’
Ms Wilson’s second attempt was more confident and she found she enjoyed it. Afterwards, the patient was relaxed and engaged in conversation with the nurses in a way she had not previously.
That evening Ms Wilson researched mental health nursing and storytelling but could find no evidence to work from. But she discovered that she could learn how to tell stories, and undertook a weekend course.
On her return to work she started to tell stories as part of group sessions. Then, in response to patient requests, she set up a storytelling club on weekends and evenings.
When nurses on other wards became interested, she trained 36 nurses and other members of the multidisciplinary team in how to use storytelling in their practice.
Ms Wilson decided to start building the evidence base and Elysium funded her master’s degree in professional practice research.
The study indicated that storytelling helped the development of a positive therapeutic relationship, which became more open and collaborative. It also showed that learning storytelling as a skill improved nurses’ practice, says Ms Wilson.
Balm for racing thoughts
But it is the difference that storytelling makes to patients that is most important to her. Asked what she is most proud of, Ms Wilson recalls doing a night shift, following the usual routine – handover, allocation of tasks and then starting the 10pm administration of medication.
‘A patient came to the clinic where I was doing the medication. It was usual for her to ask for some medication to help settle her racing thoughts before bed. On this occasion, however, instead of asking for the usual “PRN lorazepam” she asked for “PRN story”. Once all my tasks had been completed and I found a bit of time I told her a story. She slept that night without extra medication.’
Embedded video of Jess talking about her project at the award
Flight of the imagination impressed award judges
Jess Wilson was highly commended at the RCNi Nurse Awards 2017 for her work using oral storytelling to build therapeutic relationships in an Elysium Healthcare forensic unit.
She says the award in the mental health category ‘added credibility and gravitas’ to her work. Storytelling might seem a bit woolly to people but being recognised at the awards showed that it is something that makes sense to a lot of people and leading nurses.
‘The chief executive could see that this was being taken seriously by the profession and when I got back to work people were really impressed. I had colleagues asking me to explain storytelling – it really piqued people’s interest.’
Momentum and courage
‘I absolutely recommend entering the nurse awards, even if you think your project is quite unusual, like mine,’ she adds. ‘It is really worthwhile. It has given my work momentum – and me the courage – to carry on and develop it.’
Elysium Healthcare chief nurse Keith Barry says Ms Wilson’s awards success highlighted her work and raised her profile to managers.
He says: ‘Jess is very passionate about her storytelling work and it was great to see her get recognised nationally.’
Find out more
There are 14 categories in the RCNi Nurse Awards 2018. To enter the awards click here