Xue Chen,Xiang-Shu Cui＊

1School of nursing,Yanbian University,Yanji,Jilin,China

Abstract

Keywords:Narrative teaching,Nursing,Nursing students,Meta-analysis

Introduction

Narrative refers to the process in which the narrator narrates his or others' experiences and stories [1].Narrative education method refers to a teaching method that educators reconstruct and narrate their own or others' experiences and stories to help students understand and master the teaching contents, so as to achieve the teaching purpose [2].This concept originated from 1993, when Diekelmann, an American doctor of nursing education, introduced narrative education into the field of nursing education for the first time in his research [3].In China, Wang lei [4]proposed narrative research as a new qualitative research method in the field of nursing in 2006.Then in 2012, some scholars proposed that narrative education is not only a research method, but also a teaching method [5].Since then, narrative teaching method has been widely concerned in various fields.

The famous American educator John Dewey once said, “Education is the reconstruction of experience”[6], and the narrative teaching method is a method to transform experience into educational concept and improve the teaching effect [7].Although narrative nursing teaching started late in China, it has been widely used in recent years.With the rapid development of higher nursing education, narrative teaching method has gradually become a hot issue in the field of nursing education,but at present,according to the theory of narrative teaching method in nursing students application effect yet little empirical analysis of the whole.This study adopts the method of Meta analysis on the application of narrative teaching method in nursing education are summarized, and based on its effects on the nursing students various aspects ability to clear narrative in the field of teaching method in nursing research present situation and the narrative method of teaching for nursing education field in the future application.

Materials and methods

Inclusion criteria and exclusion criteria

Inclusion criteria.(1) Research objects:nursing students, not limited to the grade, education.(2) The intervention group applied narrative nursing teaching method (including theoretical narrative teaching method,clinical narrative teaching method,etc.),while the control group applied traditional teaching method(including traditional classroom teaching method,traditional clinical teaching method,etc.).(3)Research design.Randomized Controlled Trial (RCT).(4)Outcomes.Theoretical score, skill operation score,humanistic care ability and empathy level of nursing students(no limitation on scale type)

Exclusion criteria.(1) Repeated literature and reports;(2)Insufficient data report or no measurement data.

Literature search strategy

Retrieval of databases.This study systematically retrieves randomized controlled trials published in Chinese and foreign databases, including CNKI, VIP,Wanfang, the Cochrane Library, PubMed, Web of Science, Science Direct database, as far as possible to reduce the missing document, further retrieval into the research of reference, in addition to topic review,system evaluation and Meta analysis of the literature search, and track them into research and reference.Specific retrieval steps:Firstly, search whether there is meta-analysis or systematic evaluation related to the topic in the database, and further search the references of the included studies.Secondly, by carefully analyzing the titles, keywords, and abstract contents of relevant papers in the database, the key words to be retrieved are determined.

Search terms.Finally, the key words were searched comprehensively in the database and all references that met the inclusion criteria were further tracked.The deadline is set up until October 22, 2019, with no language limit.Chinese keywords:narrative teaching,narrative education, nursing, nursing students.English keywords:narrative pedagogy, narrative, nursing,nursing student.

Literature screening and data extraction

Literature screening and evaluation by two independent researchers, carefully read the full text extracted after the following information:Researchers,year, type, sample size, the object of study, method of intervention,the intervention time, outcome indicators,such as have not sure of the literature, two people together to solve, when need please the third researchers help to discuss and make a decision.

Literature quality evaluation

The quality assessment of the included literature was conducted independently by two researchers according to the Cochrane Handbook (5.1.0) quality evaluation criteria.“Yes”, “no” and “unclear” are used to indicate the degree of bias risk.In case of uncertainty, a third researcher is invited to discuss it together[8].

Statistical analysis

Meta analysis was performed using Revman5.3 software.The included literature was expressed as 95% Confidence Interval (CI), and inter-study heterogeneity was determined by chi-square test(see 0.05).IfP≥0.1 and I ＜50%, there was no statistical heterogeneity, and the fixed effect model was used for analysis.IfP＜0.1 and I ≥50%, there was clinical homogeneity, then the random effect model was used for analysis, and the subgroup analysis was conducted to find the source of possible heterogeneity.For each included literature, the Standardized mean difference(SMD) value and 95%CI value were examined with different effect models,and the results of meta-analysis after the large sample study were removed were examined to verify the stability of the results of this study.

Results

Literature retrieval results

After preliminary search,1060 literature were obtained,and 147 literature were removed by using NoteExpress software.After further reading of the title and abstract of the literature, 875 literature unrelated to the topic and non-experimental researches were removed.After detailed full-text reading of the remaining literature,experimental researches and incomplete literature were removed.In the end, a total of 14 articles (1 in English and 13 in Chinese) were included in this study (Yang[9] conducted a cluster randomized controlled experiment of a control group and two experimental groups), all of which were done by Chinese researchers, with a total of 1,804 nursing students, and the basic characteristics of the articles are shown in Table 1.

Table 1:Includes the basic features of the literature

Quality evaluation of included studies

A total of 14 literature were included, and the quality evaluation results are shown in Table 2.

Results of meta-analysis

Influence of narrative nursing teaching method on theoretical knowledge acquisition of nursing students.Twelve [10-18, 20-22]literature were included, and 12 randomized controlled experimental studies were conducted, with data of I=97% andP＜ 0.01.Therefore, the random effects model was adopted for meta-analysis, and the results showed that narrative nursing teaching method could help improve the theoretical knowledge mastery of nursing students[SMD=1.34, 95%CI 0.70-1.97,P＜0.01], and the difference was statistically significant.Through subgroup analysis, it was found that narrative nursing teaching method had a more significant effect on improving the theoretical performance of nursing students in practice,as shown in Figure 1.

Table 2:Literature quality assessment

Influence of narrative nursing teaching method on operational skills of nursing students.6 randomized controlled experiments [11, 13, 16, 20-22] were included, and I=94%,P＜ 0.01.Therefore, the random effects model was adopted for meta-analysis,and the results showed that narrative nursing teaching method could improve the skill operation ability of nursing students [SMD=1.30, 95%CI 0.65-1.96,P＜0.01], and the difference was statistically significant.The results of the subgroup analysis show that narrative nursing teaching method has a more significant impact on improving the skill operation ability of nursing students,as shown in Figure 2.

Influence of narrative nursing teaching method on humanistic care ability of nursing students.A total of 3 randomized controlled experiments [14,17,19]were included, I=90%,P＜0.01.Therefore, the random effects model was adopted for meta-analysis, and the results showed that narrative nursing teaching method could improve the humanistic care ability of nursing students [SMD=0.98, 95%CI 0.26-1.69,P＜0.01],and the difference was statistically significant.As shown in Figure 3.

Influence of narrative nursing teaching method on the empathy level of nursing students.Participants included 4,10,15,18 research, 11 randomized controlled trial (including Yang[9]in the experimental process of the top 1, 5 times, after the test were conducted six point of measurement),I squared=29%,P＜0.01, the fixed effects model is adopted for Meta analysis, results show that the narrative nursing teaching method can significantly improve the level of empathy of nursing students [SMD=6.13, 95% CI 5.15-7.11,P＜0.01), and the difference is statistically significant.The results are shown in Figure 4.

Publication bias

Fewer literature were included in this study,and funnel plot was relatively symmetrical.After Egger method test was conducted with Stata software, it was found thatP=0.978 ＞0.05,suggesting that the possibility of publication bias in this study was low.

Sensitivity analysis

Excluding large sample studies had no substantial effect on the results of this meta-analysis, suggesting that the results of this study were stable.

Discussion

Narrative method of teaching is a kind of phenomenological method of nursing education [23],can help students to focus on specific nursing from results into a focus on how to listen and respond to the patient's experience[24],in this process,educators and students share, memory and thinking about the experiences of nursing behavior in each other,to break the traditional education only rely on isolation of educators to impart knowledge alone [25], has become an important field of nursing education teaching methods.

The results of this meta-analysis show that narrative nursing teaching method can significantly improve nursing students’mastery of theoretical knowledge and operational skills, but the effect on practical nursing students is better than that on school nursing students.Practice to protect the biological in real clinical environment, the nursing professional knowledge and skills will have a more practical experience, for the content of the narrative care more can empathy [26], combined with the clinical teaching of the teacher's precept,make practice nursing students in high school,learning to think it over and over again,in thinking about the deepening impression, eventually achieve the knowledge and skills of mastering [27].Clinical practice is the transition stage of nursing students from students to clinical nurses, and it is also a critical period in their career[28].It can be seen that the application of narrative nursing teaching method in this stage can play a far-reaching role.

Meta-analysis results based on three randomized controlled trials show that narrative nursing teaching can significantly improve the humanistic care ability of nursing students, which is consistent with the research results of Qin YL,et al.[29].Narrative nursing can help nurses analyze patients'diseases from the external body to the internal psychology [30] through the four stages of "attention, understanding, reflection and response", and even include patients' social, emotional and spiritual aspects.The teaching method of narrative nursing follows the connotation of narrative nursing.By taking art, film or literature as the carrier and storytelling as the way of expression, it provides nursing students with a near-real humanistic caring environment and helps nursing students form relevant moral qualities[31,32].

Meta-analysis results based on 4 randomized controlled trials showed that narrative nursing teaching can significantly improve the empathy level of nursing students, and foreign scholar Barbara [33] also obtained the same results in a qualitative study.The application of narrative nursing teaching method enables nursing students to interpret and respond to patients' stories and dilemmas [34, 35], and conduct in-depth and effective communication with patients through empathy in nursing activities.Parsons, et al.[36] believed that narrative teaching method could enable nursing students to develop the ability of self-reflection and empathy through text analysis.In narrative nursing teaching method, nursing students record patients' stories and reflect on their nursing behaviors through reflective writing, so as to improve their nursing ability and empathy.

Conclusion

This study uses Meta analysis to analyze the narrative nursing teaching for nursing students theoretical knowledge,operation skills and humanistic care ability and the level of empathy effect, but because of the limitation of current research related RCT number cannot under the action of different intervention time effect analysis, still need further exploration in the future, thus application narrative nursing teaching method in nursing education field to provide more reliable basis.