Figure 1
Stages of study.
Figure 2
Fitted path diagram of NCS-MS.
Table 1
Convergent and Discriminant Validity of the NCS-MS.
| DIMENSION | CONVERGENT VALIDITY | DISCRIMINANT VALIDITY | ||||
|---|---|---|---|---|---|---|
| CR | AVE | 1 | 2 | 3 | 4 | |
| 1. Narrative horizon | 0.798 | 0.497 | (0.705) | |||
| 2. Narrative construction | 0.902 | 0.698 | 0.511 | (0.830) | ||
| 3. Medical relationship | 0.897 | 0.685 | 0.544 | 0.816 | (0.827) | |
| 4. Medical care | 0.831 | 0.621 | 0.527 | 0.755 | 0.783 | (0.788) |
[i] Note: In the discriminant validity table, the values in the bracket are the square root of the AVE for each construct, while the other values are the correlation coefficients between constructs.
Appendix 1
The dimensions, sub-dismensions, and items of the formal NCS.
| Dimension 1: Narrative Horizon |
| 1. I believe that medical care should be patient-centric and that clinicians should treat their patients as unique individuals. |
| 2. I believe healthcare professionals should be able to derive meaning and insight from patients’ narratives. |
| 3. I believe medical considerations should extend beyond merely eliminating or alleviating symptoms to include the pursuit of overall well-being. |
| 4. I think that medical care should focus on not only ‘curing’ but also ‘healing’ the mind, body, and spirit. |
| 5. I believe healthcare professionals should periodically reflect on the limitations of empirical biomedicine. |
| Dimension 2: Narrative Construction |
| Subdimension 2.1: Narrative listening |
| 6. I can maintain attention and focus on the narratives of patients and their family members. |
| 7. I approach the emotions and thoughts of patients and their family members with a nonjudgemental attitude. |
| 8. I can identify key pieces of information in the narratives of patients and their family members. |
| 9. I observe and understand the body language of patients and their family members. |
| 10. I listen to the narratives of patients and their family members with openness and curiosity. |
| 11. I understand the relationship between patients’ illnesses and their real-life contexts. |
| 12. When confronted with vague or inconsistent narratives from patients and their family members, I can still accept and respond appropriately. |
| Subdimension 2.2: Narrative understanding |
| 13. I can understand patients’ perspectives and interpretations of their illnesses. |
| 14. I can grasp how major life history events affect patients. |
| 15. I can comprehend the patients’ narratives, including key elements such as plots, characters, and metaphors. |
| 16. I am attentive to the psychological, social, and cultural contexts of patients’ illnesses. |
| 17. I can understand patients’ descriptions of their illness journeys, such as living with the disease and recovery. |
| 18. Beyond patients’ functional limitations, I can recognise their potential for recovery and strengths. |
| 19. I can understand where patients are experiencing discomfort. |
| Subdimension 2.3: Narrative thinking |
| 20. I can reflect on the meaning of authentic narratives presented in medical contexts. |
| 21. I can understand the meaning of illness in a patient’s life. |
| 22. I can identify complex themes and contextual situations within patients’ narratives. |
| 23. I can engage in further inquiry about the initial narratives of patients and their family members. |
| Subdimension 2.4: Narrative representation |
| 24. I can vividly depict significant details in a patient’s narrative. |
| 25. I can use my imagination to reconstruct the patient’s narrative. |
| 26. I can empathise with the patient and reinterpret their narrative of their illness together with them. |
| 27. I can, together with patients, holistically link the illness to their real-life situations or experiences. |
| Dimension 3: Medical Relationship |
| Subdimension 3.1: Empathy |
| 28. I can understand the thoughts and feelings expressed by patients and their family members. |
| 29. I empathise appropriately, considering the perspectives of patients and their family members. |
| 30. When I listen to or witness a patient’s narrative, I am moved. |
| 31. I can empathise with patients’ experiences and feelings related to their illness. |
| 32. Even if I cannot fully understand a patient’s agony, I still strive to make them feel supported. |
| Subdimension 3.2: Communication |
| 33. I encourage patients to share their illness-related life experiences. |
| 34. When communicating with patients and their family members, I can express myself clearly and completely. |
| 35. When communicating with patients and their family members, I promptly respond to their needs and provide feedback. |
| 36. I maintain effective patient–physician interaction through dialogue and the exchange of experiences. |
| 37. I actively engage in interdisciplinary collaboration and communication. |
| Subdimension 3.3: Affiliation |
| 38. I can establish a cooperative relationship with patients and their family members through mutual understanding. |
| 39. In my medical practice, I facilitate the learning and growth of patients and their family members while also recognising my learning and growth through them. |
| 40. I understand that a patient’s narrative is a means to connect with healthcare professionals. |
| 41. I perform medical tasks entrusted to me by patients with gratitude. |
| 42. I can share in the illness and agony–related experiences of patients and their family members through empathetic responses. |
| Subdimension 3.4: Intersubjectivity |
| 43. I can develop a contextual understanding of illness experiences together with patients, starting from their initial narratives of the disease. |
| 44. I can transcend differences between myself and others (e.g. patients, family members, and peers) to understand their experiences. |
| 45. I can understand and reflect on the different values in patient–physician interactions and achieve an appropriate balance. |
| 46. I respect different medical professions and function within interdisciplinary teams. |
| Dimension 4: Medical Care |
| Subdimension 4.1: Responsive care |
| 47. I invite patients to join my medical decision–making team and provide them with ample opportunities to express their preferred approaches to care. |
| 48. I actively listen to and respond to patients’ medical opinions, including suggestions that may be challenging to adopt. |
| 49. I actively respond to patients’ needs, offering personalised care. |
| 50. By participating in discussions with medical peers, I aim to address my blind spots in the patient–physician relationship, thereby enhancing my communication skills with patients. |
| Subdimension 4.2: Balanced act |
| 51. During the healthcare process, I address my patients’ psychological needs. |
| 52. During the healthcare process, I consider the physical and spiritual aspects of diseases from a holistic perspective. |
| 53. During the healthcare process, I contemplate diseases and physical, social, and spiritual aspects from a holistic perspective. |
| Subdimension 4.3: Medical reflection |
| 54. In clinical care, I periodically review my physical and mental workload. |
| 55. I fully understand the uncertainty/variability of clinical work and adapt myself accordingly. |
| 56. I am aware of the effect of the stigmatisation of certain diseases on healthcare. |
| 57. Confronted with the complexity and variability of clinical settings, I reflect on my medical actions to enhance healthcare efficacy. |
| 58. I continuously reflect on my experiences in caring for patients, thereby deriving new insights and skills. |
| 59. Through reflection, I attempt to perceive the meanings embedded in the disease process as opportunities for change, facilitating healing for both myself and my patient. |