Drew University Library : University Archives : Theses and Dissertations
    
author Suzanne J Milkiewicz-Bryjak
title Breath One, Breath Two, Breath Three: Utilizing Narrative Consultation for Healthcare Culture Transformation
abstract The intensity of the interactions in Neonatal Intensive Care Unit (NICU) take an emotional toll on the staff, and stress scales of NICU staff rank consistently high in the profession. Due to the nature of this highly specialized form of nursing, NICU nurses experience high levels of psychological and physical stress. Compassion fatigue, the precursor to burnout, is defined as emotional distress leading to apathy brought on by the trauma of constant care for others and will be experienced by almost all healthcare workers at some point in their profession. Current literature in a meta-narrative review of 90 studies in nursing and other healthcare professionals calls for a new discourse that looks at the distinguishing characteristics, motivators, and outcome responses of occupational stress and burnout of healthcare providers. Recommendations include encouraging new models that honor the healthcare providers' lived clinical experiences. In the current healthcare climate, caring for the healthcare providers who dedicate their lives to caring for the public is no longer optional. It is essential. Narrative Consultation is a reflective support construct designed to meet this need and to be utilized with frontline clinicians. Narrative Consultation's theoretical underpinning is based on the intersecting fields of Infant Mental Health, Medical Humanities and Holistic Practice. The practice affirms the voices and lived experiences of our healthcare staff and utilizes their combined expertise as evidence which manifests as the centralized mechanism for co-constructed learning in order to better serve the public and each other as providers.

The results of a mixed methodology study at The Valley Hospital in Ridgewood New Jersey report on NICU staff (N=49) exposed to Narrative Consultation. Outcomes of statistical significance included decreased emotional exhaustion and increased teamwork on the Masloch Burnout Inventory and Team Development Scale respectively. Qualitative data, including ethnographic field notes and videos, as well as semi-structured interviews and observation over a period of 27 months, present a descriptive analysis of the mechanisms of change, revealing a healthcare staff who embraced vulnerability and honored differing perspectives in order to embed needed change and improve the way they provided healthcare. NICU staff co-created a space of shared values surrounding their work and professional identities that resulted in the recognition of the intersection of self and others within the environment. These coregulating and reciprocal relationships with patient, family and team resulted in better clinical outcomes and improved staff health and satisfaction outcomes. Narrative Consultation gives participants a platform to be heard and examine their own belief systems in order to develop trusting relationships and embrace systems change necessary to improve quality of care.

school The Caspersen School of Graduate Studies, Drew University
degree D.M.H. (2021)
advisor Merel Visse
committee Liana Piehler
full textSJMilkiewicz-Bryjak.pdf