Standardized training nurses's humanistic care practice ability: A cross‐sectional survey in western China during COVID‐19

Abstract

Aim

This study aims to investigate the current status and determinants of humanistic care practice abilities among standardized training nurses in China during the post‐COVID‐19 era, as well as to propose management strategies.

Design

A cross‐sectional study.

Methods

Deliberately chosen were 517 standardized training nursing students from a provincial‐level training facility in western China.

Results

The respondents had a mean ± SD age of 21.23 ± 1.34 years, and 92.0% of them voluntarily opted for the nursing profession. Almost all (99.8%) respondents had at least a college degree. The standardized training nurses scored an average of (130.31 ± 14.18) on humanistic care ability, which was significantly related to some sociodemographic variables. The average scores for the five dimensions of nursing communication ability, psychological adjustment ability, moral and legal application ability, nursing aesthetic ability, and care practice ability were 30.78, 17.61, 32.23, 18 and 31.67, respectively. All these dimensions showed positive correlations with the overall score of humanistic care practice ability.

1. INTRODUCTION

Humanistic care is a way of providing care that respects and values the uniqueness, dignity and worth of each person. It involves caring for the whole person, not just their physical condition, but also their emotional, social, spiritual and cultural needs (Gao et al., 2021; Nibbelink & Brewer, 2018; Raveesh et al., 2019). Humanistic care is based on the principles of humanism, which emphasize the potential and autonomy of human beings. According to Taghinezhad (Taghinezhad et al., 2022), humanistic care is ‘the internal quality of nursing staff concerning morality, humanity, and integration of knowledge, concepts, and attitudes. Nursing humanistic care ability includes caring experience ability and caring behaviour ability (Gonzalo, 2016). The necessary psychological characteristics of personality are regarded as a special ability’. Humanistic care is a process that begins with nursing education and progresses through different stages of clinical practice (Létourneau et al., 2020). Previous studies have explored the concept of nurses' humanistic caring ability and humanistic literacy in China (Niu et al., 2021; Wen et al., 2023), but few have examined how these abilities are developed and practiced by standardized training nurses.

Standardized training nurses are nurses who undergo a policy‐based program in China that was launched in 2015 by the National Health Commission (Interpretation of “Training Outline for New Nurses (Trial)”, 2016). The program aims to improve the quality and competence of newly graduated nurses by providing them with 2–3 years of continuing education training in designated hospitals. The training covers both theoretical knowledge and clinical skills in various specialities and departments. The program also intends to bridge the gap between academic and clinical settings, and to help nurses adapt to the real clinical environment (Aljohani et al., 2021; Zhou et al., 2020). Standardized training nurses are an important and novel group to study in relation to humanistic care because they face various challenges and opportunities in their transition from students to professionals (Chang et al., 2022).

This study evaluates the humanistic care practice abilities of standardized training nurses in China. We expected that these findings would offer new perspectives for leaders and teachers of similar training programs on how to foster and enhance humanistic care among standardized training nurses.

2. MATERIALS AND METHODS

2.1. Study design

Since we are still in the pandemic period, we adopted a descriptive cross‐sectional study design and conducted a survey online. We selected a standardized training base for nurses in Sichuan Province, which had 600 students, so the sample size was sufficient. The researchers used purposive sampling and snowball sampling methods. A total of 517 people participated in this study. Participants who meet the following criteria must meet all of the following standards: (a) The participant is a student of the Sichuan Provincial Nurse Standardization Training Base. (b) All students who graduate obtain a nurse certificate and engage in clinical nursing work. (c) No cognitive impairment. (d) Students who have not experienced traumatic events within 1 week. (e) Students infected with COVID‐19 who are receiving treatment. Data collection was done online, and the questionnaire was prepared in the form of the China Questionnaire Star. The link was shared in the WeChat group of nursing students, and only the management department of the hospital had access to the backend management of the data platform. The total duration of this study was 6 months, from February to July 2022.

2.2. Ethics statement

Ethical approval was obtained from the Ethics Review Committee of Suining Central Hospital, Sichuan Province, China (approval number #2022‐01‐11). Written permission was obtained from the nursing department of the hospital to start collecting relevant data. In the introduction section of the survey questionnaire, the purpose of the study was clearly explained, and those who agreed to participate in the study had to click the continue button to confirm that they were fully aware of the survey content and consented to participate in the study before they could proceed to complete the survey. During the study, the Questionnaire Star online platform rigorously protected the personal privacy of the researchers, and only participants and authorized personnel from the hospital management department could access the original data. No one else could view the original data.

2.3. Study instrument

The questionnaire consisted of three parts of which the first two parts were designed by the researchers themselves, while the third part used a validated scale of humanistic practice competence for nurses.

Part 1: a questionnaire on the demographic information of the participants (gender, place of birth, age, educational background, whether they were an only child).

Part 2: a questionnaire on the occupational information of the participants (whether they voluntarily chose the nursing profession, their current department, whether they had received humanistic training in nursing, whether they had felt humanistic care from their senior teachers in their work).

Part 3: a standard Likert scale to measure the humanistic practice competence of nurses. This scale was used in a study by Zhang in China (Zhang et al., 2021). the HPAN scale was suitable for the situation in China (Wang et al., 2021). The HPAN model includes five dimensions: nursing communication ability, psychological adjustment ability, ethical and legal application ability, nursing aesthetic ability and nursing practice ability. Score ranges from strongly disagree = 1 to strongly agree = 5 (1. strongly disagree 2. disagree 3. Neither agree nor disagree 4. Agree 5. Strongly agree). The split‐half reliability coefficient of the scale was 0.98, the split‐half reliability coefficient of each dimension was 0.86–0.99, Cronbach's α coefficient was 0.96, and Cronbach's α coefficient of each dimension was 0.87–0.98. The total score on the scale ranges from 29 to 145 points. Nursing staff were evaluated according to their actual situation, and the higher the score, the higher the HPAN (Du et al., 2020). The definitions for the 5 latitudes were as follows:

1. Nursing communication: the ability to achieve desired goals or meet patient needs through communication.

2. Psychological adjustment: the ability of people to respond to environmental pressures in various ways that are beneficial to individuals or groups, to them survive better.

3. Ethics and Legal Application: A nurse's ability to identify and analyse professional legal issues that contribute to final overall decision‐making in nursing practice.

4. Nursing aesthetics: the ability of nurses to accept, understand, evaluate and create nursing beauty in nursing practice.

5. Caring practice: the ability to effectively express the humanistic spirit of nursing in nursing practice.

2.4. Statistical methods

During the survey phase, a small team was formed by three researchers and the project leader. The research team received the materials submitted by the participants every day, reviewed the data and provided face‐to‐face or online technical assistance if any anomalies or missing values were found, ensuring the completeness, consistency and accuracy of the data. Out of 600 students, only 517 students participated in this study. The data were analysed using SPSS version 26.0.

The general status of the respondents was analysed using descriptive statistics, measurement data were expressed as mean ± SD, and the scores of humanistic care ability were generated based on the scale questionnaire. The humanistic care practice ability was analysed using the t‐test and variance analysis, and Pearson correlation was used to determine the relationship among the five domains. and p < 0.05 was considered statistically significant.

3. RESULTS

3.1. Demographic and career information

As shown in Table 1, a total of 517 survey responses were received. There were 465 (99%) females and only 57 (1%) males. The study included 505 (97.68%) trainees under the age of 24. More than 60% of the trainees were urban residents, 49% were only children, and 99.8% had college or bachelor's degrees. A total of 166 trainees were from the internal medical department (32%), 228 from the surgical department (44%), 88 from the emergency and ICU department (17%), and 35 trainees (7%) from other departments. Almost half of the participants (45%) had never participated in humanistic care learning before the standardization training. (56%) of the students sometimes received humanistic care from their clinical mentors.

TABLE 1.

Demographic and Career Information of participants.

Participants' demographic and occupation‐related characteristics (n = 517)
	n	%
Gender
Male	52	1
Female	465	99
Birthplace
City	310	60
The countryside	207	40
Age
Above 24	12	2.32
21 ~ 23	333	64.41
19 ~ 20	168	32.5
16 ~ 18	4	0.77
Level of education
Junior college	1	0.19
College	486	94
Undergraduate	30	5.8
One of a kind
Yes	202	29
No	315	61
Educated in nursing humanities
Yes	284	55
No	233	45
Have you ever experienced humanistic care from your superiors?
Sometimes	289	56.00
Often	161	31.00
Always	67	13.00
The decision to become a nurse on a voluntary basis
Yes	476	92.07
No	41	7.93
Department
Medicine internal	166	32.00
Surgery	228	44.00
Critical	88	17.00
Others (Medical Examination Center and Rehabilitation)	35	7.00

3.2. The overall and dimensional scores of nursing humanistic practice ability

A total of 130.31 ± 14.18 scores were awarded for humanistic care practice ability based on the survey findings, with the scores for each dimension provided in Table 2. The results of the five dimensions from high to low are: Ethics and legal application ability (95%), Caring practical ability (90%), Nursing aesthetic ability (90%), psychological adjustment ability (88%), and Nursing communication ability (87%).

TABLE 2.

The scores of nursing trainees on each dimension of humanistic care practice in a standardized training program.

Dimension	Min	Max	Mean ± standard deviation
Nursing communication ability	19	35	30.78 ± 3.91
Psychological adjustment ability	10	20	17.61 ± 2.34
Ethics and legal application ability	20	35	32.23 ± 3.42
Nursing aesthetic ability	12	20	18.00 ± 2.16
Caring practical ability	20	35	31.67 ± 3.61

3.3. The association between humanistic nursing practice competence and selected sociodemographic and occupational information variables

Table 3 shows the p‐values between students' humanistic nursing practice competence and its variables. The items of being an only child, birthplace, having received a nursing humanities education, receiving humanistic care from clinical mentors, and department all have statistical significance (p < 0.05). Female students have higher average scores than male students, and among the age groups, the 16–18 group has the highest score, while the above 24 group has the lowest score.

TABLE 3.

Humanistic care practice ability scores based on univariate analysis.

Items	Characteristic	n (%)	Mean ± standard deviation (x ± s)	t/F	p
Gender	Male	52 (1)	128.96 ± 14.35	0.52T	0.46
	Female	465 (99)	130.46 ± 14.17
One of a kind	Yes	202 (39)	128.82 ± 15.17	0.31T	0.05
	No	315 (61)	131.27 ± 13.44
Age	16 ~ 18	4 (0.77)	137 ± 9.93	1.05F	0.36
	19 ~ 20	168 (32.5)	130.63 ± 15.15
	21 ~ 23	333 (64.41)	130.29 ± 13.72
	Above 24	12 (2.32)	124.25 ± 13.35
Level of education	Junior college	1 (0.19)	145 ± 0	0.55F	0.57
	College	486 (94)	130.26 ± 14.05
	Undergraduate	30 (5.8)	130.73 ± 16.38
Birthplace	City	310 (60)	128.85 ± 14.46	0.46T	0.004
	The countryside	207 (40)	132.5 ± 13.49
Have you ever experienced humanistic care from your superiors	Sometimes	289 (56)	128.92 ± 14.47	3.23F	0.04
	Often	161 (30)	131.89 ± 13.92
	Always	67 (13)	132.54 ± 13.02
Educated in nursing humanities	No	284 (55)	128.83 ± 14.52	0.57T	0.009
	Yes	233 (45)	132.12 ± 13.57
The decision to become a nurse on a voluntary basis	Yes	476 (92.07)	130.63 ± 13.99	0.36T	0.08
	No	41 (7.93)	126.66 ± 15.96
Department	Medicine internal	166 (32)	129.35 ± 15.04	2.61F	0.05
	Surgery	228 (44)	129.65 ± 14.12
	Critical	88 (17)	131.53 ± 12.82
	Others (Medical Examination Center and Rehabilitation)	35 (7)	136.11 ± 12.51

3.4. One‐way ANOVA analysis among different departments

As shown in Tables 4 and 5, the humanistic nursing competence varies across different clinical settings. The highest mean score was obtained by other settings, followed by critical care, surgery and internal medicine. Other settings showed significant differences in comparison with internal medicine and surgery.

TABLE 4.

A statistical description of the humanistic nursing competence in various clinical settings.

Statistical description of the total score of nursing humanistic care practice ability
	N	Mean	Std. deviation	Std. error	95% confidence interval for mean		Minimum	Maximum
					Lower bound	Upper bound
Internal	166	129.3494	15.04453	1.16768	127.0439	131.6549	85	145
Surgery	228	129.6535	14.12712	0.93559	127.81	131.4971	87	145
Critical	88	131.5341	12.82056	1.36668	128.8177	134.2505	105	145
Others (Medical Examination Center and Rehabilitation)	35	136.1143	12.51534	2.11548	131.8151	140.4135	108	145
Total	517	130.3133	14.18573	0.62389	129.0877	131.539	85	145

TABLE 5.

The LSD method was used to conduct pairwise comparisons among different settings.

Multiple comparisons (LSD)
Department	Department	Mean difference (I–J)	Std. error	Sig.	95% confidence interval
					Lower bound	Upper bound
Internal	Surgery	−0.30411	1.44063	0.833	−3.1344	2.5261
	Critical	−2.18469	1.86186	0.241	−5.8425	1.4731
	Others	−6.76489*	2.62625	0.01	−11.9244	−1.6054
Surgery	Internal	0.30411	1.44063	0.833	−2.5261	3.1344
	Critical	−1.88058	1.77199	0.289	−5.3618	1.6007
	Others	−6.46078*	2.56332	0.012	−11.4967	−1.4249
Critical	Internal	2.18469	1.86186	0.241	−1.4731	5.8425
	Surgery	1.88058	1.77199	0.289	−1.6007	5.3618
	Others	−4.58019	2.82165	0.105	−10.1236	0.9632
Others	Internal	6.76489*	2.62625	0.01	1.6054	11.9244
	Surgery	6.46078*	2.56332	0.012	1.4249	11.4967
	Critical	4.58019	2.82165	0.105	−0.9632	10.1236

^*The mean difference is significant at the 0.05 level.

3.5. The correlation of various dimensions of humanistic nursing practice ability

Table 6 shows the responses of the standardized training nurses in five domains of humanistic nursing practice and their respective p‐values. All domains were positively correlated with the overall humanistic nursing practice of the students. We also found that communication skills had the strongest correlation with psychological adjustment skills; psychological adjustment skills were most correlated with nursing ethics and legal application, and nursing aesthetics skills; nursing ethics and legal skills were most correlated with nursing caring practice skills; nursing aesthetics skills were most correlated with nursing caring practice skills.

TABLE 6.

The correlation coefficient matrix between the total score and each dimension of humanistic nursing practice ability.

	Mean	SD	Total score	Communication	Psychological adjust	Ethics and legal application	Aesthetic	Caring practical
Total score	130.31	14.185	1
Communication	30.78	3.917	0.912**	1
Psychological adjust	17.61	2.343	0.890**	0.820**	1
Ethics and legal application	32.23	3.425	0.916**	0.756**	0.769**	1
Aesthetic	18	2.169	0.923**	0.773**	0.769**	0.827**	1
Caring practical	31.67	3.614	0.937**	0.782**	0.767**	0.834**	0.903**	1

^**Correlation is significant at the 0.01 level (two‐tailed).

4. DISCUSSION

4.1. The current situation of humanistic care practice ability of standardized training nurses

Standardized training nurses, as the reserve talents of the nursing team, have an impact on the overall quality of the nursing team and the quality of nursing service with their humanistic care practice ability. this study found that the total score of humanistic care practice ability of standardized training nursing students was 130.31 ± 14.18, which was lower than the result of Wang (Wang & Zhou, 2021a, 2021b), 187.43 ± 18.92, indicating that the humanistic nursing practice ability of this group deserved attention and improvement (Qi et al., 2022). However, we also found that the subjects of Wang's study were undergraduate nursing students who had not entered the clinical internship stage, so they could only be used as a reference. Also, nursing students need to improve their humanistic care because it started late and the results are unclear. Professional identity, interpersonal communication, and lack of social resources are the key factors affecting nursing students humanistic care abilities (Jian et al., 2022). Thus, a realization to enhance further the nursing curricula with the integration of a humanistic approach of caring as to the future nurses to understand their professional duties and responsibilities at their best performance. To capture its purpose, standardized training is warranted.

4.2. The influencing factors of humanistic care practice ability of standardized training nurses

This study identified five demographic factors that influenced humanistic care practice ability, including place of birth, being an only child, having received humanistic care nursing training courses, demonstration by clinical mentors, and current department. Being an only child might be related to their growing environment and parents' education methods, as they tend to be self‐centered and lack experience in getting along with peers, which is different from Li's (Li et al., 2021) study.

The work intensity of nurses influences the implementation of humanistic care. In this study, the humanistic care practice ability scores of nurses in some departments were significantly higher than those in other departments, and there were statistical differences between them and the nurses in the internal medicine and surgery departments, suggesting a possible imbalance in human resources allocation. The current number of nurses in China is still insufficient. There is a huge gap between different provinces (Su & Du, 2019). Consistent with Hassandoost's study, humanistic care stagnation occurs when nurses' care is insufficient to meet all patients' needs (Hassandoost et al., 2022). Domestic studies also confirmed this view, that nurses' high‐intensity work has a certain hindrance to the implementation of humanistic care (Yang et al., 2023), and if the hospital's nurse staffing is not adequate, the ability of humanistic care will decline in the process of clinical work, especially in the context of heavy clinical work tasks, both work satisfaction and overall enthusiasm will decrease (Li et al., 2017; Tian et al., 2020).

We were pleased to find that the better the organizational caring atmosphere, the stronger the humanistic caring ability of undergraduate nursing students. The caring behaviour shown by teachers themselves and the learning environment full of caring created for students would motivate students to actively learn humanistic caring knowledge and skills and internalize them into their humanistic caring literacy, which was consistent with our results. If the shortage of human resources cannot be improved in the short term, nursing managers should focus on the various work processes of nursing, and adopt scientific methods to enhance the satisfaction of nurses.

4.3. Future management recommendations

To improve the humanistic care practice ability of standardized training nurses, the following specific strategies are suggested:

• Creating a positive social environment that appreciates and acknowledges the work of nurses, such as giving a thank‐you letter or a message of gratitude on the wish wall when discharging patients, and educating the public about the value of nurses, which can enhance their subjective well‐being.

• Emphasizing the practical education of humanistic care in clinical work, and guiding standardized training nurses to apply theoretical knowledge to humanistic nursing practice behaviours.

• Adopting flexible and diverse training methods, helping standardized training students identify and resolve common medical disputes in clinical settings, and using simulation exercises to teach them correct problem‐solving skills and ways to seek help from others.

• Scientific allocation of human resources for clinical nurses, and developing good coping skills for professional setbacks, can enable nurses to maintain a confident and calm attitude towards work, and dedicate themselves to nursing positions with more focus and enthusiasm, ease the professional tension atmosphere, reduce the negative cognition of the profession, and thus demonstrate higher humanistic care ability that can lead to model development.

4.4. Significance of research

This cross‐sectional survey can objectively analyse the current situation and influencing factors of humanistic care practice skills of standardized training nurses, and provide effective improvement strategies for hospital nursing managers and educators.

5. CONCLUSION

Humanistic care practice ability is a crucial issue for standardized training nurses, which requires the attention of hospital managers and educators. This study revealed that standardized training nurses in Western China had a low level of humanistic care practice ability, which was influenced by factors such as being an only child, place of birth, previous humanistic nursing training, humanistic care from preceptors and current department. The priority should be to enhance the communication ability and psychological adjustment ability in these two dimensions. It is recommended that hospitals should improve the standardized training system, refine the teaching methods and increase the professional benefit and identity of standardized training nurses.

5.1. Research limitations

This study has some limitations that can be considered in future research. First, although this study used purposive and snowball sampling, the research sample was limited to standardized nurse training bases in western China due to budget and time constraints, and no further large‐scale survey was conducted. Future research should include more standardized training bases in Sichuan Province, China, or even beyond Sichuan Province, to confirm the existing research findings. This study summarized the main findings of the preliminary survey. Future research may also consider the curriculum design for enhancing humanistic care practice skills.

AUTHOR CONTRIBUTIONS

Xixi Li: Conceptualization; Jin Yang: Methodology; Xiquan Wang: Writing – original draft; Daoxin Jin: Writing – review and editing; Jing Liu: Data curation; Luyao Yang: Data curation; Ronnell D. Dela Rosa: Supervision.

FUNDING INFORMATION

This research did not receive any external funding.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no competing interests. The authors are responsible for the article's content and writing. The manuscript was critically revised by all authors. The final manuscript has been approved for submission, and all authors have agreed to be accountable for the accuracy and integrity of the work.

ETHICS STATEMENT

To minimize the study's risks and protect the subjects' identities, all recruited participants were provided with informed consent materials and a brief description of the study, including its purpose, time commitment and risks. Before beginning the survey, all participants read and signed the informed consent. Authors who contributed to the writing of the article analysed the data.

Li, X. , Yang, J. , Wang, X. , Jin, D. , Liu, J. , Yang, L. , & Dela Rosa, R. D. (2024). Standardized training nurses's humanistic care practice ability: A cross‐sectional survey in western China during COVID‐19. Nursing Open, 11, e2123. 10.1002/nop2.2123

DATA AVAILABILITY STATEMENT

All data were collected using an online survey on the Wenjuanxing Platform (https://www.wjx.cn/). The corresponding author can provide additional detailed data upon reasonable request.