| This study is divided into three parts: first,the theoretical interpretation of narrative medicine;second,using qualitative research(narrative medicine interviews)to analyze patients' disease narrative;third,using quantitative research to test the clinical effect of narrative medicine.These three parts are interlaced in the full text.In the part of theoretical interpretation,the author combs the historical evolution of narrative medicine and explains the theoretical basis and interdisciplinary integration of narrative medicine from philosophy,literature,psychology,anthropology,communication and nursing.The academic views of two main scholars in narrative medicine,Rita Charon and Arthur Kleinman,were compared.It also explained three elements of narrative medicine: attention,description and trust;two core competencies: empathy and reflection;five narrative characteristics: timeliness,uniqueness,causality/contingency,intersubjectivity and ethics.Qualitative research takes breast cancer patients and liver transplantation patients as examples to analyze their cultural narrative,social relationship narrative and philosophical narrative,describe their real psychosocial state and life situation,excavate the multiple states of body-mind-society-spirit outside the field of evidence-based medicine,and restore the view of patients' life and death,suffering and medical concept.Results: In terms of cultural narrative,liver transplantation patients with liver cancer are facing post-transplantation dilemma.After operation,they felt multiple rejection including physical,psychological,social and cultural rejection.Their body consciousness was stronger,and they formed a new body view,which made the body scientific and objective.In the narrative of social relations,patients experienced the transformation of multiple social relations and the experience of new roles.For example,in the family,they changed from caregiver to be took of;their social roles changed because of illness,and they felt warmth and isolation;the role of patients were also deepening.Patients rebuilt social relations and expanded social capital after fell ill.They were faced with intimacy and breakdown of partnership,support and alienation of relatives and friends,relationships between the patients which were compassionate with each other and depended on each other.Because of their different perspectives with doctors,they also felt the collision between doctors and patients,and dependence on doctors and support from doctors.In terms of philosophical narrative,patients faced spiritual dilemma and needs.These dilemmas and needs included the sense of self-existence,the relationship with oneself,the relationship with others,the pursuit of the meaning of life,religious/cultural beliefs,love and care and hope.They completed physical and mental remodeling after suffering,and grew up and had a thorough understanding of life in suffering.They gradually faced the reality,adjusted their physical and mental state,grew up after trauma,and sublimated their view of life and death,suffering and medical treatment.They gained grace and courage,and accomplished self-transcendence and self-realization.The patients' narrative presents their multiple sufferings after suffering from cancer,which suggests that medical staff should pay attention to the humanities and pathology of the disease,improve the medical dimension through narrative medicine,and construct a warmer medicine with both medical care and treatment and comfort.Quantitative research part verified the clinical effect of narrative medicine,which was divided into three independent studies.The purpose was to explore the impact of narrative medicine and empathy ability of medical staff on patients' physical and mental health.Methods: The demographic parameters of the patients were investigated by questionnaires.Patients' blood biochemical indexes such as T lymphocyte subsets and inflammatory factors were investigated,and polysomnography were used.The empathy ability of doctors was investigated with scale.Statistical methods: Epi Data 3.0 software was used to input data,and SAS 9.4software was used to establish database and make statistical analysis.The descriptive analysis of measurement data was expressed by MąSD,and the descriptive analysis of counting data was expressed by frequency and constituent ratio(n,%).The measurement data all satisfied the homogeneity of variance,so the analysis of variance,LSD test and t test were used for comparison among groups.Multivariate linear regression analysis was used in multivariate analysis.Pearson correlation analysis or Spearman correlation analysis were used according to the situation.Chi-square test was used to compare the constituent ratios.Structural Equation Modeling(SEM)was constructed by Mplus 7.1 software to test the mediation effect.The first study was the application of narrative medicine in patients with inflammatory bowel disease(IBD).120 patients with IBD were randomly divided into four groups with 30 in each group.Patients in the control group were given routine health education on the premise of routine treatment.The three treatment groups were given health education based on narrative medicine,online patient mutual assistance group intervention and combined intervention.Compared with the control group,patients in narrative medicine group and online patient mutual assistance group had less depression,joint pain,IBS symptoms,lower serum proinflammatory factors and higher sleep efficiency.The positive impact of the combined intervention group on the above indicators was more significant.Therefore,the positive role of narrative medicine in the physical and mental health of patients with IBD had been confirmed.The second study was the impact of nurses' empathy on psychological distress and benefit finding in breast cancer patients.Psychological distress and benefit finding of360 breast cancer patients and empathy ability of their nurses were investigated,and the relationship between mental health of patients and empathy ability of nurses were analyzed.The results showed that under the condition of balancing other conditions,each increase of nurses' empathy score reduced patients' psychological distress score by 0.01 points,and the benefit finding score increased by 0.14 points.In this study,the impact of empathy of oncology nurses on psychological distress and benefit finding in breast cancer patients was confirmed.The third study was the influence of doctors' empathy on cellular immunity in patients with prostate cancer,and to explore the mediating effects of self-efficacy,stigma and anxiety.At admission,14 days later and 3 months later,the self-efficacy,stigma,anxiety and T cell subsets of 175 patients were measured.At admission,the empathy ability of their doctors was measured.After analyzing the relationships between the above variables,it was confirmed that the patients' sense of stigma,self-efficacy and anxiety played a mediating role in the influence of doctors' empathy ability on patients' NK subset.These studies suggest that medical staff should pay attention to their narrative and empathic abilities,which can help to improve the physical and mental health of patients.Based on the above research,the clinical intervention of narrative medicine was reviewed.This paper summarized how to write parallel medical record and exchange logs and the approaches of narrative medicine intervention,pointed out the practical dilemma of clinical medicine humanities,and put forward the vision blind area and development direction of narrative medicine.The clinical significance of narrative medicine was summarized as followings: 1.Opening up a new pattern of whole-person healing;2.Promoting the dual-track model of technology-humanities medicine and evidence-based-narrative medicine;3.Promoting the formation of a common decision-making mechanism between doctors and patients;4.Helping to cope with clinical difficulties and construct clinical philosophy;5.Bridging differences between doctors and patients and helping to establish mutual trust between doctors and patients;6.Broadening the interface and connotation of health education;7.Enlightening patients' thinking and spiritual needs for life and death;8.Compassion,companionship and witness are the warmest care of life. |
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