Effectiveness of Narrative Nursing Education on Humanistic Care Quality of Nursing Interns ()
1. Introduction
Narrative nursing was proposed and entered the nursing field from the development of narrative medicine (Charon, 2001). Narrative nursing refers to a nursing practice in which nurses deconstruct problems in patients’ stories and reconstruct the meaning of stories by listening to and responding to patients’ stories and using narrative nursing abilities such as empathy and reflection to implement targeted nursing interventions for patients (Huang & Liu, 2016). At present, narrative nursing is regarded as an effective method to enter into patient experience and has a recognized positive intervention and treatment role in nursing work (Fioretti et al., 2016). Compared with the traditional teaching method, narrative nursing education can effectively mobilize the learning enthusiasm of nursing interns, and help to combine theory with practice, so as to improve the learning validity. In addition, narrative teaching method is helpful to cultivate students’ comprehensive abilities, such as humanistic care ability and communication ability, and is conducive to enhancing professional identity, which is a teaching concept in line with the development of contemporary nursing professional education (Guo et al., 2020).
In recent years, policy documents such as the Outline of the Healthy China 2030 Plan (State Council of the People’s Republic of China, 2020) and the Action Plan on Further Improving Nursing Services (2023-2025) issued by the State have emphasized the concept of humanistic care to varying degrees, requiring nurses to enhance their awareness of active service and humanistic care, and to care for, love and respect patients in the nursing process. Provide careful care, psychological support and humanistic care. Therefore, it is the demand of future nursing development to train nursing talents with high-level humanistic care ability. As a backup for clinical nurses, nursing students also need to receive humanistic education and develop humanistic caring skills. In China, humanistic courses are primarily provided in the form of lectures with very few opportunities for students to experience real-world scenarios outside the classroom (Liu et al., 2023). Narrative nursing teaching can be used in clinical practice setting to create a visual and perceptible experience for nursing students to perceive and experience humanistic care. This study aims to explore the effectiveness of narrative nursing education on the quality of humanistic care for clinical nursing interns, in order to provide theoretical basis for further promoting narrative nursing education for nursing interns.
2. Methods
2.1. Sample and Study Design
A total of 132 nursing interns from July to December 2023 in a tertiary general hospital in Guangzhou, China were invited as the research objects. According to the practice teaching arrangement of the clinical nursing teaching department of the hospital, they were divided into the experimental group and the control group by random number table method, with 66 interns in each group. Participants were included in the criteria: Participating in hospital clinical nursing practice from July to December 2023; Volunteer for projects and surveys. Participants were excluded in the criteria: continuous interruption of clinical practice for more than one week during the study period; Present with mental or neurological disorders; did not complete narrative nursing education training; also participate in other interventional studies. This study was approved by the Hospital Ethics Committee (KY-2023-092).
2.2. Research Procedures
2.2.1. The Control Group
The traditional practice teaching method was adopted to impart education on nursing interns. The clinical teachers conducted practical teaching of nursing interns’ theory and skills according to the practice teaching syllabus formulated by the Department of Clinical Nursing Education. After the end of the study, the control group was given compensatory narrative nursing education training.
2.2.2. The Experimental Group
The experimental group integrated narrative nursing teaching approach on the basis of traditional practice teaching approach from July to December 2023, and the process were as follows:
Step 1: The formation of narrative nursing education team
The narrative nursing education team was composed of 4 teachers with rich experience in clinical management education and practical teaching, all of whom have participated in the design and teaching of humanistic nursing courses in a nursing school, including 1 director of the Humanistic Nursing Teaching and Research Department, 1 educational manager and 2 clinical supervisor. The team members are familiar with the relevant professional knowledge and narrative nursing knowledge of diseases. Team responsibilities include the design of narrative nursing education curriculum, organization and implementation of training, guidance and consultation of nursing interns’ narrative nursing clinical practice, review of nursing life history, and organization of face-to-face narrative nursing case sharing and discussion.
Step 2: The design of narrative nursing teaching course
On the basis of literature review (Du et al., 2023; Zhang, 2023; Yu et al., 2019; Li, 2016; Li et al., 2019), combined with the survey results of the situation of nursing interns, narrative nursing education teams were organized to form narrative nursing teaching programs by focus group discussion. Narrative nursing practice teaching plan included theory module and practice module. The theoretical teaching content is as follows: Introduction to narrative nursing including narrative nursing concept, purpose, meaning, method, application value, etc.; Narrative nursing steps and skills focusing on the core content of narrative nursing; Responsibility, self-confidence, caring and nursing communication; The writing of parallel medical records. The content of clinical practice module was as follows: Nursing interns carry out clinical practice of narrative nursing; Nursing interns write one parallel nursing medical record; Nursing interns participate in narrative case sharing sessions.
Step 3: Implementation of narrative nursing teaching
The narrative nursing practice teaching was carried out according to the established teaching scheme. From July to August 2023, nursing interns would be trained in the theoretical content of narrative nursing. 2 class hours each time, a total of 5 times theoretical lessons; From September to October 2023, nursing interns would try to apply narrative nursing techniques and communication skills to clinical practice. Two practical teaching teachers regularly went into the clinic to understand the practical feelings of nursing interns, guided nursing interns to in-depth narrative nursing practice, and answered questions of nursing interns by a WeChat group; In November 2023, nursing interns were required to complete the writing and submission of a parallel nursing medical record based on narrative nursing practice cases. The clinical supervisions collected the nurse’s life history and carefully reviewed it on time and gave comments and feedback to nursing interns; In December 2023, 63 nursing interns in the experimental group were divided into 8 groups, and the nursing interns were organized to share narrative nursing case groups, each of whom shared their views on narrative nursing, application feelings and experiences, and selected excellent narrative cases.
2.3. Measurements
Nursing Caring Characters Assessment Tool (NCCAT) developed by Liu and Jiang (2012) was used to evaluate the humanistic care quality of nursing interns. The scale consisted of 29 items in 4 dimensions, including the concept of humanistic care (7 items), knowledge of humanistic care (7 items), ability of humanistic care (7 items) and perception of humanistic care (8 items). A five-point Likert was used, with scores ranging from disagree to strongly agree. The scoring threshold of the scale ranges from 29 to 145 points. The higher the score, the higher the level of humanistic care quality of nurses. Cronbach’s alpha coefficients were as follows: 0.931 for the total scale, and 0.714 - 0.849 for 4 dimensions of the scale.
2.4. Data Collection
A questionnaire survey was conducted independently by two researchers. The questionnaire was compiled by the questionnaire Star software and WeChat links and QR codes were generated. Before and after the implementation of the project, researchers sent questionnaires to two WeChat groups and supervised nursing interns to fill in them. The questionnaire uses unified guidance to introduce the filling requirements to the research subjects. The filling time is limited to 5 - 15 minutes. The respondents can fill in and submit the questionnaire using intelligent terminals such as computers or mobile phones, and the same Internet protocol address or mobile phone number is limited to one filling. All questions are required. Only after all questions are answered can the questionnaire be submitted. The effective recovery rate was 100%.
2.5. Statistical Analysis
The quantitative analysis was conducted using SPSS Statistics version 25.0. Means and standard deviations were adopted to describe variables data. Frequencies and composition ratios described the counting data. Comparing the differences within the group before and after the measurement was done using the paired t-test.
3. Results
3.1. Demographic Characteristics of the Two Groups
During the project implementation stage, 3 nursing interns in the experimental group and 1 nursing interns in the control group did not participate in the follow-up study due to their own reasons. Finally, a total of 128 nursing interns were enrolled in the study, including 63 in the experimental group and 65 in the control group. There were no significant differences between the groups in demographic characteristics (Table 1).
Table 1. Demographic characteristics of participants.
items |
experimental group (n = 63) |
control group (n = 65) |
t/X2 |
P |
Age |
21.06 ± 1.09 |
20.91 ± 1.04 |
0.426 |
0.671 |
Gender |
|
|
|
|
Male |
13 (20.63) |
15 (23.08) |
0.332 |
0.741 |
Female |
50 (79.37) |
50 (79.62) |
|
|
Residence |
|
|
|
|
Urban |
30 (47.62) |
25 (38.46) |
1.043 |
0.299 |
Rural |
33 (52.38) |
40 (61.54) |
|
|
Educational level |
|
|
|
|
Associate degree |
45 (71.43) |
50 (76.92) |
0.706 |
0.481 |
Bachelor degree |
18 (28.57) |
15 (23.08) |
|
|
Only child of family |
|
|
|
|
Yes |
5 (7.94) |
6 (9.23) |
0.259 |
0.796 |
No |
58 (92.06) |
59 (90.77) |
|
|
Previous narrative nursing education experience |
|
|
|
|
Yes |
45 (71.43) |
49 (75.38) |
0.503 |
0.616 |
No |
18 (28.57) |
16 (24.62) |
|
|
3.2. Comparison of Humanistic Care Quality Outcomes between the Two Groups
There was no statistical significance in the total score and each dimensions core of humanistic care quality between the two groups before intervention (P > 0.05) (Table 2). After the completion of the intervention, the experimental group had significantly higher scores on the dimension of caring perception and caring ability of humanistic care quality than the control group, while there was no statistical difference in caring ability and caring knowledge between the two groups (Table 3).
Table 2. Comparison of outcome about humanistic care quality between the two groups before intervention.
items |
cases |
Caring concept |
Caring perception |
Caring ability |
Caring knowledge |
total |
Experimental group |
63 |
20.20 ± 3.758 |
32.00 ± 4.945 |
25.88 ± 3.863 |
26.58 ± 4.116 |
104.66 ± 10.855 |
Control group |
65 |
19.90 ± 4.661 |
30.78 ± 5.152 |
25.06 ± 4.867 |
26.26 ± 4.793 |
102.00 ± 14.035 |
t |
|
0.354 |
1.208 |
0.933 |
0.358 |
1.060 |
P |
|
0.724 |
0.230 |
0.353 |
0.721 |
0.292 |
Table 3. Comparison of outcome about humanistic care quality between the two groups after intervention.
items |
cases |
Caring concept |
Caring perception |
Caring ability |
Caring knowledge |
total |
Experimental group |
63 |
25.78 ± 3.929 |
32.88 ± 4.383 |
28.00 ± 4.145 |
28.08 ± 3.516 |
114.74 ± 11.487 |
Control group |
65 |
25.68 ± 4.456 |
30.96 ± 4.513 |
25.58 ± 4.509 |
26.64 ± 3.983 |
108.86 ± 12.397 |
t |
|
0.119 |
2.158 |
2.794 |
1.916 |
2.460 |
P |
|
0.906 |
0.033* |
0.006* |
0.058 |
0.016* |
*Statistical differences at P < 0.05.
4. Discussion
The results of this study showed that the total score of humanistic care quality, humanistic care perception ability and humanistic care ability dimension scores of nursing interns in experimental group were significantly higher than those in control group after narrative nursing education training (all P < 0.05), but there were no significant differences in humanistic care concept and humanistic care knowledge dimension between experimental group and control group after training (P > 0.05). The reasons may be as follows: In this study, the design of narrative nursing training courses pays more attention to the training of practical knowledge such as narrative nursing techniques and nursing communication skills, while the training of theoretical knowledge of humanistic care is less involved, resulting in the low level of humanistic care knowledge of nursing interns. In addition, humanistic care perception and humanistic care ability can be acquired through training and clinical practice, which is easier to improve. The concept of humanistic care is the embodiment of human values, which is related to nursing interns’ professional value orientation and the accumulation and precipitation required for a long time. It may also be related to the fact that the exploration and practice of humanistic care concept is still in the initial stage in China and the practice atmosphere of humanistic nursing in hospitals is not good (Shang et al., 2018). In the future, it is necessary to continue to explore and improve the content of narrative nursing education for trainee nursing interns, promote the normalization of narrative nursing clinical practice, and cultivate more nursing talents with comprehensive humanistic literacy.
Humanistic care perception refers to the perceptual knowledge that nurses acquire after implementing nursing humanistic care actions, which is integrated with the feeling state and emotional experience of themselves and nursing objects, including the perception of caring objects and caring self-perception (Liu, 2011). The results of this study showed that the scores of nursing interns in the experimental group were significantly higher than those in the control group through narrative nursing education and training, with statistical significance (P < 0.05), which was more consistent with the results of Wang Shanshan et al. (Wang et al., 2019). First of all, the design and training of narrative nursing theory course make nursing interns have a general understanding and clear feeling of humanistic nursing practice. In addition, in the implementation of narrative nursing in clinical practice, nursing interns need to explore the context of patients’ problems with narrative questioning and communication, deconstruct and solve patients’ problems, have in-depth communication and close interaction with patients, and can deeply perceive patients’ responses and their sense of safety and trust, identification and hope, and warmth and harmony after receiving care. Through narrative nursing practice, nursing interns can also obtain a sense of professional achievement, self-worth satisfaction, moral pleasure and a sense of mission to the good after receiving patients’ response and positive recognition. Therefore, the implementation of narrative nursing education can improve nursing interns’ humanistic care perception ability, and the improvement of nursing interns’ humanistic care perception ability also lays a good foundation for the formation of their humanistic care ability.
Humanistic care ability refers to the relevant ability required by nurses to implement nursing humanistic care action, including caring experience ability and caring behavior ability (Liu, 2011). In this study, the score of humanistic caring ability of nursing interns in experimental group was significantly higher than that in control group through narrative nursing education training, and the difference was statistically significant (P < 0.05). It can be seen that in the process of clinical practice teaching, the use of narrative nursing practice teaching model can effectively improve the humanistic care ability of nursing interns. First of all, through the training and application of the five technologies of narrative nursing, namely externalization, deconstruction, rewriting, external witness and treatment documents, nursing interns can be guided to pay attention to the behavioral responses of patients in clinical practice, listen to the voices of patients and their families, understand the pain and needs of patients, and integrate the social roles, cultural backgrounds and personality characteristics of patients. Analyze the connotation and influencing factors of nursing interns’ caring needs, so as to improve their caring experience ability; In addition, through responsibility, care and nursing communication and other content training, nursing interns’ emotional communication ability, spiritual support ability, interpersonal coordination ability and problem solving ability can be fully mobilized to implement humanistic care actions for patients, which can effectively improve nursing interns’ narrative nursing ability. In addition, the training and practice of parallel medical record writing can also enable nursing interns to better understand the disease situation of patients and improve their empathy ability (Chen & Yang, 2019). Moreover, by reviewing and giving feedback to the parallel medical records written by nursing interns, practical teachers can also correct their inappropriate understanding and practice of narrative nursing, thus promoting the continuous improvement of their humanistic care ability.
5. Conclusion
With the continuous progress in the field of medical care, nursing work has placed more emphasis on humanistic care services. In recent years, narrative nursing as a humanistic nursing method has been applied in the clinical practice teaching of nursing interns, opening up a new way to carry out nursing humanistic teaching (Yu et al., 2022; Wang, 2020). In this study, we can conclude that the implementation of narrative nursing education has a positive effect on improving the humanistic care quality of nursing interns. This study only conducted narrative nursing education research in one medical institution. In the future, the research setting can be expanded to include multiple hospitals across different regions to enhance the generalizability and explore cultural influences on narrative nursing education. In addition, the sample size of this study is small, and it can be continued to increase the sample size and possibly extend duration of the study in the future to examine the long-term impact of narrative nursing education on humanistic care quality. Future studies could also explore potential barriers to improving the understanding of caring knowledge and caring concept through narrative nursing education methods.
Funding
The work was supported by grants from Nursing Research Special fund of the First Affiliated Hospital of Jinan University (Grant No. 2022219).