Construction And Implementation Of Narrative Nursing Practice Model

BackgroundThe return of medical humanism is the trend of the time and is an urgent approach to enhance the relationship between health providers and patients.The educational approach of traditional medical humanities can hardly solve the problem of internalization of the humanistic care quality of medical staffs and stimulate the professional spirit of love and care for patients.It is also very difficult for medical staffs to enter the patients’ world and understand their behavior and needs.The emergence of narrative medicine and narrative nursing provide a new idea and perspective to solve the dilemma of medical humanities,so that the nurses and patients are able to establish a trust and harmonious relationship in the interaction,understand and respect each other through the patients’ stories,and seek solutions together.It not only improves patients’ satisfaction,but also improves patients’ outcomes.Although narrative nursing has started,it is still a novel thing in China.Narrative nursing is seldom carried out in clinical,and the effect of narrative nursing is not precisely evaluated.Many hospitals want to implement narrative nursing,but lack of scientific,systematic,normative and instructive practice framework to carry out narrative nursing.ObjectiveThe aim of this study is to analyze the current situation of clinical humanistic care practice and perception and demand of narrative nursing;analyze the problem of clinical narrative nursing practice;construct the clinical narrative nursing practice model and implementation plan;implement the narrative nursing practice model and constant revise,explore the effect of the model.MethodsBased on the framework of action research,this study was divided into five stages: identifying problems,analyzing problems,making a plan,implementing it and evaluating the effect of the model.In the first stage,researchers found the difficulty of medical humanities from theory to practice in clinical nursing work,while narrative nursing,as a new method to solve this dilemma,lacks the guidance of scientific norms and systems in clinical application.In the second stage,through investigation and literature research to find the problem of clinical humanistic nursing practice and the perception and need of narrative nursing.In the third stage,the researcher constructed narrative nursing practice model by applying theoretical research,literature research and expect meeting method and build the practice plan through the method of group brainstorming.In the fourth stage,the narrative nursing program was implemented in the oncology department and breast cancer department in the hospital.Problems and Suggestions were found through observation and qualitative interview,and the narrative nursing practice model and program were modified combined with the reflection of the researcher.In the fifth stage,through interviews with narrative nursing practitioners,nurse managers and patients from multiple perspectives,the effect and influence of narrative nursing practice model are evaluated,in order to provide reference for more extensive practice in the future.In this action research,the school expert team applied the previous research(narrative nursing course)to the clinical nurses to cultivate their narrative nursing theory,in order to lay a good foundation for action.Participants included clinical nurses,head nurses,nursing management expert and the researcher.In this study,the reaearch methdology include participant observation,focus group interview,in-depth interview,investigation,literature research,brainstorming and expert meeting method.ResultsStudy 1: In the investigation of the current situation of clinical humanistic care,it is found that cancer patients suffer physical and mental torture,which is in urgent need of nurses’ care.There is a certain difference between patients’ narrative behavior observed by nurses and patients’ self-reported narrative needs,which indicates that patients have needs and have an easy experience of emotional release after telling stories.However,patients subjectively believe that many internal thoughts outside the disease,such as family troubles,are relatively private things,not suitable for telling others,or that these are not the work of nurses,so they tend to suppress in the heart.From the perspective of nurses,this study found that although nurses are aware of the importance of humanistic care,they lack the means and ability to get into patients’ hearts,and they are also limited by insufficient time and energy caused by human resources,workload and so on.In the literature research,it is found that narrative nursing clinical practice in China is mainly the application of narrative medicine in nursing area,and lacks scientific,systematic and normative theoretical guidance and specific content.As a new concept derived from narrative medical theory,narrative nursing has not been applied in clinical practice.Study 2: Narrative nursing practice model and implementation plan were constructed by theoretical research,literature research and expert meeting.Through theoretical research,narrative nursing practice model consisted of four layers: philosophy foundation layer,method layer,operation layer and technique layer.The philosophical basis of this model is postmodernism,social constructivism and medical anthropology.Under the support of this philosophy,narrative nursing pays attention to bilateral relations.Both nurses and patients use language and stories to understand and construct the external world and understand their own inner world.When nurses and patients face sufferings together,they construct the meaning of life together with patients through witness,deconstruction,understanding,empathy,respect and reconstruction.The theoretical basis of the method layer is the theory of narrative medicine,which provides the basis for narrative nursing model to cultivate narrative ability and design narrative activities.Operation layer refers to narrative nursing practice process based on narrative nursing theory,which provides operational steps for nurses to implement narrative nursing.The technical level refers to some key technologies formed on the theoretical basis of narrative therapy,such as externalization,deconstruction,technical documentation,reconstruction,etc.,these ideas and thoughts can provide references for nurses.However,personnel who implement narrative therapy need to be trained or certified in psychology.Through literature research,the narrative nursing practice model draw on the experience of Buckley’s narrative practice framwork,who is an Irish scholar did narrative practice research of geriatric nursing home.The key elements such as "story","prerequisite","care environment","care process","narrative aspects of nursing" from Buckley’s framwork has been incorporated into our study.After integration,abandonment and adjustment,the framework of the narrative nursing practice model of this study has been formed.Finally,through the demonstration of the expert meeting,the narrative nursing process was further revised,and the key points in the narrative nursing process were classified and stratified,forming three categories: attitude,basic technology and professional technology.Studies 3: The outcomes of running narrative nursing practice model in clinical: after two rounds of action research circulation,we revised and improved the mode and meanwhile carried out 33 class hours’ narrative nursing training and held 17 narrative nursing group activities in order to improve the lack of nursing knowledge,improved the nurses’ narrative ability.And we also created a narrative nursing environment,designed narrative activities such as “reading life”,“writing life” and “sharing stories”,design a narrative platform named “Soul ward”.Totally,138 patients participated in the activities of writting their stories.The implementation of narrative nursing practice model enriched the form of clinical humanistic nursing practice,improved the professional identity of nurses,changed the behavior of nurses,and improved patients’ satisfaction.ConclusionsThe construction of narrative nursing practice model can effectively provide a new way for nurses to carry out humanistic care,help nurses to listen to patients’ stories,enrich their understanding of disease and life world,respect patients and give patients comfort,encouragement,confidence and support,in order to provide warmly and spiritual care for patients.After receiving narrative nursing,patients’ needs for respect,love and belonging and self-realization can be satisfied,and their hearts are full of gratitude and trust.At the same time,a good interaction between nurses and patients satisfies nurses’ sense of professional achievement,promotes the professional spirit of nurses and enhances their sense of professional identity.The narrative nursing practice model has innovated the humanistic nursing practice method,has solved the dilemma of "empty shell" and "floating" of medical humanities,has enriched the nursing knowledge system,and has enriched the methods and techniques of clinical humanistic care.