Effects of Narrative Nursing Based on the Body-Mind-Spirit Holistic Health Model on Inpatients with Schizophrenia

Effects of Narrative Nursing Based on the Body-Mind-Spirit Holistic Health Model on Inpatients with Schizophrenia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of Narrative Nursing Based on the Body-Mind-Spirit Holistic Health Model on Inpatients with Schizophrenia Xu Du, Tao Li, Lan Zhang, Xiucheng Ma, Keyu Su This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6846721/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Objective This study aimed to evaluate the effects of narrative nursing interventions grounded in the Body-Mind-Spirit (BMS) holistic health model on subjective well-being, social functioning, and depressive symptoms among inpatients with schizophrenia. Methods A randomized controlled trial was conducted with 119 hospitalized patients diagnosed with schizophrenia, who were randomly assigned to an intervention group (n = 60) or a control group (n = 59). While the control group received routine care, the intervention group received an additional four-week BMS-based narrative nursing program, comprising weekly group sessions (2–3 hours each). Outcome measures included the General Well-Being Schedule, the Social Functioning of Inpatients with Schizophrenia Scale, and the Hamilton Depression Rating Scale, assessed pre- and post-intervention. Results Following the intervention, the experimental group demonstrated statistically significant improvements in subjective well-being and social functioning scores, alongside a significant reduction in depressive symptoms ( P < 0.001). Analysis of covariance further indicated that the reduction in HAMD scores was significantly greater in the intervention group compared to controls (F = 42.482, P < 0.001). Effect size analysis using Cohen’s d revealed large effects in favor of the intervention across all outcome domains. Conclusion The BMS-based narrative nursing intervention significantly alleviated depressive symptoms and enhanced both subjective well-being and social functioning in inpatients with schizophrenia. These findings suggest that narrative nursing guided by a holistic in the Body-Mind-Spirit framework holds promising clinical value and warrants broader application in psychiatric rehabilitation. Schizophrenia Narrative Nursing Body-Mind-Spirit Model Subjective Well-Being Social Functioning Depression Introduction Schizophrenia is a prevalent chronic psychiatric disorder that notablely impairs cognitive, emotional, and social functioning. Patients often experience persistent depressive moods, reduced interest, and social withdrawal, resulting in diminished subjective well-being and quality of life [ 1 ] . While pharmacological treatments and cognitive-behavioral interventions can alleviate some symptoms, they are often insufficient in addressing deeper emotional support, existential meaning, and spiritual needs [ 2 , 3 ] . The Mental Health Law of the People’s Republic of China explicitly states that individuals with mental disorders are entitled to comprehensive support in medical care, rehabilitation, and societal integration [ 4 ] .The Body-Mind-Spirit (BMS) holistic health model, an integrative healthcare approach emphasizing coordinated development of physical, psychological, and spiritual domains, has demonstrated positive outcomes in chronic illness, oncology, and geriatric care [ 5 ] . Narrative nursing, a patient-centered psychological intervention, facilitates personal storytelling and cognitive restructuring, thereby enhancing patients’ inner resilience and social adaptation. Its application has gained growing attention in psychiatric nursing practice [ 6 ] . Subjective well-being, reflecting individuals’ affective states and life satisfaction, is an important psychological indicator for recovery in psychiatric populations [ 7 – 9 ] . However, empirical studies integrating the BMS model with narrative nursing—particularly in improving well-being, reducing depressive symptoms, and enhancing social functioning among patients with schizophrenia—remain limited. This study aimed to develop and implement a structured narrative nursing intervention grounded in the BMS framework and evaluate its effectiveness in alleviating depressive symptoms, promoting subjective well-being, and improving social functioning among inpatients with schizophrenia. The goal is to provide theoretical support and practical guidance for psychiatric rehabilitation. Methods Participants A total of 119 inpatients diagnosed with schizophrenia were recruited from a tertiary-level psychiatric hospital in Sichuan Province between September and December 2024 using convenience sampling. Inclusion criteria were as follows: (1) a confirmed diagnosis of schizophrenia based on the International Classification of Diseases, 10th Revision (ICD-10) [ 10 ] ; (2) age between 18 and 60 years; (3) completion of at least primary education, with adequate communication and comprehension abilities; (4) an expected hospitalization period of no less than three months; and (5) voluntary participation with written informed consent obtained from both the patient and their legal guardian. Exclusion criteria included: (1) co-occurrence of other severe psychiatric or neurological disorders; (2) being in an acute psychotic state or presenting a high risk of aggression or self-injury; (3) serious comorbid physical illness or substance dependence; and (4) having received any similar psychological or narrative intervention within the past three months. This study employed the GWBS [ 11 ] , the Social Functioning of Inpatients with Schizophrenia Scale (SSFPI) [ 12 ] , and the Hamilton Depression Rating Scale (HAMD)[14] as the primary outcome measures. The required sample size was calculated using the formula for comparing the means of two independent samples: \(\:{n}_{1}={n}_{2}=2\times\:{\left(\frac{{U}_{{\alpha\:}}+{U}_{{\beta\:}}}{{\delta\:}/{\sigma\:}}\right)}^{2}+\frac{1}{4}{U}_{{\alpha\:}}^{2}\) , where Uα represents the standard normal deviate at the α significance level, Uβ denotes the standard normal deviate at the β significance level, δ is the expected difference in means between the two groups, and σ is the standard deviation. Considering a 20% dropout rate, a total of 120 eligible participants were ultimately enrolled. Patients were numbered consecutively upon admission, and random numbers from 1 to 120 were generated using SPSS 27.0. After sorting, the first 60 participants were assigned to the intervention group, and the remaining 59 to the control group. One patient in the control group withdrew from the study due to family reasons. In total, 119 patients completed the intervention and were included in the final analysis: 60 in the intervention group and 59 in the control group. Baseline demographic characteristics of the two groups are presented in Table 1 . Table 1 Comparison of Baseline Characteristics Between Groups [N = 119, n (%)] Variable Intervention Group(n = 60) Control Group(n = 59) χ² P Age(x̄±s) 35.1 ± 10.2 34.9 ± 9.8 0.16 0.87 Gender 0.00 1.00 Male 28(47.5%) 28(51.7%) Female 32(52.5%) 31(48.3%) Education Level 1.920 0.589 Junior high or below 14(23.3%) 17(28.8%) High school 13(21.7%) 17(28.8%) Junior college 21(35.0%) 16(27.1%) Bachelor's or above 12(20.0%) 9(15.3%) Marital Status 1.133 0.769 Married 15(25.0%) 16(27.1%) Unmarried 38(63.3%) 34(57.6%) Divorced 6(10.0%) 7(11.9%) Widowed 1(1.7%) 2(3.4%) Monthly Income (CNY) 2.487 0.478 20000 4(6.7%) 1(1.7%) Presence of Comorbidities 0.957 0.328 No 41(68.3%) 46(78.0%) Yes 19(31.7%) 13(22.0%) Methods Intervention Team Formation To ensure the scientific design and implementation of the intervention, a multidisciplinary team consisting of six members was established. The team included: two psychologists with a master’s degree or above and at least three years of clinical experience, responsible for developing and supervising the psychological components of the intervention; one psychiatrist with a senior professional title and over five years of experience in clinical psychiatry, responsible for evaluating patients' mental health and coordinating pharmacological treatment; two registered psychiatric nurses with a bachelor’s degree or above and more than three years of clinical experience in mental health nursing, who were trained in the BMS model and narrative nursing procedures, and served as the primary facilitators of the group sessions; one licensed social worker with over three years of mental health-related experience, responsible for supporting the reconstruction of patients’ social functioning; and one data analyst with a background in statistics and more than two years of experience in data processing and analysis. The two psychiatric nurses acted as the core implementers of the intervention under the supervision of the expert panel, ensuring consistent and standardized delivery throughout the study. Intervention Protocol Development The intervention protocol was developed through a four-stage process: (1) a comprehensive literature review to identify relevant theoretical frameworks and evidence-based practices in the BMS model and narrative nursing; (2) two rounds of expert consultation to refine the thematic structure and content of the sessions; (3) pilot testing of the preliminary version in a group of six inpatients to evaluate feasibility and acceptability; and (4) revision and finalization based on expert feedback and pilot outcomes. The resulting intervention manual was organized into a structured seven-step format to ensure consistency in implementation across sessions. Routine Care for the Control Group The control group received routine nursing care, consisting of the following components: (1) Health education: psychiatric nurses provided patients with information about schizophrenia and its treatment to improve understanding and compliance; (2) Psychological support: psychiatric nurses paid attention to patients’ emotional states and offered basic counseling to alleviate anxiety and fear; (3) Social functioning training: role-playing and scenario simulations, such as greeting others or making phone calls, as well as training in daily living skills, were conducted to promote engagement in daily activities; (4) Medication guidance: psychiatric nurses provided instructions on medication adherence, monitored therapeutic effects, and explained drug actions and possible side effects; and (5) Diet and exercise guidance: patients were encouraged to maintain a balanced diet and participate in moderate physical activity, such as walking or calisthenics, two to three times per week. Narrative Nursing Intervention for the Experimental Group In addition to routine care, patients in the intervention group received a structured group-based narrative nursing intervention grounded in the Body-Mind-Spirit (BMS) model. Originally proposed by Professor Chen Liyun[13], the BMS model emphasizes the integration of physical, psychological, and spiritual dimensions, aiming to enhance overall health, self-identity, and a sense of life meaning. The intervention was administered once per week for four consecutive weeks, with each session lasting 2–3 hours. Prior to the intervention, psychiatric nurses conducted individual interviews to assess the patient's psychiatric status, psychological readiness, and communication ability. Participants were then assigned into four groups (8–10 individuals per group) with balanced characteristics. Each group was led by two psychiatric nurses who had completed standardized training in narrative nursing and held professional psychological nursing qualifications from a tertiary hospital. To ensure consistency, the same facilitators remained with each group throughout the intervention. Group sessions were held every Wednesday from 14:30 to 17:00 in a dedicated therapy room within the ward, providing a quiet and supportive environment free from interruptions. Each session followed a seven-step structured process: introduction, theme discussion, body-mind exercise, emotional regulation, narrative sharing, cognitive integration, and reflective homework. The content addressed topics such as physical relaxation, self-exploration, value clarification, emotional expression, and construction of life meaning, aiming to foster multidimensional recovery and growth across body, mind, and spirit. The intervention lasted for four weeks with weekly sessions of 2–3 hours. Outcome evaluations were conducted both before and after the intervention using the GWBS, SSFPI, and HAMD scales. Pre-post comparison results are presented in Table 2 . Table 2 Schedule and Content of Narrative Nursing Intervention Based on the BMS Holistic Health Model Week Intervention Goals Activities Week 1 Building trust and self-exploration (1) Introduction: Group rules and BMS model overview; breathing relaxation. (2) Narrative sharing: Self-introduction and sharing strengths/interests. (3) Thematic discussion: Mind-body interaction. (4) Mind-body practice: Life review. (5) Summary & homework: Draw a picture reflecting inner state. Week 2 Releasing negative emotions and self-acceptance ((1) Introduction: Sharing homework drawings to explore emotions. (2) Narrative sharing: Discuss a painful/confusing experience. (3) Thematic discussion: Facing pain and finding strength. (4) Mind-body practice: Breathing meditation. (5) Summary & homework: Write about overcoming a hardship. Week 3 Discovering life’s pleasures (1) Introduction: Sharing stories of overcoming adversity. (2) Narrative sharing: Discussing one joyful experience. (3) Thematic discussion: Where happiness comes from. (4) Mind-body practice: Light exercise, music relaxation, mindfulness breathing. (5) Homework: Record three joyful events. Week 4 Exploring meaning and life goals (1) Introduction: Sharing “three joyful things” homework. (2) Narrative sharing: Share “the most important thing in my life.” (3) Thematic discussion: Meaning of life. (4) Mind-body practice: Meditation and “future vision” writing. (5) Summary & homework: Compose a life purpose statement. Psychometric Indicators Subjective Well-Being In this study, the overall level of subjective well-being among inpatients with schizophrenia was assessed using the Chinese version of the General Well-Being Schedule (GWBS), adapted by Duan Jianhua et al [ 11 ] . This scale is designed to evaluate an individual’s overall perception of happiness and well-being. It comprises 18 items across six dimensions, encompassing emotional state, life satisfaction, and perceived physical health. The scale adopts a mixed scoring format depending on the item: Items 2 and 5–7 are rated on a 5-point scale; Items 1, 3, 4, and 8–14 are rated on a 6-point scale; and Items 15–18 are rated on a 10-point scale. The total score ranges from 0 to 120, with higher scores indicating greater subjective well-being. According to the total score, subjective well-being is classified into five levels: 0–24: very low 25–48: low, 49–72: moderate, 73–96: high, 97–120: marked, Higher scores reflect stronger perceived well-being. The GWBS scale demonstrated excellent internal consistency in this study, with a Cronbach’s alpha of 0.947. Social Functioning Social functioning was assessed using the Social Functioning of Inpatients with Schizophrenia Scale (SSFPI), compiled by Zhou Zhaodang et al [ 12 ] . The scale consists of 12 items and is designed to comprehensively evaluate the level of social functioning in hospitalized patients with schizophrenia. It covers three dimensions: (1) daily life skills; (2) mobility and interpersonal communication; and (3) social participation. Each item is rated on a 5-point scale ranging from 0 to 4, with a total possible score of 0 to 48. A higher score indicates a higher level of social functioning. In this study, the SSFPI showed strong internal consistency, with a Cronbach’s alpha coefficient of 0.94. Depressive Symptoms Depressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17), developed by Max Hamilton [ 14 ] . This clinician-administered instrument is widely used for evaluating the severity of depression in patients with mental disorders. It covers five dimensions: mood, cognitive and behavioral performance, physical symptoms, sleep disturbances, and suicidal ideation. Each item is rated on a scale of 0 to 4, resulting in a total score ranging from 0 to 52. Based on the total score, depression severity is classified into five levels: 0–7 (no or minimal depression), 8–13 (mild), 14–18 (moderate), 19–22 (severe), and ≥ 23 (very severe). In the present study, the HAMD-17 demonstrated acceptable internal reliability, with a Cronbach’s alpha of 0.85. Data Collection Methods Data were collected at two time points: prior to the intervention and immediately after the four-week intervention. All evaluations were conducted face-to-face in a quiet setting by two psychiatric nurses who were blinded to group allocation. Before data collection, both assessors received standardized training in the administration and scoring of the GWBS, SSFPI, and HAMD-17 instruments to ensure consistency. Prior to the baseline assessment, informed consent was obtained from both patients and their legal guardians. Demographic data—including gender, age, education level, duration of illness, and number of hospitalizations—were recorded. The same assessment tools and procedures were used before and after the intervention to ensure uniformity. All data were entered into SPSS 27.0 using a double-entry approach by two independent researchers to ensure accuracy. Results Within-Group Pre-Post Comparisons of Outcome Scores Paired t-tests were used to analyze the changes in scores before and after the intervention within each group. The results showed that, in the intervention group, HAMD scores significantly decreased after receiving the narrative nursing intervention (t = 23.644, p < 0.001), while GWBS scores (t = -16.996, p < 0.001) and SSFPI scores (t = -17.346, P < 0.001) significantly increased, indicating a marked effect of the intervention. Although the control group also exhibited improvements under routine care, the degree of change was smaller. Nevertheless, the differences were still statistically significant ( P < 0.001). See Table 3 for details. Table 3 Comparison of Pre- and Post-Intervention Scores Between Groups (x̄ ± s) Indicator n Pre-Intervention (x̄±s) Post-Intervention(x̄±s) t P GWB Intervention 59 116.07 ± 18.39 122.48 ± 17.53 -16.996 < 0.001 Control 60 117.39 ± 15.96 121.37 ± 16.38 -11.465 < 0.001 SSFPI Intervention 59 25.37 ± 9.83 31.48 ± 9.57 -17.346 < 0.001 Control 60 25.42 ± 11.50 28.81 ± 11.23 -13.491 < 0.001 HAMD Intervention 59 20.20 ± 12.65 11.78 ± 12.50 23.644 < 0.001 Control 60 17.81 ± 9.35 12.75 ± 9.72 14.301 < 0.001 ANCOVA and Effect Size Analysis of Post-Intervention Between-Group Differences To control for potential baseline differences affecting outcomes, this study used analysis of covariance (ANCOVA) to examine post-intervention scores of primary outcome variables. After adjusting for baseline HAMD scores, the intervention group exhibited significantly lower post-intervention HAMD scores than the control group, with a significant main effect of group (F = 42.482, P < 0.001). This indicates the intervention had a marked advantage in alleviating depressive symptoms. Cohen’s d effect sizes were calculated for pre-post changes in each group to evaluate the intervention’s practical impact. The intervention group achieved large effect sizes (d > 0.8) across all three outcome measures, with the most pronounced improvement observed in HAMD scores. These outcomes underscore narrative nursing based on the Body-Mind-Spirit holistic health model exerts significant multidimensional therapeutic effects for inpatients with schizophrenia. Discussion Narrative Nursing Based on the Body-Mind-Spirit Holistic Model Helps Alleviate Depressive Symptoms in Patients with Schizophrenia The results of this study showed a significant decrease in HAMD scores in the intervention group after the intervention ( P < 0.001), indicating that narrative nursing based on the Body-Mind-Spirit (BMS) holistic model is effective in alleviating depressive symptoms in hospitalized patients with schizophrenia. During hospitalization, patients with schizophrenia often experience pronounced improvement emotional disturbances and negative emotional reactions. Traditional nursing approaches, which primarily focus on symptom control and behavioral management, often fail to address deeper psychological needs such as emotional expression, meaning of life, self-identity, belonging, and spiritual support. In contrast, the intervention developed in this study integrates the BMS philosophy, emphasizing the interconnection of physical, psychological, and spiritual dimensions [ 15 ] . Through structured narratives, group discussions, and mindfulness-based relaxation, patients were guided to release suppressed emotions and reconstruct cognitive frameworks, thereby enhancing psychological resilience and emotional regulation. Intervention components such as "life review" and "future vision writing" strengthened patients’ sense of meaning and purpose, reducing feelings of isolation and hopelessness—key mechanisms in alleviating depressive symptoms [ 16 ] . Previous studies, such as that by Zhou Qian et al, have demonstrated that narrative-based psychological interventions enhance emotional regulation and cognitive restructuring in patients with schizophrenia [ 17 ] . The present findings further support the positive role of narrative nursing grounded in the BMS model and offer a feasible path for individualized psychological care. Narrative Nursing Based on the Body-Mind-Spirit Holistic Model Enhances Subjective Well-Being in Patients with Schizophrenia Post-intervention, the intervention group showed a statistically significant increase in GWBS scores ( P < 0.001), suggesting that narrative nursing based on the BMS model effectively enhances subjective well-being in hospitalized patients with schizophrenia. Due to long-term illness and impaired social functioning, these patients often experience loneliness, meaninglessness, and hopelessness, contributing to generally low levels of well-being [ 18 , 19 ] . This study encouraged patients to identify positive experiences and explore personal meaning through activities such as "future vision writing" and "three things that make me happy," fostering the reconstruction of personal values and life purpose. Enhancing well-being not only involves satisfaction with one’s current life but also includes affirmation of self-worth and expectations for the future [ 20 ] . Emotional expression and group interaction were emphasized in the intervention, allowing patients to experience a sense of belonging and acceptance through sharing and feedback, which reinforced positive perceptions of self and others. The intervention group demonstrated a greater effect size in well-being improvement compared to the control group, further validating the efficacy of the approach in promoting subjective well-being. Narrative nursing under the BMS framework thus not only mitigates negative emotions but also reawakens patients’ enthusiasm and hope for life, offering a new pathway and practical strategy to enhance well-being. Narrative Nursing Based on the Body-Mind-Spirit Holistic Model Promotes Recovery of Social Functioning in Patients with Schizophrenia After the intervention, SSFPI scores in the intervention group significantly increased ( P < 0.001), indicating that narrative nursing based on the BMS holistic concept effectively promotes the recovery of social functioning in hospitalized patients with schizophrenia. Due to the nature of the disorder, these patients often exhibit reduced initiative, social withdrawal, and impaired role functioning, leading to severe social dysfunction that hinders recovery and community reintegration [ 21 , 22 ] . The intervention incorporated body-mind exercises, theme sharing, and group role-play to improve communication, problem-solving, and interpersonal collaboration skills, thereby enhancing adaptability and engagement in daily life. Specifically, modules on "real-life scenario simulation" and "social interaction training" provided patients with a safe environment to rebuild interpersonal connections and behavioral patterns, which significantly boosted their social confidence and self-efficacy. The intervention group demonstrated a greater effect size in social functioning improvement compared to the control group, supporting the statistical significance of the intervention's impact. In summary, narrative nursing integrating physical, psychological, and social dimensions demonstrated a positive effect on the social recovery of hospitalized patients with schizophrenia, showing promise for enhancing social adaptability and readiness for discharge. Summary Narrative nursing based on the Body-Mind-Spirit holistic model effectively alleviated depressive symptoms, enhanced subjective well-being, and improved social functioning in hospitalized patients with schizophrenia. The intervention demonstrated both practical utility and clinical application potential. However, limitations such as the short intervention duration and relatively small sample size remain. Future research should aim to refine the intervention content, optimize implementation pathways, and explore long-term effects to strengthen the evidence base for integrating this approach into psychiatric nursing practice. Declarations Acknowledgements We sincerely thank all participating patients and the multidisciplinary intervention team for their contributions to this study. We are also grateful to Professor Liyun Chen for her guidance on the Body-Mind-Spirit (BMS) model, which provided the theoretical foundation for the intervention design. Authors’ Contributions Study conception and design: DX; Participant recruitment and data collection: SKY, MXC; Intervention implementation: DX, SKY; Data analysis and interpretation: ZL, LT; Manuscript drafting: DX, MXC; Critical revision of the manuscript: ZL, DX All authors read and approved the final version of the manuscript. Funding This study was supported by the Chengdu Municipal Health Commission (Project Code: 2020506). Availability of Data and Materials The datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality. Ethics Approval and Consent to Participate This study was approved by the Ethics Committee of The Ethics Committee of The Fourth People’s Hospital of Chengdu, under approval number [2020]伦理字（26）号. Written informed consent was obtained from all participants and their legal guardians.The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. 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Hemager N, Gregersen M, Christiani C J, et al. Development of social functioning in preadolescent children at familial high risk of schizophrenia or bipolar disorder: A 4-year follow-up study from age 7 to 11. Psychiatry Research, 2023, 327: 115397. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 11 Jul, 2025 Editor invited by journal 12 Jun, 2025 Editor assigned by journal 12 Jun, 2025 Submission checks completed at journal 12 Jun, 2025 First submitted to journal 08 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-6846721","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484964238,"identity":"17895090-e738-402a-9668-af9a0781a400","order_by":0,"name":"Xu Du","email":"","orcid":"","institution":"The Fourth People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Xu","middleName":"","lastName":"Du","suffix":""},{"id":484964239,"identity":"ac1263cb-25f0-47f6-8911-58b3b6ec196a","order_by":1,"name":"Tao Li","email":"","orcid":"","institution":"The Fourth People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Li","suffix":""},{"id":484964240,"identity":"ba33ad77-a5f2-41a3-91b5-b621b7b9b838","order_by":2,"name":"Lan Zhang","email":"","orcid":"","institution":"The Fourth People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Lan","middleName":"","lastName":"Zhang","suffix":""},{"id":484964241,"identity":"b9f8dd1b-baeb-4a1e-a152-5aa2f3259866","order_by":3,"name":"Xiucheng Ma","email":"","orcid":"","institution":"The Fourth People's Hospital of Chengdu","correspondingAuthor":false,"prefix":"","firstName":"Xiucheng","middleName":"","lastName":"Ma","suffix":""},{"id":484964242,"identity":"a10eee3f-f101-4771-bc87-973d7f43c47c","order_by":4,"name":"Keyu Su","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACfvbmgw8+/PhXz8beQKQWyZ5jyYYzew4k8PEcIFKLwY0cM2ketgMJchIJxLrszAEDCR6eO3lsko833mCosYkmqIOxvSHBQMLiWTGbdFqxBcOxtNwGQlqYeQ4cSDDgYWZsk84xk2BsOExYC5tEYsOBBDagFskzRGrhkUhmbDjAdjixTYKHSC0SPMeYGRt70ozZeIB+SSDGL/bH+7///vPDRk6+/fDGGx9qbAhrQQYGxEcNQgupOkbBKBgFo2BkAABU10Cd2Z1q4wAAAABJRU5ErkJggg==","orcid":"","institution":"The Fourth People's Hospital of Chengdu","correspondingAuthor":true,"prefix":"","firstName":"Keyu","middleName":"","lastName":"Su","suffix":""}],"badges":[],"createdAt":"2025-06-08 09:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6846721/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6846721/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86739932,"identity":"d8d33d5c-4fca-486c-aa51-8e56270b6a89","added_by":"auto","created_at":"2025-07-15 06:36:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":960859,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6846721/v1/3c260905-d4c2-45af-812b-96619e57134a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of Narrative Nursing Based on the Body-Mind-Spirit Holistic Health Model on Inpatients with Schizophrenia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSchizophrenia is a prevalent chronic psychiatric disorder that notablely impairs cognitive, emotional, and social functioning. Patients often experience persistent depressive moods, reduced interest, and social withdrawal, resulting in diminished subjective well-being and quality of life\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. While pharmacological treatments and cognitive-behavioral interventions can alleviate some symptoms, they are often insufficient in addressing deeper emotional support, existential meaning, and spiritual needs\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The Mental Health Law of the People\u0026rsquo;s Republic of China explicitly states that individuals with mental disorders are entitled to comprehensive support in medical care, rehabilitation, and societal integration\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.The Body-Mind-Spirit (BMS) holistic health model, an integrative healthcare approach emphasizing coordinated development of physical, psychological, and spiritual domains, has demonstrated positive outcomes in chronic illness, oncology, and geriatric care\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Narrative nursing, a patient-centered psychological intervention, facilitates personal storytelling and cognitive restructuring, thereby enhancing patients\u0026rsquo; inner resilience and social adaptation. Its application has gained growing attention in psychiatric nursing practice\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Subjective well-being, reflecting individuals\u0026rsquo; affective states and life satisfaction, is an important psychological indicator for recovery in psychiatric populations\u003csup\u003e[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. However, empirical studies integrating the BMS model with narrative nursing\u0026mdash;particularly in improving well-being, reducing depressive symptoms, and enhancing social functioning among patients with schizophrenia\u0026mdash;remain limited. This study aimed to develop and implement a structured narrative nursing intervention grounded in the BMS framework and evaluate its effectiveness in alleviating depressive symptoms, promoting subjective well-being, and improving social functioning among inpatients with schizophrenia. The goal is to provide theoretical support and practical guidance for psychiatric rehabilitation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eA total of 119 inpatients diagnosed with schizophrenia were recruited from a tertiary-level psychiatric hospital in Sichuan Province between September and December 2024 using convenience sampling. Inclusion criteria were as follows: (1) a confirmed diagnosis of schizophrenia based on the International Classification of Diseases, 10th Revision (ICD-10)\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e; (2) age between 18 and 60 years; (3) completion of at least primary education, with adequate communication and comprehension abilities; (4) an expected hospitalization period of no less than three months; and (5) voluntary participation with written informed consent obtained from both the patient and their legal guardian. Exclusion criteria included: (1) co-occurrence of other severe psychiatric or neurological disorders; (2) being in an acute psychotic state or presenting a high risk of aggression or self-injury; (3) serious comorbid physical illness or substance dependence; and (4) having received any similar psychological or narrative intervention within the past three months. This study employed the GWBS\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, the Social Functioning of Inpatients with Schizophrenia Scale (SSFPI)\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, and the Hamilton Depression Rating Scale (HAMD)[14] as the primary outcome measures. The required sample size was calculated using the formula for comparing the means of two independent samples: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{n}_{1}={n}_{2}=2\\times\\:{\\left(\\frac{{U}_{{\\alpha\\:}}+{U}_{{\\beta\\:}}}{{\\delta\\:}/{\\sigma\\:}}\\right)}^{2}+\\frac{1}{4}{U}_{{\\alpha\\:}}^{2}\\)\u003c/span\u003e\u003c/span\u003e, where Uα represents the standard normal deviate at the α significance level, Uβ denotes the standard normal deviate at the β significance level, δ is the expected difference in means between the two groups, and σ is the standard deviation. Considering a 20% dropout rate, a total of 120 eligible participants were ultimately enrolled. Patients were numbered consecutively upon admission, and random numbers from 1 to 120 were generated using SPSS 27.0. After sorting, the first 60 participants were assigned to the intervention group, and the remaining 59 to the control group. One patient in the control group withdrew from the study due to family reasons. In total, 119 patients completed the intervention and were included in the final analysis: 60 in the intervention group and 59 in the control group. Baseline demographic characteristics of the two groups 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 Groups [N\u0026thinsp;=\u0026thinsp;119, n (%)]\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\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention Group(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group(n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;\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\u003eAge(x̄\u0026plusmn;s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.00\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=\"left\" colname=\"c2\"\u003e\u003cp\u003e28(47.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(51.7%)\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=\"left\" colname=\"c2\"\u003e\u003cp\u003e32(52.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31(48.3%)\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\u003eEducation Level\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.920\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.589\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJunior high or below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(23.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(28.8%)\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\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(21.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(28.8%)\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\u003eJunior college\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21(35.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(27.1%)\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\u003eBachelor's or above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12(20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(15.3%)\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\u003eMarital Status\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.769\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15(25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(27.1%)\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\u003eUnmarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38(63.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34(57.6%)\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\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(10.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(11.9%)\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\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(1.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(3.4%)\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\u003eMonthly Income (CNY)\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.487\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.478\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31(51.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28(47.5%)\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\u003e5001\u0026ndash;10000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20(33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(39.0%)\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\u003e10001\u0026ndash;20000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(8.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(11.9%)\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\u0026gt;\u0026thinsp;20000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(6.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.7%)\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\u003ePresence of Comorbidities\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=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.957\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.328\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(68.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46(78.0%)\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\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19(31.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13(22.0%)\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\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\u003eIntervention Team Formation\u003c/h2\u003e\u003cp\u003eTo ensure the scientific design and implementation of the intervention, a multidisciplinary team consisting of six members was established. The team included: two psychologists with a master\u0026rsquo;s degree or above and at least three years of clinical experience, responsible for developing and supervising the psychological components of the intervention; one psychiatrist with a senior professional title and over five years of experience in clinical psychiatry, responsible for evaluating patients' mental health and coordinating pharmacological treatment; two registered psychiatric nurses with a bachelor\u0026rsquo;s degree or above and more than three years of clinical experience in mental health nursing, who were trained in the BMS model and narrative nursing procedures, and served as the primary facilitators of the group sessions; one licensed social worker with over three years of mental health-related experience, responsible for supporting the reconstruction of patients\u0026rsquo; social functioning; and one data analyst with a background in statistics and more than two years of experience in data processing and analysis. The two psychiatric nurses acted as the core implementers of the intervention under the supervision of the expert panel, ensuring consistent and standardized delivery throughout the study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eIntervention Protocol Development\u003c/h3\u003e\n\u003cp\u003eThe intervention protocol was developed through a four-stage process: (1) a comprehensive literature review to identify relevant theoretical frameworks and evidence-based practices in the BMS model and narrative nursing; (2) two rounds of expert consultation to refine the thematic structure and content of the sessions; (3) pilot testing of the preliminary version in a group of six inpatients to evaluate feasibility and acceptability; and (4) revision and finalization based on expert feedback and pilot outcomes. The resulting intervention manual was organized into a structured seven-step format to ensure consistency in implementation across sessions.\u003c/p\u003e\n\u003ch3\u003eRoutine Care for the Control Group\u003c/h3\u003e\n\u003cp\u003eThe control group received routine nursing care, consisting of the following components: (1) Health education: psychiatric nurses provided patients with information about schizophrenia and its treatment to improve understanding and compliance; (2) Psychological support: psychiatric nurses paid attention to patients\u0026rsquo; emotional states and offered basic counseling to alleviate anxiety and fear; (3) Social functioning training: role-playing and scenario simulations, such as greeting others or making phone calls, as well as training in daily living skills, were conducted to promote engagement in daily activities; (4) Medication guidance: psychiatric nurses provided instructions on medication adherence, monitored therapeutic effects, and explained drug actions and possible side effects; and (5) Diet and exercise guidance: patients were encouraged to maintain a balanced diet and participate in moderate physical activity, such as walking or calisthenics, two to three times per week.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eNarrative Nursing Intervention for the Experimental Group\u003c/h2\u003e\u003cp\u003eIn addition to routine care, patients in the intervention group received a structured group-based narrative nursing intervention grounded in the Body-Mind-Spirit (BMS) model. Originally proposed by Professor Chen Liyun[13], the BMS model emphasizes the integration of physical, psychological, and spiritual dimensions, aiming to enhance overall health, self-identity, and a sense of life meaning. The intervention was administered once per week for four consecutive weeks, with each session lasting 2\u0026ndash;3 hours.\u003c/p\u003e\u003cp\u003ePrior to the intervention, psychiatric nurses conducted individual interviews to assess the patient's psychiatric status, psychological readiness, and communication ability. Participants were then assigned into four groups (8\u0026ndash;10 individuals per group) with balanced characteristics. Each group was led by two psychiatric nurses who had completed standardized training in narrative nursing and held professional psychological nursing qualifications from a tertiary hospital. To ensure consistency, the same facilitators remained with each group throughout the intervention.\u003c/p\u003e\u003cp\u003eGroup sessions were held every Wednesday from 14:30 to 17:00 in a dedicated therapy room within the ward, providing a quiet and supportive environment free from interruptions. Each session followed a seven-step structured process: introduction, theme discussion, body-mind exercise, emotional regulation, narrative sharing, cognitive integration, and reflective homework. The content addressed topics such as physical relaxation, self-exploration, value clarification, emotional expression, and construction of life meaning, aiming to foster multidimensional recovery and growth across body, mind, and spirit.\u003c/p\u003e\u003cp\u003eThe intervention lasted for four weeks with weekly sessions of 2\u0026ndash;3 hours. Outcome evaluations were conducted both before and after the intervention using the GWBS, SSFPI, and HAMD scales. Pre-post comparison results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSchedule and Content of Narrative Nursing Intervention Based on the BMS Holistic Health Model\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention Goals\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eActivities\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBuilding trust and self-exploration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1) Introduction: Group rules and BMS model overview; breathing relaxation. (2) Narrative sharing: Self-introduction and sharing strengths/interests. (3) Thematic discussion: Mind-body interaction. (4) Mind-body practice: Life review. (5) Summary \u0026amp; homework: Draw a picture reflecting inner state.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReleasing negative emotions and self-acceptance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e((1) Introduction: Sharing homework drawings to explore emotions. (2) Narrative sharing: Discuss a painful/confusing experience. (3) Thematic discussion: Facing pain and finding strength. (4) Mind-body practice: Breathing meditation. (5) Summary \u0026amp; homework: Write about overcoming a hardship.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiscovering life\u0026rsquo;s pleasures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1) Introduction: Sharing stories of overcoming adversity. (2) Narrative sharing: Discussing one joyful experience. (3) Thematic discussion: Where happiness comes from. (4) Mind-body practice: Light exercise, music relaxation, mindfulness breathing. (5) Homework: Record three joyful events.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExploring meaning and life goals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1) Introduction: Sharing \u0026ldquo;three joyful things\u0026rdquo; homework. (2) Narrative sharing: Share \u0026ldquo;the most important thing in my life.\u0026rdquo; (3) Thematic discussion: Meaning of life. (4) Mind-body practice: Meditation and \u0026ldquo;future vision\u0026rdquo; writing. (5) Summary \u0026amp; homework: Compose a life purpose statement.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePsychometric Indicators\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eSubjective Well-Being\u003c/h2\u003e\u003cp\u003eIn this study, the overall level of subjective well-being among inpatients with schizophrenia was assessed using the Chinese version of the General Well-Being Schedule (GWBS), adapted by Duan Jianhua et al \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. This scale is designed to evaluate an individual\u0026rsquo;s overall perception of happiness and well-being. It comprises 18 items across six dimensions, encompassing emotional state, life satisfaction, and perceived physical health. The scale adopts a mixed scoring format depending on the item: Items 2 and 5\u0026ndash;7 are rated on a 5-point scale; Items 1, 3, 4, and 8\u0026ndash;14 are rated on a 6-point scale; and Items 15\u0026ndash;18 are rated on a 10-point scale. The total score ranges from 0 to 120, with higher scores indicating greater subjective well-being. According to the total score, subjective well-being is classified into five levels: 0\u0026ndash;24: very low 25\u0026ndash;48: low, 49\u0026ndash;72: moderate, 73\u0026ndash;96: high, 97\u0026ndash;120: marked, Higher scores reflect stronger perceived well-being. The GWBS scale demonstrated excellent internal consistency in this study, with a Cronbach\u0026rsquo;s alpha of 0.947.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSocial Functioning\u003c/h2\u003e\u003cp\u003eSocial functioning was assessed using the Social Functioning of Inpatients with Schizophrenia Scale (SSFPI), compiled by Zhou Zhaodang et al\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. The scale consists of 12 items and is designed to comprehensively evaluate the level of social functioning in hospitalized patients with schizophrenia. It covers three dimensions: (1) daily life skills; (2) mobility and interpersonal communication; and (3) social participation. Each item is rated on a 5-point scale ranging from 0 to 4, with a total possible score of 0 to 48. A higher score indicates a higher level of social functioning. In this study, the SSFPI showed strong internal consistency, with a Cronbach\u0026rsquo;s alpha coefficient of 0.94.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eDepressive Symptoms\u003c/h2\u003e\u003cp\u003eDepressive symptoms were assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17), developed by Max Hamilton \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. This clinician-administered instrument is widely used for evaluating the severity of depression in patients with mental disorders. It covers five dimensions: mood, cognitive and behavioral performance, physical symptoms, sleep disturbances, and suicidal ideation. Each item is rated on a scale of 0 to 4, resulting in a total score ranging from 0 to 52. Based on the total score, depression severity is classified into five levels: 0\u0026ndash;7 (no or minimal depression), 8\u0026ndash;13 (mild), 14\u0026ndash;18 (moderate), 19\u0026ndash;22 (severe), and \u0026ge;\u0026thinsp;23 (very severe). In the present study, the HAMD-17 demonstrated acceptable internal reliability, with a Cronbach\u0026rsquo;s alpha of 0.85.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eData Collection Methods\u003c/h2\u003e\u003cp\u003eData were collected at two time points: prior to the intervention and immediately after the four-week intervention. All evaluations were conducted face-to-face in a quiet setting by two psychiatric nurses who were blinded to group allocation. Before data collection, both assessors received standardized training in the administration and scoring of the GWBS, SSFPI, and HAMD-17 instruments to ensure consistency. Prior to the baseline assessment, informed consent was obtained from both patients and their legal guardians. Demographic data\u0026mdash;including gender, age, education level, duration of illness, and number of hospitalizations\u0026mdash;were recorded. The same assessment tools and procedures were used before and after the intervention to ensure uniformity. All data were entered into SPSS 27.0 using a double-entry approach by two independent researchers to ensure accuracy.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eWithin-Group Pre-Post Comparisons of Outcome Scores\u003c/h2\u003e\u003cp\u003ePaired t-tests were used to analyze the changes in scores before and after the intervention within each group. The results showed that, in the intervention group, HAMD scores significantly decreased after receiving the narrative nursing intervention (t\u0026thinsp;=\u0026thinsp;23.644, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while GWBS scores (t = -16.996, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and SSFPI scores (t = -17.346, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) significantly increased, indicating a marked effect of the intervention. Although the control group also exhibited improvements under routine care, the degree of change was smaller. Nevertheless, the differences were still statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for details.\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\u003eComparison of Pre- and Post-Intervention Scores Between Groups (x̄ \u0026plusmn; s)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndicator\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePre-Intervention\u003c/p\u003e\u003cp\u003e(x̄\u0026plusmn;s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePost-Intervention(x̄\u0026plusmn;s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\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\u003eGWB\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e116.07\u0026thinsp;\u0026plusmn;\u0026thinsp;18.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e122.48\u0026thinsp;\u0026plusmn;\u0026thinsp;17.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-16.996\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e117.39\u0026thinsp;\u0026plusmn;\u0026thinsp;15.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e121.37\u0026thinsp;\u0026plusmn;\u0026thinsp;16.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-11.465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSSFPI\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e25.37\u0026thinsp;\u0026plusmn;\u0026thinsp;9.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e31.48\u0026thinsp;\u0026plusmn;\u0026thinsp;9.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-17.346\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e25.42\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e28.81\u0026thinsp;\u0026plusmn;\u0026thinsp;11.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-13.491\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHAMD\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e20.20\u0026thinsp;\u0026plusmn;\u0026thinsp;12.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e11.78\u0026thinsp;\u0026plusmn;\u0026thinsp;12.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23.644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e17.81\u0026thinsp;\u0026plusmn;\u0026thinsp;9.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e12.75\u0026thinsp;\u0026plusmn;\u0026thinsp;9.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14.301\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eANCOVA and Effect Size Analysis of Post-Intervention Between-Group Differences\u003c/h2\u003e\u003cp\u003eTo control for potential baseline differences affecting outcomes, this study used analysis of covariance (ANCOVA) to examine post-intervention scores of primary outcome variables. After adjusting for baseline HAMD scores, the intervention group exhibited significantly lower post-intervention HAMD scores than the control group, with a significant main effect of group (F\u0026thinsp;=\u0026thinsp;42.482, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This indicates the intervention had a marked advantage in alleviating depressive symptoms.\u003c/p\u003e\u003cp\u003eCohen\u0026rsquo;s d effect sizes were calculated for pre-post changes in each group to evaluate the intervention\u0026rsquo;s practical impact. The intervention group achieved large effect sizes (d\u0026thinsp;\u0026gt;\u0026thinsp;0.8) across all three outcome measures, with the most pronounced improvement observed in HAMD scores. These outcomes underscore narrative nursing based on the Body-Mind-Spirit holistic health model exerts significant multidimensional therapeutic effects for inpatients with schizophrenia.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cb\u003eNarrative Nursing Based on the Body-Mind-Spirit Holistic Model Helps Alleviate Depressive Symptoms in Patients with Schizophrenia\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results of this study showed a significant decrease in HAMD scores in the intervention group after the intervention (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), indicating that narrative nursing based on the Body-Mind-Spirit (BMS) holistic model is effective in alleviating depressive symptoms in hospitalized patients with schizophrenia. During hospitalization, patients with schizophrenia often experience pronounced improvement emotional disturbances and negative emotional reactions. Traditional nursing approaches, which primarily focus on symptom control and behavioral management, often fail to address deeper psychological needs such as emotional expression, meaning of life, self-identity, belonging, and spiritual support. In contrast, the intervention developed in this study integrates the BMS philosophy, emphasizing the interconnection of physical, psychological, and spiritual dimensions\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Through structured narratives, group discussions, and mindfulness-based relaxation, patients were guided to release suppressed emotions and reconstruct cognitive frameworks, thereby enhancing psychological resilience and emotional regulation. Intervention components such as \"life review\" and \"future vision writing\" strengthened patients’ sense of meaning and purpose, reducing feelings of isolation and hopelessness—key mechanisms in alleviating depressive symptoms\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Previous studies, such as that by Zhou Qian et al, have demonstrated that narrative-based psychological interventions enhance emotional regulation and cognitive restructuring in patients with schizophrenia \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The present findings further support the positive role of narrative nursing grounded in the BMS model and offer a feasible path for individualized psychological care.\u003c/p\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eNarrative Nursing Based on the Body-Mind-Spirit Holistic Model Enhances Subjective Well-Being in Patients with Schizophrenia\u003c/h2\u003e\u003cp\u003ePost-intervention, the intervention group showed a statistically significant increase in GWBS scores (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), suggesting that narrative nursing based on the BMS model effectively enhances subjective well-being in hospitalized patients with schizophrenia. Due to long-term illness and impaired social functioning, these patients often experience loneliness, meaninglessness, and hopelessness, contributing to generally low levels of well-being\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. This study encouraged patients to identify positive experiences and explore personal meaning through activities such as \"future vision writing\" and \"three things that make me happy,\" fostering the reconstruction of personal values and life purpose. Enhancing well-being not only involves satisfaction with one’s current life but also includes affirmation of self-worth and expectations for the future \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Emotional expression and group interaction were emphasized in the intervention, allowing patients to experience a sense of belonging and acceptance through sharing and feedback, which reinforced positive perceptions of self and others. The intervention group demonstrated a greater effect size in well-being improvement compared to the control group, further validating the efficacy of the approach in promoting subjective well-being. Narrative nursing under the BMS framework thus not only mitigates negative emotions but also reawakens patients’ enthusiasm and hope for life, offering a new pathway and practical strategy to enhance well-being.\u003c/p\u003e\u003cp\u003e\u003cb\u003eNarrative Nursing Based on the Body-Mind-Spirit Holistic Model Promotes Recovery of Social Functioning in Patients with Schizophrenia\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAfter the intervention, SSFPI scores in the intervention group significantly increased (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001), indicating that narrative nursing based on the BMS holistic concept effectively promotes the recovery of social functioning in hospitalized patients with schizophrenia. Due to the nature of the disorder, these patients often exhibit reduced initiative, social withdrawal, and impaired role functioning, leading to severe social dysfunction that hinders recovery and community reintegration \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. The intervention incorporated body-mind exercises, theme sharing, and group role-play to improve communication, problem-solving, and interpersonal collaboration skills, thereby enhancing adaptability and engagement in daily life. Specifically, modules on \"real-life scenario simulation\" and \"social interaction training\" provided patients with a safe environment to rebuild interpersonal connections and behavioral patterns, which significantly boosted their social confidence and self-efficacy. The intervention group demonstrated a greater effect size in social functioning improvement compared to the control group, supporting the statistical significance of the intervention's impact. In summary, narrative nursing integrating physical, psychological, and social dimensions demonstrated a positive effect on the social recovery of hospitalized patients with schizophrenia, showing promise for enhancing social adaptability and readiness for discharge.\u003c/p\u003e\u003c/div\u003e"},{"header":"Summary","content":"\u003cp\u003eNarrative nursing based on the Body-Mind-Spirit holistic model effectively alleviated depressive symptoms, enhanced subjective well-being, and improved social functioning in hospitalized patients with schizophrenia. The intervention demonstrated both practical utility and clinical application potential. However, limitations such as the short intervention duration and relatively small sample size remain. Future research should aim to refine the intervention content, optimize implementation pathways, and explore long-term effects to strengthen the evidence base for integrating this approach into psychiatric nursing practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe sincerely thank all participating patients and the multidisciplinary intervention team for their contributions to this study. We are also grateful to Professor Liyun Chen for her guidance on the Body-Mind-Spirit (BMS) model, which provided the theoretical foundation for the intervention design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy conception and design: DX; Participant recruitment and data collection: SKY, MXC; Intervention implementation: DX, SKY; Data analysis and interpretation: ZL, LT; Manuscript drafting: DX, MXC; Critical revision of the manuscript: ZL, DX\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThis study was supported by the Chengdu Municipal Health Commission (Project Code: 2020506).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to patient confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003cbr\u003e\u003c/strong\u003eThis study was approved by the Ethics Committee of The Ethics Committee of The Fourth People\u0026rsquo;s Hospital of Chengdu, under approval number [2020]伦理字（26）号. Written informed consent was obtained from all participants and their legal guardians.The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003cbr\u003e\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration\u003cbr\u003e\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003cbr\u003e\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHuang Y, Wang Y, Wang H, et al. Prevalence of mental disorders in China: A cross-sectional epidemiological study. The Lancet Psychiatry, 2019, 6(3): 211\u0026ndash;224.\u003c/li\u003e\n\u003cli\u003eTong F, Zhang L M, Yang D S, et al. Integration and exploration of narrative medicine and clinical spiritual care: Soul narrative. Chinese Medical Ethics, 2024, 37(11): 1289\u0026ndash;1294.\u003c/li\u003e\n\u003cli\u003eDeng Y N, Zhou J J, Wang G. Research progress on the role and mechanism of probiotics in depression treatment. Chinese Medical Journal, 2024, 59(11): 1176\u0026ndash;1181.\u003c/li\u003e\n\u003cli\u003eMental Health Law of the People\u0026apos;s Republic of China. The State Council of the People\u0026apos;s Republic of China. [2024-11-27]. https://www.gov.cn/guoqing/2021-10/29/content_5647635.htm.\u003c/li\u003e\n\u003cli\u003eYang F. A study on the promotion of overall health in the elderly by the Body-Mind-Spirit holistic health model. Changchun University of Science and Technology, 2019.\u003c/li\u003e\n\u003cli\u003eHuang L X, Zhou C F, Zhang C C, et al. Review of Chinese literature on narrative nursing. Medicine and Philosophy, 2023, 44(12): 63\u0026ndash;67.\u003c/li\u003e\n\u003cli\u003eTang H Y, Xu M M, Chen J Y, et al. 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Trial results and analysis of the General Well-Being Schedule among Chinese college students. Chinese Journal of Clinical Psychology, 1996(1): 56\u0026ndash;57.\u003c/li\u003e\n\u003cli\u003eZhou Z D, Jia S C, Pu J G. Development and psychometric evaluation of the Social Functioning Scale for inpatients with mental illness. Sichuan Mental Health, 2004(3): 144\u0026ndash;146.\u003c/li\u003e\n\u003cli\u003eChen L Y, Fan F M, Liang P R. Body-Mind-Spirit holistic health model: Chinese culture and group counseling. Beijing: China Light Industry Press, 2009.\u003c/li\u003e\n\u003cli\u003eHamilton M. A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 1960, 23(1): 56\u0026ndash;62.\u003c/li\u003e\n\u003cli\u003eBettis R J, Faith L A, Beard A M, et al. Narrative forewarnings: A qualitative analysis of the themes preceding disorganized speech in schizophrenia. Behavioral Sciences, 2024, 14(3): 212.\u003c/li\u003e\n\u003cli\u003eMo X Z. A practical study on emotional management groups for families of schizophrenia patients: A case study of the \u0026quot;Emotion Steward\u0026quot; group in Community B. South China University of Technology, 2021.\u003c/li\u003e\n\u003cli\u003eZhou Q, Huang Z F, Wei X W, et al. The effects of group narrative intervention on self-stigma, self-esteem, and psychological capital in patients with schizophrenia. Journal of Nursing, 2024, 39(23): 83\u0026ndash;86.\u003c/li\u003e\n\u003cli\u003eSerimaa O, Keltikangas-J\u0026auml;rvinen L, Lyytik\u0026auml;inen L-P, et al. Polygenic risk for schizophrenia and subjective well-being in a general population sample. Psychological Medicine, 2025, 55: e133.\u003c/li\u003e\n\u003cli\u003eHsiao F H. The application of Body-Mind-Spirit integrated psychotherapy in nursing practice. The Journal of Nursing, 2017, 64(3): 27\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eXia X, Gao F, Xu S, et al. The Self-Awareness Brain Network: Construction, characterization, and alterations in schizophrenia and major depressive disorder. NeuroImage, 2025, 311: 121205.\u003c/li\u003e\n\u003cli\u003eChen S, Wang Y. Reply to dynamic network analysis of schizophrenia spectrum traits, affective symptoms, and social functioning\u0026mdash;Opportunities and challenges. Schizophrenia Research, 2025, 280: 59.\u003c/li\u003e\n\u003cli\u003eHemager N, Gregersen M, Christiani C J, et al. Development of social functioning in preadolescent children at familial high risk of schizophrenia or bipolar disorder: A 4-year follow-up study from age 7 to 11. Psychiatry Research, 2023, 327: 115397.\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-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Schizophrenia, Narrative Nursing, Body-Mind-Spirit Model, Subjective Well-Being, Social Functioning, Depression","lastPublishedDoi":"10.21203/rs.3.rs-6846721/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6846721/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aimed to evaluate the effects of narrative nursing interventions grounded in the Body-Mind-Spirit (BMS) holistic health model on subjective well-being, social functioning, and depressive symptoms among inpatients with schizophrenia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA randomized controlled trial was conducted with 119 hospitalized patients diagnosed with schizophrenia, who were randomly assigned to an intervention group (n\u0026thinsp;=\u0026thinsp;60) or a control group (n\u0026thinsp;=\u0026thinsp;59). While the control group received routine care, the intervention group received an additional four-week BMS-based narrative nursing program, comprising weekly group sessions (2\u0026ndash;3 hours each). Outcome measures included the General Well-Being Schedule, the Social Functioning of Inpatients with Schizophrenia Scale, and the Hamilton Depression Rating Scale, assessed pre- and post-intervention.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFollowing the intervention, the experimental group demonstrated statistically significant improvements in subjective well-being and social functioning scores, alongside a significant reduction in depressive symptoms (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Analysis of covariance further indicated that the reduction in HAMD scores was significantly greater in the intervention group compared to controls (F\u0026thinsp;=\u0026thinsp;42.482, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Effect size analysis using Cohen\u0026rsquo;s d revealed large effects in favor of the intervention across all outcome domains.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe BMS-based narrative nursing intervention significantly alleviated depressive symptoms and enhanced both subjective well-being and social functioning in inpatients with schizophrenia. These findings suggest that narrative nursing guided by a holistic in the Body-Mind-Spirit framework holds promising clinical value and warrants broader application in psychiatric rehabilitation.\u003c/p\u003e","manuscriptTitle":"Effects of Narrative Nursing Based on the Body-Mind-Spirit Holistic Health Model on Inpatients with Schizophrenia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 06:20:11","doi":"10.21203/rs.3.rs-6846721/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-07-11T08:36:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-12T07:39:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-12T07:25:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-12T07:21:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-06-08T09:41:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"686167e6-c8c3-404d-81f1-09aaf65694e3","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-15T06:20:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 06:20:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6846721","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6846721","identity":"rs-6846721","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}