How clinical stories survive or disappear: a narrative life-course study of multidisciplinary critical care

Abstract Objectives This study examines how clinical stories emerge, circulate, and ultimately gain or lose influence within a pediatric intensive care unit (PICU). While narrative medicine has focused on attention, representation, and affiliation within dyadic encounters, less is known about how these narrative processes operate within multidisciplinary teams (MDTs). This article conceptualizes the life course of clinical stories and identifies the institutional, temporal, and epistemic forces that shape their trajectories. Methods A narrative-oriented ethnography was conducted in the PICU of a major children’s hospital in China. The second author entered the setting as a temporary medical social worker, enabling embedded observation while remaining outside the formal medical hierarchy. Fieldwork over three months included observations of rounds, handovers, bedside interactions, and informal team exchanges, supplemented by 13 semi-structured interviews with physicians, nurses, and medical social workers (MSWs). Data were analyzed inductively, tracing how stories surfaced, were reframed, or disappeared in everyday clinical practice. Results Stories followed a four-stage life course. Emergence depended on physical proximity and brief cross-professional alignments that allowed narrative cues to be noticed. Translation involved epistemic filtering and documentation norms that compressed contextual knowledge into biomedical fragments. Affiliation relied on informal alliances, particularly between nurses and medical social workers, to sustain relational narratives across clinical transitions. Collapse arose when spatial marginality, time constraints, or credibility deficits limited MSWs’ ability to carry stories into team decision-making, leading to strategic withdrawal.