Factors associated with medical narrative competence of nurses: a qualitative study

Background: The nursing ability for medical narrative is essential for patient-focused practice within the bio-psycho-social model of medicine. This study sought to identify influential factors affecting nursing competence in medical narrative skills among practicing nurses in healthcare settings to determine the personal, environmental, relational, and organizational elements that impact this essential competency using grounded theory and constructivist theoretical frameworks. Methods: A qualitative study design was employed with semi-structured interviews distributed to nurses with expertise in narrative and communication skills. Twenty nurses were selected through purposive sampling to assess: (1) their narrative medicine knowledge and practice; and (2) factors influencing their narrative competency for those with recognized communication expertise in nursing practice. The study used thematic content analysis for data interpretation. Both individual and contextual data were collected. Results: Twenty nurses participated in this study. Four major categories of influencing factors emerged: personal factors including lack of narrative medicine knowledge, inadequate communication skills, non-standard behaviors, work dissatisfaction, low self-learning capability, and insufficient technical skills; environmental factors including family life situations, relief benefits, working atmosphere, and hospital humanistic culture; relational factors including patient and family interactions; and organizational factors including problematic training models, low emphasis on narrative skills, and ineffective medical processes. These factors demonstrated complex interrelationships affecting overall narrative competency in nursing practice. Conclusions: The present findings demonstrate that nursing competence in medical narrative is influenced by complex, interlocking factors at multiple levels. Such evidence can be used to support nursing policy and practice improvement through comprehensive strategies including narrative medicine education, incentive-based compensation systems, adequate staffing and supportive environments, primary nursing care models, and integrated organizational approaches for humanistic nursing practice quality.