Development of a Narrative Nursing Competency Training Programme for Clinical Nurses: A Delphi Study

In hospitals, the work of a nurse is often measured by the precision of their technical skills: the correct dosage of medicine, the sterile handling of a wound, the monitoring of vital signs. These tasks are the backbone of modern healthcare, rooted in the belief that a disease is a biological problem with a standardized solution. Yet, for decades, a quieter movement has been growing within the medical world, suggesting that healing requires more than just fixing a broken body. It demands an understanding of the person living inside it. This approach, known as narrative nursing, asks caregivers to listen to the stories patients tell about their illness, to understand the fear, hope, and history that shape their experience, and to respond with genuine human connection rather than just clinical efficiency. While research has shown that listening to these stories can reduce anxiety and improve a patient's quality of life, a significant gap remained: there was no clear, structured way to teach these skills to the nurses already working in busy hospitals. Most training existed only for students or was limited to short, informal workshops, leaving experienced professionals without a roadmap to develop this vital form of care.

To address this gap, a team of researchers in China set out to build a comprehensive training program specifically designed for practicing clinical nurses. They did not simply guess what should be taught; instead, they turned to a rigorous method called the Delphi study, a process that brings together a group of experts to reach a shared agreement on complex topics. The researchers began by reviewing existing literature and drafting a preliminary outline of what a narrative nursing course might look like. They then invited seventeen experts from hospitals and universities across four provinces to review this draft. These experts, who had spent years working in nursing education, psychology, and clinical care, were asked to rate the importance of every single component of the proposed program, from the specific learning goals to the qualifications of the instructors.

The process unfolded over two rounds of consultation. In the first round, the experts reviewed eighty-eight different items, offering detailed feedback on what to keep, what to change, and what to remove. They suggested splitting some broad topics into smaller, more manageable pieces and deleting others that were redundant or difficult to apply in a real hospital setting. After the research team revised the program based on this feedback, the experts returned for a second round. By this time, the group had narrowed their focus, and their opinions had become much more aligned. The final result was a streamlined, highly structured curriculum containing seventy-three specific items. This program is organized into three main sections: theoretical knowledge, practical skills, and professional development. It covers everything from the core concepts of listening and understanding to specific techniques for helping patients reframe their stories, such as using tools like family trees or life maps to visualize their experiences. Crucially, the program also defines who should teach these courses, ensuring that instructors have the necessary background in both nursing and the psychological aspects of care.

Once the experts had agreed on the content, the researchers wanted to know if the program would actually work in the real world. They gathered a small group of eight people, including four nurse managers and four practicing nurses, for a focus group discussion. These participants reviewed the final plan and offered their thoughts on its feasibility. The response was overwhelmingly positive. The nurses felt that the content was directly relevant to their daily work, covering the emotional and psychological challenges they face every day. They appreciated the mix of online learning, which offered flexibility for busy schedules, and in-person sessions, which allowed for practicing skills and discussing real cases. However, the group also offered two practical suggestions for making the training more successful. They recommended that hospitals link the training to continuing education credits, which would provide a formal incentive for nurses to participate. They also suggested that the training should be tiered, offering different levels of difficulty for nurses with varying amounts of experience, so that beginners would not feel overwhelmed while experienced staff could still find new challenges.

The study concludes that this newly developed program is a systematic and feasible way to teach narrative nursing to clinical staff. It represents a shift from viewing nursing care as a series of isolated tasks to seeing it as a holistic practice that integrates technical skill with deep human understanding. While the program has been carefully vetted by experts and found to be practical by frontline workers, the researchers note that its true effectiveness in improving patient outcomes and nurse well-being has not yet been fully tested in large-scale trials. The work done so far provides a solid foundation and a clear guide for hospitals that wish to train their staff in the art of listening, but the journey of proving its impact on the daily reality of patient care is just beginning.