Study On The Development Of Narrative Nursing Theory And Its Course And The Exploration Of The Effectiveness

AimsThe current nursing humanities knowledge system in China is theory-targeted and with a lack of diversity,and nursing humanistic education features a low level of practicability.In this context,this research first aims to define the concepts related with “narrative nursing” and develop the narrative nursing theory using Walker and Avant's Derivation Process of Concept and Theory with reference to the parent field of narrative medicine;then to develop the Narrative Nursing course based on the narrative nursing theory and design an educational experiment to explore the feasibility and effectiveness of this course.This study attempts to provide an effective approach to achieve the training goals of cultivating nursing students' humanistic spirits and their caring abilities.Research methods1.Establish the structure of the narrative nursing theory and develop its contentsThe Derivation Process of Concept,Statement and Theory was adopted to guide the process of developing the narrative nursing theory.The researcher first used literature content analysis to summarize the theories and methods that nurses use in clinical practice to collect,understand and respond to patients' narratives.Then “narrative medicine” was selected as the parent field for the derivation process.The core concepts related to “narrative nursing” were derived and defined;the structure of the theory was established with reference to the key elements of a discipline;the contents of the theory were designed by analogue and elaborated in details.An expert panel meeting was organized to discuss and refine the narrative nursing theory.2.Develop and demonstrate the Narrative Nursing courseWith reference to the narrative nursing theory,the Discipline-based Approach and the Tyler Rationale were used as theoretical foundations to guide the development of the Narrative Nursing course.Fink's Model of Integrated Course Design was followed step by step and the draft of the course syllabus consisted of six key components of the course,including course nature,learning goals,teaching contents,teaching strategies and methods,feedback and assessment approaches,and course overall scheme.The Delphi method was then adopted to demonstrate the syllabus of the Narrative Nursing course.Modifications and revisions were made according to the statistical results and experts' comments and the final version of the course syllabus was determined.3.Design an educational experiment to explore the effectiveness of the Narrative Nursing courseBased on the course syllabus,the experiment plan was designed.A mixed-method design was selected for the experiment integrating both the quantitative and qualitative methods.A pre-and post-test study was implemented in a sample of the 25 students participating in the Narrative Nursing course;a control study was conducted between two groups of students,with 10 students from the Class-2014 enrolled in the course allocated in the experimental group and 10 students from the Class-2013 who were not enrolled in the course as the control group;a qualitative study using semi-structured interviews was carried out to learn about the students' learning experiences and gains from the Narrative Nursing course,as well as their evaluations of and suggestions on the course.Results1.The structure and contents of the narrative nursing theoryThe final structure of the narrative nursing theory was established with reference to the key elements of a discipline and consisted of the core concepts,transdisciplinary theoretical foundations,research objects,primary research contents and specific research methods.The three core concepts of the narrative nursing theory are narrative nursing practice,narrative nursing competence and narrative nursing;the transdisciplinary theoretical foundations involve the philosophical paradigms,specific psychological and anthropological theories and some related nursing theories;the research object is the whole process of narrative nursing practice;the primary research contents include narrative nursing practice procedure(attending,interpreting,reflecting,responding),narrative nursing knowledge(certain knowledge in literature,anthropology,sociology,psychotherapy),narrative nursing competence(four domains and thirteen essentials);the specific research methods refer to the methods of theoretical study,narrative inquiry,field study and clinical practice.2.The Narrative Nursing course and its syllabusThe Narrative Nursing course is a nursing humanistic course and was developed with the guidance of Fink's model.The syllabus involves six key components,including course nature,learning goals,teaching contents,teaching strategies and methods,feedback and assessment approaches,and course overall scheme.The significant learning goals focus on the narrative nursing competence,consisting of foundational knowledge,application,integration,human dimension,caring and learning how to learn.The teaching contents are designed with reference to the narrative nursing theory and follow the logical sequence of “overview-specialty-summary”,covering the topics of introduction of narrative nursing,knowledge and skills of narrative nursing,and practice of narrative nursing.The major part of teaching contents focuses on the four steps of narrative nursing practice in order.Diverse narrative teaching methods are adopted to emphasize “active learning” which involves the learning types of receiving information and ideas,experience and reflective dialogue.The mainly used feedback and assessment approaches are the forward-looking assessment and “FIDeLity” feedback(Frequent,Immediate,Discriminating,Loving feedback),involving the evaluation of students' performance in drama-in-education and reflective writing.The course has a total of 10 lessons and 30 credit hours,with 14 credits hours planned for theory learning and 16 credits hours for in-class practice.3.Results of the educational experiment of the Narrative Nursing courseThe quantitative results of the experiment showed that: the students participating in the Narrative Nursing course demonstrated a significantly higher level of the overall narrative nursing competence than those students who were not enrolled(p<0.05,r=0.569);although no significant differences were found between the two groups in the scores of the dimensions of attention,interpretation and response(p>0.05),the effect size of these dimensions were at a moderate or moderate-to-high level.There were no significant increases between the pre-and post-test scores of the enrolled students' humanistic caring qualities,listening skills,and level of empathy(p>0.05),however,students with diverse experiences(participating in student clubs or not;holding a leadership position in class or not)revealed significant differences in the changes of their pre-and post-test scores of their listening skills and humanistic perception and attitude(p<0.05).A total of 45 categories were extracted from the transcripts of students' interviews and can be classified into 5 themes and 13 subthemes.The qualitative results provided further evidence that the Narrative Nursing course could improve the nursing students' narrative nursing competence.Besides,this course could help students cultivate correct professional cognition and professionalism,and positive life attitudes.Students who participated in the Narrative Nursing course gave a high evaluation on the course;those difficulties and comments proposed by them may direct further improvement of the course.ConclusionsFrom the theoretical perspective,this study was the first to propose and define the term of narrative nursing(practice)and develop the narrative nursing theory,which improved the comprehensiveness and diversity of the nursing humanities knowledge system in China.The Narrative Nursing course was developed in a scientific method and aims to develop the nursing students' narrative nursing competence.Its syllabus with six key components(course nature,learning goals,teaching contents,teaching strategies and methods,feedback and assessment approaches,course overall scheme)could provide detailed guidance on implementation.In practice,the educational experiment examined the effectiveness of the Narrative Nursing course,and the results showed that the course could develop students' narrative nursing competence,proper professional cognition and positive life attitudes.This study not only adds new perspectives to the current nursing humanistic knowledge system of our country,but also promotes the reform and development of nursing humanistic education in China.