Does experience undermine expertise? The paradoxical relationship between clinical tenure and narrative competence in psychiatric nursing

Does experience undermine expertise? 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The paradoxical relationship between clinical tenure and narrative competence in psychiatric nursing Yanhua Qu, Jing Zhao, Saiying Gao, Lian Qiu, jing Shao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8849020/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Globally, psychiatric nurses practice in high-stress clinical environments that pose a heightened risk of burnout, making narrative competence a critical skill for establishing therapeutic alliances. Although clinical experience is traditionally considered to enhance such competencies, this assumption has not been adequately examined in high-demand healthcare settings. This study aimed to assess the level of narrative competence among psychiatric nurses in China, with particular focus on evaluating the roles of education, systematic training, and clinical experience as its key predictors. Methods A cross-sectional survey was conducted among 525 registered nurses from a tertiary psychiatric hospital in Beijing. Participants completed the Narrative Competence Scale for Medical Practitioners (NCSMP). Data on demographic characteristics, educational level, systematic narrative training, and years of psychiatric work experience were collected. Multiple linear regression analysis was employed to identify factors influencing narrative competence. Results The nurses demonstrated a significant gap between narrative cognition (81.81% of maximum score) and narrative behavior (76.97%), with peer communication being the weakest area. Multiple linear regression revealed that higher education (β = 0.144, p = .002) and systematic narrative training (β = 0.127, p = .003) were positive predictors of narrative competence. Contrary to conventional wisdom, a longer tenure in psychiatry unexpectedly predicted lower competence (β= -0.188, p < .001).The regression model explained 7.6% of the variance (Adjusted R² = 0.076). Conclusion This study challenges the foundational assumption that experience alone fosters narrative skills, revealing that prolonged clinical exposure without structured support can erode core humanistic capacities. This erosion effect underscores the urgent need for healthcare institutions to integrate sustained, systematic narrative training into lifelong professional development. Specific strategies including reflective practices and Balint groups are critical to counteract this trend, safeguard nurse well-being, and ensure the delivery of empathetic, relationship-centered care. Psychiatric nursing Narrative competence Clinical experience Humanistic care Cross-sectional study Person-environment fit Background Mental disorders represent a major and increasing global public health burden [ 1 – 3 ], posing ongoing challenges to healthcare systems worldwide. The World Health Organization highlights their profound societal and economic impact and advocates for effective, person-centered mental health interventions [ 4 – 6 ]. In China, a national survey reported a high lifetime prevalence of mental disorders among adults [ 7 ], underscoring the substantial demand for humane mental health service. The complexity and prolonged nature of psychiatric care demand that nurses not only possess clinical expertise but also humanistic communication skills to foster therapeutic alliances and actively support patient recovery [ 8 , 9 ]. Narrative medicine serves as a crucial tool for fostering medical humanism [ 10 ] and plays a vital role in psychiatric nursing. Since its inception, it has aimed to bridge medical differences and promote harmony between doctors and patients [ 11 , 12 ]. 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 [ 13 – 16 ]. In this context, narrative competence, defined as the ability to access, comprehend, and integrate patients’ stories and dilemmas, operationalizes this philosophy as an integrative ability. This competence includes understanding narrative structures, engaging in reflective practice, and responding to patients' illness narratives through empathic communication [ 17 – 19 ]. In psychiatric settings, where patients’ subjective experiences and identity disruption are central to diagnosis and healing, narrative competence may support empathy development, therapeutic alliance building, and patients’ reconstruction of a coherent self-narrative [ 20 , 21 ]. 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 [ 22 – 25 ]. However, 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 [ 19 , 26 ]. This challenge is particularly pronounced in pediatric care [ 18 ], but also extends to psychiatric nursing contexts. This gap between theoretical awareness and practical application can be understood through the lens of Person-Environment Fit Theory [ 27 ], which suggests that performance and well-being result from the interaction between individual capabilities and workplace demands, particularly in emotionally demanding environments like psychiatric nursing [ 25 ]. This theoretical perspective is complemented by frameworks of reflective practice and professional burnout [ 28 ], which help explain how emotionally demanding psychiatric environments may theoretically influence narrative openness and empathic engagement over time. While clinical experience contributes to knowledge accumulation, prolonged emotional labor may lead to compassion fatigue or emotional distancing [ 29 ], which could affect narrative competence. In China, research has similarly highlighted patient-centered outcomes [ 17 ], yet a key gap remains in understanding nurses' own narrative competencies, which are essential for effective narrative-based care implementation. Therefore, this study aimed to assess the current level of narrative competence among psychiatric nurses in China, examining how educational background, systematic narrative training, and psychiatric work tenure can directly impact clinical practice. Specifically, we explore how improving narrative competence in nurses can strengthen the therapeutic alliance, improve patient communication, and enhance overall care quality in psychiatric settings, while also testing the hypothesis that prolonged clinical exposure without adequate support might potentially undermine rather than enhance this core humanistic capacity. Methods Study Design and Participants A quantitative, cross-sectional study design was employed. Using a convenience sampling method, registered psychiatric nurses from a tertiary psychiatric hospital in Beijing were recruited between November 11 and 20, 2024. The inclusion criteria were: (1) a registered nurse employed in a psychiatric department, and (2) possession of a valid nursing practice certificate. Nurses who were on extended leave (e.g., maternity, sick, or study leave) or in non-clinical roles during the survey period were excluded. The sample size was determined based on the principle of 5–10 participants per independent variable. With 12 independent variables initially considered and an allowance for a 20% invalid response rate, the minimum required sample size was calculated to be between 72 and 144. The final sample of 525 participants significantly exceeded this requirement, ensuring adequate statistical power for the analysis. Ethical Considerations This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. According to the institutional policy and because the research involved a survey of healthcare professionals without collecting sensitive personal identifiers, it was exempt from formal ethical review board approval. Prior to participation, all nurses provided informed consent through a mandatory statement at the beginning of the online questionnaire, which clearly explained the study purpose, voluntary nature, anonymity of data, and their right to withdraw at any time. All data were collected and stored anonymously to ensure participant confidentiality. Instruments (1) General Information Questionnaire: A self-designed form used to collect demographic and professional characteristics, including age, gender, education level, years of psychiatric work experience, and whether they had received systematic narrative training. (2) Narrative Competence Scale for Medical Practitioners (NCSMP): This 61-item scale, developed by Yang Xiaolin et al.[ 30 ], was used to assess narrative competence. It comprises two subscales: Narrative Cognition (23 items) and Narrative Behavior (38 items). Items are rated on a 4-point Likert scale, ranging from 1 (strongly disagree) to 4 (strongly agree), with total scores ranging from 61 to 244. The scale has demonstrated good reliability, with a Cronbach's α coefficient of 0.978 in this study. Data Collection and Quality Control Data collection was conducted online via a survey platform. To ensure data quality, several control measures were implemented: (1) each IP address was restricted to a single submission to prevent duplicate responses; (2) all questionnaire items were set as mandatory to avoid missing data; and (3) responses with implausibly short completion times (less than 5 minutes) were excluded from the final analysis. Statistical Analysis Data analysis was performed using SPSS software (version 26.0). Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarize the participants' characteristics and narrative competence scores. Independent sample t-tests and one-way analysis of variance (ANOVA) were employed to examine group differences in narrative competence scores based on categorical variables. Pearson correlation analysis was conducted to explore the relationships between narrative competence scores and other continuous variables. Multiple linear regression analysis was used to identify the factors influencing the overall NCSMP total score, which was treated as the dependent variable. The independent variables entered into the regression model included educational level (coded ordinally: 1 = Associate Degree, 2 = Bachelor's Degree, 3 = Master's Degree or above), systematic narrative training (coded as 1 = Yes, 0 = No), and psychiatric work tenure (treated as a continuous variable in years). Multicollinearity among the independent variables was assessed using tolerance (Tol) and the variance inflation factor (VIF), with Tol > 0.4 and VIF < 3 indicating no significant multicollinearity. A p-value of less than 0.05 was considered statistically significant for all analyses. Results Participant Characteristics A total of 525 registered nurses from a tertiary psychiatric hospital in Beijing successfully completed the survey. The majority of participants were female (68.4%) and held a bachelor’s degree (59.2%). A significant proportion of the nurses had extensive clinical experience in psychiatry, with 67.4% having worked in the field for over 10 years. Slightly more than half of the participants (53.9%) reported having received systematic narrative training. The detailed demographic and professional characteristics of the participants are presented in Table 1 . Table 1 Demographic and Professional Characteristics of Participants (N = 525) Characteristic n (%) Gender Male 166 (31.62) Female 359 (68.38) Education Level Associate Degree 185 (35.24) Bachelor’s Degree 330 (62.86) Master’s Degree or above 10 (1.90) Years of Psychiatric Experience 20 years 166 (31.62) Received Systematic Narrative Training Yes 283 (53.90) No 242 (46.10) Scores of narrative competence The overall narrative competence score for the participants was 193.44 ± 26.87, which represents 79.27% of the maximum possible score, indicating a level of basic narrative awareness. A notable discrepancy was observed between the Narrative Cognition subscale (75.27 ± 13.65, 81.81% of maximum score) and the Narrative Behavior subscale (117.36 ± 22.33, 76.97% of maximum score), suggesting a cognitive-behavioral gap. The dimension of ‘Peer Narrative Communications’ within the behavioral subscale received the lowest score (12.57 ± 2.49). The detailed scores for each domain and dimension are shown in Table 2 . Table 2 Narrative Competence Scores among Psychiatric Nurses (N = 525) Domain/Dimension Items Score (Mean ± SD) Percentage of Total Score (%) Narrative Cognition Subscale ​ 23 75.27 ± 13.65 81.81 Life-Health Narrative Awareness 9 28.93 ± 5.64 Professional Narrative Thinking 14 46.33 ± 8.37 Narrative Behavior Subscale 38 117.36 ± 22.33 76.97 Life-Health Narrative Behaviors 8 25.22 ± 4.75 Family Narrative Connections 8 25.31 ± 4.96 Career Narrative Development 8 25.88 ± 6.73 Peer Narrative Communications 5 12.57 ± 2.49 Doctor-Patient Narrative Interactions 9 28.36 ± 5.43 Total Score 61 193.44 ± 26.87 79.27 Note: A score ≤ 60% of the total indicates low Narrative Competence; a score between 60% and 80% reflects basic narrative awareness; a score between 80% and 90% suggests narrative thinking; and a score ≥ 90% of the total signifies narrative wisdom. Factors influencing narrative competence Multiple linear regression analysis was performed to identify the key factors influencing the overall narrative competence score. The results indicated that a higher education level (β = 0.144, p=.002) and having received systematic narrative training (β = 0.127, p= .003) were significant positive predictors of narrative competence. Crucially, and contrary to conventional assumptions, a longer tenure in psychiatric nursing was a significant negative predictor of narrative competence (β= -0.188, p < .001). The regression model, which included these three variables, was statistically significant (F = 18.208, p < .001) and explained 7.6% of the total variance in narrative competence scores (Adjusted R² = 0.076). Multicollinearity diagnostics confirmed that tolerance values were greater than 0.4 and variance inflation factor (VIF) values were below 3, indicating no multicollinearity concerns among the predictors. The detailed results of the regression analysis are presented in Table 3 . Table 3 Multiple Linear Regression Analysis of Factors Influencing narrative competence (N = 525) Variable​ B​ SE​ β​ t-value​ P-value​ 95% CI (Constant) 193.436 13.969 13.848 < 0.001 165.987 ~ 220.885 Educational Level 8.285 2.660 0.144 3.114 0.002 3.052 ~ 13.518 Psychiatric Work Experience (Years) -3.418 1.025 -0.188 -3.334 < 0.001 -5.431~ -1.405 Systematic Narrative Training (Yes) 8.643 2.889 0.127 2.991 0.003 2.965 ~ 14.321 Note: R² = 0.086, Adjusted R² = 0.076. Discussion This study provides important insights into the current status and influencing factors of narrative competence among psychiatric nurses in China. The key findings reveal a moderate overall level of narrative competence, a discernible cognition-behavior gap, and most significantly, a counterintuitive negative association between years of clinical experience and narrative competence. These results challenge conventional assumptions and have substantial implications for nursing education and practice. From Awareness to Action: Addressing the Narrative Competence Implementation Gap Our findings indicate that while nurses possess a relatively high level of narrative cognition (81.81%), their ability to translate this understanding into actual narrative behaviors is comparatively lower (76.97%). This “knowing-doing” gap, consistent with findings in pediatric nursing [ 18 , 31 ], represents a critical challenge in clinical practice. The Person-Environment Fit theory [ 27 ] helps explain why this implementation gap persists: high workload intensity and extensive documentation demands in psychiatric settings often leave limited protected time for meaningful narrative engagement [ 32 ]. When healthcare organizations prioritize quantifiable outcomes over essential communication skills, nurses receive inadequate institutional support to bridge this gap [ 33 ]. The particularly low performance in “Peer Narrative Communications” underscores an organizational challenge: the lack of structured platforms for narrative exchange among nursing staff weakens the overall narrative culture [ 33 ]. This finding suggests that enhancing narrative competence requires not only individual training but also creating supportive workplace environments where narrative practices are valued and facilitated [ 34 ] . The Experience Paradox: When Clinical Tenure Undermines Narrative Competence Contrary to expectations that experience enhances skills, our analysis revealed that longer tenure in psychiatric nursing predicted lower narrative competence. This paradox has significant implications for how we support career development in nursing. Senior nurses educated under traditional biomedical curricula may find it challenging to adapt to contemporary narrative approaches [ 35 ], highlighting the need for continuous professional education. More importantly, prolonged exposure to emotionally demanding environments may lead to protective emotional distancing, a psychological coping mechanism that preserves psychological well-being at the potential cost of diminished empathic responsiveness over time [ 36 ]. This finding challenges the assumption that clinical exposure naturally preserves humanistic capacities [ 8 ] and indicates that without structured organizational support, experience may gradually erode essential narrative competencies. Beyond Education and Training: Unexplored Factors in Narrative Competence Development Although our identified factors were statistically significant, they explained only 7.6% of the total variance in narrative competence scores. This modest explanatory power points to the importance of factors beyond formal education and training systems. Individual characteristics such as inherent empathy, emotional stability, and reflective practice habits [ 17 , 37 , 38 ], along with organizational factors including leadership styles and team psychological safety [ 39 – 41 ], likely play crucial roles in narrative competence development. This limited explanatory power also highlights methodological considerations. While self-report measures provide valuable insights, they may not fully capture the complex, context-dependent nature of narrative competence in real clinical settings [ 19 ]. Future research should employ multi-method approaches to better understand the comprehensive ecosystem supporting narrative competence. Building Support Systems: Educational and Organizational Strategies for Sustainable Competence Our findings suggest that sustaining narrative competence requires a systematic approach spanning educational and organizational domains. Educational institutions should integrate narrative medicine into core curricula using experiential methods like reflective writing and situational simulations [ 42 , 43 ]. Healthcare organizations need to implement formal assessment systems and provide protected reflection platforms such as Narrative Nursing Workshops [ 23 , 44 ]. For experienced nurses specifically, institutions should develop targeted programs that address the unique challenges of maintaining narrative competence over a long career. This might include mentorship programs pairing senior and junior nurses, regular reflective practice sessions, and leadership training that emphasizes the value of narrative skills in clinical supervision and team management [ 45 ]. Navigating Limitations and Future Directions for Narrative Competence Research Several limitations of our study point to important directions for future research. The cross-sectional design prevents causal inferences, suggesting the need for longitudinal studies tracking the evolution of narrative competence throughout nurses’ careers. The single-center sampling, while controlling for institutional variations, limits generalizability, indicating the value of multi-center studies across diverse healthcare settings. Future research should also explore the organizational and environmental factors that our model did not capture, particularly how different leadership styles, team dynamics, and institutional policies either support or hinder the development and maintenance of narrative competence over time. Limitations Several limitations of this study should be considered when interpreting the results. First, the cross-sectional design prevents us from establishing causal relationships among the variables. While we identified significant associations, the direction of these relationships requires verification through longitudinal studies. Second, the convenience sampling method from a single tertiary psychiatric hospital, although controlling for inter-institutional variations, may limit the generalizability of our findings to other healthcare settings or regions. Third, the reliance on self-reported measures may introduce social desirability bias, where participants might provide responses they believe are socially acceptable rather than reflecting their actual practices. Additionally, while the NCSMP demonstrated good reliability, its self-report nature may not fully capture the complex, context-dependent manifestation of narrative competence in real clinical environments. Finally, our model explained only 7.6% of the variance in narrative competence scores, indicating that other important individual and organizational factors not measured in this study likely contribute to narrative competence development. Conclusions This study indicates that psychiatric nurses’ narrative competence is at a moderate level, with a noticeable gap between cognitive understanding and practical application. Contrary to expectations, longer clinical experience predicted lower narrative competence, suggesting a potential erosion effect in high-demand environments lacking systematic support. While higher education and narrative training were positive influencing factors, the complex nature of narrative competence necessitates multidimensional improvement strategies. These findings highlight the importance of implementing personalized educational approaches and fostering supportive workplace environments to enhance narrative competence in psychiatric nursing practice. Declarations Ethics approval and consent to participate This study involved an anonymous online survey of healthcare professionals, with no collection of personally identifiable information. It was granted an exemption from formal ethical review by the Ethics Committee of Beijing Huilongguan Hospital, Capital Medical University, in accordance with national regulations and the principles of the Declaration of Helsinki. Detailed study information was provided on the first page of the questionnaire. Participants’ voluntary completion of the survey was taken as their implied informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding This research was supported by the Beijing Research Ward Excellence Program (BRWEP), grant number BRWEP2024W072130116. Author Contribution YQ: Conceived and designed the study, collected the data, analysed and interpreted the data, and wrote the manuscript. JS: Conceived and designed the study, and wrote the manuscript. SG: Collected the data. LQ: Collected the data. JZ: Analysed and interpreted the data. 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Implementing learning into practice from continuous professional development activities: a scoping review of health professionals' views and experiences. BMC Med Educ. 2024;24(1):1031. Luo Y, Chen Y, Feng M. The Perception of Career Planning and Development Among Senior Clinical Nurses: A Qualitative Analysis. Int Nurs Rev. 2025;72(3):e70050. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 07 Apr, 2026 Editor invited by journal 18 Mar, 2026 Editor assigned by journal 13 Feb, 2026 Submission checks completed at journal 13 Feb, 2026 First submitted to journal 11 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8849020","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":620351015,"identity":"38f4b4d0-ab54-4628-a5b6-644f6188033f","order_by":0,"name":"Yanhua Qu","email":"","orcid":"","institution":"Beijing Huilongguan Hospital, Capital Medical University, Beijing, China","correspondingAuthor":false,"prefix":"","firstName":"Yanhua","middleName":"","lastName":"Qu","suffix":""},{"id":620351018,"identity":"9c62c8ce-0ee9-42ae-a92d-685f7cc3fc1b","order_by":1,"name":"Jing Zhao","email":"","orcid":"","institution":"Beijing Huilongguan Hospital, Capital Medical University, Beijing, China","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Zhao","suffix":""},{"id":620351020,"identity":"c30278da-6d92-46e0-bfcc-0a9ef58e6f81","order_by":2,"name":"Saiying Gao","email":"","orcid":"","institution":"Beijing Huilongguan Hospital, Capital Medical University, Beijing, China","correspondingAuthor":false,"prefix":"","firstName":"Saiying","middleName":"","lastName":"Gao","suffix":""},{"id":620351024,"identity":"4a26a028-056c-4b2e-b91a-889558a7136f","order_by":3,"name":"Lian Qiu","email":"","orcid":"","institution":"Beijing Huilongguan Hospital, Capital Medical University, Beijing, China","correspondingAuthor":false,"prefix":"","firstName":"Lian","middleName":"","lastName":"Qiu","suffix":""},{"id":620351026,"identity":"0d7d9ade-0d31-4c9f-9556-73e845e5e6bc","order_by":4,"name":"jing Shao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIie2ROwrCQBBAJwSSJph2U+UKA4JYhHiVyMLabCF4gYiNhQcIeIl4g8RBbTxAihSKYGWRSiws3Ci2SUrBfTDFwDzmB6DR/CKsDgSw7HmcVRiE3RXXoTxPpoJ3U2q8RHByqq0Rtxn+enE+DadlmBYSKcDMBJt2aZOC5b6PDK88Pd6QJJY9cIQoGhUWDRhD4niQtXI1gTmDRsVPJvePkilliGTEbQoU8t0l9JYiIuiiYCFnaheK1JGzfIWCW227qME2F/akkXrlono8g9C1ad88mMJUvxnH38xqK68xKoBRl0KNRqP5U15f6lE5C+7YgAAAAABJRU5ErkJggg==","orcid":"","institution":"Beijing Huilongguan Hospital, Capital Medical University, Beijing, China","correspondingAuthor":true,"prefix":"","firstName":"jing","middleName":"","lastName":"Shao","suffix":""}],"badges":[],"createdAt":"2026-02-11 08:24:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8849020/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8849020/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106759157,"identity":"927005f8-8f13-44be-ac23-a66cf30f5e4a","added_by":"auto","created_at":"2026-04-13 08:28:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":904678,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8849020/v1/58fea10b-0980-4259-bb13-863669598d9e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does experience undermine expertise? The paradoxical relationship between clinical tenure and narrative competence in psychiatric nursing","fulltext":[{"header":"Background","content":"\u003cp\u003eMental disorders represent a major and increasing global public health burden [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], posing ongoing challenges to healthcare systems worldwide. The World Health Organization highlights their profound societal and economic impact and advocates for effective, person-centered mental health interventions [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In China, a national survey reported a high lifetime prevalence of mental disorders among adults [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], underscoring the substantial demand for humane mental health service. The complexity and prolonged nature of psychiatric care demand that nurses not only possess clinical expertise but also humanistic communication skills to foster therapeutic alliances and actively support patient recovery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNarrative medicine serves as a crucial tool for fostering medical humanism [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and plays a vital role in psychiatric nursing. Since its inception, it has aimed to bridge medical differences and promote harmony between doctors and patients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. 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 [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In this context, narrative competence, defined as the ability to access, comprehend, and integrate patients\u0026rsquo; stories and dilemmas, operationalizes this philosophy as an integrative ability. This competence includes understanding narrative structures, engaging in reflective practice, and responding to patients' illness narratives through empathic communication [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn psychiatric settings, where patients\u0026rsquo; subjective experiences and identity disruption are central to diagnosis and healing, narrative competence may support empathy development, therapeutic alliance building, and patients\u0026rsquo; reconstruction of a coherent self-narrative [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. 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 [\u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, 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 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This challenge is particularly pronounced in pediatric care [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], but also extends to psychiatric nursing contexts. This gap between theoretical awareness and practical application can be understood through the lens of Person-Environment Fit Theory [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], which suggests that performance and well-being result from the interaction between individual capabilities and workplace demands, particularly in emotionally demanding environments like psychiatric nursing [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis theoretical perspective is complemented by frameworks of reflective practice and professional burnout [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], which help explain how emotionally demanding psychiatric environments may theoretically influence narrative openness and empathic engagement over time. While clinical experience contributes to knowledge accumulation, prolonged emotional labor may lead to compassion fatigue or emotional distancing [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], which could affect narrative competence. In China, research has similarly highlighted patient-centered outcomes [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], yet a key gap remains in understanding nurses' own narrative competencies, which are essential for effective narrative-based care implementation.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to assess the current level of narrative competence among psychiatric nurses in China, examining how educational background, systematic narrative training, and psychiatric work tenure can directly impact clinical practice. Specifically, we explore how improving narrative competence in nurses can strengthen the therapeutic alliance, improve patient communication, and enhance overall care quality in psychiatric settings, while also testing the hypothesis that prolonged clinical exposure without adequate support might potentially undermine rather than enhance this core humanistic capacity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Participants\u003c/h2\u003e \u003cp\u003eA quantitative, cross-sectional study design was employed. Using a convenience sampling method, registered psychiatric nurses from a tertiary psychiatric hospital in Beijing were recruited between November 11 and 20, 2024. The inclusion criteria were: (1) a registered nurse employed in a psychiatric department, and (2) possession of a valid nursing practice certificate. Nurses who were on extended leave (e.g., maternity, sick, or study leave) or in non-clinical roles during the survey period were excluded.\u003c/p\u003e \u003cp\u003eThe sample size was determined based on the principle of 5\u0026ndash;10 participants per independent variable. With 12 independent variables initially considered and an allowance for a 20% invalid response rate, the minimum required sample size was calculated to be between 72 and 144. The final sample of 525 participants significantly exceeded this requirement, ensuring adequate statistical power for the analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. According to the institutional policy and because the research involved a survey of healthcare professionals without collecting sensitive personal identifiers, it was exempt from formal ethical review board approval. Prior to participation, all nurses provided informed consent through a mandatory statement at the beginning of the online questionnaire, which clearly explained the study purpose, voluntary nature, anonymity of data, and their right to withdraw at any time. All data were collected and stored anonymously to ensure participant confidentiality.\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003e(1) General Information Questionnaire: A self-designed form used to collect demographic and professional characteristics, including age, gender, education level, years of psychiatric work experience, and whether they had received systematic narrative training.\u003c/p\u003e \u003cp\u003e(2) Narrative Competence Scale for Medical Practitioners (NCSMP): This 61-item scale, developed by Yang Xiaolin et al.[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], was used to assess narrative competence. It comprises two subscales: Narrative Cognition (23 items) and Narrative Behavior (38 items). Items are rated on a 4-point Likert scale, ranging from 1 (strongly disagree) to 4 (strongly agree), with total scores ranging from 61 to 244. The scale has demonstrated good reliability, with a Cronbach's α coefficient of 0.978 in this study.\u003c/p\u003e\n\u003ch3\u003eData Collection and Quality Control\u003c/h3\u003e\n\u003cp\u003eData collection was conducted online via a survey platform. To ensure data quality, several control measures were implemented: (1) each IP address was restricted to a single submission to prevent duplicate responses; (2) all questionnaire items were set as mandatory to avoid missing data; and (3) responses with implausibly short completion times (less than 5 minutes) were excluded from the final analysis.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using SPSS software (version 26.0). Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarize the participants' characteristics and narrative competence scores. Independent sample t-tests and one-way analysis of variance (ANOVA) were employed to examine group differences in narrative competence scores based on categorical variables. Pearson correlation analysis was conducted to explore the relationships between narrative competence scores and other continuous variables.\u003c/p\u003e \u003cp\u003eMultiple linear regression analysis was used to identify the factors influencing the overall NCSMP total score, which was treated as the dependent variable. The independent variables entered into the regression model included educational level (coded ordinally: 1\u0026thinsp;=\u0026thinsp;Associate Degree, 2\u0026thinsp;=\u0026thinsp;Bachelor's Degree, 3\u0026thinsp;=\u0026thinsp;Master's Degree or above), systematic narrative training (coded as 1\u0026thinsp;=\u0026thinsp;Yes, 0\u0026thinsp;=\u0026thinsp;No), and psychiatric work tenure (treated as a continuous variable in years). Multicollinearity among the independent variables was assessed using tolerance (Tol) and the variance inflation factor (VIF), with Tol\u0026thinsp;\u0026gt;\u0026thinsp;0.4 and VIF\u0026thinsp;\u0026lt;\u0026thinsp;3 indicating no significant multicollinearity. A p-value of less than 0.05 was considered statistically significant for all analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eA total of 525 registered nurses from a tertiary psychiatric hospital in Beijing successfully completed the survey. The majority of participants were female (68.4%) and held a bachelor\u0026rsquo;s degree (59.2%). A significant proportion of the nurses had extensive clinical experience in psychiatry, with 67.4% having worked in the field for over 10 years. Slightly more than half of the participants (53.9%) reported having received systematic narrative training. The detailed demographic and professional characteristics of the participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and Professional Characteristics of Participants (N\u0026thinsp;=\u0026thinsp;525)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e166 (31.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e359 (68.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssociate Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e185 (35.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e330 (62.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u0026rsquo;s Degree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (1.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of Psychiatric Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86 (16.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70 (13.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (2.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e75 (14.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e113 (21.52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e166 (31.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceived Systematic Narrative Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e283 (53.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e242 (46.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eScores of narrative competence\u003c/h3\u003e\n\u003cp\u003eThe overall narrative competence score for the participants was 193.44\u0026thinsp;\u0026plusmn;\u0026thinsp;26.87, which represents 79.27% of the maximum possible score, indicating a level of basic narrative awareness. A notable discrepancy was observed between the Narrative Cognition subscale (75.27\u0026thinsp;\u0026plusmn;\u0026thinsp;13.65, 81.81% of maximum score) and the Narrative Behavior subscale (117.36\u0026thinsp;\u0026plusmn;\u0026thinsp;22.33, 76.97% of maximum score), suggesting a cognitive-behavioral gap. The dimension of \u0026lsquo;Peer Narrative Communications\u0026rsquo; within the behavioral subscale received the lowest score (12.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49). The detailed scores for each domain and dimension are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNarrative Competence Scores among Psychiatric Nurses (N\u0026thinsp;=\u0026thinsp;525)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain/Dimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScore (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage of Total Score (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNarrative Cognition Subscale\u003c/b\u003e​\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e75.27\u0026thinsp;\u0026plusmn;\u0026thinsp;13.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLife-Health Narrative Awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e28.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional Narrative Thinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e46.33\u0026thinsp;\u0026plusmn;\u0026thinsp;8.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNarrative Behavior Subscale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e117.36\u0026thinsp;\u0026plusmn;\u0026thinsp;22.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLife-Health Narrative Behaviors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25.22\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Narrative Connections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCareer Narrative Development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e25.88\u0026thinsp;\u0026plusmn;\u0026thinsp;6.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeer Narrative Communications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e12.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor-Patient Narrative Interactions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e28.36\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e193.44\u0026thinsp;\u0026plusmn;\u0026thinsp;26.87\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e79.27\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote: A score\u0026thinsp;\u0026le;\u0026thinsp;60% of the total indicates low Narrative Competence; a score between 60% and 80% reflects basic narrative awareness; a score between 80% and 90% suggests narrative thinking; and a score\u0026thinsp;\u0026ge;\u0026thinsp;90% of the total signifies narrative wisdom.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFactors influencing narrative competence\u003c/h2\u003e \u003cp\u003eMultiple linear regression analysis was performed to identify the key factors influencing the overall narrative competence score. The results indicated that a higher education level (β\u0026thinsp;=\u0026thinsp;0.144, p=.002) and having received systematic narrative training (β\u0026thinsp;=\u0026thinsp;0.127, p= .003) were significant positive predictors of narrative competence.\u003c/p\u003e \u003cp\u003eCrucially, and contrary to conventional assumptions, a longer tenure in psychiatric nursing was a significant negative predictor of narrative competence (β= -0.188, p \u0026lt; .001).\u003c/p\u003e \u003cp\u003eThe regression model, which included these three variables, was statistically significant (F\u0026thinsp;=\u0026thinsp;18.208, p \u0026lt; .001) and explained 7.6% of the total variance in narrative competence scores (Adjusted R\u0026sup2; = 0.076). Multicollinearity diagnostics confirmed that tolerance values were greater than 0.4 and variance inflation factor (VIF) values were below 3, indicating no multicollinearity concerns among the predictors. The detailed results of the regression analysis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple Linear Regression Analysis of Factors Influencing narrative competence (N\u0026thinsp;=\u0026thinsp;525)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable​\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB​\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE​\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ​\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et-value​\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value​\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e193.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.848\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e165.987\u0026thinsp;~\u0026thinsp;220.885\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.052\u0026thinsp;~\u0026thinsp;13.518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychiatric Work Experience (Years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-5.431~ -1.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystematic Narrative Training (Yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.965\u0026thinsp;~\u0026thinsp;14.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote: R\u0026sup2; = 0.086, Adjusted R\u0026sup2; = 0.076.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides important insights into the current status and influencing factors of narrative competence among psychiatric nurses in China. The key findings reveal a moderate overall level of narrative competence, a discernible cognition-behavior gap, and most significantly, a counterintuitive negative association between years of clinical experience and narrative competence. These results challenge conventional assumptions and have substantial implications for nursing education and practice.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eFrom Awareness to Action: Addressing the Narrative Competence Implementation Gap\u003c/h2\u003e \u003cp\u003eOur findings indicate that while nurses possess a relatively high level of narrative cognition (81.81%), their ability to translate this understanding into actual narrative behaviors is comparatively lower (76.97%). This \u0026ldquo;knowing-doing\u0026rdquo; gap, consistent with findings in pediatric nursing [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], represents a critical challenge in clinical practice. The Person-Environment Fit theory [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] helps explain why this implementation gap persists: high workload intensity and extensive documentation demands in psychiatric settings often leave limited protected time for meaningful narrative engagement [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. When healthcare organizations prioritize quantifiable outcomes over essential communication skills, nurses receive inadequate institutional support to bridge this gap [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe particularly low performance in \u0026ldquo;Peer Narrative Communications\u0026rdquo; underscores an organizational challenge: the lack of structured platforms for narrative exchange among nursing staff weakens the overall narrative culture [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. This finding suggests that enhancing narrative competence requires not only individual training but also creating supportive workplace environments where narrative practices are valued and facilitated [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] .\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eThe Experience Paradox: When Clinical Tenure Undermines Narrative Competence\u003c/h2\u003e \u003cp\u003eContrary to expectations that experience enhances skills, our analysis revealed that longer tenure in psychiatric nursing predicted lower narrative competence. This paradox has significant implications for how we support career development in nursing. Senior nurses educated under traditional biomedical curricula may find it challenging to adapt to contemporary narrative approaches [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], highlighting the need for continuous professional education.\u003c/p\u003e \u003cp\u003eMore importantly, prolonged exposure to emotionally demanding environments may lead to protective emotional distancing, a psychological coping mechanism that preserves psychological well-being at the potential cost of diminished empathic responsiveness over time [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This finding challenges the assumption that clinical exposure naturally preserves humanistic capacities [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and indicates that without structured organizational support, experience may gradually erode essential narrative competencies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eBeyond Education and Training: Unexplored Factors in Narrative Competence Development\u003c/h2\u003e \u003cp\u003eAlthough our identified factors were statistically significant, they explained only 7.6% of the total variance in narrative competence scores. This modest explanatory power points to the importance of factors beyond formal education and training systems. Individual characteristics such as inherent empathy, emotional stability, and reflective practice habits [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], along with organizational factors including leadership styles and team psychological safety [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], likely play crucial roles in narrative competence development.\u003c/p\u003e \u003cp\u003eThis limited explanatory power also highlights methodological considerations. While self-report measures provide valuable insights, they may not fully capture the complex, context-dependent nature of narrative competence in real clinical settings [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Future research should employ multi-method approaches to better understand the comprehensive ecosystem supporting narrative competence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eBuilding Support Systems: Educational and Organizational Strategies for Sustainable Competence\u003c/h2\u003e \u003cp\u003eOur findings suggest that sustaining narrative competence requires a systematic approach spanning educational and organizational domains. Educational institutions should integrate narrative medicine into core curricula using experiential methods like reflective writing and situational simulations [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Healthcare organizations need to implement formal assessment systems and provide protected reflection platforms such as Narrative Nursing Workshops [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor experienced nurses specifically, institutions should develop targeted programs that address the unique challenges of maintaining narrative competence over a long career. This might include mentorship programs pairing senior and junior nurses, regular reflective practice sessions, and leadership training that emphasizes the value of narrative skills in clinical supervision and team management [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eNavigating Limitations and Future Directions for Narrative Competence Research\u003c/h2\u003e \u003cp\u003eSeveral limitations of our study point to important directions for future research. The cross-sectional design prevents causal inferences, suggesting the need for longitudinal studies tracking the evolution of narrative competence throughout nurses\u0026rsquo; careers. The single-center sampling, while controlling for institutional variations, limits generalizability, indicating the value of multi-center studies across diverse healthcare settings.\u003c/p\u003e \u003cp\u003eFuture research should also explore the organizational and environmental factors that our model did not capture, particularly how different leadership styles, team dynamics, and institutional policies either support or hinder the development and maintenance of narrative competence over time.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations of this study should be considered when interpreting the results. First, the cross-sectional design prevents us from establishing causal relationships among the variables. While we identified significant associations, the direction of these relationships requires verification through longitudinal studies. Second, the convenience sampling method from a single tertiary psychiatric hospital, although controlling for inter-institutional variations, may limit the generalizability of our findings to other healthcare settings or regions. Third, the reliance on self-reported measures may introduce social desirability bias, where participants might provide responses they believe are socially acceptable rather than reflecting their actual practices. Additionally, while the NCSMP demonstrated good reliability, its self-report nature may not fully capture the complex, context-dependent manifestation of narrative competence in real clinical environments. Finally, our model explained only 7.6% of the variance in narrative competence scores, indicating that other important individual and organizational factors not measured in this study likely contribute to narrative competence development.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study indicates that psychiatric nurses\u0026rsquo; narrative competence is at a moderate level, with a noticeable gap between cognitive understanding and practical application. Contrary to expectations, longer clinical experience predicted lower narrative competence, suggesting a potential erosion effect in high-demand environments lacking systematic support.\u003c/p\u003e \u003cp\u003eWhile higher education and narrative training were positive influencing factors, the complex nature of narrative competence necessitates multidimensional improvement strategies. These findings highlight the importance of implementing personalized educational approaches and fostering supportive workplace environments to enhance narrative competence in psychiatric nursing practice.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis study involved an anonymous online survey of healthcare professionals, with no collection of personally identifiable information. It was granted an exemption from formal ethical review by the Ethics Committee of Beijing Huilongguan Hospital, Capital Medical University, in accordance with national regulations and the principles of the Declaration of Helsinki. Detailed study information was provided on the first page of the questionnaire. Participants\u0026rsquo; voluntary completion of the survey was taken as their implied informed consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research was supported by the Beijing Research Ward Excellence Program (BRWEP), grant number BRWEP2024W072130116.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYQ: Conceived and designed the study, collected the data, analysed and interpreted the data, and wrote the manuscript. JS: Conceived and designed the study, and wrote the manuscript. SG: Collected the data. LQ: Collected the data. JZ: Analysed and interpreted the data.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe sincerely thank all psychiatric nurses who participated in the study and all members of our study team.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRehm J, Shield KD. Global Burden of Disease and the Impact of Mental and Addictive Disorders. Curr Psychiatry Rep. 2019;21(2):10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFan Y, Fan A, Yang Z, Fan D. Global burden of mental disorders in 204 countries and territories, 1990\u0026ndash;2021: results from the global burden of disease study 2021. 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The Intervention of Medical Social Workers: Humanistic Care of Cardiovascular Disease Patients. J Multidiscip Healthc. 2025;18:4725\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu XL, Chen BZ, Lin YY, Chen ZX, Zhu QH. The Communication-Based Intervention Program Based on Narrative Medicine Theory Effectively Improves the Quality of Nursing Care for Nasopharyngeal Cancer Patients Undergoing Radiotherapy and Chemotherapy. Cancer Manag Res. 2025;17:1925\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang K, Wang Y. Person-Environment Fit and Employee Creativity: The Moderating Role of Multicultural Experience. \u003cem\u003eFront Psychol\u003c/em\u003e 2018, 9:1980.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. 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Simulated Practice Learning Experience in a Virtual Environment: An Innovative Pedagogical Approach to Practice Learning for Nursing Students. Nurs Rep 2025, 15(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Omary H, Soltani A, Stewart D, Nazar Z. Implementing learning into practice from continuous professional development activities: a scoping review of health professionals' views and experiences. BMC Med Educ. 2024;24(1):1031.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo Y, Chen Y, Feng M. The Perception of Career Planning and Development Among Senior Clinical Nurses: A Qualitative Analysis. Int Nurs Rev. 2025;72(3):e70050.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Psychiatric nursing, Narrative competence, Clinical experience, Humanistic care, Cross-sectional study, Person-environment fit","lastPublishedDoi":"10.21203/rs.3.rs-8849020/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8849020/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eGlobally, psychiatric nurses practice in high-stress clinical environments that pose a heightened risk of burnout, making narrative competence a critical skill for establishing therapeutic alliances. Although clinical experience is traditionally considered to enhance such competencies, this assumption has not been adequately examined in high-demand healthcare settings. This study aimed to assess the level of narrative competence among psychiatric nurses in China, with particular focus on evaluating the roles of education, systematic training, and clinical experience as its key predictors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted among 525 registered nurses from a tertiary psychiatric hospital in Beijing. Participants completed the Narrative Competence Scale for Medical Practitioners (NCSMP). Data on demographic characteristics, educational level, systematic narrative training, and years of psychiatric work experience were collected. Multiple linear regression analysis was employed to identify factors influencing narrative competence.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe nurses demonstrated a significant gap between narrative cognition (81.81% of maximum score) and narrative behavior (76.97%), with peer communication being the weakest area. Multiple linear regression revealed that higher education (β\u0026thinsp;=\u0026thinsp;0.144, p = .002) and systematic narrative training (β\u0026thinsp;=\u0026thinsp;0.127, p = .003) were positive predictors of narrative competence. Contrary to conventional wisdom, a longer tenure in psychiatry unexpectedly predicted lower competence (β= -0.188, p \u0026lt; .001).The regression model explained 7.6% of the variance (Adjusted R\u0026sup2; = 0.076).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study challenges the foundational assumption that experience alone fosters narrative skills, revealing that prolonged clinical exposure without structured support can erode core humanistic capacities. This erosion effect underscores the urgent need for healthcare institutions to integrate sustained, systematic narrative training into lifelong professional development. Specific strategies including reflective practices and Balint groups are critical to counteract this trend, safeguard nurse well-being, and ensure the delivery of empathetic, relationship-centered care.\u003c/p\u003e","manuscriptTitle":"Does experience undermine expertise? The paradoxical relationship between clinical tenure and narrative competence in psychiatric nursing","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-13 08:26:53","doi":"10.21203/rs.3.rs-8849020/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-07T11:24:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-18T08:11:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-13T05:05:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-13T05:03:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-02-11T07:58:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"70f43c5e-395d-4af7-b6ed-e35ffedd20f2","owner":[],"postedDate":"April 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T08:26:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-13 08:26:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8849020","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8849020","identity":"rs-8849020","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}