Understanding the 4th Person Point of View: Definition and Examples of fourth person point of view (POV) for Nurses

Nursing narratives are fundamental to effective clinical communication and the accurate documentation of patient care. The choice of narrative points of view shapes how experiences, observations, and decisions are conveyed, influencing both understanding and collaboration among healthcare professionals. The 4th Person Point of View presents a distinctive approach to narration, emphasizing a collective perspective rather than focusing on a single individual’s thoughts or actions. Unlike first-person or third-person perspectives, which center on a single character or individual viewpoint, the fourth-person point of view allows a narrator to capture the experiences, perceptions, and actions of multiple people simultaneously, creating a collective voice that reflects shared experiences and group dynamics.

The concept of the 4th Person Point of View is particularly relevant in nursing, where patient care often involves teams, multidisciplinary collaboration, and shared responsibility. By employing this perspective, narratives can highlight the collective experience of a group, illustrate coordinated care processes, and demonstrate how decisions are made collectively. The use of plural pronouns such as “we” and “us” contributes to a unison narrative voice, enabling the narration to communicate both the thoughts and feelings of multiple individuals while maintaining clarity and cohesion. This approach also allows for a degree of immersive storytelling, where the narrative voice conveys a sense of shared responsibility and collective perception without privileging a single participant’s perspective.

Beyond grammatical structure, the fourth-person perspective functions as a tool for portraying systems-level interactions and team-based dynamics. It provides a framework for writing in fourth person that balances individual patient details with the broader context of collaborative care. Through careful use of plural pronouns, person POV, and collective consciousness, narratives can illustrate how multiple healthcare professionals contribute to patient outcomes, highlight patterns of care, and convey the experience of multiple viewpoints in a single, coherent story.

This discussion explores the 4th Person Point of View, offering definition and examples, an examination of narrative mechanics, and guidance on how this perspective can be applied in nursing narratives. Understanding and applying the fourth-person point of view enhances documentation, promotes clarity in team communication, and captures the complexities of modern healthcare delivery through a perspective that values collective observation and shared experience.

Introduction to Fourth-Person Point of View in Nursing Narratives

What Is the Fourth Person Point of View?

The 4th Person Point of View represents a narrative perspective that emphasizes the collective experience of multiple individuals, rather than focusing on a single character or an external observer. In nursing narratives, this perspective is particularly useful because healthcare delivery is inherently collaborative, involving teams, patients, and support staff, each contributing to care outcomes. Unlike the first-person perspective, which is limited to a single character’s thoughts and feelings, or the third-person perspective, which observes from an external or omniscient viewpoint, the fourth-person POV allows a unified narrator to reflect multiple perspectives simultaneously. It also differs from second-person POV, which addresses the reader directly as “you,” because fourth-person narration conveys shared experience within the story itself rather than instructing or involving the reader directly.

Key features of the fourth-person point of view include:

1. Plural Pronouns: The narration often uses pronouns like “we” and “us,” signaling a collective voice rather than focusing on an individual.
   • Example: “We assess the patient’s vitals, review the care plan, and communicate with the family,” emphasizes team-based observations rather than one nurse’s actions.
2. Collective Perspective: The narrator captures the thoughts, actions, and feelings of multiple people, creating a shared narrative consciousness.
   • This is particularly effective in documenting ward rounds, multidisciplinary team meetings, or coordinated interventions, where the outcome depends on multiple actors.
3. Unison Narrative Voice: By using the fourth-person perspective, the narrator conveys group-level experiences while maintaining clarity and cohesion.
   • Example: A surgical handover can be written as: “We summarize each patient’s status, update the documentation, and ensure continuity across shifts,” reflecting a team-wide responsibility.
4. Immersive Storytelling: The perspective allows readers to experience the interconnectedness of clinical actions, enhancing understanding of collaborative care.

The role of the narrator in fourth-person narration is critical because it functions as both observer and synthesizer. The narrator must integrate multiple perspectives without privileging any single individual, ensuring that shared responsibilities, interactions, and observations are conveyed in a coherent narrative. In nursing documentation, this allows for accurate reflection of team-based actions while maintaining a professional and structured narrative style.

Importance of Points of View in Clinical Storytelling

Understanding points of view in nursing narratives is essential because the perspective chosen dictates how information is interpreted, communicated, and applied. The fourth-person POV plays a significant role in supporting team cohesion, patient safety, and accurate documentation.

1. Supports Shared Responsibility:
   • Fourth-person narration emphasizes collective actions, showing how multiple team members contribute to patient care.
   • Example: In a scenario where multiple nurses monitor a patient post-operatively, a fourth-person narrative can integrate everyone’s tasks: “We monitor vitals, administer medications, and coordinate with the physiotherapy team.” This approach reflects shared accountability.
2. Enhances Immersive Narration:
   • By capturing multiple perspectives, the fourth-person POV allows readers to experience complex clinical interactions in a holistic manner.
   • It fosters empathy and understanding of team dynamics, rather than focusing solely on a single practitioner or patient.
3. Facilitates Coordinated Care Representation:
   • Using plural pronouns and a collective voice, the narrative can show how interventions are planned and executed collaboratively.
   • Example: During a community health outreach, “We review patient histories, distribute medications, and provide education,” reflects a systematic and coordinated approach.
4. Creates Clarity and Cohesion in Documentation:
   • Fourth-person narration ensures that the story of care is presented in a structured and professional manner, reducing ambiguity in multi-stakeholder scenarios.
   • It allows the narrator to integrate multiple observations, reducing gaps in communication across shifts or departments.
5. Reinforces Professional Storytelling:
   • Beyond documentation, the fourth-person POV enables nurses to tell a story that captures the interconnected roles in healthcare delivery.
   • It balances individual contributions with the collective experience of the group, making narratives suitable for reflective practice, case studies, or teaching scenarios.

By adopting the fourth-person perspective, narratives in nursing achieve a high level of professionalism, demonstrating both accuracy and inclusivity. This perspective not only records what is done but also how it is coordinated, reflecting the shared experiences, responsibilities, and decision-making processes essential to modern clinical practice.

Use Fourth Person POV Explained: Mechanics and Narrative Style

Using Pronouns and Plural Forms in Fourth Person

The 4th Person Point of View is defined largely by its use of plural pronouns such as “we” and “us,” which are central to establishing a unison narrative voice. In nursing narratives, these plural pronouns allow the narrator to reflect the actions, thoughts, and observations of multiple people simultaneously, creating a collective experience rather than focusing on a single character. This use of first-person plural pronouns distinguishes the fourth-person POV from other points of view:

1. First-Person vs Fourth Person:
   • A first-person narrator uses singular pronouns like “I” or “me” to convey personal experiences.
   • Example: “I checked the patient’s vital signs and administered medication.”
   • In contrast, the fourth-person perspective uses plural pronouns to reflect group involvement: “We check the patient’s vital signs, administer medications, and coordinate care,” creating an immersive experience that emphasizes shared responsibility.
2. Third-Person vs Fourth Person:
   • Third-person POV may describe actions externally or use an omniscient point of view to relay the thoughts of multiple characters.
   • Example: “The nurses checked the patient’s vitals while the physician updated the care plan.”
   • Fourth-person POV integrates these observations into a collective voice: “We check the patient’s vitals and review the care plan together,” allowing readers to experience the team’s shared perspective as a unified narrator.
3. Second-Person vs Fourth Person:
   • Second-person POV addresses the reader directly (“you”) and does not convey collective experiences.
   • Fourth-person POV focuses on the shared experience of a group, maintaining person perspective without engaging the reader directly.

Using plural pronouns in writing in fourth person helps convey both individual contributions and the collective consciousness, allowing the narrator to maintain a consistent narrative voice that is both immersive and reflective of real-world nursing teamwork.

Creating a Collective or Unified Narrator Voice

The fourth-person perspective requires careful attention to narrative structure to maintain a cohesive and consistent voice. Unlike first-person narration, which presents only a single character’s viewpoint, or third-person POV, which may shift between multiple characters or rely on an omniscient perspective, the fourth-person POV integrates multiple person POVs into a single unison narrative.

Key techniques include:

1. Consistent Use of Plural Pronouns:
   • All sentences should employ “we,” “us,” or “our” when telling the story.
   • Switching between singular pronouns and plural forms disrupts the collective voice and reduces clarity.
2. Balancing Individual and Collective Observations:
   • Specific patient details can be included without compromising the shared perspective.
   • Example: “We administer the scheduled medications while noting the patient’s discomfort and discussing adjustments collectively.”
   • This reflects a shared experience while maintaining a clear narrative perspective.
3. Maintaining Immersive Narrative Flow:
   • Each action, observation, and reflection is presented as part of the collective consciousness.
   • Example: “We review each chart, discuss lab results, and coordinate care across departments,” demonstrating collaborative nursing care in a 4th person POV narrative.
4. Reflecting Team Dynamics:
   • The narrator in fourth-person narration captures multiple viewpoints while emphasizing unison and coordination, highlighting the shared responsibility in patient care.

Differentiating Fourth Person from Other Points of View

Understanding how fourth-person narration compares to other points of view is critical in nursing storytelling:

1. First-Person vs Fourth Person:
   • First-person POV: Singular perspective, e.g., “I performed the assessment.”
   • Fourth-person POV: Collective perspective, e.g., “We performed the assessment and discussed findings together.”
   • The fourth-person narrative allows a broader, team-based representation, enhancing immersive storytelling and shared accountability.
2. Third-Person vs Fourth Person:
   • Third-person POV: External observation, e.g., “The nurse assessed the patient.”
   • Fourth-person POV: Integrates multiple actions into a unified narrative voice, e.g., “We assess the patient, coordinate the plan, and communicate updates as a team,” creating collective consciousness and person and 4th person integration.
3. Omniscient POV vs Fourth Person:
   • An omniscient narrator knows all thoughts but remains detached.
   • Fourth-person POV uses plural pronouns and person perspective to convey the collective thoughts and actions of the team, maintaining immersive, shared storytelling.
4. Benefits of Fourth-Person POV in Nursing Narratives:
   • Highlights team-based interventions.
   • Enhances clarity, cohesion, and immersive understanding.
   • Reflects shared experience and collective voice in documentation and case storytelling.
   • Integrates multiple person POVs without privileging one individual, supporting professional narrative style.

By understanding these differences, nurses can effectively use fourth-person POV to tell a story that captures the interconnected actions, thoughts, and responsibilities of a care team, providing a more immersive and accurate representation of clinical practice.

Practical Applications of Fourth Person in Nursing Writing

When and Why to Use Fourth-Person Narrative

The fourth-person point of view is an emerging narrative style in nursing writing that emphasizes the collective experience of a group, highlighting the interconnected roles of multiple healthcare providers. This narrative perspective differs from first-person POV (focusing on one character), third-person POV (which can be omniscient or limited), and second-person POV (addressing the reader directly) because it emphasizes shared responsibility and unison action through plural pronouns like “we” and “us.”

Advantages of Fourth-Person POV in Clinical Narratives:

1. Represents Team-Based Care Effectively:
   • Nursing practice is inherently collaborative. Writing in fourth person allows the narrator to integrate actions, observations, and decisions of multiple people in a unified narrative voice.
   • Example: “We monitor patient vitals, administer medications, and coordinate with the physiotherapy team,” conveys a collective consciousness that reflects the shared experience of a care team.
2. Enhances Immersive Storytelling:
   • The fourth-person perspective allows readers to feel immersed in the real-life workflow of a clinical environment.
   • By using plural pronouns and a collective voice, the narrative communicates the interconnectedness of patient care, improving comprehension and empathy.
3. Supports Shared Accountability and Responsibility:
   • In clinical documentation and teaching narratives, fourth-person POV emphasizes unison action and joint decision-making, ensuring that the story reflects system-level coordination rather than only individual actions.
   • Example: “We observe the patient’s response to therapy, adjust interventions as necessary, and update the care plan collectively,” demonstrates how the team shares responsibility for outcomes.

Limitations and Risks:

• Loss of Individual Clarity: Excessive focus on the collective may obscure who is accountable for specific actions.
• Complexity in Documentation: Maintaining a consistent narrative perspective requires careful attention to plural pronouns and the unison narrative voice.
• Potential Ambiguity: If not written clearly, fourth-person narratives may confuse readers regarding individual contributions versus collective actions.

Despite these limitations, fourth-person POV is highly effective for educational, reflective, and system-level narratives where understanding the shared experience is crucial.

Techniques for Writing in Fourth Person POV

Effective writing in fourth person requires deliberate strategies to maintain clarity, consistency, and immersion. Techniques include:

1. Consistent Use of Plural Pronouns:
   • Use “we,” “us,” and “our” consistently to maintain the collective voice.
   • Avoid switching between singular and plural pronouns, which can confuse the reader and break the unison narrative flow.
2. Integrate Individual Observations into a Collective Narrative:
   • Include specific patient details or individual staff contributions without breaking the shared perspective.
   • Example: “We note the patient’s slight discomfort during physiotherapy and discuss adjustments together,” balances individual observation with collective responsibility.
3. Maintain a Cohesive Narrative Voice:
   • All actions and reflections must contribute to the team-based perspective, ensuring the narrator represents the shared experience of multiple people.
   • Avoid disjointed sentences or fragmented reporting that disrupts the immersive experience.
4. Exercises to Build Skill in Fourth-Person Narration:
   • Exercise 1: Rewrite a first-person clinical note in fourth-person POV, emphasizing plural pronouns and collective voice.
   • Exercise 2: During a simulated ward scenario, narrate all team actions using fourth-person pronouns, capturing shared decisions and observations.
   • Exercise 3: Compare narratives of the same scenario written in first-person, third-person, and fourth-person POV to understand how narrative perspective shapes reader immersion and comprehension.

These exercises reinforce mechanics, narrative perspective, and collective voice, enhancing the ability to tell a story from a fourth-person point of view while maintaining clarity, cohesion, and professional standards.

Examples of Fourth Person POV in Clinical Narratives

Practical examples illustrate how fourth-person POV operates in real-world nursing contexts:

Short Sample – Ward Shift:

• Fourth-Person POV: “We check each patient’s vital signs, administer medications according to protocol, and communicate changes during shift handover. We observe patient responses and discuss adjustments collectively.”
• First-Person POV: “I checked the patient’s vitals, gave medications, and informed the physician of any changes.”
• Third-Person POV: “The nurse checked the patient’s vital signs, administered medications, and reported changes to the physician.”

Observations:

• The fourth-person narrative emphasizes team coordination, shared responsibility, and immersive collective experience, unlike first-person, which is limited to one nurse’s perspective, or third-person, which is observational.

Real-World Examples:

• Published case studies often use fourth-person POV for multidisciplinary care documentation, describing interventions across teams.
• Example: In a published ICU narrative: “We implement infection control measures, monitor patient progress, and educate new staff members collectively,” highlighting team accountability, plural pronouns, and immersive narrative voice.

By using fourth-person POV, nurses can:

• Document system-level interventions effectively.
• Highlight collaborative care and team decision-making.
• Present shared patient experiences in a coherent, immersive, and professionally appropriate manner.

Impact of Fourth Person POV on Readers and Patient Care Understanding

Enhancing Empathy and Immersive Experience

The fourth-person point of view is uniquely positioned to foster empathy, engagement, and immersive understanding in readers by presenting narratives from a collective consciousness rather than a single character. Unlike first-person POV, which provides insight into one individual’s experience, or third-person POV, which may describe actions externally, the 4th person POV integrates multiple perspectives into a unified narrative voice, allowing readers to experience the shared experiences of a nursing team or group of patients.

Key ways fourth-person narration enhances empathy and immersion include:

1. Shared Experience of Multiple Characters:
   • Using plural pronouns like “we” and “us” enables readers to understand the thoughts and feelings of many people simultaneously.
   • Example: “We notice the patient’s discomfort during therapy, discuss potential interventions collectively, and adjust care plans as a team,” highlights the collective perspective and fosters empathy for both caregivers and patients.
2. Collective Voice and Narrative Perspective:
   • The narrator in fourth-person narration does not belong to a single character but represents a group or team, creating a narrative style that mirrors real-world collaboration.
   • This immersive viewpoint allows readers to experience both individual patient experiences and team-based responses, enhancing understanding of clinical dynamics.
3. Reducing Bias Through Multiple Perspectives:
   • By presenting events from a shared perspective, fourth-person POV minimizes the bias inherent in first-person narration and provides a more balanced view of patient care.
   • Example: During shift handover: “We observe each patient, assess their needs, and communicate our findings to the next shift,” communicates team-based vigilance and shared responsibility without overemphasizing any single perspective.

Narrating Systems-Level and Team-Based Events

The fourth-person point of view is especially effective in representing systems-level nursing interventions and team-based events, where actions are distributed across multiple caregivers.

Applications include:

1. Highlighting Multidisciplinary Collaboration:
   • In hospital settings, patient care involves nurses, physicians, therapists, and support staff. Writing in fourth-person POV allows the narrator to capture these interactions cohesively.
   • Example: “We coordinate patient transfers, update electronic health records, and communicate critical changes to the multidisciplinary team,” demonstrates shared responsibility, plural pronouns, and immersive collective narration.
2. Depicting Collective Decision-Making:
   • Fourth-person narratives emphasize joint decision-making, making it easier for readers to see how care outcomes result from team consensus rather than individual actions.
   • Example: During infection control rounds: “We discuss new protocols, monitor adherence, and educate staff collectively,” reflects systematic teamwork and collective experience.
3. Creating an Immersive Understanding of Clinical Workflows:
   • Using 4th person POV allows documentation and storytelling to reflect real-world complexity, such as overlapping shifts, shared responsibilities, and simultaneous interventions, which cannot be captured effectively with first-person or third-person POV.

By focusing on team and systems-level narration, fourth-person POV provides a more holistic understanding of patient care and emphasizes the importance of collective action in improving outcomes.

Measuring Reader Engagement and Perspective Awareness

Understanding the impact of fourth-person POV on readers—whether students, new nurses, or interdisciplinary teams—requires evaluation tools and strategies to assess comprehension, empathy, and perception of shared experiences.

Strategies for measuring engagement and awareness include:

1. Comparative Narrative Exercises:
   • Present the same clinical scenario in first-person, third-person, and fourth-person POV, then assess reader engagement and empathy through surveys or reflective discussions.
   • Example: Learners or readers rate which version provides the clearest understanding of team-based care, shared responsibility, and immersive experience.
2. Observation of Reflective Responses:
   • Use reflective journals or debrief sessions to analyze how readers perceive team dynamics and patient care in narratives written in fourth-person POV.
   • This provides insight into whether the collective voice effectively conveys shared experiences and person perspectives.
3. Use of Simulation Scenarios:
   • Integrate fourth-person narratives in simulated nursing exercises. Observe if participants adopt team-based thinking, collaborative planning, and awareness of multiple perspectives.
   • Example: After reading a fourth-person ward shift narrative, nurses report greater understanding of collective responsibilities, improved communication strategies, and enhanced empathy toward patients and colleagues.
4. Reader Comprehension Assessments:
   • Quizzes or case-study evaluations can measure whether the immersive collective perspective improves understanding of protocol adherence, collaborative interventions, and systems-level outcomes.

By employing these strategies, nursing educators and writers can quantify the benefits of fourth-person POV, demonstrating that it not only improves narrative engagement but also reinforces team-based thinking, shared accountability, and empathetic care.

Conclusion

The fourth-person point of view represents a unique and powerful narrative perspective in nursing writing, offering the ability to convey the collective experience of multiple caregivers and patients in a cohesive, immersive, and professional manner. By using plural pronouns such as “we” and “us,” the narrator establishes a unison narrative voice that reflects shared responsibility, coordinated decision-making, and team-based interventions, distinguishing the 4th person POV from first-person, third-person, and omniscient points of view.

Through writing in fourth person, nurses and clinical writers can document systems-level care, highlight collaborative practices, and foster empathy and perspective awareness among readers. The collective voice encourages engagement, allows readers to perceive the minds of many people simultaneously, and supports immersive understanding of both individual patient experiences and team dynamics.

While the fourth-person POV requires careful attention to plural pronouns, narrative perspective, and cohesive voice, its advantages in educational, clinical, and reflective storytelling are substantial. It enhances the clarity, cohesion, and professional quality of nursing narratives, offering a lens through which readers can grasp the interconnectedness of care delivery, shared experiences, and collective accountability.

In practice, using fourth-person POV allows writers to tell a story that represents not just one viewpoint, but a collective consciousness of care teams, making it an invaluable tool for clinical documentation, educational narratives, and professional reflective writing. By integrating plural pronouns, immersive storytelling, and a consistent narrative voice, the 4th person perspective transforms traditional documentation into engaging, instructive, and empathetic narratives that reflect the realities of modern nursing practice.

Ultimately, the fourth-person point of view is more than a stylistic choice—it is a method for communicating collaboration, shared responsibility, and collective insight, ensuring that narratives capture the full scope of patient care and professional teamwork. Its thoughtful application can elevate the standard of clinical writing, enhance learning, and foster deeper understanding of complex, multi-perspective healthcare experiences.

Frequently Asked Questions

What are the 4 phases of Peplau?

Peplau’s Interpersonal Relations Theory identifies four phases in the nurse-patient relationship:

1. Orientation Phase – Establishing rapport, identifying patient needs, and clarifying expectations.
2. Identification Phase – Patients begin to express feelings, recognize problems, and identify with the nurse’s guidance.
3. Exploitation Phase – Patients take full advantage of nursing services and resources to address health issues.
4. Resolution Phase – The patient’s needs have been met, and the therapeutic relationship ends as independence is achieved.

What is the 4th person point of view in writing?

The fourth-person point of view (4th person POV) is a narrative style that presents the collective perspective of a group or multiple characters rather than focusing on a single character. It uses plural pronouns like “we” and “us” to create a unison, immersive narrative voice that conveys shared experiences, collective responsibility, and multiple viewpoints simultaneously, often used in professional or collaborative contexts like nursing narratives.

What are the 4 main concepts of nursing?

The four central concepts of nursing are:

1. Person – The individual, family, or community receiving care.
2. Health – The patient’s overall physical, mental, and social well-being.
3. Environment – The internal and external factors that affect health and care.
4. Nursing – The actions, interventions, and professional practice aimed at promoting, maintaining, or restoring health.

What is the fourth phase of the nursing process?

The fourth phase of the nursing process is Implementation. This phase involves carrying out planned interventions, providing direct patient care, educating patients or families, and coordinating with the healthcare team to achieve desired outcomes identified in the planning phase.