Current situation and influencing factors of clinical narrative competence of pediatric specialist nurses: a cross-sectional study

Narrative medicine is a crucial tool for fostering medical humanism. Since its inception, it has aimed to bridge medical differences and promote harmony between doctors and patients [1]. This approach involves patients, their families, and healthcare professionals, including doctors and nurses. Nurses, who play a central role in delivering medical care, emphasize a blend of scientific rigor and humanistic care, with the latter highlighting the reintegration of humanism into medicine [2, 3]. In this context, narrative medicine serves as a vital expression of this return to humanistic values in medical practice [4].

In recent years, narrative medicine has become a significant focus of research within the nursing field. Clinical narrative competence is the ability to access, comprehend, and integrate patients’ stories and dilemmas, enabling healthcare providers to act accordingly [5, 6]. This competence is crucial for ensuring that patients receive optimal, humanistic, and high-quality nursing care and represents an innovative approach to enhancing patients’ health outcomes [7]. Humanistic care competence encompasses caregivers’ ability to provide emotional support and assistance, thereby improving and promoting patients’ mental health through a keen awareness of their needs in clinical practice [8]. Research has demonstrated that enhancing humanistic care and clinical narrative competence can improve patients’ quality of life, reduce the incidence of negative emotions, strengthen nurse-patient relationships, increase public satisfaction with nursing services, and significantly contribute to building a harmonious society [9].

Studies have demonstrated that despite increasing attention and training in narrative medicine within clinical practice, the clinical narrative competence of healthcare providers remains at an intermediate level or below, with limited progress toward effective integration into clinical practice [10, 11]. This challenge is particularly pronounced in pediatric care [12]. Children, as a unique population, often lack social experience, possess limited cognitive abilities, exhibit poor self-regulation, and have a low awareness of their illnesses [13]. Consequently, pediatric nurses face dual challenges: children’s limited ability to express themselves and parents’ high expectations for medical outcomes [14]. To address these demands, pediatric nurses require advanced narrative skills to develop personalized and holistic care strategies for children and their families [15]. Strengthening these skills ensures the effective implementation of clinical nursing practices, enhances parental satisfaction, reinforces the professional value of nursing, and expands the societal influence of narrative nursing practices [16].

The research subjects of narrative medicine mainly focus on the medical and nursing students [17, 18], and the research on the pediatric specialist nurse group has not yet been reported. Moreover, the research perspective is relatively single and only involves the individual level of the medical and nursing students. However, the person-environment fit theory believes that the performance of human ability results from the interaction between the individual and the environment, and this fit will have positive feedback on the individual and the organization [19, 20]. Therefore, our study addressed the following research question: What is the current level of clinical narrative competence among pediatric specialist nurses, and how do humanistic care quality and spiritual climate influence it?

With the development of narrative medicine, nurses, as the primary implementers of narrative medicine, face opportunities and challenges in developing nursing organizations [3]. The total clinical narrative competence score of 115 pediatric specialist nurses investigated in this study was (156.57 ± 17.42), which was higher than the total clinical narrative competence score of 216 nurses who look after AIDS in Yunnan province (148.09 ± 20.31) by Dai Y et al. [26], and also higher than the total clinical narrative competence score of 704 nurses in a tertiary hospital in Wuhan, Hubei province (149.46 ± 20.0) by Cui JR et al. [27]. This indicates that differences in the perceived importance of narrative medicine among study participants from various medical institutions in different provinces and cities may play a role. Overall, the clinical narrative competence of pediatric specialist nurses in this study was assessed at a medium level, indicating that there is still room for improvement in their knowledge and skills related to clinical narratives [13, 28, 29]. While maintaining the status, administrators and educators need to improve relevant management and training strategies in the future. Narrative medicine has established an essential position in clinical medicine, and universities such as Peking Union Medical College and Southern Medical University have established public elective courses in narrative medicine [30]. However, narrative medicine education has not yet been incorporated into the standardized training of nursing staff or specialist nurses. Nursing managers and educators can incorporate it into the training curriculum [10, 31, 32], which strengthens the cultivation of humanistic qualities, promotes the landing of medical humanism, and leads to better development of the nursing team.

The total humanistic quality score for pediatric specialist nurses was 124.27 ± 12.78, which was higher than the total humanistic quality score of 214 outpatient nurses in Jinan, Shandong province (113.80 ± 17.65) by Sheng L et al. [33], and also higher than the total humanistic quality score of 334 nurses from 33 hospitals in Enshi Tujia and Miao autonomous prefecture (121.60 ± 13.16) by He J et al. [34]. The likely reasons are twofold: first, nursing administrators and educators have increasingly focused on the humanistic care of clinical nursing staff [35]; second, the Chinese Association for the Care of Life has organized experts to integrate and collate the results and experiences of humanistic care practices in healthcare institutions across many provinces, forming an expert consensus of practice norms to guide comprehensive implementation in clinical nursing practice [36].

Additionally, the total mental climate score of pediatric specialist nurses was 16.87 ± 2.18, which was higher than the total humanistic quality score of 471 outpatient nurses in Jinan, Shandong province (13.55 ± 6.28) by Ge Wenjie et al. [37], and also higher than the total humanistic quality score of 275 Greek clinical nurses from (12.84 ± 4.27) by Evangelos C. Fradeloset et al. [38]. The differences may stem from the complex nature of the mental climate, which arises from multiple factors, including regional cultural differences and nurses’ varying perceptions of the work environment at different career stages.

The study found the total score and dimension scores of pediatric specialist nurses’ clinical narrative competence were positively correlated with the total score and dimensions of humanistic care quality and spiritual climate. This means that higher levels of humanistic care quality and a better spiritual climate are associated with higher levels of clinical narrative competence. This is because narrative medicine embodies the return of humanistic care to medicine, and humanistic care quality is the foundation of clinical narrative competence [28, 39]. Empathy, a core competency of narrative medicine, facilitates nurse-patient communication and exchange. At the same time, a positive mental climate helps nurses communicate effectively in the workplace and enhance overall work effectiveness, thus providing high-quality nursing care for patients [40]. Nursing administrators and educators can organize medical narrative-oriented nursing checkups, business studies, and essay and speech contests on humanistic care stories to cultivate nurses’ awareness of humanistic care. Experiential teaching, situational role simulation, and case recapitulation can help improve nurses’ nonverbal empathy skills and clinical narrative competence [41].

The study found that humanistic care quality significantly influences the clinical narrative competence of pediatric specialist nurses (P < 0.001). Higher levels of humanistic care quality are associated with more substantial clinical narrative competence. This finding is consistent with studies by Fan and Mo F [17, 28]. Humanistic care quality is a crucial component of clinical narrative competence, with communication being the externalized behavior of humanistic care quality [42, 43]. Pediatric specialist nurses with high humanistic care quality can use communication skills to decode and encode information accurately in nurse-patient interactions, providing personalized care and attention. The education of clinical narrative competence relies heavily on cultivating humanistic caring competence, primarily expressed through empathy [5, 44]. Strong humanistic caring abilities enable pediatric specialist nurses to communicate effectively with children and their families, fostering emotional resonance and establishing trust and understanding. This, in turn, helps improve children’s moods and promotes their mental health. Therefore, nursing administrators and educators should organize narrative nursing practice to enhance humanistic care awareness among pediatric specialist nurses [4]. Introducing new teaching elements in narrative competence education and training [10] and organizing health science symposiums with children’s families can strengthen three-dimensional communication among doctors, nurses, and patients. Additionally, conducting disease-related games for children can help pediatric specialist nurses reinforce the concept of humanistic care in practice, thereby improving their clinical narrative competence.

The study also identified spiritual climate as an essential factor influencing the clinical narrative competence of pediatric nurses, with a positive correlation between the two. Mental climate, organizational climate, and collective perception of the work environment are associated with leaders, the work environment, and peer support [14, 38]. Nurse leaders must establish a supportive culture in the work environment, promoting intrinsic harmony and addressing adverse emotions promptly [45, 46]. Nursing managers should act as drivers to enhance the spiritual climate by focusing on four core elements: positive influence (setting up spiritual incentives within the nursing unit [47]), inspirational motivation (conducting stress reduction activities such as Balint group activities [4]), intellectual stimulation (conducting group interactive activities and effective collective reflection symposia [48]), and personalized training (tailoring approaches based on nurses’ backgrounds, work hours, and values [49]). Enhancing nurses’ self-worth identity in work situations and creating a united work atmosphere in the department can improve their clinical narrative skills.

The following suggestions are proposed to bolster clinical narrative competence: Using simulation technology to create realistic pediatric clinical scenarios. For example, they can role-play as nurses reporting to physicians or communicating with parents about a child’s health status. Instructors or peers can provide feedback to help them improve their narrative skills [50]. Invite experienced pediatric clinicians, medical writers, or communication experts to give guest lectures and conduct workshops. These experts can share their insights and practical tips on effective clinical narration and provide case studies and real-life examples [51, 52]. Secondly, mentorship programs should be established to pair experienced pediatric nurses with those who need to improve their narrative skills. Mentors can guide mentees through writing nursing notes, presenting cases, and communicating with the healthcare team. They can offer personalized advice, review written narratives, and provide constructive feedback to help mentees grow. Incorporating clinical narrative competence into the performance evaluation system and organizing regular continuing education sessions, seminars, and conferences related to clinical narrative competence. Lastly, nurses can engage in peer review sessions with their colleagues. Sharing your written narratives, case presentations, or communication experiences and ask for their feedback. Seizing every opportunity to practice your clinical narrative skills in real clinical settings [53]. When writing nursing notes, be mindful of the structure, language, and details you include. Remember how you convey information clearly and effectively when communicating with patients, families, or other healthcare professionals. This triadic linkage of school-hospital-individual aims to enhance pediatric specialist nurses’ clinical narrative competence comprehensively.

In summary, person-environment fit theory highlights the importance of multidimensional alignment in clinical medicine competence, humanistic care quality, and spiritual climate. Nurses’ clinical medicine competence and humanistic care quality are mutually reinforcing; high-quality humanistic care enhances nurses’ clinical competencies, while robust clinical skills reflect and support humanistic care. A positive spiritual climate also provides essential support and resources, enabling nurses to leverage their clinical competencies and care qualities better. We can continuously enhance nurses’ clinical medicine competence, humanistic care quality, and spiritual climate by conducting regular assessments and providing feedback. Utilizing various methods such as questionnaires, satisfaction surveys, and peer assessments will help us gain valuable insights into the status of pediatric specialist nurses in these areas, allowing us to identify issues promptly and implement improvement measures.

This study has several limitations. First, using a convenience sampling method limited to Jiangsu province may introduce sample bias and restrict the depth and breadth of the findings, as it did not include questionnaire data from other provinces. A stratified random sampling approach could be considered to improve sample representativeness in future research. Second, the reliance on questionnaires may lead to responses influenced by social desirability bias, personal emotions, and other factors, resulting in potential subjective bias. Third, the cross-sectional design allows only the observation of correlations between factors affecting clinical narrative competence, making it difficult to establish causal relationships. Future research could address this limitation by employing longitudinal studies to explore causal relationships among the variables.

Pediatric nurses’ ability to deliver humanistic care and utilize clinical narratives is at a moderate level. Cultivating and improving the quality of humanistic care and the working environment and atmosphere is an effective way to enhance clinical narrative competence. Strengthening the education and training of pediatric nurses in narrative medicine and narrative nursing in a personalized way from a multi-dimensional perspective is essential.