A Survey Of Nurses' Knowledge,Attitudes And Practice Toward Narrative Nursing In Grade A Hospital

Objectives1.To develop a questionnaire of “Knowledge-Attitude-Practice Survey of Clinical Nurses on Narrative Nursing”, and then use this questionnaire to evaluate the current situation of knowledge, attitude and practice of narrative nursing of clinical nurses,and further more, to get the pictures of the development of narrative nursing in today's clinical nursing.2.To make some strategies of helping narrative nursing finding its way in clinical nursing according to the analyses of these survey results, and also provide some advises to make the nurse-patient relationship much more harmonious and to improve the quality of care service and ameliorate the medical experiences of patients as well as the emotional experience of nurses.Methods1.Literature review: systematically searched and reviewed the related literatures about narrative nursing and narrative medicine, on this basis, got a grasp of the development status of narrative nursing, and then set the interview outline of a qualitative study about what the nurses' perception on patient narrative.2.Interview method: Purposive sampling method was adopted to choose 10 clinical nurses, a face to face interview was taken out to got to know how the clinical nurses perceived the narrative nursing, Combined the results of this qualitative study and the literature review, the first draft of the questionnaire of “Knowledge-Attitude-Practice Survey of Clinical Nurses on Narrative Nursing” had been made on the basis of knowledge-attitude-practice theory.3.Delphi experts consultation:16 experts from the domains of narrative nursing,humanistic nursing, narrative medicine, nurse-patient communication were selected to revise and modify the first draft of the questionnaire.After two turns of consultation,the opinions of experts tended to be convergent.According to the feedback from the experts, some modifications was made, ultimately, the pilot questionnaire of“Knowledge-Attitude-Practice Survey of Clinical Nurses on Narrative Nursing” was formed.4.Item selection and reliability and validity assessment: the nurses who were invited to participate this investigation should meet the following three conditions:worked in the hospital 2 years or more, knew the purpose of this survey and agreed to participate in. According to the results of the pilot survey, item analysis and factor analysis were used to select items; the questionnaire reliability was assessed by Cronbach's Alpha and reset reliability; the questionnaire validity was assessed by content validity,discriminate validity and structure validity.5.Questionnaire survey:478 nurses from Wuhan Union Hospital, 161 Hospital of PLA and Yichang Central Hospital were selected to finish thefield questionnaire by the method of convenient sampling in In November 5, 10, 16,2015.Used the Software2013 and SPSS to analysis all the data.6.Quality control:Firstly,in order to ensure the interview quality, the researcher took the charge of interviewer, formed an elaborate interview outline to ask some modified advice from experts,and then conducted the pilot interview.Before the formal interview, researcher got the purposes of this study across to the interviewer so as to make the interviewees cooperative.The whole interview process lasted for 20 to 60 minutes that the interviewees won't be tired, and all the conversations were recorded. Secondly, to control the quality of surveys, the researcher was responsible for the whole-course investigation, including training the investigators and organizing formal investigation. Lastly, some measures were taken to make sure of the correctness of the data, the recording should be converted into text and interview notes which included the non-verbal behaviors of the interviewees should be arranged on the right day.The questionnaire data was tapped in by one person and checked by another, 30% of the were repeat-checked when we finished the work of inputting data.Results1.Qualitative study results: Three themes were extracted: nurses were willing to listen and encourage patient narrative; patient narrative could produce positive influences;there needed some certain conditions that patient narrative could went smoothly.2.Delphi experts consultation results: The response rate was 88.89% for the first round and 93.57% for the second. The experts put forward 30 suggestions, 23 of them were accepted, the adoption rate was 76.67%.The experts' authority coefficient was0.861. The Kendall coefficient was 0.209 for the round 1 and 0.222 for the round 2(P<0.001). The variation coefficient fluctuated between 0.07 to 0.277 for round 1 and0.052 to 0.188 for round 2.3.Reliability and validity assessment results: The final questionnaire' s Cronbach Alpha was 0.846, reset reliability was 0.952(P<0.001). The KMO of this questionaire was 0.768 and Bartlett test c 2 was 728.234(P<0.001). Restricted extraction common factor method and orthogonal rotation method were used to extract common factors.Common factors were restricted to 3(named knowledge, attitude, practice), the result showed that the factor loads for 22 items were all greater than 0.400, the classification of the 22 items were in reasonable agreement with the basic structure of the questionnaire.4.Clinical nursing staff narrative nursing knowledge, attitude, behavior survey results:61.29% of the respondents never headed the narrative nursing, 34.10% headed but not very familiar with the it, only 2.09% and 1.88% of the respondents had an intimate knowledge of it, there was a significant difference in the awareness rate of narrative nursing of respondents who differed in age, work department, education level, work experience, job title, job position(P<0.001). There was a statistical significance in different departments, education, job title, duties of nursing staff in narrative nursing knowledge, attitude and behavior score differences(P<0.01). The knowledge score difference was statistically significant between the nursing staff who came from different departments, educational background, job title and position. The attitude scores of the nursing staff who had different gender, educational level showed statistical differences(P<0.01). The behavior scores differed statistically significantly between the nursing staff who came from different gender, age, department, work experience, job position(P<0.01). Linear multiple regression analysis revealed that the gender(?=7.394), age(?=1.266), education level(?=1.396), job title(?=0.067), job position(?=4.675) were included in the regression equation which the clinical nursing staff of nursing knowledge, narrative attitude and behavior total score acted as the dependent variable. Bivariate correlations analysis showed that there was a positive correlation between narrative nursing knowledge and attitudes scores, knowledge and behavior scores, attitude and behavior scores, the correlation coefficients were0.313(P<0.01),0.148(P<0.01),0.499(P<0.01).5.Limited time-spatial condition(70.31%), deficiency of managers' attention and guidance(11.30%)are the main factors that hinder the development of narrative nursing.Conclusions1. The reliability and validity of the questionnaire were favorable, it can reflect the knowledge, attitude, practice of narrative nursing among the nurses stuff, and can objectively reflect the current development of narrative nursing in today's clinical nursing.2. Although the awareness rate of clinical nursing staff of narrative nursing was low,the channels that the respondents know the narrative nursing showed diversity, but mainly form lectures or network.3. The score of narrative nursing knowledge of the respondents was satisfactory, and the attitude of them toward narrative nursing was also positive, but the narrative nursing behavior of them was poor. Generally speaking, the narrative nursing knowledge, attitude and behavior of clinical nursing staff were acceptable.4.There was a positive correlation between the knowledge, attitude and behavior of the clinical nursing staff on narrative nursing, the correlation degree of attitude and behavior of narrative nursing was the highest, the correlation degree of knowledge and attitude was the second, and the correlation degree of knowledge and behavior was the lowest. Generally speaking, there existed an phenomenon that narrative nursing knowledge, attitude disconnected with the behavior.5. Most of the nursesthought that the development of narrative nursing can improve the nurse patient communication, but there are many subjective and objective factors that hinder the development of narrative nursing in clinical practice,mainly forrestriction of the time and room, and insufficiency of advocation from the head nurses. We should make some measures according to the different conditions to promote the development of narrative nursing.