Development,reliability And Validity Of The Narrative Competence Scale

Background Narrative competence is the ability to listen,absorb,analyze,interpretand respond to other people's stories and dilemmas.Medical narrative competence helps medical staff to improve their empathy,professionalism,affinity and self-behavior in medical activities.And it should be available to every medical staff.Comprehensive assessment of the medical narrative competence of medical staff is of great significance for further development of narrative medicine,narrative nursing training,effective evaluation of training effectsand humane care level of medical staff.At present,there is still a lack of a comprehensive assessment of the medical narrative competence of medical staff.This study uses a mixed research design,combined with narrative-related theories and clinical practice,to develop a comprehensive assessment scale for medical staff's medical narrative capabilities,.The final aim is to provide an assessment tool for testing the competence level of narrative medicine and narrative nursing care.Objective 1.This study adopts the standardized process of developing scale,based on Charon's conception of narrative competence and theory related to narrative to construct the Narrative Competence Scale(NCS),which provides an effective,accurate and rapid assessment tool of the narrative competence of medical staff.And also it provides a reference for further systematic training and inspection of its results.2.Conduct preliminary assessment of narrative competence within the medical staff group toverify the reliability and validity of the medical narrative competence scale,analyze the status of narrative competence of medical staffand further explore strategies to promote the clinical development of narrative medicine and narrative nursing care.Materials and Methods 1.Using method of literature analysis to comprehensively search and systematically read books and articles on narrative nursing and narrative medicineall over the world,focusing on collecting relevant parts of the literature related to this research topicand then construct an entry pool.2.Using the method of qualitative research,guided by SNC narrative theory,story theoryand Noddings care theory and also withreference to the relevant literature,to complete the preliminary draft semi-structured interview outlines.Using the method of purposed sampling to selectthe medical staff withoverone-year experience of narrative medicine or narrative nursing.The doctors and nurses conducted face-to-face in-depth semi-structured interviewsand the sample volume reached saturation at 17.Respondents' informed consent was obtained to record the interviews,and the observation method was used to collect the data.The recordings were transcribed verbatim into the manuscripts within 24 hours after the interviewand the data was extracted using the Colaizzi7-step analysis to extract the subject and supplement the modified item pool.3.Using the Delphi expert consultationto invite 21 experts in the field of narrative to evaluate the scale items.Through two circles of expert consultation,the experts' opinions on the questionnaire were collected.The two indicators of item importance and coefficient of variation were used as the main basis for the deletion of the items.At the same time,the opinions of the experts were modified and supplemented to form the narrative ability of the medical staff to formthe initial table of the scale.4.Using questionnaires to conduct pre-experiment and do reliability and validity test.It is convenient to select 302 clinical medical personnel from Shandong,Hebei and Jiangsu province to conduct pre-surveyand issue the initial medical narrative competencescale with electronic questionnaire called questionnaire starto collect data.Using the method of discrimination analysis,correlation coefficient analysis,Cronbach's ? coefficient analysis to analyze each item.Principal component analysis method to delete the item with factor load <0.4 and commonality <0.3.Using exploratory factor analysis(KMO value and Bartlett's Sphericity test,common factor method extraction common factor,gravel map test)to further identify the potential structure,reduce the number of variablesand make the structure scientific and reasonable.A total of 14 medical institutions in Jiangsu Province(9 in 3A,one in 3B,and 4 in the 2A)were selected.A total of 630 medical staff were tested for reliability and validity.One month later,150 medical personnel were randomly selected for retesting.The reliability test was carried out by using Cronbach's ? coefficient and test-retest reliability.The validity of the scale was verified by the validity of the content validity,discriminant validity and structural validity.Results 1.This study interviewed 17 medical staff with narrative medicine experience in narrative nursing.Their understanding of medical narrative ability is basically consistent with Rita Charon's conception of Narrative competence.And it fits well with SNC narrative theory,story theoryand Noddings care theory framework.After analysis,we got ten themes: attention,guidance,listening,understanding,empathy,deconstruction,reflection,response,record,and learning.Based on this,combined with literature analysis,the initial 65 pool of entries was formed.2.The authoritative coefficient of 21 experts is 0.75~0.9(0.84±0.08),the research fields are 7 people in the field of narrative medicine(33.33%),7 people in the narrative nursing field(33.33%)and 2 people in the humanistic care field(9.52%).Two patients(9.52%)in the doctor-patient communication field and three in the psychological nursing field(14.29%).the recovery rate of the two rounds of expert consultation questionnaires was 95%(21/24)and100%(21/21).The degree of expert coordination(Kendall's W)were 0.143 and 0.152 respectively.The significance test was P<0.01.The expert consistency was good.Based on the expert opinion and group discussion,a total of 15 entries were merged,28 entries were deleted,4 entries were added and 21 entries were modified to form an initial version of 33 entries.3.Pre-investigation is distribution of 302 questionnaires.290 effective questionnaires were recoveredand the effective recovery rate was 96.03%.The results of the project analysis showed that the items 19,21,24,30 and 32 in the initial scale did not meet the three of the screening indicators.One or more of them are deleted,and the entry 11 is difficult to understand and the official scale of 27 items is obtained according to the deletion of the opinions of the person filling.Exploratory factor analysis showed a KMO value of 0.966 and a Bartlett spherical test P = 0.000,indicating that the scale is suitable for factor analysis.According to the initial factor analysis,the commonality of all 27 items is >0.2,the item load is ?0.4,and 27 items are reserved.The gravel map extracts 3 common factors,and the cumulative variance contribution rate is 65.02%.According to the content of the items included in each factor and expert advice,they are named as listening,understanding and reflecting.4.The Cronbach's ? coefficient of the medical narrative ability scale is 0.950 The Cronbach's ? coefficients of each factor are 0.835,0.912 and 0.842 respectively andall above 0.8.The total semi-trust reliability is 0.935 and the semi-trust reliability of each factor is 0.793,0.924,0.835 respectively.P value is less than 0.01 so that the internal consistency is better.Afterone-month retesting,the test-retest reliability of the total scale was 0.717.And the test-retest reliability of each factor was 0.720,0.663,and 0.649 respectively,which were statistically significant(P<0.01).The correlation coefficient between each dimension was 0.768~0.901 and the correlation coefficient between scores and total scores of each dimension was 0.895~0.965.The scores of medical staff narrative competence scale were positively correlated with the total score and each dimension of JSE-HP,CAI(r=0.237~0.965,P<0.01)so that it has good reliability and validity.Conclusion The medical narrative competence scale for medical staff formed in this study has good reliability and validityand is suitable for the evaluation of medical narrative ability level of medical staff in China.The contents of this scale can convey the conception and connotation of the narrative to the medical staff,helping the medical staff to be familiar with the narrative ability requirements during the filling processand reflecting on whether they have the ability to listen,understand,reflect and reproduce so that the narrative medicine/ the behavior of narrative care could play a guiding role.This can accurately assess the level of medical staff's narrative ability and further explore strategies to promote the clinical development of narrative medicine/narrative care.