Development and application of a narrative medicine-based training course to improve health education competency in nursing interns

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Narrative medicine, emphasizing empathy and understanding patient stories, offers a potential pedagogical solution. Objective ​This study aimed to develop, implement, and evaluate the effectiveness of a narrative medicine-based health education training program for nursing interns, using diabetes education as an example. Methods The constructed curriculum, Health Education Training for Nursing Interns from the Perspective of Narrative Medicine: A Case Study of Diabetes Health Education, comprised five components: (1) theoretical foundations and practical applications of narrative medicine, (2) fundamental knowledge of diabetes health education, (3) practical application of narrative medicine in diabetes health education, (4) training in health education communication skills, and (5) emotional support and humanistic care for diabetic patients. We used convenience sampling, 85 nursing interns at China-Japan Friendship Hospital from August to October 2023 were selected as participants and randomly divided into an intervention group (n = 43) and a control group (n = 42) via a random number table. The intervention group received the narrative medicine-based training, while the control group followed traditional training methods. Differences between the two groups were compared in terms of health education competency, nurse-patient communication, empathy, and humanistic care ability before and after the intervention. Results After intervention, compared with the control group, the intervention group scored significantly higher for total health education competency (Z=-1.987, P < 0.05), nurse-patient communication (t = 2.465, P < 0.05), and empathy (Z = 2.07, P 0.05). Conclusion The narrative medicine-based training curriculum effectively improved nursing interns'health education competency, nurse-patient communication, and empathy, but its impact on humanistic care ability and practical application of health education was limited. narrative medicine nursing interns health education competency curriculum development Introduction Nurses are professionally obligated to conduct health education [ 1 ] , and health education competence is one of the essential core competencies in nursing practice. With the implementation of China's Healthy China initiative and the continuous advancement of healthcare reform, public demand for health knowledge has significantly increased. This trend inevitably imposes higher requirements on nurses'health education knowledge and skills. As the future backbone of the nursing workforce, cultivating Nursing interns'health education competence is a critical component of nursing education. Whether a nurse can become an effective health educator after entering clinical practice depends not only on their sense of responsibility but, more importantly, on their mastery of health education knowledge and practical implementation skills. Based on the conceptual framework of health education and related competence definitions, domestic scholars have defined health education competence as "the integrated combination of knowledge, techniques, abilities, and behavioral attitudes required to effectively carry out health education activities" [ 2 ] . This competence is regarded as an internalized professional attribute that can be demonstrated in practice, representing a specialized skill set. Existing research on Nursing interns'health education competence reveals widespread deficiencies. Multiple studies indicate that nursing students generally lack sufficient knowledge and skills for effective health education. For example, Wang Miaoqin et al [ 3 ] investigated the health education competence of vocational, associate, and baccalaureate nursing interns and found common issues, including inadequate foundational knowledge, poor clinical application skills (e.g., communication techniques), and a lack of empathy toward patients. Similarly, Zhu Lanming et al [ 4 ] reported that nursing interns'overall health education competence was suboptimal, with assessment, planning, implementation, and evaluation dimensions all falling below the "basic competency" level. Mai Guiying's [ 5 ] study further revealed that only 34.6% of nursing students could systematically apply health education protocols in patient care. With rising living standards and accelerated lifestyles, chronic and lifestyle-related diseases have become increasingly prevalent, intensifying public demand for health knowledge. Consequently, nursing health education has evolved into a therapeutic intervention for many conditions. Therefore, enhancing Nursing interns'health education competence is crucial to improving their adaptability, professional competitiveness, and ability to meet diverse societal needs. Achieving seamless integration between nursing education and clinical practice has become a key objective in contemporary nursing education. Proposed by Dr. Rita Charon, Professor of Medicine at Columbia University, narrative medicine is defined in her 2006 seminal work as "medicine practiced by clinicians with narrative competence" - the ability to recognize, absorb, interpret, and be moved by patients'illness stories [ 6 ] . Serving as a vital bridge in clinician-patient relationships [ 7 ] , narrative medicine enables healthcare providers to identify root causes of health issues through attentive story listening, uncover positive elements in patients'narratives, and guide them in reconstructing empowering health stories that activate intrinsic motivation for behavioral change. Notably, its originators have demonstrated its pivotal role in health education through narrative interventions [ 8 ] . The efficacy of narrative approaches in health education stems from their inherent characteristics: communicative power, action-oriented nature, realism, and homogeneity. As stories serve as the primary medium, they possess a unique capacity to convey health concepts profoundly, creating lasting motivational impacts [ 9 ] . Smith [ 10 ] further highlights that narrative methods foster collaborative nurse-patient partnerships, significantly enhancing care intervention effectiveness through narrative empathy - the cornerstone of therapeutic alliances. In clinical practice, narrative nursing tailors communication strategies according to patients'family backgrounds, social experiences, and education levels, effectively bridging the clinician-patient gap and optimizing health education outcomes [ 11 ] . Essentially, narrative medicine cultivates storytelling competence, emphasizing attentive listening to patients'and families'experiences - a fundamental prerequisite for effective health education. Its three core elements (attention, representation, and affiliation) can be systematically developed through training nursing students in active listening, communication techniques, and reflective practice, making narrative integration into health education curricula both necessary and feasible. Current health education training for nursing students focuses on enhancing humanistic care, communication skills, and health promotion competencies, particularly in listening, empathy, and self-expression. The abundance of clinical cases provides rich resources for narrative-based health education. Therefore, incorporating narrative medicine into curricula equips future nurses with innovative perspectives and personalized thinking approaches for health education, while fostering humanistic awareness and independent critical thinking. This study will develop a diabetes health education curriculum for nursing students at China-Japan Friendship Hospital's Endocrinology Department, guided by narrative medicine's tripartite framework (attention, representation, affiliation). The intervention aims to enhance Nursing interns'health education competence, communication skills, humanistic care capacity, and empathetic abilities, potentially serving as a reference for clinical nursing education. The curriculum will be implemented and evaluated among endocrine rotation nursing interns to assess its effectiveness. Materials and methods General Information This study employed a convenience sampling method to select 85 nursing interns who were undergoing clinical training at China-Japan Friendship Hospital from August to October 2023 as research participants. Using a random number table, the participants were allocated into two groups: an experimental group (n = 43) and a control group (n = 42). The inclusion criteria were: (1) voluntary participation in this teaching improvement program; and (2) provision of signed informed consent. The exclusion criterion was failure to complete the course curriculum. The study in accordance with the Declaration of Helsinki and was approved by the China-Japan Friendship hospital's Ethics Committee (Approval No. : 2023-KY-180), and written informed consent was obtained from all participants prior to their enrollment in the study. Clinical trial number: not applicable. Baseline characteristics were well-balanced between the intervention (n = 43) and control (n = 42) groups, with no statistically significant differences observed in demographic and pre-training parameters (all P > 0.05). Both groups showed comparable distributions in gender (9.30% vs 16.67% male), age (mean 20.86 ± 0.83 vs 20.83 ± 0.82 years), educational background (≈ 30% in 3-year program), and clinical experience profiles (53.49% vs 59.52% with prior clinical exposure). Similar proportions were noted in professional interest (≈ 76% positive) and diabetes-related experience (62.79% in both groups). Detailed comparisons are presented in Table 1 . Table 1 Comparison of Baseline Characteristics Between Two Groups of Nursing Students Item Intervention Group (n = 43) Control Group (n = 42) Statistical Value P Gender χ²=1.023¹ 0.312 Male 4 (9.30%) 7 (16.67%) Female 39 (90.70%) 35 (83.33%) Age (years) 20.86 ± 0.83 20.83 ± 0.82 t = 0.151² 0.880 Program Duration χ²=0.005¹ 0.943 3-year 13 (30.23%) 13 (30.95%) 4-year 30 (69.77%) 29 (69.05%) CPC Membership 1.000³ Yes 3 (6.98%) 3 (7.14%) No 40 (93.02%) 39 (92.86%) Prior Clinical Experience χ²=0.315¹ 0.575 Yes 23 (53.49%) 25 (59.52%) No 20 (46.51%) 17 (40.48%) Interest in Major χ²=0.004¹ 0.952 Yes 33 (76.74%) 32 (76.19%) No 10 (23.26%) 10 (23.81%) Career Intention 0.433³ Yes 38 (88.37%) 40 (95.24%) No 5 (11.63%) 2 (4.76%) Prior Contact with Diabetic Patients χ²=1.190¹ 0.275 Yes 27 (62.79%) 27 (62.79%) No 16 (37.21%) 16 (37.21%) Prior Endocrinology Rotation χ²=0.704¹ 0.401 Yes 8 (18.60%) 11 (26.19%) No 35 (81.40%) 31 (73.81%) Footnotes :¹ Chi-square value ² t-value ³ Fisher's exact test Methods Study Design and Participants​​ A randomized controlled trial was conducted between August and October 2023 at China-Japan Friendship Hospital. A convenience sampling method was used to recruit 85 nursing interns (including vocational college and undergraduate students) who were undertaking their clinical practicum during this period. The inclusion criteria were: (1) voluntary participation in this teaching improvement project; and (2) provision of signed informed consent. The sole exclusion criterion was failure to complete the course. This study was approved by the Hospital Ethics Committee of China-Japan Friendship Hospital (Approval No: 2023-KY-180). All participants provided written informed consent before randomization. Randomization and Grouping ​​ Eligible participants were randomly assigned to either an intervention group (n = 43) or a control group (n = 42) using a computer-generated random number table. The allocation sequence was concealed from the researchers responsible for recruitment until the intervention was assigned.​ Development of the Narrative Medicine-Based Training Curriculum ​​ A curriculum development team was established, comprising eight members from the hospital's Department of Internal Medicine Education, including one director of nursing, one head nurse of the general internal medicine department, and six clinical instructors with over five years of teaching experience. All held bachelor's degrees or higher, with two possessing master's degrees. Guided by the three core elements of narrative medicine practice—attention, representation, and affiliation—the team developed the curriculum by reviewing literature [ 12 ] and then analyzing primary reasons for interns' low health education competency (e.g., insufficient theoretical knowledge, poor communication, lack of practice opportunities). The curriculum, using the fourth edition of Practical Diabetologyas a foundational guide, was finalized through repeated discussions and revisions. The Narrative Medicine-Based Health Education Competency Training Curriculum for Nursing Interns: A Case Study of Diabetesconsisted of five modules: Theoretical foundation and practical application of narrative medicine. Fundamental knowledge of diabetes health education. Practical application of narrative medicine in diabetes health education. Health education communication skills training. Emotional support and humanistic care for patients with diabetes. Teaching materials included PowerPoint presentations and selected narrative films (e.g., The Bucket List, The Sea Inside) to enhance engagement. Clinical instructors received standardized training on narrative medicine theory, diabetes knowledge, communication skills, and parallel chart writing. See Table 2 for details. Table 2 Narrative Medicine-Based Health Education Competency Training Curriculum for Nursing Interns: A Case Study of Diabetes Health Education​​ Module Teaching Objectives Course Content Teaching Methods Duration ​ ​Module 1: Theoretical Basis and Practical Application of Narrative Medicine​ ​ To understand the basic concepts of narrative medicine and its application in health education. - Overview of narrative medicine (Three core elements: attention, representation, affiliation) - Differences and connections between narrative medicine and traditional medicine - The impact of narrative medicine on nursing communication - Case analysis: Application of narrative medicine in diabetes health education Lecture + Film Viewing + Group Discussion 2 hours ​ ​Module 2: Fundamental Knowledge of Diabetes Health Education​ ​ To help interns master fundamental knowledge of diabetes, providing a scientific basis for health education. - Definition, classification, and diagnosis of diabetes - Diabetic complications and their prevention - Self-management and lifestyle interventions for patients with diabetes Theoretical Teaching + Case Analysis 2 hours ​ ​Module 3: Practical Application of Narrative Medicine in Diabetes Health Education​ ​ To learn how to apply narrative medicine methods in diabetes health education. - Listening to patient stories to focus on their emotional needs - Enhancing empathy by narratively reconstructing the patient's life context - Establishing trust with patients to promote healthy behavior change - Narrative communication skills: active listening, feedback, and expression Simulated Role-Playing + Group Discussion + Video Case Analysis 2 hours ​ ​Module 4: Health Education Communication Skills Training: Using Insulin Injection Education as an Example​ ​ To enhance interns' communication skills, enabling them to flexibly apply narrative medicine techniques. - Basic communication skills: open-ended questions, listening, feedback - Communication techniques for patient education using narrative methods - Enhancing patient compliance through emotional support Communication Skills Training (Clinical Practice) + Group Discussion 2 hours ​ ​Module 5: Emotional Support and Humanistic Care for Patients with Diabetes (Including Parallel Chart Writing)​ ​ To provide emotional support and demonstrate humanistic care during the health education process. - Psychological status and emotional needs of patients with diabetes - Application of humanistic care in diabetes health education - Introduction and demonstration of parallel chart writing Case Analysis + Role-Playing + Interactive Discussion + Parallel Chart Submission 2 hours Intervention group : Implementation of the Health Education Competency Training Curriculum from a Narrative Medicine Perspective The experimental group participated in the developed curriculum over eight weeks, following a “theoretical learning—progressive practice—deep reflection” teaching model. The curriculum combined lectures, clinical practice, case-based teaching, and reflective writing to ensure interns effectively integrated narrative medicine into diabetes health education. Phase 1 (Theoretical Training: Weeks 1–2) Interns received systematic theoretical training to build their health education knowledge base and understand the application of narrative medicine in diabetes health education. The modular curriculum covered narrative medicine theory, core diabetes health education knowledge, communication skills, emotional support, and humanistic care. Teaching methods included lectures, case analyses, film viewing, and group discussions. Role-playing and situational simulations were used to train interns'communication skills, such as simulating nurse-patient interactions to demonstrate the impact of different communication styles on patient compliance. Phase 2 (Clinical Practice: Weeks 3–6) Interns entered the endocrinology department for clinical practice, applying their knowledge under the guidance of clinical instructors. Each intern was required to select at least two diabetes patients and provide individualized health education on insulin pen usage, tailoring their approach based on the patients'conditions, cultural backgrounds, and cognitive abilities. Interns used narrative medicine methods to listen to patients'health stories, identify their needs, and employ effective communication techniques to enhance understanding and acceptance of health education. Weekly case discussions were held for interns to report their experiences and collaboratively address challenges in patient education. Bedside teaching, case guidance, and group discussions were used to strengthen clinical skills. Phase 3 (Reflective Writing: Weeks 7–8) To promote self-awareness and skill development, interns were required to write reflective parallel charts based on their health education experiences with selected patients. These charts documented the education process, patient feedback, and personal growth. Interns analyzed patients'emotional needs from a narrative medicine perspective and reflected on their strengths and weaknesses in health education communication. Instead of grading, instructors provided guided feedback to encourage deep reflection and continuous improvement in future clinical practice. Control group :The control group received standard diabetes education training, focusing on both theoretical knowledge and health education frameworks and techniques. During the initial phase of the internship, participants in the control group underwent a systematic training program on diabetes health education. The curriculum encompassed essential topics including the definition and classification of diabetes, complication management, patient self-care, insulin pen usage, and health education techniques. The instructional methods primarily consisted of lectures, PowerPoint presentations, case analyses, and group discussions, with an emphasis on developing the students' ability to apply knowledge and master skills in health education contexts. To enhance the students' practical teaching competencies, we implemented communication skills training through simulated scenarios. These exercises aimed to improve the interns'patient education capabilities, particularly in explaining critical aspects of insulin injection and enhancing patient compliance. During the clinical practice phase, under the guidance of clinical instructors, the interns applied their acquired health education knowledge in patient education for individuals with diabetes. Each intern was required to select at least two diabetic patients and provide personalized health education focusing on insulin pen usage, adapting their teaching strategies according to the patients'conditions and cognitive abilities. Clinical instructors provided bedside demonstrations, guiding the interns in optimizing their health education content and offering real-time feedback to enhance their teaching techniques. Additionally, we organized case discussion sessions where interns shared their practical experiences in health education, addressed common clinical challenges, and developed strategies for improving health education methods through group discussions. Outcome Measure (1) Health Education Competency Health education competency was assessed using the Health Education Competency Scale developed by Tong et al. [ 13 ] . The scale comprises 38 items across four dimensions: assessment (11 items), planning (8 items), implementation (12 items), and evaluation (6 items). Each item is scored on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with total scores ranging from 38 to 190. Higher scores indicate greater competency. The scale demonstrated excellent reliability (Cronbach’s α = 0.949) and validity (CVI = 0.9). (2) Nurse-Patient Communication Skills Nurse-patient communication skills were evaluated using the Nurse-Patient Communication Competence Scale by Xu et al. [ 14 ] . The 43-item scale includes six dimensions: planning and preparation (6 items), initiating communication (7 items), information gathering (11 items), information giving (6 items), understanding patient perspectives (6 items), and concluding communication (6 items). Each item is rated on a 5-point Likert scale (1 = poor to 5 = excellent). The scale showed high internal consistency (Cronbach’s α = 0.953) and stability (split-half reliability = 0.965). (3) Humanistic Caring Ability Humanistic caring ability was measured using the Caring Ability Inventory (CAI) developed by Nkongho [ 15 ] and adapted into Chinese by Xu et al. [ 16 ] . The 37-item scale assesses three dimensions: understanding, courage, and patience. Items are scored on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree), with 13 reverse-scored items. The scale demonstrated good reliability (Cronbach’s α = 0.751) and validity (KMO = 0.876). (4) Empathy Empathy was evaluated using the Jefferson Scale of Empathy adapted by An et al. [ 17 ] . The 20-item scale includes three dimensions: perspective-taking (10 items), compassionate care (8 items), and standing in the patient’s shoes (2 items). Items are scored on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree), with total scores ranging from 20 to 140. Higher scores indicate greater empathy. The scale showed acceptable reliability (Cronbach’s α = 0.750; split-half reliability = 0.771) and test-retest reliability (r = 0.659). All assessment scales used in this study (the Health Education Competency Scale, Nurse-Patient Communication Competence Scale, Caring Ability Inventory, and Jefferson Scale of Empathy) were previously published and validated instruments, as cited in the respective references [ 13 , 14 , 16 , 17 ] . No new questionnaires were developed specifically for this study. Quality Control This project required collaboration among all teaching nurses in the Internal Medicine Teaching and Research Office. The project applicant served as the team leader, organizing curriculum development workshops to determine the course content. Subsequently, teaching nurses received pre-training to ensure consistency in course delivery. A research archive was established for nursing interns, and attendance was recorded for each session. Interns who missed sessions were provided with individual tutoring and required to complete make-up sessions to ensure all participants received the full training. A WeChat group was created to facilitate timely communication and address any issues promptly. Data Collection Methods Prior to the study, non-endocrinology teaching instructors administered paper-based questionnaires to assess the interns’ health education competency, humanistic caring ability, and empathy. The nurse-patient communication competence scale, being an observer-rated tool, was evaluated by teaching instructors based on the interns’ daily interactions with patients before the intervention. After completing the training for both the experimental and control groups, all four outcome measures were reassessed using paper-based questionnaires. The nurse-patient communication competence was specifically evaluated during the interns’ second insulin injection education session. On the day of questionnaire collection, the researcher carefully reviewed each form and reminded participants to complete any missing items. During data entry, double-checking was performed to ensure accuracy. Statistical Analysis Data were analyzed using SPSS 22.0. Descriptive statistics were used to summarize the data. Normally distributed continuous variables were expressed as mean ± standard deviation (x̄ ± SD), while non-normally distributed continuous variables were presented as median (25th percentile, 75th percentile), i.e., M (P25, P75). Categorical variables were reported as frequencies (%). For between-group comparisons, independent samples t-tests were used for normally distributed continuous variables, and non-parametric tests were applied for non-normally distributed data. Categorical variables were compared using chi-square tests (χ²) or Fisher’s exact tests. A p-value of less than 0.05 was considered statistically significant. Results Comparison of Health Education Competency, Nurse-Patient Communication Skills, Humanistic Care Ability, and Empathy Between Groups Before and After Training Pre-training assessment: No significant differences were observed between the intervention (n = 43) and control (n = 42) groups across all dimensions and total scores of health education competency, nurse-patient communication skills, humanistic care ability, and empathy (all P > 0.05), confirming comparable baseline characteristics (Table 3 ). Post-training outcomes: Health education competency:The intervention group demonstrated significantly higher scores in assessment (P = 0.049) and planning dimensions (P = 0.041), along with total scores (P = 0.047), while no significant differences were found in implementation (P = 0.142) or evaluation dimensions (P = 0.077). Nurse-patient communication: The intervention group showed superior performance across all communication subscales - planning/preparation (P = 0.036), initiation (P = 0.016), information gathering (P = 0.012), information delivery (P = 0.016), and perspective-taking (P = 0.034) - except for communication closure (P = 0.078). Total communication scores were significantly higher (P = 0.016). (3)Humanistic care ability: No significant intergroup differences were detected in any dimensions (understanding, courage, patience) or total scores (all P > 0.05). (4)Empathy: The intervention group achieved significantly higher scores in perspective-taking (P = 0.048) and total empathy (P = 0.038), while emotional care (P = 0.099) and role-taking (P = 0.137) showed no significant differences. Table 3 Pre-intervention Comparison of Competency Scores Between Groups [M(P25,P75)/(x̄±s)] Domain Intervention (n = 43) Control (n = 42) Statistic (Z/t) P Health Education Assessment 16(16,20) 16.5(14.75,21.25) -0.97 0.922 Planning 16(16,20) 16.5(14.75,21.25) -0.04 0.968 Implementation 24(24,27) 25(19.5,29.5) -0.12 0.905 Evaluation 12(12,13) 12(8.75,15) -0.31 0.756 Total 76(74,87) 77(65.5,95.5) -0.19 0.853 Communication Planning/Preparation 23.53 ± 2.46 22.60 ± 2.20 1.85 0.067 Initiation 28.07 ± 4.55 27.17 ± 3.20 1.06 0.294 Information Gathering 38.42 ± 3.97 37.79 ± 4.18 0.72 0.476 Information Delivery 22.51 ± 3.28 21.79 ± 2.91 1.08 0.284 Perspective-Taking 22.07 ± 2.52 21.36 ± 2.11 1.41 0.161 Closure 25.53 ± 3.95 24.17 ± 4.00 1.59 0.117 Total 160.14 ± 16.34 154.86 ± 12.06 1.69 0.094 Humanistic Care Understanding 82(71,91) 82(75,88) -0.27 0.788 Courage 46(40,55) 46(38.75,58) -0.29 0.771 Patience 60(54,64) 57.5(52.75,62) -0.86 0.465 Total 187(173,197) 188(178.25,198) -0.24 0.784 Empathy Perspective-Taking 43(38,60) 41(35,46.5) -1.87 0.062 Emotional Care 40(36,53) 38.5(34.75,42) -1.59 0.112 Role-Taking 8(9,11) 8(8,10.25) -0.95 0.345 Total 89(82,120) 84.5(80,102) -1.93 0.054 Table 4 Post-intervention Comparison of Competency Scores [M(P25,P75)/x̄±s] Domain Intervention (n = 43) Control (n = 42) Statistic (Z/t) P Health Education Assessment 45(44,55) 44(41,51) -1.96 0.049 Planning 29(27,35) 28(25.75,30.25) -2.04 0.041 Implementation 50(48,60) 48(46.75,53.25) -1.47 0.142 Evaluation 25(24,30) 24(24,27.5) -1.77 0.077 Total 151(143,178) 144(137,159.25) -1.99 0.047 Communication Planning/Preparation 23.88 ± 2.24 22.86 ± 2.20 2.13 0.036 Initiation 28.21 ± 4.66 27.29 ± 3.13 2.46 0.016 Information Gathering 40.44 ± 4.40 38.02 ± 4.25 2.58 0.012 Information Delivery 23.67 ± 3.17 22.02 ± 3.02 2.46 0.016 Perspective-Taking 23.30 ± 2.68 22.00 ± 2.90 2.15 0.034 Closure 27(24,28) 24.81 ± 4.05 1.78 0.078 Total 165.91 ± 17.36 157.00 ± 15.90 2.47 0.016 Humanistic Care Understanding 82(73,92) 81.50(74.75,88) -0.62 0.538 Courage 50(40,56) 47.5(38.75,59.25) -0.26 0.795 Patience 64(56,66) 60(54.5,64) -0.95 0.344 Total 191(177,203) 190.5(180.75,195.75) -0.19 0.853 Empathy Perspective-Taking 42(38,64) 40.50(35,45.25) -1.98 0.048 Emotional Care 39(36,50) 34(36,40.50) -1.65 0.099 Role-Taking 9(8,12) 8(8,10) -1.49 0.137 Total 88(81,120) 84.5(80,97.25) -2.07 0.038 P < 0.05 indicates statistical significance Discussion The Narrative Medicine-Based Training Curriculum Promoted Health Education Competency, Nurse-Patient Communication, and Empathy in Nursing Interns ​​ The findings of this study demonstrate that the constructed narrative medicine-based training curriculum significantly improved the health education competency, nurse-patient communication skills, and empathy of nursing interns. In clinical practice, nurses' health education competency is a key factor determining the quality and effectiveness of patient education, which is directly related to patient rehabilitation and quality of life improvement [ 18 ] . Empathy, as a core element of nurse-patient communication, serves not only as a starting point for building a positive relationship but also as a crucial guarantee for enhancing patient adherence and optimizing the healthcare experience. The synergistic development of communication skills and empathy provides a dual assurance for establishing trust and improving the effectiveness of health education. Health education competency for nursing interns is a multi-dimensional construct encompassing assessment, goal-setting, planning, implementation, and evaluation [ 19 ] . Narrative medicine, as a clinical practice model emphasizing narrative skills, has been shown in previous studies to significantly enhance empathy and communication skills in medical students [ 20 ] . For interns newly entering the clinical environment, systematic training is essential to improve their practical abilities and ensure professional nursing service. Our results indicated that after the 8-week intervention, the intervention group showed significantly greater improvements than the control group in the assessment and planning dimensions (and total score) of health education competency, in most dimensions (planning and preparation, initiation, information gathering, information giving, understanding the patient's perspective, and total score) of nurse-patient communication, and in the perspective-taking dimension (and total score) of empathy (all P < 0.05). This finding is consistent with the results reported by Liu Dacheng et al. [ 21 ] , whose research indicated that narrative methods, through situational simulation, can effectively stimulate emotional support and enhance communication and empathy by helping interns resolve practical problems. The current curriculum, incorporating modules such as simulated patient stories, emotional support training, and reflective writing, helped interns master core skills like "active listening" and "empathetic feedback." This not only facilitated the effective implementation of health education but also strengthened their ability to assess individual patient needs, enabling the development of more targeted education plans. Furthermore, the integrated basic knowledge of diabetes health education provided essential professional support. However, no significant differences were observed between the two groups in the implementation and evaluation dimensions of health education competency, or in the closure dimension of communication (P > 0.05). Several factors may explain these findings. First, the relatively short 8-week intervention period may have been insufficient for interns to accumulate enough practical experience to fully translate learned knowledge into actionable skills. Second, limited clinical practice opportunities might have restricted their sensitivity to feedback on education effectiveness. Third, the traditional pedagogical model, where interns often assume a passive role, may make it challenging to foster an active evaluation mindset within a short timeframe. These findings suggest that future curriculum optimization should emphasize simulated practice and feedback mechanisms to enhance the development of practical skills. The lack of significant improvement in the "compassionate care" and "standing in the patient's shoes" dimensions of empathy suggests that evoking deep emotional resonance through narrative medicine may require longer-term practice, whereas short-term training might primarily enhance cognitive perspective-taking. Analysis of Reasons for the Lack of Improvement in Humanistic Care Ability ​​ The "Healthy China 2030" Plan Outline [ 22 ] explicitly calls for strengthening humanistic care in health services to build harmonious patient-provider relationships. Concurrently, the National Health Commission has emphasized that nursing personnel should enhance their proactive service awareness and humanistic care ability. Humanistic care quality in nurses refers to a relatively stable professional characteristic developed through practice and manifested in caring behaviors [ 23 ] , influenced by multiple factors. Previous research has indicated a positive effect of narrative competence on nurses' humanistic care quality [ 24 ] . Contrary to expectations, the results of this study showed no significant differences in the overall score or any sub-dimensions (understanding, courage, patience) of humanistic care ability between the intervention and control groups after the training (P > 0.05), indicating that the curriculum did not achieve the intended effect in this domain. This finding differs from some existing studies. For instance, Yang Shuzhen et al. [ 25 ] reported that narrative education significantly improved humanistic care ability among midwifery interns. This discrepancy may be attributed to their focus on a specific student population (midwifery) and a curriculum deliberately designed around enhancing humanistic care, utilizing literature and documentaries directly related to obstetric care (e.g., Gentle Birth, The Birth of Life). In contrast, our study involved a general cohort of nursing interns, and the curriculum was primarily focused on health education and communication, with less direct emphasis on humanistic care cultivation. Furthermore, although empathy improved significantly in our study, humanistic care ability did not follow suit. This contrasts with studies by Fan Xiaoting et al. [ 26 ] and Xu Linxia et al. [ 27 ] , which suggested that narrative ability mediates the relationship between empathy and humanistic care quality among clinical nurses. Therefore, our results might imply that the narrative competence developed by the interns in this short-term program had not yet reached a threshold necessary to foster significant improvement in humanistic care. It is important to note that humanistic care is a complex psychological trait influenced by personal experiences, values, and socio-cultural factors. The brief 8-week intervention period might have been insufficient to effect a fundamental change in the interns' deeply held attitudes towards care. This suggests that future curriculum designs should consider the following: extending the training duration to allow for deeper internalization; incorporating more content specifically aimed at fostering humanistic care ability, such as narrative materials directly relevant to nursing practice; and strengthening practical components through clinical simulations and reflective practice to help interns internalize humanistic care as a professional virtue. Conclusion This study provides evidence supporting the effectiveness of a narrative medicine-based approach in enhancing key competencies among nursing interns. The developed curriculum demonstrated significant positive impacts on health education capability, communication proficiency, and empathic capacity, while revealing opportunities for further refinement in other domains. These findings contribute to the growing body of knowledge on innovative nursing education methodologies and their potential to prepare students for the complexities of contemporary healthcare practice. Several limitations should be acknowledged when interpreting these results. The relatively short intervention period and modest sample size may have constrained our ability to detect more comprehensive effects, particularly in areas requiring extended skill development. Additionally, the single-center design limits generalizability, suggesting the need for broader validation studies. Future research should explore longer intervention durations, enhanced practical components, and more robust integration of humanistic care elements. Such developments could further optimize the program's effectiveness and better address the multifaceted demands of nursing practice in diverse clinical settings. Despite these limitations, the current study offers valuable insights for nursing education reform. The successful application of narrative medicine principles to health education training represents a promising avenue for developing more holistic, patient-centered approaches to nursing education. As healthcare systems worldwide continue to emphasize the importance of both technical competence and humanistic qualities in nursing practice, such innovative educational strategies will likely play an increasingly important role in preparing the next generation of nursing professionals. Future iterations of this program should build on these findings while addressing the identified areas for improvement, ultimately contributing to the cultivation of well-rounded nursing professionals capable of delivering exceptional, compassionate care. Abbreviations CAI Caring Ability Inventory Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of China-Japan Friendship Hospital (Approval No.: 2023-KY-180). Written informed consent was obtained from all participants prior to their enrollment in the study. Consent for publication Not applicable. This manuscript does not contain any individual person's data in a identifiable form. Competing interests The authors declare that they have no competing interests. Funding: Education and Teaching Reform Project of Capital Medical University (2023JYY475) Author Contribution Juan Cheng: Conceptualization, Methodology, Formal analysis, Writing - Original Draft. Qi Lian: Investigation, Data Curation. Shasha Liu: Resources, Project administration. He Sun: Validation, Visualization. Lu Wang: Software, Supervision. Yangxi Li: Writing - Review & Editing, Funding acquisition. Acknowledgements The authors would like to thank all the nursing interns who participated in this study and the clinical instructors from the Department of Internal Medicine Education at China-Japan Friendship Hospital for their support in implementing the training curriculum. Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to protections of participant privacy but are available from the corresponding author on reasonable request. Authors' information All authors are affiliated with the Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China. References Bao JM. Nursing Health Education and Health Promotion. Beijing: People's Medical Publishing House; 2014. p. 9. Xu R, Li XH. Research status of health education competence of hospital and community nurses in China. Chin J Mod Nurs. 2011;17(4):489-491. Wang MQ, Cui LJ. Investigation, analysis and countermeasures of health education competence of nursing interns. Int J Nurs. 2009;28(2):251-253. Zhu LM, Feng GH, Fu W. Analysis of the current situation of health education ability of nursing interns and countermeasures. Chin J Mod Nurs. 2015;21(11):1333-1337. Mai GY. Investigation on the cognition and influencing factors of health education among college nursing students. Chin Gen Pract Nurs. 2012;8(10):2189-2190. Charon R. Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press; 2006. Giroux J. Communication-making the human connection. Urol Nurs. 2013;33(6):265. Zhang J, Zhang XY, He H. Clinical application research of narrative medicine. Chin Nurs Res. 2013;27(23):2439-2440. Huang H, Liu YL. Research progress on clinical application of narrative nursing. Chin J Nurs. 2016;51(2):196-199. doi:10.3761/j.issn.0254-1769.2016.02.012 Smith BL, Lorenz R, Leander S. Listening with care: using narrative methods to cultivate nurses' responsive relationship in a home visiting intervention with teen mothers. Nurs Inq. 2013;20(3):188-198. Ji YZ, Yu T, Zheng D. Exploration of the application of narrative nursing in health education for perioperative patients. China Health Care Nutr. 2017;27(17):254. Pan JW, Wang DK, Bai K, et al. Research progress on health education competency of nursing interns: a review. Int J Nurs. 2024;43(23):4406-4410. doi:10.3760/cma.j.cn221370-20240701-01022 Tong HJ, Li XH. Development and testing of the Health Education Competency Scale for nursing staff. J Nurs Sci. 2010;25(23):17-18. doi:10.3870/hlxzz.2010.23.017 Xu YH. Development of a Nurse-Patient Communication Ability Scale for Nursing Students[dissertation]. Liaoning: China Medical University; 2006. Nkongho NO. The Caring Ability Inventory. In: Strickland OL, Waltz CF, editors. Measurement of Nursing Outcomes. Volume 4: Measuring Client Self-Care and Coping Skills. New York: Springer Publishing Company; 1990. p. 3-16. Xu J, Liu YL. Investigation and analysis of caring ability among clinical nurses. J Nurs Sci. 2008;23(2):16-18. doi:10.3969/j.issn.1001-4152.2008.03.007 An XQ, Yang H, Xu JP, et al. Compilation and evaluation of the Chinese version of the Jefferson Scale of Empathy for health professionals. Chin Nurs Res. 2008;22(22):2063-2064, 2066. doi:10.3969/j.issn.1009-6493.2008.22.050 Zheng DL, Ma FZ, Ji SD, et al. Status and influencing factors of health education competency among clinical nurses in Ningxia. Chin J Nurs Educ. 2023;20(11):1355-1360. doi:10.3761/j.issn.1672-9234.2023.11.012 He YG, He S, Hu GJ, et al. Current status and prospects of research on improving health education ability of nursing students. Mod Nurse. 2020;27(3):6-8. doi:10.19793/j.cnki.1006-6411.2020.09.003 Zhang HP, Li Q, Zheng YJ, et al. Effect of narrative medicine on the narrative and communication skills of resident trainees. J Fujian Med Univ (Soc Sci Ed). 2024;25(5):57-61. Liu DC, Shi Y, Huang J, et al. Intervention study of narrative education combined with workshop training model on empathy and communication ability of nursing students. Chongqing Med. 2023;52(24):3822-3825. doi:10.3969/j.issn.1671-8348.2023.24.027 The State Council of the People's Republic of China. Outline of the "Healthy China 2030" Plan [Internet]. 2016 Oct 25 [cited 2022 Feb 26]. Available from: https://www.gov.cn/gongbao/content/2016/content_5133024.htm Meng M, Zhang X, Jiang A. A theoretical framework of caring in the Chinese context: a grounded theory study. J Adv Nurs. 2011;67(7):1523-1536. doi:10.1111/j.1365-2648.2010.05573.x Cui JR, Hu LH, Kuang W, et al. Correlation between humanistic care quality and medical narrative ability of clinical nurses. J Nurs Sci. 2021;36(9):58-60. doi:10.3870/j.issn.1001-4152.2021.09.058 Yang SZ, Zheng HY, Guo P, et al. Effect of narrative medicine education on empathy and humanistic care ability of undergraduate midwifery students. Chin J Nurs Educ. 2023;20(6):672-677. doi:10.3761/j.issn.1672-9234.2023.06.006 Fan XT, Sun HC, Zhang HX. Influence of medical narrative and empathy ability on humanistic care ability of nursing interns. Chin J Health Psychol. 2024;32(4):610-616. doi:10.13342/j.cnki.cjhp.2024.04.024 Xu LX, Song MX, Wu XL, et al. Mediating effect of medical narrative ability between empathy and humanistic care quality in clinical nurses. J Nurs Adm. 2024;24(5):408-412. doi:10.3969/j.issn.1671-315x.2024.05.009 Additional Declarations No competing interests reported. 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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-7878405","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":556426786,"identity":"12fc4835-7223-4b86-a24c-d611f9291de4","order_by":0,"name":"Juan Cheng","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"","lastName":"Cheng","suffix":""},{"id":556426788,"identity":"0df74384-082d-47bb-becf-8ff25fa3756e","order_by":1,"name":"Qi Lian","email":"","orcid":"","institution":"China-Japan Friendship 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With the implementation of China's Healthy China initiative and the continuous advancement of healthcare reform, public demand for health knowledge has significantly increased. This trend inevitably imposes higher requirements on nurses'health education knowledge and skills. As the future backbone of the nursing workforce, cultivating Nursing interns'health education competence is a critical component of nursing education. Whether a nurse can become an effective health educator after entering clinical practice depends not only on their sense of responsibility but, more importantly, on their mastery of health education knowledge and practical implementation skills. Based on the conceptual framework of health education and related competence definitions, domestic scholars have defined health education competence as \"the integrated combination of knowledge, techniques, abilities, and behavioral attitudes required to effectively carry out health education activities\" \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. This competence is regarded as an internalized professional attribute that can be demonstrated in practice, representing a specialized skill set. Existing research on Nursing interns'health education competence reveals widespread deficiencies. Multiple studies indicate that nursing students generally lack sufficient knowledge and skills for effective health education. For example, Wang Miaoqin et al \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e investigated the health education competence of vocational, associate, and baccalaureate nursing interns and found common issues, including inadequate foundational knowledge, poor clinical application skills (e.g., communication techniques), and a lack of empathy toward patients. Similarly, Zhu Lanming et al \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e reported that nursing interns'overall health education competence was suboptimal, with assessment, planning, implementation, and evaluation dimensions all falling below the \"basic competency\" level. Mai Guiying's \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e study further revealed that only 34.6% of nursing students could systematically apply health education protocols in patient care. With rising living standards and accelerated lifestyles, chronic and lifestyle-related diseases have become increasingly prevalent, intensifying public demand for health knowledge. Consequently, nursing health education has evolved into a therapeutic intervention for many conditions. Therefore, enhancing Nursing interns'health education competence is crucial to improving their adaptability, professional competitiveness, and ability to meet diverse societal needs. Achieving seamless integration between nursing education and clinical practice has become a key objective in contemporary nursing education.\u003c/p\u003e\u003cp\u003eProposed by Dr. Rita Charon, Professor of Medicine at Columbia University, narrative medicine is defined in her 2006 seminal work as \"medicine practiced by clinicians with narrative competence\" - the ability to recognize, absorb, interpret, and be moved by patients'illness stories \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Serving as a vital bridge in clinician-patient relationships \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, narrative medicine enables healthcare providers to identify root causes of health issues through attentive story listening, uncover positive elements in patients'narratives, and guide them in reconstructing empowering health stories that activate intrinsic motivation for behavioral change. Notably, its originators have demonstrated its pivotal role in health education through narrative interventions \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe efficacy of narrative approaches in health education stems from their inherent characteristics: communicative power, action-oriented nature, realism, and homogeneity. As stories serve as the primary medium, they possess a unique capacity to convey health concepts profoundly, creating lasting motivational impacts \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Smith \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e further highlights that narrative methods foster collaborative nurse-patient partnerships, significantly enhancing care intervention effectiveness through narrative empathy - the cornerstone of therapeutic alliances.\u003c/p\u003e\u003cp\u003eIn clinical practice, narrative nursing tailors communication strategies according to patients'family backgrounds, social experiences, and education levels, effectively bridging the clinician-patient gap and optimizing health education outcomes\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Essentially, narrative medicine cultivates storytelling competence, emphasizing attentive listening to patients'and families'experiences - a fundamental prerequisite for effective health education. Its three core elements (attention, representation, and affiliation) can be systematically developed through training nursing students in active listening, communication techniques, and reflective practice, making narrative integration into health education curricula both necessary and feasible. Current health education training for nursing students focuses on enhancing humanistic care, communication skills, and health promotion competencies, particularly in listening, empathy, and self-expression. The abundance of clinical cases provides rich resources for narrative-based health education. Therefore, incorporating narrative medicine into curricula equips future nurses with innovative perspectives and personalized thinking approaches for health education, while fostering humanistic awareness and independent critical thinking.\u003c/p\u003e\u003cp\u003e This study will develop a diabetes health education curriculum for nursing students at China-Japan Friendship Hospital's Endocrinology Department, guided by narrative medicine's tripartite framework (attention, representation, affiliation). The intervention aims to enhance Nursing interns'health education competence, communication skills, humanistic care capacity, and empathetic abilities, potentially serving as a reference for clinical nursing education. The curriculum will be implemented and evaluated among endocrine rotation nursing interns to assess its effectiveness.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eGeneral Information\u003c/h2\u003e\u003cp\u003eThis study employed a convenience sampling method to select 85 nursing interns who were undergoing clinical training at China-Japan Friendship Hospital from August to October 2023 as research participants. Using a random number table, the participants were allocated into two groups: an experimental group (n\u0026thinsp;=\u0026thinsp;43) and a control group (n\u0026thinsp;=\u0026thinsp;42). The inclusion criteria were: (1) voluntary participation in this teaching improvement program; and (2) provision of signed informed consent. The exclusion criterion was failure to complete the course curriculum. The study in accordance with the Declaration of Helsinki and was approved by the China-Japan Friendship hospital's Ethics Committee (Approval No. : 2023-KY-180), and written informed consent was obtained from all participants prior to their enrollment in the study. Clinical trial number: not applicable.\u003c/p\u003e\u003cp\u003eBaseline characteristics were well-balanced between the intervention (n\u0026thinsp;=\u0026thinsp;43) and control (n\u0026thinsp;=\u0026thinsp;42) groups, with no statistically significant differences observed in demographic and pre-training parameters (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Both groups showed comparable distributions in gender (9.30% vs 16.67% male), age (mean 20.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83 vs 20.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82 years), educational background (\u0026asymp;\u0026thinsp;30% in 3-year program), and clinical experience profiles (53.49% vs 59.52% with prior clinical exposure). Similar proportions were noted in professional interest (\u0026asymp;\u0026thinsp;76% positive) and diabetes-related experience (62.79% in both groups). Detailed comparisons 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\u003eComparison of Baseline Characteristics Between Two Groups of Nursing Students\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention Group (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStatistical Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\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\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=1.023\u0026sup1;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.312\u003c/p\u003e\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\u003e4 (9.30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (16.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e39 (90.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35 (83.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.151\u0026sup2;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.880\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProgram Duration\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.005\u0026sup1;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.943\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13 (30.23%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (30.95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30 (69.77%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29 (69.05%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCPC Membership\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u0026sup3;\u003c/p\u003e\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\u003e3 (6.98%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (7.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e40 (93.02%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39 (92.86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrior Clinical Experience\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.315\u0026sup1;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.575\u003c/p\u003e\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\u003e23 (53.49%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25 (59.52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e20 (46.51%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17 (40.48%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInterest in Major\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.004\u0026sup1;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.952\u003c/p\u003e\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\u003e33 (76.74%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32 (76.19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e10 (23.26%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (23.81%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCareer Intention\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.433\u0026sup3;\u003c/p\u003e\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\u003e38 (88.37%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40 (95.24%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e5 (11.63%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (4.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrior Contact with Diabetic Patients\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=1.190\u0026sup1;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.275\u003c/p\u003e\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\u003e27 (62.79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27 (62.79%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e16 (37.21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16 (37.21%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrior Endocrinology Rotation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.704\u0026sup1;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.401\u003c/p\u003e\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\u003e8 (18.60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (26.19%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e35 (81.40%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31 (73.81%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eFootnotes\u003c/b\u003e:\u0026sup1; Chi-square value \u0026sup2; t-value \u0026sup3; Fisher's exact test\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Participants​​\u003c/h2\u003e\u003cp\u003eA randomized controlled trial was conducted between August and October 2023 at China-Japan Friendship Hospital. A convenience sampling method was used to recruit 85 nursing interns (including vocational college and undergraduate students) who were undertaking their clinical practicum during this period.\u003c/p\u003e\u003cp\u003eThe inclusion criteria were: (1) voluntary participation in this teaching improvement project; and (2) provision of signed informed consent. The sole exclusion criterion was failure to complete the course. This study was approved by the Hospital Ethics Committee of China-Japan Friendship Hospital (Approval No: 2023-KY-180). All participants provided written informed consent before randomization.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRandomization and Grouping\u003c/b\u003e​​\u003c/p\u003e\u003cp\u003eEligible participants were randomly assigned to either an intervention group (n\u0026thinsp;=\u0026thinsp;43) or a control group (n\u0026thinsp;=\u0026thinsp;42) using a computer-generated random number table. The allocation sequence was concealed from the researchers responsible for recruitment until the intervention was assigned.​\u003cb\u003eDevelopment of the Narrative Medicine-Based Training Curriculum\u003c/b\u003e​​\u003c/p\u003e\u003cp\u003eA curriculum development team was established, comprising eight members from the hospital's Department of Internal Medicine Education, including one director of nursing, one head nurse of the general internal medicine department, and six clinical instructors with over five years of teaching experience. All held bachelor's degrees or higher, with two possessing master's degrees.\u003c/p\u003e\u003cp\u003eGuided by the three core elements of narrative medicine practice\u0026mdash;attention, representation, and affiliation\u0026mdash;the team developed the curriculum by reviewing literature \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e and then analyzing primary reasons for interns' low health education competency (e.g., insufficient theoretical knowledge, poor communication, lack of practice opportunities). The curriculum, using the fourth edition of Practical Diabetologyas a foundational guide, was finalized through repeated discussions and revisions. The Narrative Medicine-Based Health Education Competency Training Curriculum for Nursing Interns: A Case Study of Diabetesconsisted of five modules:\u003c/p\u003e\u003cp\u003eTheoretical foundation and practical application of narrative medicine.\u003c/p\u003e\u003cp\u003eFundamental knowledge of diabetes health education.\u003c/p\u003e\u003cp\u003ePractical application of narrative medicine in diabetes health education.\u003c/p\u003e\u003cp\u003eHealth education communication skills training.\u003c/p\u003e\u003cp\u003eEmotional support and humanistic care for patients with diabetes.\u003c/p\u003e\u003cp\u003eTeaching materials included PowerPoint presentations and selected narrative films (e.g., The Bucket List, The Sea Inside) to enhance engagement. Clinical instructors received standardized training on narrative medicine theory, diabetes knowledge, communication skills, and parallel chart writing. See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for details.\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 Medicine-Based Health Education Competency Training Curriculum for Nursing Interns: A Case Study of Diabetes Health Education​​\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModule\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeaching Objectives\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCourse Content\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTeaching Methods\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDuration\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\u003e​Module 1: Theoretical Basis and Practical Application of Narrative Medicine​\u003c/b\u003e​\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTo understand the basic concepts of narrative medicine and its application in health education.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Overview of narrative medicine (Three core elements: attention, representation, affiliation)\u003c/p\u003e\u003cp\u003e- Differences and connections between narrative medicine and traditional medicine\u003c/p\u003e\u003cp\u003e- The impact of narrative medicine on nursing communication\u003c/p\u003e\u003cp\u003e- Case analysis: Application of narrative medicine in diabetes health education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLecture\u0026thinsp;+\u0026thinsp;Film Viewing\u0026thinsp;+\u0026thinsp;Group Discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 hours\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e​\u003cb\u003e​Module 2: Fundamental Knowledge of Diabetes Health Education​\u003c/b\u003e​\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTo help interns master fundamental knowledge of diabetes, providing a scientific basis for health education.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Definition, classification, and diagnosis of diabetes\u003c/p\u003e\u003cp\u003e- Diabetic complications and their prevention\u003c/p\u003e\u003cp\u003e- Self-management and lifestyle interventions for patients with diabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTheoretical Teaching\u0026thinsp;+\u0026thinsp;Case Analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 hours\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e​\u003cb\u003e​Module 3: Practical Application of Narrative Medicine in Diabetes Health Education​\u003c/b\u003e​\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTo learn how to apply narrative medicine methods in diabetes health education.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Listening to patient stories to focus on their emotional needs\u003c/p\u003e\u003cp\u003e- Enhancing empathy by narratively reconstructing the patient's life context\u003c/p\u003e\u003cp\u003e- Establishing trust with patients to promote healthy behavior change\u003c/p\u003e\u003cp\u003e- Narrative communication skills: active listening, feedback, and expression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSimulated Role-Playing\u0026thinsp;+\u0026thinsp;Group Discussion\u0026thinsp;+\u0026thinsp;Video Case Analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 hours\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e​\u003cb\u003e​Module 4: Health Education Communication Skills Training: Using Insulin Injection Education as an Example​\u003c/b\u003e​\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTo enhance interns' communication skills, enabling them to flexibly apply narrative medicine techniques.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Basic communication skills: open-ended questions, listening, feedback\u003c/p\u003e\u003cp\u003e- Communication techniques for patient education using narrative methods\u003c/p\u003e\u003cp\u003e- Enhancing patient compliance through emotional support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCommunication Skills Training (Clinical Practice)\u0026thinsp;+\u0026thinsp;Group Discussion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 hours\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e​\u003cb\u003e​Module 5: Emotional Support and Humanistic Care for Patients with Diabetes (Including Parallel Chart Writing)​\u003c/b\u003e​\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTo provide emotional support and demonstrate humanistic care during the health education process.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e- Psychological status and emotional needs of patients with diabetes\u003c/p\u003e\u003cp\u003e- Application of humanistic care in diabetes health education\u003c/p\u003e\u003cp\u003e- Introduction and demonstration of parallel chart writing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCase Analysis\u0026thinsp;+\u0026thinsp;Role-Playing\u0026thinsp;+\u0026thinsp;Interactive Discussion\u0026thinsp;+\u0026thinsp;Parallel Chart Submission\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 hours\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention group\u003c/b\u003e: Implementation of the Health Education Competency Training Curriculum from a Narrative Medicine Perspective\u003c/p\u003e\u003cp\u003e The experimental group participated in the developed curriculum over eight weeks, following a \u0026ldquo;theoretical learning\u0026mdash;progressive practice\u0026mdash;deep reflection\u0026rdquo; teaching model. The curriculum combined lectures, clinical practice, case-based teaching, and reflective writing to ensure interns effectively integrated narrative medicine into diabetes health education.\u003c/p\u003e\u003cp\u003ePhase 1 (Theoretical Training: Weeks 1\u0026ndash;2)\u003c/p\u003e\u003cp\u003eInterns received systematic theoretical training to build their health education knowledge base and understand the application of narrative medicine in diabetes health education. The modular curriculum covered narrative medicine theory, core diabetes health education knowledge, communication skills, emotional support, and humanistic care. Teaching methods included lectures, case analyses, film viewing, and group discussions. Role-playing and situational simulations were used to train interns'communication skills, such as simulating nurse-patient interactions to demonstrate the impact of different communication styles on patient compliance.\u003c/p\u003e\u003cp\u003ePhase 2 (Clinical Practice: Weeks 3\u0026ndash;6)\u003c/p\u003e\u003cp\u003eInterns entered the endocrinology department for clinical practice, applying their knowledge under the guidance of clinical instructors. Each intern was required to select at least two diabetes patients and provide individualized health education on insulin pen usage, tailoring their approach based on the patients'conditions, cultural backgrounds, and cognitive abilities. Interns used narrative medicine methods to listen to patients'health stories, identify their needs, and employ effective communication techniques to enhance understanding and acceptance of health education. Weekly case discussions were held for interns to report their experiences and collaboratively address challenges in patient education. Bedside teaching, case guidance, and group discussions were used to strengthen clinical skills.\u003c/p\u003e\u003cp\u003ePhase 3 (Reflective Writing: Weeks 7\u0026ndash;8)\u003c/p\u003e\u003cp\u003eTo promote self-awareness and skill development, interns were required to write reflective parallel charts based on their health education experiences with selected patients. These charts documented the education process, patient feedback, and personal growth. Interns analyzed patients'emotional needs from a narrative medicine perspective and reflected on their strengths and weaknesses in health education communication. Instead of grading, instructors provided guided feedback to encourage deep reflection and continuous improvement in future clinical practice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eControl group\u003c/b\u003e:The control group received standard diabetes education training, focusing on both theoretical knowledge and health education frameworks and techniques. During the initial phase of the internship, participants in the control group underwent a systematic training program on diabetes health education. The curriculum encompassed essential topics including the definition and classification of diabetes, complication management, patient self-care, insulin pen usage, and health education techniques. The instructional methods primarily consisted of lectures, PowerPoint presentations, case analyses, and group discussions, with an emphasis on developing the students' ability to apply knowledge and master skills in health education contexts.\u003c/p\u003e\u003cp\u003eTo enhance the students' practical teaching competencies, we implemented communication skills training through simulated scenarios. These exercises aimed to improve the interns'patient education capabilities, particularly in explaining critical aspects of insulin injection and enhancing patient compliance. During the clinical practice phase, under the guidance of clinical instructors, the interns applied their acquired health education knowledge in patient education for individuals with diabetes. Each intern was required to select at least two diabetic patients and provide personalized health education focusing on insulin pen usage, adapting their teaching strategies according to the patients'conditions and cognitive abilities.\u003c/p\u003e\u003cp\u003eClinical instructors provided bedside demonstrations, guiding the interns in optimizing their health education content and offering real-time feedback to enhance their teaching techniques. Additionally, we organized case discussion sessions where interns shared their practical experiences in health education, addressed common clinical challenges, and developed strategies for improving health education methods through group discussions.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOutcome Measure\u003c/h3\u003e\n\u003cp\u003e(1) Health Education Competency\u003c/p\u003e\u003cp\u003eHealth education competency was assessed using the Health Education Competency Scale developed by Tong et al. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. The scale comprises 38 items across four dimensions: assessment (11 items), planning (8 items), implementation (12 items), and evaluation (6 items). Each item is scored on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree), with total scores ranging from 38 to 190. Higher scores indicate greater competency. The scale demonstrated excellent reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.949) and validity (CVI\u0026thinsp;=\u0026thinsp;0.9).\u003c/p\u003e\u003cp\u003e(2) Nurse-Patient Communication Skills\u003c/p\u003e\u003cp\u003eNurse-patient communication skills were evaluated using the Nurse-Patient Communication Competence Scale by Xu et al. \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. The 43-item scale includes six dimensions: planning and preparation (6 items), initiating communication (7 items), information gathering (11 items), information giving (6 items), understanding patient perspectives (6 items), and concluding communication (6 items). Each item is rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;poor to 5\u0026thinsp;=\u0026thinsp;excellent). The scale showed high internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.953) and stability (split-half reliability\u0026thinsp;=\u0026thinsp;0.965).\u003c/p\u003e\u003cp\u003e(3) Humanistic Caring Ability\u003c/p\u003e\u003cp\u003eHumanistic caring ability was measured using the Caring Ability Inventory (CAI) developed by Nkongho \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e and adapted into Chinese by Xu et al. \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. The 37-item scale assesses three dimensions: understanding, courage, and patience. Items are scored on a 7-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 7\u0026thinsp;=\u0026thinsp;strongly agree), with 13 reverse-scored items. The scale demonstrated good reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.751) and validity (KMO\u0026thinsp;=\u0026thinsp;0.876).\u003c/p\u003e\u003cp\u003e(4) Empathy\u003c/p\u003e\u003cp\u003eEmpathy was evaluated using the Jefferson Scale of Empathy adapted by An et al. \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The 20-item scale includes three dimensions: perspective-taking (10 items), compassionate care (8 items), and standing in the patient\u0026rsquo;s shoes (2 items). Items are scored on a 7-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 7\u0026thinsp;=\u0026thinsp;strongly agree), with total scores ranging from 20 to 140. Higher scores indicate greater empathy. The scale showed acceptable reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.750; split-half reliability\u0026thinsp;=\u0026thinsp;0.771) and test-retest reliability (r\u0026thinsp;=\u0026thinsp;0.659).\u003c/p\u003e\u003cp\u003eAll assessment scales used in this study (the Health Education Competency Scale, Nurse-Patient Communication Competence Scale, Caring Ability Inventory, and Jefferson Scale of Empathy) were previously published and validated instruments, as cited in the respective references \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. No new questionnaires were developed specifically for this study.\u003c/p\u003e\n\u003ch3\u003eQuality Control\u003c/h3\u003e\n\u003cp\u003eThis project required collaboration among all teaching nurses in the Internal Medicine Teaching and Research Office. The project applicant served as the team leader, organizing curriculum development workshops to determine the course content. Subsequently, teaching nurses received pre-training to ensure consistency in course delivery. A research archive was established for nursing interns, and attendance was recorded for each session. Interns who missed sessions were provided with individual tutoring and required to complete make-up sessions to ensure all participants received the full training. A WeChat group was created to facilitate timely communication and address any issues promptly.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Collection Methods\u003c/h2\u003e\u003cp\u003ePrior to the study, non-endocrinology teaching instructors administered paper-based questionnaires to assess the interns\u0026rsquo; health education competency, humanistic caring ability, and empathy. The nurse-patient communication competence scale, being an observer-rated tool, was evaluated by teaching instructors based on the interns\u0026rsquo; daily interactions with patients before the intervention. After completing the training for both the experimental and control groups, all four outcome measures were reassessed using paper-based questionnaires. The nurse-patient communication competence was specifically evaluated during the interns\u0026rsquo; second insulin injection education session. On the day of questionnaire collection, the researcher carefully reviewed each form and reminded participants to complete any missing items. During data entry, double-checking was performed to ensure accuracy.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS 22.0. Descriptive statistics were used to summarize the data. Normally distributed continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄ \u0026plusmn; SD), while non-normally distributed continuous variables were presented as median (25th percentile, 75th percentile), i.e., M (P25, P75). Categorical variables were reported as frequencies (%). For between-group comparisons, independent samples t-tests were used for normally distributed continuous variables, and non-parametric tests were applied for non-normally distributed data. Categorical variables were compared using chi-square tests (χ\u0026sup2;) or Fisher\u0026rsquo;s exact tests. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eComparison of Health Education Competency, Nurse-Patient Communication Skills, Humanistic Care Ability, and Empathy Between Groups Before and After Training\u003c/b\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePre-training assessment:\u003c/h2\u003e\u003cp\u003eNo significant differences were observed between the intervention (n\u0026thinsp;=\u0026thinsp;43) and control (n\u0026thinsp;=\u0026thinsp;42) groups across all dimensions and total scores of health education competency, nurse-patient communication skills, humanistic care ability, and empathy (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), confirming comparable baseline characteristics (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePost-training outcomes:\u003c/h2\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHealth education competency:The intervention group demonstrated significantly higher scores in assessment (P\u0026thinsp;=\u0026thinsp;0.049) and planning dimensions (P\u0026thinsp;=\u0026thinsp;0.041), along with total scores (P\u0026thinsp;=\u0026thinsp;0.047), while no significant differences were found in implementation (P\u0026thinsp;=\u0026thinsp;0.142) or evaluation dimensions (P\u0026thinsp;=\u0026thinsp;0.077).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eNurse-patient communication: The intervention group showed superior performance across all communication subscales - planning/preparation (P\u0026thinsp;=\u0026thinsp;0.036), initiation (P\u0026thinsp;=\u0026thinsp;0.016), information gathering (P\u0026thinsp;=\u0026thinsp;0.012), information delivery (P\u0026thinsp;=\u0026thinsp;0.016), and perspective-taking (P\u0026thinsp;=\u0026thinsp;0.034) - except for communication closure (P\u0026thinsp;=\u0026thinsp;0.078). Total communication scores were significantly higher (P\u0026thinsp;=\u0026thinsp;0.016).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003e(3)Humanistic care ability: No significant intergroup differences were detected in any dimensions (understanding, courage, patience) or total scores (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e(4)Empathy: The intervention group achieved significantly higher scores in perspective-taking (P\u0026thinsp;=\u0026thinsp;0.048) and total empathy (P\u0026thinsp;=\u0026thinsp;0.038), while emotional care (P\u0026thinsp;=\u0026thinsp;0.099) and role-taking (P\u0026thinsp;=\u0026thinsp;0.137) showed no significant differences.\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\u003ePre-intervention Comparison of Competency Scores Between Groups [M(P25,P75)/(x̄\u0026plusmn;s)]\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDomain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStatistic (Z/t)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16(16,20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.5(14.75,21.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.922\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlanning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16(16,20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.5(14.75,21.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.968\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImplementation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24(24,27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(19.5,29.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.905\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvaluation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(12,13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(8.75,15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.756\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e76(74,87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77(65.5,95.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.853\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCommunication\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlanning/Preparation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInitiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.07\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.17\u0026thinsp;\u0026plusmn;\u0026thinsp;3.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.294\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInformation Gathering\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.476\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInformation Delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.51\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.284\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerspective-Taking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.36\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClosure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e160.14\u0026thinsp;\u0026plusmn;\u0026thinsp;16.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e154.86\u0026thinsp;\u0026plusmn;\u0026thinsp;12.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.094\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHumanistic Care\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderstanding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82(71,91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e82(75,88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.788\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCourage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46(40,55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46(38.75,58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.771\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60(54,64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.5(52.75,62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.465\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e187(173,197)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e188(178.25,198)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.784\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmpathy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerspective-Taking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43(38,60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(35,46.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40(36,53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.5(34.75,42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.112\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRole-Taking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(9,11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(8,10.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.345\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e89(82,120)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.5(80,102)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePost-intervention Comparison of Competency Scores [M(P25,P75)/x̄\u0026plusmn;s]\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDomain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStatistic (Z/t)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Education\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45(44,55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44(41,51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlanning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29(27,35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(25.75,30.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.041\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImplementation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50(48,60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48(46.75,53.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.142\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvaluation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25(24,30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(24,27.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e151(143,178)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e144(137,159.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCommunication\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlanning/Preparation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInitiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.21\u0026thinsp;\u0026plusmn;\u0026thinsp;4.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.29\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInformation Gathering\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40.44\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.02\u0026thinsp;\u0026plusmn;\u0026thinsp;4.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInformation Delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.67\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.02\u0026thinsp;\u0026plusmn;\u0026thinsp;3.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerspective-Taking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.00\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClosure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27(24,28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.81\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e165.91\u0026thinsp;\u0026plusmn;\u0026thinsp;17.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e157.00\u0026thinsp;\u0026plusmn;\u0026thinsp;15.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHumanistic Care\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderstanding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82(73,92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.50(74.75,88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.538\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCourage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50(40,56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.5(38.75,59.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.795\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64(56,66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60(54.5,64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.344\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e191(177,203)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e190.5(180.75,195.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.853\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEmpathy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerspective-Taking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42(38,64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.50(35,45.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39(36,50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34(36,40.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.099\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRole-Taking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(8,12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(8,10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88(81,120)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84.5(80,97.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates statistical significance\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003eThe Narrative Medicine-Based Training Curriculum Promoted Health Education Competency, Nurse-Patient Communication, and Empathy in Nursing Interns\u003c/b\u003e​​\u003c/p\u003e\u003cp\u003eThe findings of this study demonstrate that the constructed narrative medicine-based training curriculum significantly improved the health education competency, nurse-patient communication skills, and empathy of nursing interns. In clinical practice, nurses' health education competency is a key factor determining the quality and effectiveness of patient education, which is directly related to patient rehabilitation and quality of life improvement \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Empathy, as a core element of nurse-patient communication, serves not only as a starting point for building a positive relationship but also as a crucial guarantee for enhancing patient adherence and optimizing the healthcare experience. The synergistic development of communication skills and empathy provides a dual assurance for establishing trust and improving the effectiveness of health education. Health education competency for nursing interns is a multi-dimensional construct encompassing assessment, goal-setting, planning, implementation, and evaluation \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Narrative medicine, as a clinical practice model emphasizing narrative skills, has been shown in previous studies to significantly enhance empathy and communication skills in medical students \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. For interns newly entering the clinical environment, systematic training is essential to improve their practical abilities and ensure professional nursing service.\u003c/p\u003e\u003cp\u003eOur results indicated that after the 8-week intervention, the intervention group showed significantly greater improvements than the control group in the assessment and planning dimensions (and total score) of health education competency, in most dimensions (planning and preparation, initiation, information gathering, information giving, understanding the patient's perspective, and total score) of nurse-patient communication, and in the perspective-taking dimension (and total score) of empathy (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This finding is consistent with the results reported by Liu Dacheng et al. \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e, whose research indicated that narrative methods, through situational simulation, can effectively stimulate emotional support and enhance communication and empathy by helping interns resolve practical problems. The current curriculum, incorporating modules such as simulated patient stories, emotional support training, and reflective writing, helped interns master core skills like \"active listening\" and \"empathetic feedback.\" This not only facilitated the effective implementation of health education but also strengthened their ability to assess individual patient needs, enabling the development of more targeted education plans. Furthermore, the integrated basic knowledge of diabetes health education provided essential professional support.\u003c/p\u003e\u003cp\u003eHowever, no significant differences were observed between the two groups in the implementation and evaluation dimensions of health education competency, or in the closure dimension of communication (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Several factors may explain these findings. First, the relatively short 8-week intervention period may have been insufficient for interns to accumulate enough practical experience to fully translate learned knowledge into actionable skills. Second, limited clinical practice opportunities might have restricted their sensitivity to feedback on education effectiveness. Third, the traditional pedagogical model, where interns often assume a passive role, may make it challenging to foster an active evaluation mindset within a short timeframe. These findings suggest that future curriculum optimization should emphasize simulated practice and feedback mechanisms to enhance the development of practical skills. The lack of significant improvement in the \"compassionate care\" and \"standing in the patient's shoes\" dimensions of empathy suggests that evoking deep emotional resonance through narrative medicine may require longer-term practice, whereas short-term training might primarily enhance cognitive perspective-taking.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis of Reasons for the Lack of Improvement in Humanistic Care Ability\u003c/b\u003e​​\u003c/p\u003e\u003cp\u003eThe \"Healthy China 2030\" Plan Outline \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e explicitly calls for strengthening humanistic care in health services to build harmonious patient-provider relationships. Concurrently, the National Health Commission has emphasized that nursing personnel should enhance their proactive service awareness and humanistic care ability. Humanistic care quality in nurses refers to a relatively stable professional characteristic developed through practice and manifested in caring behaviors \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, influenced by multiple factors. Previous research has indicated a positive effect of narrative competence on nurses' humanistic care quality \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Contrary to expectations, the results of this study showed no significant differences in the overall score or any sub-dimensions (understanding, courage, patience) of humanistic care ability between the intervention and control groups after the training (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that the curriculum did not achieve the intended effect in this domain.\u003c/p\u003e\u003cp\u003eThis finding differs from some existing studies. For instance, Yang Shuzhen et al. \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e reported that narrative education significantly improved humanistic care ability among midwifery interns. This discrepancy may be attributed to their focus on a specific student population (midwifery) and a curriculum deliberately designed around enhancing humanistic care, utilizing literature and documentaries directly related to obstetric care (e.g., Gentle Birth, The Birth of Life). In contrast, our study involved a general cohort of nursing interns, and the curriculum was primarily focused on health education and communication, with less direct emphasis on humanistic care cultivation. Furthermore, although empathy improved significantly in our study, humanistic care ability did not follow suit. This contrasts with studies by Fan Xiaoting et al. \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e and Xu Linxia et al. \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e, which suggested that narrative ability mediates the relationship between empathy and humanistic care quality among clinical nurses. Therefore, our results might imply that the narrative competence developed by the interns in this short-term program had not yet reached a threshold necessary to foster significant improvement in humanistic care.\u003c/p\u003e\u003cp\u003eIt is important to note that humanistic care is a complex psychological trait influenced by personal experiences, values, and socio-cultural factors. The brief 8-week intervention period might have been insufficient to effect a fundamental change in the interns' deeply held attitudes towards care. This suggests that future curriculum designs should consider the following: extending the training duration to allow for deeper internalization; incorporating more content specifically aimed at fostering humanistic care ability, such as narrative materials directly relevant to nursing practice; and strengthening practical components through clinical simulations and reflective practice to help interns internalize humanistic care as a professional virtue.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides evidence supporting the effectiveness of a narrative medicine-based approach in enhancing key competencies among nursing interns. The developed curriculum demonstrated significant positive impacts on health education capability, communication proficiency, and empathic capacity, while revealing opportunities for further refinement in other domains. These findings contribute to the growing body of knowledge on innovative nursing education methodologies and their potential to prepare students for the complexities of contemporary healthcare practice.\u003c/p\u003e\u003cp\u003eSeveral limitations should be acknowledged when interpreting these results. The relatively short intervention period and modest sample size may have constrained our ability to detect more comprehensive effects, particularly in areas requiring extended skill development. Additionally, the single-center design limits generalizability, suggesting the need for broader validation studies. Future research should explore longer intervention durations, enhanced practical components, and more robust integration of humanistic care elements. Such developments could further optimize the program's effectiveness and better address the multifaceted demands of nursing practice in diverse clinical settings.\u003c/p\u003e\u003cp\u003eDespite these limitations, the current study offers valuable insights for nursing education reform. The successful application of narrative medicine principles to health education training represents a promising avenue for developing more holistic, patient-centered approaches to nursing education. As healthcare systems worldwide continue to emphasize the importance of both technical competence and humanistic qualities in nursing practice, such innovative educational strategies will likely play an increasingly important role in preparing the next generation of nursing professionals. Future iterations of this program should build on these findings while addressing the identified areas for improvement, ultimately contributing to the cultivation of well-rounded nursing professionals capable of delivering exceptional, compassionate care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCAI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCaring Ability Inventory\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of China-Japan Friendship Hospital (Approval No.: 2023-KY-180). Written informed consent was obtained from all participants prior to their enrollment in the study.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable. This manuscript does not contain any individual person\u0026apos;s data in a identifiable form.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eEducation and Teaching Reform Project of Capital Medical University (2023JYY475)\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eJuan Cheng: Conceptualization, Methodology, Formal analysis, Writing - Original Draft. Qi Lian: Investigation, Data Curation. Shasha Liu: Resources, Project administration. He Sun: Validation, Visualization. Lu Wang: Software, Supervision. Yangxi Li: Writing - Review \u0026amp; Editing, Funding acquisition.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank all the nursing interns who participated in this study and the clinical instructors from the Department of Internal Medicine Education at China-Japan Friendship Hospital for their support in implementing the training curriculum.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to protections of participant privacy but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; information\u003c/h2\u003e\n\u003cp\u003eAll authors are affiliated with the Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBao JM. Nursing Health Education and Health Promotion. Beijing: People\u0026apos;s Medical Publishing House; 2014. p. 9. \u003c/li\u003e\n\u003cli\u003eXu R, Li XH. Research status of health education competence of hospital and community nurses in China. Chin J Mod Nurs. 2011;17(4):489-491. \u003c/li\u003e\n\u003cli\u003eWang MQ, Cui LJ. Investigation, analysis and countermeasures of health education competence of nursing interns. Int J Nurs. 2009;28(2):251-253. \u003c/li\u003e\n\u003cli\u003eZhu LM, Feng GH, Fu W. Analysis of the current situation of health education ability of nursing interns and countermeasures. Chin J Mod Nurs. 2015;21(11):1333-1337. \u003c/li\u003e\n\u003cli\u003eMai GY. Investigation on the cognition and influencing factors of health education among college nursing students. Chin Gen Pract Nurs. 2012;8(10):2189-2190. \u003c/li\u003e\n\u003cli\u003eCharon R. Narrative Medicine: Honoring the Stories of Illness. New York: Oxford University Press; 2006. \u003c/li\u003e\n\u003cli\u003eGiroux J. Communication-making the human connection. Urol Nurs. 2013;33(6):265. \u003c/li\u003e\n\u003cli\u003eZhang J, Zhang XY, He H. Clinical application research of narrative medicine. Chin Nurs Res. 2013;27(23):2439-2440. \u003c/li\u003e\n\u003cli\u003eHuang H, Liu YL. Research progress on clinical application of narrative nursing. Chin J Nurs. 2016;51(2):196-199. doi:10.3761/j.issn.0254-1769.2016.02.012 \u003c/li\u003e\n\u003cli\u003eSmith BL, Lorenz R, Leander S. Listening with care: using narrative methods to cultivate nurses\u0026apos; responsive relationship in a home visiting intervention with teen mothers. Nurs Inq. 2013;20(3):188-198. \u003c/li\u003e\n\u003cli\u003eJi YZ, Yu T, Zheng D. Exploration of the application of narrative nursing in health education for perioperative patients. China Health Care Nutr. 2017;27(17):254. \u003c/li\u003e\n\u003cli\u003ePan JW, Wang DK, Bai K, et al. Research progress on health education competency of nursing interns: a review. Int J Nurs. 2024;43(23):4406-4410. doi:10.3760/cma.j.cn221370-20240701-01022 \u003c/li\u003e\n\u003cli\u003eTong HJ, Li XH. Development and testing of the Health Education Competency Scale for nursing staff. J Nurs Sci. 2010;25(23):17-18. doi:10.3870/hlxzz.2010.23.017 \u003c/li\u003e\n\u003cli\u003eXu YH. Development of a Nurse-Patient Communication Ability Scale for Nursing Students[dissertation]. Liaoning: China Medical University; 2006. \u003c/li\u003e\n\u003cli\u003eNkongho NO. The Caring Ability Inventory. In: Strickland OL, Waltz CF, editors. Measurement of Nursing Outcomes. Volume 4: Measuring Client Self-Care and Coping Skills. New York: Springer Publishing Company; 1990. p. 3-16. \u003c/li\u003e\n\u003cli\u003eXu J, Liu YL. Investigation and analysis of caring ability among clinical nurses. J Nurs Sci. 2008;23(2):16-18. doi:10.3969/j.issn.1001-4152.2008.03.007 \u003c/li\u003e\n\u003cli\u003eAn XQ, Yang H, Xu JP, et al. Compilation and evaluation of the Chinese version of the Jefferson Scale of Empathy for health professionals. Chin Nurs Res. 2008;22(22):2063-2064, 2066. doi:10.3969/j.issn.1009-6493.2008.22.050 \u003c/li\u003e\n\u003cli\u003eZheng DL, Ma FZ, Ji SD, et al. Status and influencing factors of health education competency among clinical nurses in Ningxia. Chin J Nurs Educ. 2023;20(11):1355-1360. doi:10.3761/j.issn.1672-9234.2023.11.012 \u003c/li\u003e\n\u003cli\u003eHe YG, He S, Hu GJ, et al. Current status and prospects of research on improving health education ability of nursing students. Mod Nurse. 2020;27(3):6-8. doi:10.19793/j.cnki.1006-6411.2020.09.003 \u003c/li\u003e\n\u003cli\u003eZhang HP, Li Q, Zheng YJ, et al. Effect of narrative medicine on the narrative and communication skills of resident trainees. J Fujian Med Univ (Soc Sci Ed). 2024;25(5):57-61. \u003c/li\u003e\n\u003cli\u003eLiu DC, Shi Y, Huang J, et al. Intervention study of narrative education combined with workshop training model on empathy and communication ability of nursing students. Chongqing Med. 2023;52(24):3822-3825. doi:10.3969/j.issn.1671-8348.2023.24.027 \u003c/li\u003e\n\u003cli\u003eThe State Council of the People\u0026apos;s Republic of China. Outline of the \u0026quot;Healthy China 2030\u0026quot; Plan [Internet]. 2016 Oct 25 [cited 2022 Feb 26]. Available from: https://www.gov.cn/gongbao/content/2016/content_5133024.htm \u003c/li\u003e\n\u003cli\u003eMeng M, Zhang X, Jiang A. A theoretical framework of caring in the Chinese context: a grounded theory study. J Adv Nurs. 2011;67(7):1523-1536. doi:10.1111/j.1365-2648.2010.05573.x \u003c/li\u003e\n\u003cli\u003eCui JR, Hu LH, Kuang W, et al. Correlation between humanistic care quality and medical narrative ability of clinical nurses. J Nurs Sci. 2021;36(9):58-60. doi:10.3870/j.issn.1001-4152.2021.09.058 \u003c/li\u003e\n\u003cli\u003eYang SZ, Zheng HY, Guo P, et al. Effect of narrative medicine education on empathy and humanistic care ability of undergraduate midwifery students. Chin J Nurs Educ. 2023;20(6):672-677. doi:10.3761/j.issn.1672-9234.2023.06.006 \u003c/li\u003e\n\u003cli\u003eFan XT, Sun HC, Zhang HX. Influence of medical narrative and empathy ability on humanistic care ability of nursing interns. Chin J Health Psychol. 2024;32(4):610-616. doi:10.13342/j.cnki.cjhp.2024.04.024 \u003c/li\u003e\n\u003cli\u003eXu LX, Song MX, Wu XL, et al. Mediating effect of medical narrative ability between empathy and humanistic care quality in clinical nurses. J Nurs Adm. 2024;24(5):408-412. doi:10.3969/j.issn.1671-315x.2024.05.009 \u003c/li\u003e\n\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-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"narrative medicine, nursing interns, health education competency, curriculum development","lastPublishedDoi":"10.21203/rs.3.rs-7878405/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7878405/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003e​The development of health education competency in nursing interns is crucial, yet many struggle with effective patient communication and engagement. Narrative medicine, emphasizing empathy and understanding patient stories, offers a potential pedagogical solution.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003e​This study aimed to develop, implement, and evaluate the effectiveness of a narrative medicine-based health education training program for nursing interns, using diabetes education as an example.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe constructed curriculum, Health Education Training for Nursing Interns from the Perspective of Narrative Medicine: A Case Study of Diabetes Health Education, comprised five components: (1) theoretical foundations and practical applications of narrative medicine, (2) fundamental knowledge of diabetes health education, (3) practical application of narrative medicine in diabetes health education, (4) training in health education communication skills, and (5) emotional support and humanistic care for diabetic patients. We used convenience sampling, 85 nursing interns at China-Japan Friendship Hospital from August to October 2023 were selected as participants and randomly divided into an intervention group (n\u0026thinsp;=\u0026thinsp;43) and a control group (n\u0026thinsp;=\u0026thinsp;42) via a random number table. The intervention group received the narrative medicine-based training, while the control group followed traditional training methods. Differences between the two groups were compared in terms of health education competency, nurse-patient communication, empathy, and humanistic care ability before and after the intervention.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAfter intervention, compared with the control group, the intervention group scored significantly higher for total health education competency (Z=-1.987, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), nurse-patient communication (t\u0026thinsp;=\u0026thinsp;2.465, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and empathy (Z\u0026thinsp;=\u0026thinsp;2.07, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, no statistically significant differences were observed in health education implementation, evaluation, or total humanistic care ability and its subdimensions (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe narrative medicine-based training curriculum effectively improved nursing interns'health education competency, nurse-patient communication, and empathy, but its impact on humanistic care ability and practical application of health education was limited.\u003c/p\u003e","manuscriptTitle":"Development and application of a narrative medicine-based training course to improve health education competency in nursing interns","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 09:46:13","doi":"10.21203/rs.3.rs-7878405/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-11T16:01:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84385809970731536936239049803655799042","date":"2026-04-06T12:30:10+00:00","index":"hide","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-27T11:10:03+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"308355299374737167332134533017192401624","date":"2025-12-10T10:18:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-05T08:29:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-06T10:06:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-06T03:59:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-11-06T03:55:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3fc89b67-353c-4c8a-b620-b63cfd612a0d","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T09:46:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 09:46:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7878405","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7878405","identity":"rs-7878405","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}