Understanding patients’ emotional needs to strengthen therapeutic relationships: A deep insight into narrative nursing

Abstract

Narrative nursing has emerged as a vital approach in patient-centered care, and emphasize the importance of understanding patients’ emotional experiences in addition to their physical health needs. In this article, we comment on the article by Zhou et al. Diseases such as acute pancreatitis can cause significant suffering and severely impact patients’ quality of life. During treatment, routine nursing procedures such as gastric tube placement, oxygen therapy, monitoring, and nasogastric feeding often lack effective communication, which can adversely affect patients’ recovery. This article highlights how narrative nursing can provide deeper insights into patients’ emotional experiences, ultimately resulting in improved care outcomes. We also emphasize the role of narrative nursing in understanding and addressing these emotional needs to achieve personalized care, which can strengthen the therapeutic relationship between healthcare providers and patients. By recognizing the critical role of emotional well-being in patient care, we can develop comprehensive strategies that facilitate recovery and enhance overall quality of life.

Key Words: Narrative nursing; Emotional need; Anxiety; Depression; Patient-centered care

Core Tip: This article underscores the significance of narrative nursing in enhancing therapeutic relationships and patient recovery. Narrative nursing goes beyond traditional medical approaches by recognizing that patients' experiences and emotions are integral to their healing journey. By focusing on patients’ emotional needs and personal stories, narrative nursing fosters deeper insights, leading to improved care outcomes. It emphasizes the importance of emotional well-being in patient care, highlighting how personalized, empathetic nursing can strengthen the therapeutic alliance and promote recovery.

INTRODUCTION

The rapid development of technology and science in modern medical practice has greatly enhanced our capabilities in diagnosing and treating diseases. However, the focus on technological progress sometimes leads to the neglect of patients’ individual experiences and emotional needs. For instance, patients with acute pancreatitis often experience severe persistent upper abdominal pain, abdominal distension, nausea, vomiting, and in some cases, shock symptoms such as tachycardia, hypotension, and oliguria[1]. These patients typically exhibit a range of negative emotions, including depression, anxiety, sadness, fear, and complex emotions such as shame, suffering, disappointment, and guilt[2]. Not only patients with acute pancreatitis, but also those with chronic kidney disease requiring frequent dialysis[3], cancer patients undergoing chemotherapy and radiotherapy[4], amputees[5], perioperative patients and their families[6,7], often experience negative emotions. However, current standard nursing procedures often lack effective communication, which may hinder patient recovery. Studies have shown that emotional needs affect not only patients’ mental health but also their physical recovery and overall treatment outcomes[8]. A notable study identified persistent depression as an independent predictor of mortality within a 12-month period[9]. In addition, a meta-analysis suggested that mental health treatment plays a role in cardiac rehabilitation among patients with coronary heart disease[10]. Another meta-analysis found that psycho-emotional support was associated with a significant improvement in successful treatment outcomes in patients with tuberculosis[11]. Patients need to be listened to, understood, and supported during their treatment, which helps to alleviate anxiety and fear. Meeting patients’ emotional needs in the treatment relationship is crucial. Good emotional support can enhance patient compliance, increase treatment satisfaction, and promote trust. Against this backdrop, narrative nursing has emerged. By actively listening and understanding the emotional nuances of patients’ narratives, healthcare providers can develop a profound sense of empathy. This empathetic connection allows providers to better comprehend the patients’ perspectives, validate their feelings, and offer more compassionate and personalized care. Ultimately, narrative nursing enhances empathy by fostering a genuine understanding of patients' emotional journeys, leading to stronger therapeutic relationships and improved treatment outcomes[12]. This article comments on the article by Zhou et al[13], published in the World Journal of Psychiatry, and discusses the importance of patients’ emotional needs and their role in the treatment relationship, and how narrative nursing can provide a deeper understanding of patients' emotional experiences, ultimately improving nursing outcomes.

WHAT IS NARRATIVE NURSING

Narrative nursing is a patient-centered approach that emphasizes providing personalized care through listening to and understanding patients' stories. This method recognizes that each individual has unique life experiences and narratives about their illness, which are crucial for their health and recovery[12]. The concept of narrative nursing was first introduced by Charon[14] in 2001, who defined narrative competence as the ability of healthcare providers to absorb, interpret, and respond to patients' stories. Charon coined the term “narrative medicine” to highlight the importance of narrative skills in clinical practice. Subsequently, scholars began to explore the theoretical foundations of narrative medicine, including how narratives can be used to understand patients’ experiences, emotions, and needs. During this period, narrative nursing gradually emerged as a method that could enhance the doctor-patient relationship, foster empathy, and improve the quality of care[15]. The implementation of narrative nursing typically involves several key steps[16]: First, healthcare providers engage in in-depth conversations with patients to listen to their experiences and feelings related to their illness. Second, they assist patients in identifying and articulating the key issues and emotions present in their stories. Third, through dialogue and reflection, healthcare providers and patients collaboratively explore potential solutions and care plans. Finally, narrative nursing may also include documenting and sharing patients’ stories to facilitate communication and understanding between patients and the healthcare team.

NARRATIVE NURSING IN CLINICAL PRACTICE

Narrative nursing, as an innovative nursing model, has been applied in the treatment process of various diseases with positive results. According to the surface under the cumulative probability ranking curve values, narrative nursing emerged as one of the most impactful psychological interventions among the top four for reducing symptoms of anxiety and depression[17]. Patients with acute pancreatitis often experience severe complications, leading to negative emotions. These negative emotions can promote the secretion of stress hormones, increase blood glucose levels, and enhance insulin resistance, which in turn increase the risk of acute pancreatitis[18,19]. Zhou et al[13] found that narrative nursing interventions in patients with acute pancreatitis not only effectively improve negative emotions but also play a significant role in improving disease outcomes and prognosis. In addition to alleviating negative emotions, other studies have shown that narrative nursing can also improve patients’ sleep quality[20], reduce feelings of shame[21], and alleviate psychological stress[22].

Cancer patients often experience sleep disturbances, and even insomnia. On the one hand, anxiety and depression in patients can lead to sleep disorders, and even suicidal tendencies[23]. On the other hand, the degree of pain is positively correlated with its impact on sleep; the longer and more intense the pain, the greater the influence on sleep, thereby severely affecting the quality of life of cancer patients[24-26]. The reason why narrative nursing may improve patients’ sleep could be that the improvement in patients’ physiological pain and psychological emotions plays a role in enhancing the comfort of patients’ physical and mental state, which in turn improves their overall well-being. The reduction of adverse stimuli during sleep subsequently enhances sleep quality. As the patients’ physical and mental state improves, it also leads to better dietary quality and physical strength, thereby resulting in a more substantial improvement in overall quality of life[20].

Conventional preoperative and postoperative care primarily emphasizes patient health education and prevention of surgical complications, ignoring the encouragement and development of patients’ inherent capabilities to actively engage in their own treatment and nursing processes. Narrative nursing not only helps perioperative patients relieve their fear of surgery and the psychological burden caused by treatment costs, but also helps patients improve their compliance with treatment and fully mobilize their own resources and potential[22].

Narrative nursing can help patients reduce feelings of shame, especially for amputees. Regardless of the cause of amputation, it has a significant impact on patients’ bodies, external appearance, and physical activities, dealing a heavy blow to their self-esteem and generating intense feelings of shame[27]. Currently, there is a lack of research on the factors influencing the sense of shame in amputees[28], and pharmacological treatments have been found to be ineffective in helping amputees deal with the psychological trauma of amputation surgery[29]. The narrative nursing model, when applied to amputees, can improve patients’ mental state and psychological well-being, alleviate their feelings of shame, and enhance their satisfaction with care.

During the coronavirus disease 2019 pandemic, narrative nursing was used to support frontline nursing staff in coping with psychological pressure and emotional challenges[30]. Moreover, narrative nursing is effective across various age groups, including the elderly[31] and children[32], and aids in enhancing patients’ understanding of their disease and confidence in treatment. Generally, the significance of narrative nursing lies in its ability to enhance patient satisfaction and care quality while helping patients better cope with the emotional and psychological pressures associated with their illness. Through narrative nursing, patients feel respected and understood, which is vital for their overall well-being and treatment outcomes. Additionally, narrative nursing aids healthcare professionals in gaining deeper insights into patients’ needs, enabling them to provide more humane and personalized care.

HOW NARRATIVE NURSING ENHANCES THE THERAPEUTIC RELATIONSHIP

Narrative nursing, as an emerging model of care, primarily strengthens the therapeutic relationship between patients and healthcare providers through emotional expression and release, emotional identification and self-understanding, empathy and understanding, and emotional support. On the one hand, narrative nursing provides a safe space for patients to express emotions they might typically suppress. By telling their stories, patients can release and process emotional stress associated with their illness, which may include anxiety, depression, and loneliness[33]. Concurrently, patients construct and reconstruct their self-identity through their narratives[34]. In this process, patients may discover new meanings about themselves and their illness, which helps them better understand and accept their emotional experiences, reducing stigma and alleviating psychological crisis. On the other hand, healthcare providers can experience the world from the patient’s perspective, thereby establishing empathy. This empathy is fundamental to understanding patients’ emotional experiences as it allows providers to feel the patients’ pain, fear, and hopes from the inside out[35]. Once healthcare providers identify patients’ emotional needs, they can offer targeted support, which may include emotional comfort, psychological counseling, or social support, all of which contribute to patients’ emotional recovery and consolation.

Narrative nursing is an integral part of the entire healthcare process, and it should be seamlessly integrated it into various stages of healthcare. Taking perioperative care as an example: In the preoperative stage, patients often experience anxiety and fear. Nurses can use narrative nursing to encourage patients to share their expectations concerning the surgical outcome, their fears regarding the surgical process, and their concerns about postoperative recovery. By listening and understanding the patients’ stories, nurses can provide targeted comfort and support, helping patients alleviate anxiety, enhance their confidence concerning the surgery, and establish a good trust relationship with the patients. Postoperatively, patients may experience pain, discomfort, and uncertainty about the surgical outcome. Nurses can guide patients to express their emotions and feelings, thereby promptly identifying emotional issues and needs. If patients feel lonely and helpless after surgery, nurses can increase the time spent with them and provide psychological counseling. If patients are dissatisfied with the surgical outcome, nurses can communicate with doctors to provide more information and explanations, helping patients correctly understand the surgical results and adjust their mindset.

Narrative nursing can be integrated into the nursing workflow or implemented as an independent intervention. Firstly, narrative nursing should be incorporated into the daily nursing workflow, making it a regular part of care. For example, when patients are admitted, nurses can arrange a specific time for narrative nursing, allowing patients to share their stories and feelings, and record this information in the patients’ nursing records. Secondly, narrative nursing should be combined with other nursing measures to form a comprehensive care plan. For instance, in pain management, nurses can provide narrative nursing while administering pain medication, understanding the patients’ pain and psychological state, offering psychological support and pain relief techniques to help patients better manage their pain. Thirdly, a dedicated narrative nursing team responsible for conducting narrative nursing should be established. Team members can include nurses and psychological counselors, who can regularly provide narrative nursing services to help patients express and deal with emotional issues. For example, in an oncology ward, a narrative nursing team can offer regular narrative nursing to cancer patients, helping them cope with the psychological stress and emotional distress brought on by the disease. Last but not least, regular narrative nursing activities, such as narrative nursing group discussions and workshops should be organized, providing a dedicated platform for patients to share their stories and feelings. For example, hospitals can hold narrative nursing group discussions once a month, inviting patients and their families to share their experiences and insights during the disease treatment and care process, supporting and encouraging each other.

CHALLENGES AND OPPORTUNITIES

Although narrative nursing has many benefits in the treatment of disease, implementing narrative nursing presents various challenges, including a lack of knowledge and skills among healthcare professionals, time constraints in modern medical practice, a lack of organizational culture supporting narrative nursing, resource allocation issues, patient and family involvement, and the difficulty of assessing the effectiveness of narrative nursing. To overcome these challenges, potential solutions include strengthening education and training, optimizing time management, promoting organizational cultural change, resource optimization, improving patient and family education, and conducting more research on effectiveness evaluation. Narrative nursing strategies could include regular nursing meetings to share patients’ stories and experiences, enhancing the team’s awareness of patients’ emotional needs. Encouraging healthcare providers to actively listen to patients’ feelings in daily care, and using open-ended questions to guide communication, can better understand patients’ emotional needs. Healthcare professionals and policymakers should fully recognize the importance of narrative nursing and incorporate it into routine nursing practices.

In recent years, emerging technologies such as virtual reality (VR) and artificial intelligence (AI) have been continuously advancing and gaining widespread adoption. It is believed that in the near future, these emerging technologies can also be applied to narrative nursing, promoting its development. Through VR technology, patients can review their journey of fighting against diseases in a virtual environment, which helps them better express and understand their emotions. Additionally, VR can provide patients with a virtual emotional support environment, such as virtual natural landscapes or comfortable rooms, allowing them to feel relaxed and at ease while telling their stories, thus making them more willing to share their inner feelings. Furthermore, by simulating patients’ reactions in different emotional states using VR, nursing staff can practice how to listen and support patients more effectively. AI’s language processing technology can be used to analyze patients’ language and emotional expressions, in order to identify their emotional states and potential psychological needs. Additionally, AI technology can integrate patients’ medical data, psychological assessment results, and narrative content to generate personalized care plans. Therefore, future directions may include technology integration, interdisciplinary collaboration, policy and regulatory support, community involvement, and ongoing research and development, considering narrative nursing practices in different cultural and social contexts globally. Through these efforts, we can move towards a more humane and effective model of care, providing comprehensive and in-depth nursing services to patients.

CONCLUSION

Narrative nursing plays a crucial role in understanding patients’ emotional needs and strengthening therapeutic relationships. By listening to and focusing on patients’ personal stories, healthcare professionals can gain a deeper understanding of patients’ emotional experiences and needs. This understanding not only helps build trust but also improves communication, thereby enhancing patients’ treatment experiences and overall health outcomes. Narrative nursing offers an effective tool for healthcare providers to identify and respond to patients’ emotional needs, promoting personalized and patient-centered care. Emotional health is an indispensable key aspect of patient care. Good emotional support not only contributes to patients’ psychological comfort but also positively affects the physical recovery process. Therefore, future research should focus on exploring the application effects of narrative nursing in different disease contexts and how to quantify its impact on patient recovery and quality of life. Additionally, research should examine and train healthcare professionals to effectively implement narrative nursing, ensuring its widespread application in clinical practice.

ACKNOWLEDGEMENTS

We thank the reviewers for comments that significantly improved the final version of the manuscript. We also extend our sincere gratitude to Zhou LJ, Wu J, Huang WJ, Shen AW, Yin YP, Sun HL, and Yuan YT for their original work titled “Narrative nursing for negative emotions in patients with acute pancreatitis: Based on model construction and application”. Their contributions were instrumental in shaping this research.