Assessment of humanistic caring ability and associated factors among vocational nursing students in Jiangsu province: a cross-sectional study

Abstract

Objective

This study aimed to assess the current level of humanistic caring ability among vocational nursing students in Jiangsu Province and to identify factors associated with variability in this capacity. The findings are intended to inform enhancements in nursing education practices.

Methods

A cross-sectional survey was conducted from September to November 2022, involving 685 vocational nursing students across three academic years from three vocational higher education institutions in Jiangsu Province. Stratified random sampling was employed. Data were collected using a general demographic questionnaire and the Caring Ability Inventory (CAI).

Results

The mean CAI score was 184.87 ± 19.107, which was below the normative benchmark established in the United States. Several factors were significantly associated with humanistic caring ability, including prior high school educational background, intent to pursue a nursing career, previous caregiving experience, family economic status, perceived family support, and the quality of both teacher-student and peer relationships.

Conclusion

The findings indicate that humanistic caring ability among vocational nursing students may be suboptimal, with observable gaps in confidence, skills, and motivation related to caregiving. These results underscore the need to explore pedagogical models tailored to vocational nursing education. Targeted instructional strategies and supportive learning environments may contribute to strengthening humanistic care competencies in this population.

Background

The development of humanistic nursing education in Western contexts originated with Florence Nightingale’s emphasis on patient-centered care and evolved through the contributions of theorists such as Leininger, whose transcultural nursing theory highlighted the importance of understanding patient needs within their cultural context [1]. Watson’s theory of human caring further enriched this foundation by integrating emotional, ethical, and relational dimensions into nursing education and practice [2]. Western nursing curricula are thus supported by both theoretical frameworks and policy guidance, with organizations such as the American Association of Colleges of Nursing and the National League for Nursing identifying humanistic care as a core component of professional training.

In contrast, Chinese nursing education has historically been influenced by the functional nursing model, which has prioritized technical skill acquisition over the cultivation of humanistic values [3]. Vocational higher education institutions—post-secondary colleges designed to train technically skilled personnel—differ from undergraduate institutions in both curriculum structure and educational objectives [3]. These institutions often lack dedicated courses on humanistic care, and while full-time instructors generally acknowledge the importance of integrating humanistic principles, the teaching content remains fragmented and insufficiently embedded within professional instruction [3]. Furthermore, clinical training sites frequently emphasize technical proficiency, offering limited support for developing caring-related competencies among vocational nursing students [3].

Despite a growing awareness of the importance of humanistic care, nursing students in China, including those enrolled in vocational programs, report limited access to structured instruction in caring theory, skills, and attitudes [4]. As a result, although many students recognize the significance of humanistic care in clinical practice, they often lack the experiential learning and competency-based opportunities required to perform such care independently.

China’s nursing education system comprises a multi-tiered framework—including secondary vocational, vocational higher education, undergraduate, and postgraduate programs—designed to meet the country’s healthcare workforce needs at various levels [3]. Within this system, vocational higher education institutions play a central role, focusing on practical training while maintaining foundational theoretical instruction. However, existing research suggests that even among specialized groups, such as midwifery students, humanistic caring ability is only moderately developed. Studies have found strong correlations between this ability and personal attributes such as empathy, resilience, and professional identity, pointing to the need for targeted educational strategies [3].

In this study, humanistic care is conceptualized as a professional ethos centered on empathy, respect for patient dignity, and holistic support, integrating emotional, cognitive, and ethical elements of nursing practice [5–7]. This conceptualization aligns with foundational humanistic theories, including those of Watson and Leininger, which emphasize cultural sensitivity and interpersonal connection [2]. Qualitative studies in China have shown that nursing students often internalize caring behaviors through both positive role models and negative clinical experiences, highlighting the importance of reflective practice in developing caring competencies [4]. Similarly, nurses in Hong Kong have emphasized the role of communication skills and cultural adaptability in holistic care, while also identifying systemic barriers such as hierarchical healthcare structures and staffing shortages [8].

Existing research on humanistic care has primarily focused on clinical nurses and undergraduate students, with limited attention to vocational nursing students, despite their critical role in the future healthcare workforce [3, 9]. Cross-sectional investigations into the caring abilities of this group remain scarce, particularly studies examining contextual and educational factors within vocational higher education institutions [3].

This study seeks to address that gap by evaluating the current state of humanistic caring ability among vocational nursing students in Jiangsu Province and identifying associated influencing factors. The findings aim to support evidence-based strategies to strengthen humanistic care education in vocational nursing programs, in alignment with national goals to enhance nursing workforce quality and patient-centered care delivery.

Participants and methods

Research participants

Between September and November 2022, a stratified random sampling approach was used to recruit nursing students from three vocational higher education institutions located in the southern, central, and northern regions of Jiangsu Province. Recruitment was conducted through institutional announcements and faculty-led research initiatives. Inclusion criteria consisted of voluntary participation and provision of informed consent.

Sample size estimation followed the methodology outlined by Xiao et al., [10] which recommends a minimum of 10 to 20 times the number of independent variables used in the analysis. Based on the 37-item structure of the Caring Ability Inventory (CAI), and after accounting for possible attrition and invalid responses, the minimum required sample size was determined to be 685 participants.

Stratification variables included sex, place of origin, only-child status, residential area (urban vs. rural), and family income. Academic year (first, second, and third year) served as the primary stratification variable, reflecting the progressive structure of the nursing curriculum. Specifically, first-year students were engaged in foundational theoretical coursework; second-year students participated in scenario-based simulation training; and third-year students were involved in clinical internships. This curricular progression corresponded with differences in clinical exposure, with third-year students having the most frequent patient contact, followed by second-year and then first-year students. Previous studies have also demonstrated that nursing students’ professional values exhibit dynamic developmental changes across the three-year academic cycle.

Survey instruments

General information questionnaire

The General Information Questionnaire was developed by the research team to collect demographic and background data, including sex, academic year, perception of the nursing profession, participation in class committees, only-child status, family economic status, and intention to remain in the nursing profession after graduation. A pilot test was conducted with 40 nursing students to assess the instrument’s feasibility and clarity prior to formal data collection.

The questionnaire was constructed based on literature indicating that educational background, social support, and the “caring atmosphere”—defined as the perceived presence of empathy and support within one’s environment—are significant factors influencing the development of humanistic caring ability [11]. Items such as career intention reflect aspects of professional identity and emotional investment in the profession, consistent with findings by Li et al., which reported that stable professional attitudes are positively associated with stronger humanistic caring abilities [12].

CAI

The CAI, originally developed by Nkongho [13] and later adapted into Chinese by Tong et al., [14] is used to evaluate caring ability across three dimensions: cognition (14 items), patience (10 items), and courage (13 items), totaling 37 items. Responses are rated using a 7-point Likert scale (1 = “strongly disagree” to 7 = “strongly agree”), with higher scores indicating stronger caring ability.

The instrument has demonstrated good reliability and validity within the vocational nursing student population. Cronbach’s α coefficient for the scale was 0.822, indicating acceptable internal consistency. Construct validity was supported by a Kaiser-Meyer-Olkin (KMO) value of 0.918 and a significant Bartlett’s Test of Sphericity (χ² = 10,403.450, p < 0.001).

Survey administration

All participants were informed of the study objectives and provided informed consent prior to data collection. The survey was administered online via the “WJX” platform, with distribution facilitated through QR codes and hyperlinks shared in QQ and class group chats specific to nursing students. Participation was voluntary and anonymous, and respondents were assured that academic performance would not be affected by their participation. Survey submissions were recorded immediately upon completion.

A total of 685 questionnaires were distributed, and 683 valid responses were received, yielding an effective response rate of 99.7%.

Statistical analysis

Data were analyzed using SPSS version 22.0. Categorical variables are reported as frequencies and percentages, while continuous variables are presented as means and standard deviations (). Independent sample t-tests and one-way analysis of variance (ANOVA) were employed to compare differences in caring ability scores across groups. Multiple linear regression analysis was conducted to identify factors influencing humanistic caring ability. A p-value of < 0.05 was considered statistically significant.

Results

General information of vocational nursing students

As summarized in Table 1, the sample included 114 male (16.7%) and 569 female (83.3%) participants. The largest proportion of students were in the second academic year (n = 371, 54.3%), followed by first-year students (n = 268, 39.2%), while third-year students comprised the smallest group (n = 44, 6.4%).

Table 1.

Analysis of diversity among vocational nursing students across various characteristics (n = 683)

Variables	Categories	Number	Percentage (%)	Mean scores of humanistic care (, points)	Cognitive dimension	Courage dimension	Patience dimension
Gender	Female	569	83.3	5.01±0.50	5.07±0.68	4.32±0.73	5.83±0.68
	Male	114	16.7	4.93±4.93	5.13±0.80	4.05±0.92	5.78±0.77
Statistical value	t			1.428	-0.87	2.909	0.672
	P			0.155	0.38	0.004*	0.502
Grade level	First grade	268	39.24	5.13±0.54	5.24±0.72	4.43±0.83	5.88±0.72
	Second grade	371	54.32	4.91±0.47	4.96±0.66	4.19±0.68	5.78±0.66
	Third grade	44	6.44	4.9±0.54	5.11±0.73	3.94±0.96	5.85±0.84
Statistical value	F			15.40	12.494	12.00	1.792
	P			0.000***	0.000***	0.000***	0.167
Place of origin	Rural	422	61.79	4.99±0.52	5.07±0.71	4.29±0.78	5.8±0.71
	Town	194	28.4	4.98±0.51	5.05±0.71	4.23±0.74	5.85±0.68
	Urban	67	9.81	5.08±0.50	5.24±0.65	4.28±0.83	5.89±0.72
Statistical value	F			0.99	1.936	0.428	0.762
	P			0.372	0.145	0.652	0.467
High school major division	Liberal arts	367	53.73	5.05±0.51	5.16±0.73	4.29±0.82	5.88±0.684
	Sciences	316	46.27	4.94±0.50	4.99±0.667	4.25±0.72	5.76±0.719
	t			2.756	3.064	0.587	2.347
	P			0.006*	0.002*	0.557	0.019*
Only child	Yes	188	27.53	5.07±0.53	5.19±0.71	4.31±0.81	5.89±0.67
	No	495	72.47	4.97±0.50	5.04±0.70	4.26±0.76	5.8±0.71
Statistical value	t			2.224	2.463	0.742	1.490
	P			0.026*	0.014*	0.458	0.137
Personality	Introverted	112	16.4	4.88±0.52	4.9±0.74	4.18±0.68	5.78±0.66
	Mixed	476	69.69	4.99±0.48	5.06±0.66	4.27±0.74	5.82±0.68
	Extroverted	95	13.91	5.17±0.60	5.37±0.78	4.39±1.01	5.89±0.84
Statistical value	F			8.154	12.349	2.004	0.674
	P			0.000***	0.000***	0.136	0.510
Family monthly income	Below 1000	31	4.54	4.83±0.62	4.82±0.93	4.24±0.76	5.61±0.77
	1000–2999	117	17.13	4.94±0.48	5.01±0.69	4.22±0.74	5.77±0.66
	3000–4999	221	32.36	5.00±0.50	5.05±0.688	4.33±0.74	5.78±0.71
	5000–6999	173	25.33	4.96±0.52	5.07±0.70	4.17±0.74	5.84±0.68
	Above 7000	141	20.64	5.13±0.50	5.24±0.66	4.36±0.89	5.97±0.63
Statistical value	F			3.676	3.189	1.66	2.811
	P			0.006*	0.013*	0.158	0.025*

Note: *** indicates P < 0.001, ** indicates P < 0.01, and * indicates P < 0.05. ** is statistically significant at the 0.01 level (two-tailed); * is statistically significant at the 0.05 level (two-tailed)

Regarding place of residence, 422 students (61.8%) were from rural areas, 194 (28.4%) from suburban areas, and 67 (9.8%) from urban areas. A total of 188 participants (27.5%) were only children, while 495 (72.5%) had siblings.

Analysis of differences in humanistic caring ability among vocational nursing students

Univariate analysis of influencing factors

Univariate analysis of the mean scores indicated no statistically significant difference in overall humanistic caring ability between male and female students (p = 0.155; Table 1). However, a significant sex difference was observed in the courage dimension, with female students scoring higher than male students (p < 0.05).

Significant differences were also found across academic years (p < 0.001), suggesting that grade level is associated with variations in humanistic caring ability. Students with a high school background in liberal arts demonstrated significantly higher total scores than those from a science background (p < 0.05), particularly in the cognition and patience dimensions (p < 0.05). Participants who were only children differed significantly from those with siblings in terms of cognitive caring ability (p < 0.05), though no significant differences were observed in other dimensions.

Personality type also demonstrated a strong association with caring ability (p < 0.001). Students identified as extroverted scored significantly higher in the cognition dimension compared to those identified as introverted, indicating variation in caring-related cognitive aptitude across personality types. Additionally, family monthly income was significantly associated with differences in cognition and patience dimensions (p < 0.05), suggesting that socioeconomic factors may influence specific aspects of humanistic caring ability.

Multivariate analysis of influencing factors

To identify the primary determinants of humanistic caring ability, a multiple linear regression model was constructed using key variables derived from the survey. Humanistic caring ability served as the dependent variable. Independent variables included professional preference, career intention in nursing, family and personal health status, and the quality of teacher-student and peer relationships. Variables that demonstrated significance in univariate analysis—namely grade level, high school academic track, sibling status, personality traits, and family income—were included as control variables.

Stepwise regression was employed for model fitting and validation. Variable assignments and coding are shown in Table 2, with the regression results presented in Table 3. The analysis identified several significant predictors of humanistic caring ability: grade level (β = -0.090, t = -2.845, p < 0.05), high school major (β = 0.073, t = 2.065, p < 0.05), family monthly income (β = 0.040, t = 2.567, p < 0.05), aspirations to pursue a nursing career (β = 0.095, t = 4.168, p < 0.001), prior caregiving experience (β = 0.102, t = 2.786, p < 0.05), involvement in family caregiving (β = 0.048, t = 2.339, p < 0.05), as well as peer relationship quality (β = 0.085, t = 2.381, p < 0.05). The teacher-student relationship demonstrated a trend toward significance (β = 0.059, t = 1.739, p = 0.082), suggesting a potential association warranting further investigation.

Table 2.

Statistical description of variables

Variable	Description	Minimum value	Maximum value	Mean	Standard deviation
Humanistic caring ability	Positive continuous type, values range from 1 to 7	3.22	6.30	5.00	0.516
Grade level	1 = first grade; 2 = second grade; 3 = third grade	1	3	/	/
High school major	0 = sciences; 1 = liberal arts	0	1	/	/
Personality type	1 = introverted; 2 = mixed; 3 = extroverted	1	3	/	/
Family monthly income	1 = below 1000	1	5	/	/
	2 = 1000—2999
	3 = 3000—4999
	4 = 5000—6999
	5 = above 7000
Degree of professional preference	Positive continuous type, values range from 1–5	1	5	3.76	0.833
Intention to pursue a nursing career	Positive continuous type, values range from 1–5	1	5	3.97	0.843
Family health status	Positive continuous type, values range from 1–5	1	5	3.86	0.870
Personal health status	Positive continuous type, values range from 1–5	1	5	4.15	0.780
Experience in caring for the sick	0 = no; 1 = yes	0	1	/	/
Family care level	Positive continuous type, values range from 1–5	1	5	4.26	0.934
Harmonious teacher-student relationship	Positive continuous type, values range from 1–5	1	5	4.17	0.774
Harmonious peer relationships	Positive continuous type, values range from 1–5	1	5	4.18	0.753

Table 3.

Results and evaluation of the multiple linear Stepwise regression model

Variable	Regression coefficient	T statistic	P-value
(Constant)	3.650	20.998	0.000
Grade level	-0.090	-2.845	0.005
High school major	0.073	2.065	0.039
Family monthly income	0.040	2.567	0.010
Intention to pursue a nursing career	0.095	4.168	0.000
Experience in caring for the sick	0.102	2.786	0.005
Family care level	0.048	2.339	0.020
Harmonious teacher-student relationship	0.059	1.739	0.082
Harmonious peer relationships	0.085	2.381	0.018

Note: R² = 0.245; F = 21.829; P = 0.000

Discussion

Current status of humanistic caring ability among vocational nursing students

The mean Caring Ability Inventory (CAI) score of vocational nursing students in Jiangsu Province was 184.87 ± 19.107, which falls below the international moderate range (203.10–220.30) [15]. This result is consistent with Chen’s national survey findings, which indicated that Chinese nursing students generally have average-level humanistic caring ability [16], reflecting that the overall humanistic caring ability of vocational nursing students in Jiangsu Province is not optimal and lags behind international standards.

From the perspective of CAI’s three dimensions, the courage dimension had the lowest mean score, below the international reference value of 68.25. This suggests that students lack confidence in taking the initiative to implement caring behaviors, such as proactively communicating with patients to understand their emotional needs or advocating for patients’ legitimate rights in clinical settings. In contrast, the patience dimension had the highest mean score, a trend also observed in previous studies on Chinese nursing students [16, 17]. This pattern differs from that in Western contexts, where the courage dimension typically scores higher—Western nursing education emphasizes clinical initiative and assertive communication, enabling students to more confidently engage in caring practices [3, 18].

The root cause of this discrepancy lies in the characteristics of China’s nursing education system. Currently, humanistic care training in Chinese nursing education remains superficial and is not systematically integrated into operational and clinical practices. Nationally, humanities-related courses account for only 8% of the total curriculum hours in nursing colleges [18]. Although most students recognize the importance of patient-centered care, they lack sufficient training and practice opportunities to convert this awareness into proactive caring behaviors. Additionally, deficiencies in communication skills and patient interaction abilities further hinder the improvement of their humanistic caring ability [19].

To address these issues, it is urgent to strengthen the integration of humanistic values into nursing curricula. Educators should design targeted training programs: for example, using case-based learning to analyze clinical scenarios where proactive caring is required (e.g., comforting anxious patients before surgery), or conducting scenario simulations to let students practice initiating communication with patients. These interactive teaching methods can help students transform theoretical knowledge of humanistic care into practical skills. Meanwhile, guided peer observation and feedback sessions can enable students to identify strengths and weaknesses in caring behaviors during group activities, and educators can provide personalized guidance to promote the balanced development of students’ caring ability across dimensions.

Analysis of factors influencing the humanistic caring ability of vocational nursing students

Demographic and educational background factors

Sex

Univariate analysis showed no significant difference in overall humanistic caring ability between male and female students (p = 0.155), which contradicts Chen et al.’s study that reported higher scores in female students [9]. This inconsistency may be due to regional differences (Jiangsu Province vs. the broader national sample in Chen’s study) or variations in sample composition (e.g., the proportion of male students in this study was 16.7%, which may differ from that in Chen’s study). However, female students scored significantly higher in the courage dimension (p < 0.05), indicating that female students may be more willing to take the initiative in caring behaviors, which may be related to gender-related differences in interpersonal sensitivity.

Academic year

There were significant differences in humanistic caring ability across academic years (p < 0.001). First-year students had higher scores in the cognition dimension, while third-year students had the lowest scores in the courage dimension. This trend may be attributed to the impact of clinical internships: third-year students are exposed to real-world clinical challenges (e.g., high work pressure, complex patient conditions, and hierarchical relationships in healthcare settings), which may expose or exacerbate their lack of confidence in proactive caring [13, 14]. For example, when facing patients with negative emotions, third-year students may be hesitant to provide emotional support due to fear of making mistakes or lack of experience, leading to lower courage scores.

High school major

Students with a liberal arts background had significantly higher overall CAI scores than those with a science background (p < 0.05), especially in the cognition and patience dimensions. This aligns with existing research that humanities-oriented education cultivates empathy, reflective thinking, and interpersonal awareness—core qualities for humanistic care [12]. Liberal arts courses (e.g., literature, ethics, and psychology) help students better understand human emotions and social behaviors, enabling them to more effectively perceive patients’ needs and maintain patience in caring interactions.

Personality traits

Extroverted students scored higher in the cognition and courage dimensions than introverted students (p < 0.001). Nursing practice requires frequent communication with patients, their families, and medical team members; extroverted students tend to be more proactive in interpersonal interactions, which helps them better acquire information about patients’ conditions (improving cognition scores) and take the initiative to provide caring services (improving courage scores) [13].

Family economic status

Family monthly income was positively associated with scores in the cognition and patience dimensions (p < 0.05). Students from higher-income families may have access to better educational resources (e.g., extracurricular courses on communication or psychology) and grow up in more emotionally supportive environments, which are conducive to the development of empathy and caring skills [20]. In contrast, students from low-income families may face greater economic pressure, which may affect their focus on humanistic care learning or reduce their confidence in engaging in caring behaviors.

Professional and experiential factors

Career Aspirations in Nursing: Multiple linear regression analysis showed that clear aspirations to pursue a nursing career were a significant positive predictor of humanistic caring ability (β = 0.095, t = 4.168, p < 0.001). This confirms Wu and Chen’s findings that professional identity is closely linked to caring competence [12]. Students with firm career intentions are more likely to internalize core nursing values (e.g., empathy, respect, and patient-centeredness) and actively participate in humanistic care training. For example, they may take the initiative to join nursing volunteer activities or study humanistic care cases in their spare time, thereby improving their caring ability.

Prior Caregiving Experience: Students with prior caregiving experience (especially caring for ill family members) had significantly higher humanistic caring ability scores (β = 0.102, t = 2.786, p < 0.05). Firsthand caregiving experiences allow students to personally experience the physical and emotional suffering of patients, fostering a deeper understanding of patient needs and promoting compassionate interactions [14]. For instance, students who have cared for elderly family members with chronic diseases may be more patient when communicating with elderly patients in clinical settings and better able to provide targeted care.

Social support factors

Family, Teacher-Student, and Peer Relationships: Multiple linear regression showed that family support (reflected in family economic status and caregiving involvement), harmonious peer relationships (β = 0.085, t = 2.381, p < 0.05), and teacher-student relationships (β = 0.059, t = 1.739, p = 0.082, approaching significance) were positively associated with humanistic caring ability. From a sociological perspective, care is a learned behavior shaped by social interactions [4]. A supportive family environment helps students develop a sense of responsibility and empathy; positive peer interactions (e.g., discussing care experiences, supporting each other in clinical practice) enable students to learn from each other and build confidence in caring behaviors; and caring teacher-student relationships (e.g., instructors providing emotional support and professional guidance) serve as role models for students to imitate humanistic care practices.

Evidence-based recommendations to enhance humanistic caring ability

Optimize educational environments to address Dimension-Specific deficits

Targeted Improvement of the Courage Dimension: Given the low courage scores among students (especially third-year students), clinical training sites should establish a “supportive clinical practice environment.” For example, assign dedicated mentors to third-year interns to provide real-time guidance during patient interactions (e.g., guiding students to proactively ask about patients’ pain levels or emotional states). Additionally, simulation training can replicate challenging clinical scenarios (e.g., communicating with angry patients’ families) to let students practice proactive caring behaviors repeatedly, thereby improving their confidence and courage [13, 14].

Cultivate a humanistic campus culture

To reinforce the patience advantage and complement other dimensions, nursing colleges should integrate humanistic elements into campus spaces. Display portraits and stories of exemplary nurses (e.g., Florence Nightingale, Nightingale Award winners, and frontline nurses during the COVID-19 pandemic) in corridors, simulation centers, and training rooms. Host regular symposiums where these role models (or their representatives) share real clinical care experiences (e.g., how to maintain patience when caring for patients with long-term bedsores), linking role model stories to students’ learning needs [4]. This approach helps students internalize humanistic values and translates the patience dimension’s advantage into comprehensive caring ability.

Improve clinical practice base design

Align clinical training environments with patient-centered care principles. Add empathy-promoting signage (e.g., “Listen carefully to every patient’s voice”) in simulation labs and practice bases, design private communication spaces for patient-nurse interactions, and develop communication-focused simulation scenarios (e.g., informing patients of diagnosis results with empathy). Clearly incorporate humanistic care objectives into practical training modules (e.g., “Successfully comfort an anxious preoperative patient” as a training goal). Instructors should demonstrate compassionate behaviors (e.g., active listening, holding a patient’s hand to provide comfort) during skills training and provide timely feedback on students’ humanistic performance, ensuring that students learn to integrate humanistic care into technical operations [19].

Strengthen educator competence to model and teach humanistic care

Humanistic care training for educators

Since teacher-student relationships influence students’ caring ability, nursing colleges should require faculty to participate in annual humanistic care training programs covering empathy development, cross-cultural communication, and ethical decision-making. Use accessible platforms (e.g., MOOCs, Tencent Conference) for training to ensure continuity. Arrange for educators to conduct regular clinical practice rotations in hospitals (e.g., 2–4 weeks per year) to observe and participate in real humanistic care practices (e.g., interdisciplinary team discussions on patient care plans) [3]. This allows educators to update their humanistic care knowledge and skills, enabling them to better guide students.

Integrate humanistic assessment into teaching evaluation

Establish evaluation criteria that reflect humanistic care integration. Develop rubrics to assess educators’ performance in promoting peer support (e.g., “Encourage students to provide feedback on each other’s care behaviors”), addressing students’ emotional needs (e.g., “Provide timely comfort to students who fail in care simulations”), and creating an inclusive classroom environment. Allocate 30% of the weight in clinical and practical skills assessments to humanistic care competencies, focusing on behaviors such as patient-centered communication (e.g., using plain language to explain medical procedures) and empathetic care (e.g., responding to patients’ emotional concerns) [12]. This ensures that educators prioritize humanistic care in teaching and guide students to value it.

Reform curricula to align with influencing factors

Adjust curriculum structure based on educational background

To address the gap in caring ability between liberal arts and science students, increase the proportion of humanities courses (e.g., nursing ethics, medical psychology, nursing sociology) to at least 15% of total instruction time [18]. For science-background students, offer supplementary courses (e.g., “Introduction to Interpersonal Communication”) to enhance their empathy and interpersonal awareness. Develop interdisciplinary modules that combine clinical knowledge with humanistic themes—for example, analyzing end-of-life care cases to discuss how to balance technical treatment with emotional support for patients and their families, helping students (especially those with science backgrounds) apply humanistic principles in clinical practice [12].

Incorporate experiential learning to leverage caregiving experience

For students without prior caregiving experience, design structured experiential learning activities. Organize regular volunteer services in long-term care facilities (e.g., helping elderly patients with daily care, chatting with them) or public health campaigns (e.g., providing health education to low-income communities) [4]. These activities allow students to gain hands-on care experience, fostering empathy and improving caring skills. Additionally, use peer teaching—arrange students with caregiving experience to share their experiences (e.g., “How to soothe a child patient”) in group discussions, enabling other students to learn practical care strategies.

Strengthen career guidance to boost professional identity

Given the positive impact of career aspirations on caring ability, integrate career guidance into the entire curriculum. Invite senior clinical nurses or nursing managers to share career development paths and the value of nursing work (e.g., “How nursing care improves patients’ quality of life”) in first-year courses to help students establish initial professional identity. In second-year courses, organize “nursing career workshops” where students set personal career goals and develop plans to improve their caring ability (e.g., “Participate in at least one humanistic care training program per semester”). For third-year students, conduct internship debriefing sessions to address their doubts about nursing careers and reinforce their commitment to the profession [12].

Study limitations

This study presents several limitations that should be considered when interpreting the findings. First, the use of convenience sampling limited the generalizability of the results. Participants were drawn exclusively from vocational nursing institutions within Jiangsu Province, which may not be representative of the broader population of vocational nursing students at the national or international level [9]. Second, data collection was based on self-reported measures, relying on participants’ subjective perceptions. This introduces the potential for response bias, including social desirability and recall bias, which may have influenced the accuracy of responses [16]. Third, the cross-sectional design of the study restricts the ability to assess changes in humanistic caring ability over time. As a result, the longitudinal effects of educational interventions on the development of caring competencies could not be evaluated [24].

To address these limitations, future research should consider employing stratified or random sampling across multiple provinces or regions to improve representativeness. Additionally, the incorporation of mixed-methods approaches, including qualitative interviews and observational studies, may provide deeper insights into the contextual and experiential aspects of caring ability. Longitudinal study designs are also recommended to track the progression of humanistic competencies and assess the sustained impact of targeted educational interventions.

Conclusion

This cross-sectional study assessed the humanistic caring ability of 685 vocational nursing students in Jiangsu Province and examined the key factors influencing its development. The findings revealed that the mean CAI score (184.87 ± 19.107) was below internationally recognized moderate-level norms, with particularly low scores in the courage dimension. These results suggest a need to enhance students’ confidence and initiative in delivering compassionate care.

Several variables were found to significantly influence humanistic caring ability, including high school academic background, with liberal arts students scoring higher than their science-track peers; strong aspirations to pursue a nursing career; prior caregiving experience; family economic status; and the quality of peer and teacher relationships. These findings indicate that humanistic caring ability is shaped by a multifaceted interaction of educational preparation, professional identity, personal life experience, and social support.

Based on these insights, nursing educators are encouraged to implement targeted interventions that reinforce vocational commitment—such as structured career guidance—while integrating experiential learning opportunities, including simulation-based training and reflective caregiving activities. Fostering emotionally supportive educational environments through strong teacher-student and peer relationships is also critical.

The study emphasizes the necessity of embedding humanistic care principles within vocational nursing curricula. This involves moving beyond a solely technical focus to cultivate emotional intelligence, ethical sensitivity, and patient-centered communication. Pedagogical strategies such as scenario-based instruction, community service learning, and expanded nursing humanities coursework can help address observed deficits in caring initiative and interpersonal courage.

In conclusion, enhancing humanistic caring ability in vocational nursing students requires a comprehensive educational approach that combines curriculum reform, experiential learning, and supportive institutional culture. Such efforts are essential to prepare graduates who possess not only clinical competence but also the compassion and ethical grounding fundamental to high-quality nursing care.

Abbreviation

CAI

Caring Ability Inventory

Authors’ contributions

Conception and design of the research: Yan Wang, Cai-feng LuoAcquisition of data: Yan WangAnalysis and interpretation of the data: Yan Wang, Hao-ling GongStatistical analysis: Cai-feng LuoObtaining financing: Yan WangWriting of the manuscript: Hao-ling GongCritical revision of the manuscript for intellectual content: Hao-ling GongAll authors read and approved the final draft.

Funding

Jiangsu Provincial Department of Education University Philosophy and Social Science Research Project (2021SJA2164).

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.