Perceptions of humanistic caring among nursing students in Chinese vocational colleges: a cross-sectional study

Abstract

Background

Humanistic caring is a fundamental component of nursing practice and a key goal of nursing education. However, previous research has largely emphasized caring competence rather than nursing students’ own perceptions of humanistic caring. In China, vocational colleges educate a large proportion of the frontline nursing workforce, yet evidence regarding vocational nursing students’ perceptions of humanistic caring remains limited. This study, therefore, investigated perceptions of humanistic caring among nursing students enrolled in Chinese vocational colleges.

Methods

A cross-sectional survey was conducted among nursing students from six vocational colleges in Hubei, Guangdong, and Gansu provinces, China, between March and June 2024. Data were collected through an online questionnaire comprising participants’ background characteristics and the Nursing Students’ Perceptions of Humanistic Caring Questionnaire (NSPHCQ). A total of 1,270 valid questionnaires were included in the analysis. Descriptive statistics were used to summarize the data, with categorical variables presented as frequencies and percentages and continuous variables as means and standard deviations. Group differences were examined using independent-samples t-tests and one-way analysis of variance (ANOVA). Ethical approval was obtained from the institutional ethics committee, and informed consent was obtained from all participants before data collection.

Results

Nursing students reported a relatively high level of perceived humanistic caring, with a total score of 140.18 ± 24.94 (mean = 4.10 ± 0.73). Caring from teachers received the highest ratings, followed by caring from peers. Perceived humanistic caring differed significantly according to household registration status, reasons for choosing nursing, harmonious relationships with peers and teachers, participation in volunteer activities, experience serving as a student leader at the school, college, or class level, willingness to pursue a nursing career, and prior caregiving experience.

Conclusions

Nursing students in vocational colleges demonstrated a relatively high level of perceived humanistic caring, particularly regarding caring from teachers and peers. In comparison, lower ratings for school management and the school environment suggest that greater organizational and environmental support is needed within nursing education. Perceptions of humanistic caring also varied across several background characteristics. These findings underscore the importance of cultivating supportive learning environments, reinforcing professional commitment to nursing, and enhancing experiential learning opportunities to enhance humanistic caring in vocational nursing education further.

Background

Humanistic caring is widely recognized as a defining characteristic of nursing practice and a cornerstone of the nursing profession. Rooted in theories such as Watson’s Theory of Human Caring [1] and Leininger’s Culture Care Theory [2], humanistic caring emphasises respect for human dignity, empathy, cultural sensitivity, and authentic nurse–patient relationships. In clinical practice, these principles are reflected through caring behaviors such as active listening, emotional support, responsiveness to patients’ needs, and guidance that promotes health and well-being [3]. Although there is no universally accepted definition of caring [4, 5], it is generally understood to encompass two complementary dimensions: instrumental caring, which focuses on technical competence and task performance, and expressive caring, which emphasizes interpersonal relationships and emotional support. Both dimensions are indispensable for delivering high-quality, compassionate nursing care [6]. A growing body of evidence shows that humanistic caring enhances patient satisfaction, safety, and recovery, while also improving nurses’ professional fulfillment, resilience, and organizational commitment [4]. These findings underscore its value as both an indicator of nursing care quality and a key outcome of nursing education [6].

Against this backdrop, humanistic education in nursing seeks to foster humanistic values and cultivate caring qualities through value-based teaching, faculty role modeling, and meaningful educational experiences. Particular emphasis is placed on understanding the meaning of life, respecting individual differences, and developing ethical responsibility. The ultimate goal is to prepare compassionate, empathetic, and culturally sensitive nurses who can integrate technical expertise with humanistic care in clinical practice [7]. Therefore, developing humanistic caring competence has become a fundamental objective of contemporary nursing education worldwide [8]. The formation of caring attitudes and behaviors begins when students enter nursing programs and continues throughout their professional development as they gradually internalize professional values and standards [9]. However, humanistic caring is inherently complex, subjective, and context-dependent, shaped by individual characteristics, cultural influences, and educational and clinical environments [4]. Nursing students do not begin their education as blank slates; instead, they bring pre-existing perceptions of humanistic caring that continue to evolve through classroom learning, clinical placements, interactions with faculty, and relationships with peers.

Students’ perceptions of humanistic caring are particularly important because they influence self-confidence, reflective capacity, critical thinking, and the development of professional identity [10, 11]. Previous studies have shown that supportive learning environments, caring-centered curricula, student-focused teaching approaches, and positive faculty role modeling all promote stronger perceptions of caring. Research conducted in Europe, the Middle East, and other regions has also demonstrated that perceptions of humanistic caring vary by country, academic year, gender, and previous clinical experience, and continue to develop throughout nursing education [12–15]. Cross-cultural comparisons further indicate that Chinese nursing students generally report lower levels of perceived humanistic caring than students in several other countries, suggesting that sociocultural values, educational systems, and pedagogical approaches may substantially influence the development of caring perceptions [16]. Within China, however, most studies have focused on humanistic caring competence rather than students’ subjective perceptions of humanistic caring [17–20]. Although Wang et al. [21] provided valuable preliminary evidence regarding Chinese nursing students’ perceptions of humanistic caring, their study was conducted in a single province and included relatively few vocational nursing students, limiting the generalizability of the findings.

China’s nursing education system comprises a multi-tiered structure that includes secondary vocational, vocational college, undergraduate, and postgraduate programs, collectively designed to meet the diverse needs of the national healthcare workforce. Within this framework, vocational colleges, post-secondary institutions primarily dedicated to preparing practice-oriented healthcare professionals, play a vital role in training the nursing workforce [18]. These institutions educate a substantial proportion of frontline nurses who provide direct patient care across a wide range of healthcare settings. Compared with undergraduate programs, however, vocational college nursing programs generally have shorter training periods and devote less curricular time specifically to humanistic caring education. As a result, vocational nursing students may undergo distinct educational and clinical socialization processes that shape their perceptions and understanding of humanistic caring differently from those of undergraduate nursing students.

The nursing education landscape in China is also characterized by considerable regional diversity. Differences in economic development, educational resources, and clinical training environments across provinces may affect both the delivery of nursing education and students’ learning experiences [22]. Despite the pivotal role of vocational nursing students in China’s healthcare system, evidence regarding their perceptions of humanistic caring remains scarce. This knowledge gap highlights the need for large-scale, multi-provincial research to provide a more comprehensive and contextually relevant understanding of humanistic caring among this important student population.

Several limitations in the existing literature warrant further investigation. First, vocational nursing students have received considerably less research attention than undergraduate nursing students, and few studies have examined their experiences within the unique context of Chinese vocational nursing education. Therefore, the applicability of existing evidence to vocational nursing education remains limited. Second, previous research has primarily examined humanistic caring competence or caring behaviors. In comparison, students’ perceptions of humanistic caring, the cognitive and attitudinal foundation that underpins caring practice, have received comparatively little attention.

Addressing these gaps is essential for developing educational strategies that are both culturally appropriate and responsive to the unique characteristics of vocational nursing education in China. Therefore, this cross-sectional study aimed to investigate perceptions of humanistic caring among nursing students enrolled in Chinese vocational colleges using a large, multi-province sample and to provide empirical evidence to inform targeted educational interventions that strengthen humanistic caring within nursing education.

Methods

Design and participants

A descriptive cross-sectional study was conducted between March and June 2024. Participants were recruited via convenience sampling from six vocational nursing colleges in Hubei, Guangdong, and Gansu provinces, China. These provinces were selected to reflect regional diversity in geography and socioeconomic development, while ensuring the feasibility of data collection and institutional collaboration. Within each province, vocational nursing colleges were identified based on predefined criteria, including the availability of nursing programs, institutional willingness to participate, and the feasibility of conducting on-site data collection during the study period.

Eligible participants were full-time nursing students enrolled in vocational colleges who voluntarily agreed to participate and provided informed consent. Only first- and second-year students were included, whereas students undertaking clinical internships were excluded. In China, vocational nursing education follows a standardized three-year curriculum that combines theoretical instruction with clinical training. During the first two years, students primarily receive classroom-based education and on-campus practical skills training, while the third year is devoted almost entirely to full-time clinical internships in hospitals. Because this study aimed to examine nursing students’ perceptions of humanistic caring within the educational environment of vocational colleges, only first- and second-year students were included. Third-year students were excluded because their primary learning environment had shifted from academic institutions to clinical settings, where different educational and professional experiences could substantially influence their perceptions of humanistic caring and introduce contextual heterogeneity.

The required sample size was estimated according to the recommendation of Andrade [23], which suggests that, when the dependent variable is continuous, the minimum sample size should be 10–20 times the total number of independent and adjustment variables included in the analysis. In this study, 46 variables were included in the analysis, yielding an estimated minimum sample size of 460–920 participants. To account for an anticipated 20% non-response rate and invalid questionnaires, the target sample size was increased to 575–1,150 participants.

Instruments

The questionnaire comprised two sections: background characteristics and the Nursing Students’ Perceptions of Humanistic Caring Questionnaire (NSPHCQ). The background characteristics included 12 items: gender, age, institution, year of study, household registration status, only-child status, reasons for choosing nursing as a major, harmonious relationships with peers and teachers, participation in volunteer activities, experience serving as a student leader at the school, college, or class level, willingness to pursue a nursing career, and prior caregiving experience. In this study, “gender” referred to biological sex assigned at birth. “Only-child status” indicated students without siblings, while “prior caregiving experience” encompassed both providing care to others and receiving care themselves.

The NSPHCQ was developed by Wang et al. [21] and validated within the Chinese cultural and educational context. The questionnaire consists of 34 items across four dimensions: caring in the school environment (5 items), which assesses the physical and cultural learning climate; caring in school management (8 items), which reflects institutional policies and administrative support; caring from teachers (13 items), which evaluates teachers’ interpersonal support and caring behaviors toward students; and caring from peers (8 items), which measures mutual assistance and empathetic interactions among students. Each item is scored on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Total scores range from 34 to 170, with higher scores indicating stronger perceptions of humanistic caring. A representative item is: “When students feel anxious or nervous, they can obtain help from their teachers.”

The validated Chinese version of the NSPHCQ was used in this study. Previous research reported a content validity index of 0.897 and excellent internal consistency, with an overall Cronbach’s α of 0.953 and dimension-specific Cronbach’s α coefficients ranging from 0.821 to 0.966. In this study, the NSPHCQ similarly demonstrated excellent internal consistency, with an overall Cronbach’s α of 0.992 and dimension-specific coefficients ranging from 0.936 to 0.992.

Data collection

Recruitment information was initially provided to faculty members at vocational nursing colleges in Hubei, Guangdong, and Gansu provinces, who informed eligible students about the study using a standardized invitation. The questionnaire was administered online through the Questionnaire Star (Wenjuanxing) platform and distributed via WeChat and QQ. Students who expressed interest accessed the survey link independently and completed the questionnaire on their personal devices. Faculty members were not involved in supervising its completion, or collecting the data, thus minimizing potential response bias.

To reduce missing data, all questionnaire items were designated as mandatory. Completed questionnaires were automatically submitted via the online platform. After data collection, the research team conducted a quality assessment and excluded questionnaires with unreasonably short completion times, highly uniform response patterns, or obvious logical inconsistencies. A total of 1,288 questionnaires were received. Of these, 18 were excluded because of unreasonable completion times, highly uniform responses, or logical inconsistencies, resulting in a final sample of 1,270 valid questionnaires for analysis.

Ethical considerations

The study was conducted in accordance with the principles of the Declaration of Helsinki and received ethical approval from the Medical Ethics Committee of Shenzhen Polytechnic University (Approval No. 20251014-12). Before accessing the online questionnaire, participants were required to read an electronic informed consent statement and indicate their consent by selecting the “I agree to participate” option. Only those who provided informed consent were granted access to the questionnaire.

The consent form explained the study objectives, procedures, potential risks and benefits, measures for protecting confidentiality, and the voluntary nature of participation. Participants were informed that their decision to participate or decline would not affect their academic evaluation, course grades, or relationships with faculty members. They were also advised that they could withdraw from the study at any time before submitting the questionnaire without penalty.

No personally identifiable information was collected. All responses were stored anonymously on a secure server accessible only to the research team, and appropriate safeguards were implemented throughout the study to protect data confidentiality and ensure participant anonymity.

Data analysis

Data were analyzed using SPSS version 24.0 (IBM Corp., Armonk, NY, USA). The normality of continuous variables was assessed by examining measures of central tendency, skewness, and kurtosis. Descriptive statistics were used to summarize the data, with categorical variables presented as frequencies and percentages and continuous variables as means and standard deviations. Differences between groups were assessed using independent-samples t-tests and one-way analysis of variance (ANOVA). Statistical significance was defined as p-value < 0.05.

Results

Background characteristics

Table 1 summarizes the participants’ background characteristics. Of the 1,270 nursing students, the majority were female (n = 1166, 91.81%) and aged 18–20 years (n = 1,108, 87.24%). There were 389 (30.63%) first-year students and 881 (69.37%) second-year students. Most participants had a rural household registration (73.54%), and 18.27% were only children. More than half of the students (57.17%) reported that choosing nursing as a major was their personal decision. Nearly all participants (98.11%) described their relationships with peers and teachers as harmonious. Furthermore, 69.61% had participated in volunteer activities, 40.87% had experience serving as a student leader at the school, college, or class level, 85.98% expressed a willingness to pursue a nursing career, and 60.55% reported prior caregiving experience.3

Table 1.

Background characteristics of nursing students (n = 1,270)

Background characteristics		N (%)
Gender	Male	104(8.19)
	Female	1166(91.81)
Age	18–20 years	1108(87.24)
	21–26 years	162(12.76)
Year of study	First year	389(30.63)
	Second year	881(69.37)
Household registration status	Urban	336(26.46)
	Rural	934(73.54)
Only-child status	Yes	232(18.27)
	No	1038(81.73)
Reasons for choosing nursing as a major	Personal decision	726(57.17)
	Parents’ decision	350(27.56)
	Assigned placement	194(15.28)
Harmonious relationships with peers and teachers	Yes	1246(98.11)
	No	24(1.89)
Participation in volunteer activities	Yes	884(69.61)
	No	386(30.39)
Experience serving as a student leader at the school, college, or class level	Yes	519(40.87)
	No	751(59.13)
Willingness to pursue a nursing career	Yes	1092(85.98)
	No	178(14.02)
Prior caregiving experience	Yes	769(60.55)
	No	501(39.45)

Descriptive statistics for nursing students’ perceptions of humanistic caring

Table 2 presents the overall scores for nursing students’ perceptions of humanistic caring among the 1,270 participants. The five highest- and five lowest-scoring items from the 34-item questionnaire are summarized in Table 3.

Table 2.

Scores for nursing students’ perceptions of humanistic caring (n = 1,270) Mean ± SD

Dimensions	Overall average score	Entries evenly distributed
Caring in the school environment	19.72 ± 4.40	3.94 ± 0.88
Caring in school management	32.92 ± 6.19	4.11 ± 0.77
Caring from teachers	54.22 ± 9.79	4.17 ± 0.75
Caring from peers	33.32 ± 6.04	4.16 ± 0.75
Total scores	140.18 ± 24.94	4.10 ± 0.73

Table 3.

The five highest- and five lowest-scoring items of nursing students’ perceptions of humanistic caring

Items	Dimensions	Mean ± SD
The highest-scoring items
Respecting students	Caring from teachers	4.20 ± 0.76
Mutual respect	Caring from peers	4.18 ± 0.76
Encouraging students	Caring from teachers	4.18 ± 0.78
Peers encourage and support one another	Caring from peers	4.18 ± 0.76
Peers listen to other students’ thoughts and feelings	Caring from peers	4.18 ± 0.77
The lowest-scoring items
Prioritizing students’ interests when formulating school policies	Caring in school management	4.03 ± 0.93
Adequate library resources and opening hours that meet students’ needs	Caring in the school environment	4.00 ± 0.96
Sufficient opportunities to attend lectures and broaden students’ horizons	Caring in the school environment	3.95 ± 0.97
A clean and hygienic canteen with safe, diverse, and reasonably priced food	Caring in the school environment	3.91 ± 0.98
Clean, well-ventilated classrooms with adequate heating and cooling	Caring in the school environment	3.84 ± 1.09

Comparison of nursing students’ perceptions of humanistic caring across background characteristics

Group comparisons were performed to examine differences in the total NSPHCQ score and its four dimension scores across participants’ background characteristics. As shown in Table 4, independent-samples t-tests and one-way analysis of variance (ANOVA) identified significant differences according to several background characteristics, including household registration status, reasons for choosing nursing as a major, harmonious relationships with peers and teachers, participation in volunteer activities, experience serving as a student leader at the school, college, or class level, willingness to pursue a nursing career, and prior caregiving experience (all p < 0.05). Although age was not significantly associated with the overall NSPHCQ score, a significant difference was observed in the caring in school management dimension (p < 0.05).

Table 4.

Comparison of NSPHCQ total and subscale scores across background characteristics (n = 1,270)

Background characteristics		NSPHCQ total Mean ± SD	Caring in school environment Mean ± SD	Caring in school management Mean ± SD	Caring from teachers Mean ± SD	Caring from peers Mean ± SD
Gender	Male	4.08 ± 0.92	3.92 ± 1.02	4.06 ± 0.94	4.15 ± 0.92	4.10 ± 0.94
	Female	4.13 ± 0.72	3.95 ± 0.87	4.12 ± 0.76	4.17 ± 0.74	4.17 ± 0.74
t/F		-0.480	-0.269	-0.612	-0.286	-0.739
P		0.632	0.788	0.542	0.776	0.462
Age	18–20 years	4.13 ± 0.73	3.95 ± 0.88	4.13 ± 0.77	4.18 ± 0.75	4.18 ± 0.75
	21–26 years	4.04 ± 0.76	3.91 ± 0.87	3.99 ± 0.81	4.10 ± 0.78	4.09 ± 0.78
t/F		1.422	0.597	2.211	1.254	1.268
P		0.156	0.551	0.027*	0.211	0.206
Year of study	First year	4.10 ± 0.68	3.89 ± 0.83	4.08 ± 0.71	4.16 ± 0.70	4.13 ± 0.71
	Second year	4.13 ± 0.76	3.97 ± 0.90	4.13 ± 0.80	4.17 ± 0.78	4.18 ± 0.78
t/F		-0.878	-1.460	-1.040	-0.270	-1.000
P		0.380	0.144	0.299	0.787	0.318
Household registration status	Urban	4.19 ± 0.75	3.99 ± 0.91	4.18 ± 0.80	4.24 ± 0.78	4.26 ± 0.76
	Rural	4.10 ± 0.73	3.93 ± 0.87	4.09 ± 0.76	4.15 ± 0.74	4.13 ± 0.75
t/F		1.975	1.140	1.712	1.853	2.571
P		0.048*	0.254	0.087	0.064	0.010*
Background characteristics		NSPHCQ total Mean ± SD	Caring in school environment Mean ± SD	Caring in school management Mean ± SD	Caring from teachers Mean ± SD	Caring from peers Mean ± SD
Only-child status	Yes	4.15 ± 0.77	3.97 ± 0.94	4.17 ± 0.80	4.19 ± 0.78	4.19 ± 0.78
	No	4.12 ± 0.72	3.94 ± 0.87	4.10 ± 0.77	4.17 ± 0.75	4.16 ± 0.75
t/F		0.709	0.519	1.228	0.392	0.638
P		0.478	0.604	0.220	0.695	0.523
Reasons for choosing nursing as a major	Personal decision	4.21 ± 0.69	4.07 ± 0.82	4.21 ± 0.72	4.25 ± 0.71	4.23 ± 0.72
	Parents’ decision	3.97 ± 0.82	3.74 ± 0.97	3.95 ± 0.87	4.03 ± 0.84	4.05 ± 0.84
	Assigned placement	4.07 ± 0.67	3.85 ± 0.85	4.05 ± 0.73	4.13 ± 0.69	4.13 ± 0.71
t/F		13.174	18.681	14.725	10.252	7.446
P		< 0.001**	< 0.001**	< 0.001**	< 0.001**	< 0.001**
Harmonious relationships with peers and teachers	Yes	4.15 ± 0.70	3.96 ± 0.86	4.14 ± 0.74	4.19 ± 0.72	4.19 ± 0.72
	No	2.93 ± 1.20	2.92 ± 1.17	2.93 ± 1.27	2.97 ± 1.26	2.86 ± 1.25
t/F		4.963	4.357	4.646	4.724	5.166
P		< 0.001**	< 0.001**	< 0.001**	< 0.001**	< 0.001**
Participation in volunteer activities	Yes	4.16 ± 0.72	3.99 ± 0.88	4.16 ± 0.76	4.21 ± 0.74	4.20 ± 0.75
	No	4.04 ± 0.75	3.85 ± 0.88	4.02 ± 0.79	4.09 ± 0.78	4.09 ± 0.77
t/F		2.735	2.491	2.963	2.535	2.309
P		0.006**	0.013*	0.003**	0.011*	0.021*
Experience serving as a student leader at the school, college, or class level	Yes	4.18 ± 0.73	3.97 ± 0.93	4.18 ± 0.77	4.23 ± 0.75	4.23 ± 0.74
	No	4.08 ± 0.73	3.92 ± 0.85	4.07 ± 0.77	4.13 ± 0.75	4.12 ± 0.76
t/F		2.332	0.966	2.494	2.409	2.467
P		0.020**	0.334	0.013*	0.016*	0.014*
Willingness to pursue a nursing career	Yes	4.19 ± 0.69	4.03 ± 0.84	4.19 ± 0.73	4.24 ± 0.71	4.23 ± 0.71
	No	3.70 ± 0.85	3.44 ± 0.95	3.67 ± 0.89	3.77 ± 0.89	3.77 ± 0.88
t/F		7.389	7.682	7.325	6.718	6.643
P		< 0.001**	< 0.001**	< 0.001**	< 0.001**	< 0.001**
Background characteristics		NSPHCQ total Mean ± SD	Caring in school environment Mean ± SD	Caring in school management Mean ± SD	Caring from teachers Mean ± SD	Caring from peers Mean ± SD
Prior caregiving experience	Yes	4.18 ± 0.70	4.00 ± 0.88	4.18 ± 0.74	4.23 ± 0.72	4.22 ± 0.72
	No	4.03 ± 0.77	3.86 ± 0.88	4.01 ± 0.81	4.08 ± 0.79	4.08 ± 0.80
t/F		3.670	2.939	3.739	3.584	3.368
P		< 0.001**	0.003**	< 0.001**	< 0.001**	0.001**

Note: t, independent-samples t tests; F, one-way analysis of variance (ANOVA). * indicates p < 0.05, ** indicates p < 0.01

Discussion

In this study, nursing students reported a relatively high level of perceived humanistic caring, with a total score of 140.18 ± 24.94 and a mean item score of 4.10 ± 0.73. These findings are consistent with those reported by Wang et al. (2021), who surveyed nursing students from three institutions in Hubei Province and found a total score of 137.11 ± 20.27 and a comparable mean item score of 4.03 ± 0.59. These results suggest that nursing schools generally provide a positive, caring environment. As a fundamental professional value, humanistic caring appears well integrated into nursing education, enabling students to internalize caring values and translate them into caring behaviors during patient care, a finding consistent with previous research [24].

Among the four dimensions, caring from teachers received the highest score (4.17 ± 0.75), with “respecting students” and “providing encouragement to students” ranking among the five highest-scoring items. These findings indicate that nursing students generally perceived their teachers as demonstrating caring behaviors, particularly through respect and encouragement. The high ratings suggest that these behaviors are consistently displayed and readily recognized in teacher–student interactions. Respectful communication from teachers can foster students’ psychological safety, self-worth, and a sense of belonging in the learning environment. Similarly, encouragement provides positive reinforcement, communicating recognition and confidence in students’ abilities, improving their motivation, confidence, and engagement in learning. Previous studies have similarly shown that caring and empathetic faculty behaviors create positive learning experiences and support both students’ personal growth and professional development [25]. By demonstrating respect, openness, patience, encouragement, attentive listening, and constructive guidance, nursing educators establish compassionate educational relationships that empower students while strengthening their confidence, motivation, and capacity for compassionate care [26]. Such a supportive educational environment also facilitates the internalization of caring science and promotes the development of competencies essential for compassionate nursing practice [27].

Caring from peers was the second-highest-scoring dimension, with “mutual respect” “peers encourage and support one another” and “peers listen to other students’ thoughts and feelings” ranking among the five highest-scoring items. This finding underscores the important role of peer relationships in shaping nursing students’ perceptions of humanistic caring. Because nursing students spend substantial time studying and living together, they often develop close interpersonal relationships that enable them to recognize and respond to one another’s needs, fostering a strong culture of peer caring [21]. In this study, students perceived high levels of mutual respect, encouragement, and emotional support among their peers. Such interactions contribute to an inclusive, psychologically supportive learning environment while reinforcing students’ sense of belonging and engagement in their studies. Furthermore, attentive listening and emotional responsiveness among peers provide valuable opportunities to develop interpersonal communication and teamwork skills that are fundamental to nursing practice.

These results are consistent with previous research demonstrating that peer caring plays a pivotal role in shaping nursing students’ professional values and caring competencies [28]. Receiving care from peers facilitates the development of caring knowledge and skills while fostering empathy and communication competence [29]. Peer support has also been linked to greater resilience, more effective coping, stronger academic motivation, increased self-confidence, and enhanced teamwork [30–33]. Therefore, peer-led educational strategies have gained increasing recognition within nursing education [34]. Approaches such as peer mentoring and peer-assisted learning, grounded in a caring philosophy, have been widely implemented to strengthen both professional competence and interpersonal skills [30, 35, 36]. These supportive relationships may also ease students’ transition into nursing programs, particularly during the first year, while contributing to the preparation of compassionate, competent and professionally grounded future nurses [29]. Moreover, evidence suggests that students who experience caring interactions with their peers are more likely to demonstrate caring behaviors toward patients in clinical practice [37]. Nursing educators should therefore actively foster supportive peer relationships through structured peer mentoring programs, peer-assisted learning initiatives, and collaborative learning environments. Such strategies can further strengthen students’ perceptions of humanistic caring by promoting mutual support, emotional connectedness, and meaningful caring interactions throughout nursing education.

In this study, the lowest scores were observed for the caring in the school environment dimension (3.94 ± 0.88). Four items, “adequate library resources and opening hours that meet students’ needs” “sufficient opportunities to attend lectures and broaden students’ horizons” “a clean and hygienic canteen with safe, diverse, and reasonably priced food” and “clean, well-ventilated classrooms with adequate heating and cooling”, ranked among the five lowest-scoring items. These results suggest that nursing students perceived physical and cultural learning climate less favorably than interpersonal aspects of caring. Compared with supportive interactions with teachers and peers, the quality of physical facilities and campus services appeared to contribute less positively to students’ perceptions of a caring educational environment. Lower ratings in this dimension may reflect limitations in infrastructure, insufficient opportunities for extracurricular learning, and dissatisfaction with campus dining services.

Previous studies have emphasized that the humanistic atmosphere of educational institutions and clinical settings serves as an important implicit pathway for cultivating humanistic values in nursing education [13]. A supportive and caring environment enables students to experience these values in their daily lives, shaping their behavioral norms, professional values, and caring attitudes [38]. These results suggest that nursing administrators and educators should focus not only on curriculum delivery but also on the broader educational environment and student support services. Improving learning resources, campus facilities, and students’ daily living conditions could help create a more holistic caring environment and further strengthen students’ perceptions of humanistic caring.

This study also found that nursing students’ perceptions of humanistic caring differed significantly across several background characteristics, including sociodemographic factors, personal life experiences, professional attitudes, interpersonal support, and social practice experiences. These findings suggest that perceptions of humanistic caring are shaped not only by formal nursing education but also by students’ personal backgrounds, professional dispositions, educational relationships, and experiential learning.

Among the sociodemographic factors examined, household registration status was significantly associated with perceptions of humanistic caring. Students from urban areas reported higher overall levels of perceived humanistic caring than those from rural areas (P < 0.05). Further analysis showed that this difference was confined to the caring from peers dimension (P < 0.05). This may reflect differences in social, educational, and interpersonal experiences between urban and rural settings. Previous studies have shown that nursing students from urban areas generally possess higher levels of health literacy and greater access to educational and informational resources than their rural counterparts [39]. Students raised in urban environments have been reported to demonstrate slightly stronger humanistic caring abilities than those from rural or township areas, potentially owing to differences in family environments, educational opportunities, and exposure to diverse social interactions [40]. In this study, however, the urban–rural difference was observed only in perceptions of peer caring, suggesting that students from different backgrounds may experience and interpret peer support differently. Caring behaviors among peers, such as listening to others’ perspectives, providing academic assistance, and offering emotional encouragement, are likely influenced by previous social and educational experiences. From an educational perspective, these findings highlight the importance of recognizing the diversity of students’ backgrounds within vocational nursing education. Educational strategies such as group discussions, reflective learning activities, and structured peer interactions can provide opportunities for students to exchange perspectives and learn from one another’s experiences. Such approaches may foster mutual understanding and further strengthen students’ perceptions of humanistic caring within peer relationships.

In this study, age was not significantly associated with the overall humanistic caring score. However, a significant difference was observed in the caring in school management dimension (P < 0.05), with older students reporting lower levels of perceived caring. Previous research has suggested that nursing students’ perceptions of caring are influenced not only by formal educational experiences but also by broader personal and social experiences that shape their understanding of caring within educational settings [4]. Compared with younger students, older students may have accumulated greater life experience and developed a more mature understanding of organizational processes, enabling them to recognize better institutional support, fair management practices, and responsiveness to students’ needs. As a result, they may be more sensitive to inconsistencies between caring values promoted by educational institutions and the actual implementation of management practices, and may critically evaluate whether school policies and services adequately address students' needs. Therefore, lower perceived caring among older students may reflect their heightened expectations and more comprehensive evaluation of school management rather than a lack of appreciation for caring values. These findings underscore the importance of a caring-oriented approach to management in nursing education. Strategies such as transparent communication, accessible student support services, and opportunities for student participation in institutional decision-making can foster a more supportive educational environment and strengthen students’ perceptions of organizational caring.

Regarding personal life experiences, students with prior caregiving experience reported significantly higher levels of perceived humanistic caring than those without such experience. This difference was evident not only in the overall NSPHCQ score but also across all four dimensions (all P < 0.01). Whether through providing care to others or personally receiving care, caregiving experiences can deepen emotional sensitivity and enhance individuals’ understanding of vulnerability and human needs. Such firsthand experiences also promote a richer appreciation of empathy, compassion, and relational responsibility. Previous studies have similarly demonstrated that caregiving experiences facilitate the development of empathy and caring attitudes, suggesting that they represent an important formative influence on humanistic caring [12]. From an educational perspective, these findings support integrating experiential learning into nursing education. Educational approaches such as service learning, reflective practice, and authentic care experiences can help students translate caring values into meaningful interpersonal practice while strengthening their understanding of humanistic caring across multiple dimensions.

Professional attitudes were also closely associated with perceptions of humanistic caring. Students who had chosen nursing as a major based on personal decision (all P < 0.01) and those who expressed a willingness to pursue a nursing career (all P < 0.01) achieved significantly higher scores on both the overall NSPHCQ and each of its four dimensions. Professional motivation and a strong sense of professional identity are widely recognized as key drivers of value internalization, learning engagement, and caring behaviors throughout nursing education. Students with stronger professional commitment are more likely to perceive their educational environment as caring and supportive. This interpretation is consistent with the findings of Allari et al. [15], who reported that students with greater motivation to become nurses were more likely to demonstrate caring behaviors. These results highlight the importance of fostering professional identity and career commitment throughout nursing education. Educational strategies that encourage professional reflection, career planning, and engagement with the core values of nursing may further strengthen students’ perceptions of humanistic caring while supporting their long-term professional development.

Interpersonal support was also closely associated with nursing students’ perceptions of humanistic caring. Students who reported harmonious relationships with peers and teachers achieved significantly higher NSPHCQ scores overall and across all four dimensions (P < 0.01). Previous research has shown that supportive interpersonal relationships foster emotional security, relational trust, and the modelling of empathetic behaviors, all of which contribute to the development of compassion and interpersonal sensitivity [41]. Even within the same educational setting, differences in students’ interpersonal experiences can influence how they perceive the extent to which humanistic caring is reflected in their learning environment. These findings underscore the importance of fostering collaborative learning cultures and supportive teacher–student relationships. Educational environments characterized by mutual respect, open communication, and strong interpersonal support can reinforce students’ perceptions of humanistic caring while facilitating the integration of humanistic caring into their emerging professional identity.

Finally, regarding social practice experiences, participation in volunteer activities was associated with stronger perceptions of humanistic caring. Significant differences were observed not only in the overall NSPHCQ score but also across all four dimensions (all P < 0.05). Volunteer activities expose students to authentic caregiving situations and meaningful interpersonal interactions, fostering empathy, altruism, and a sense of social responsibility. Previous research has demonstrated that structured service learning is an effective educational approach for enhancing compassion and promoting sustained volunteer engagement among students [24]. These findings support the incorporation of structured, reflective service-learning opportunities into routine nursing education. Compared with occasional or mandatory volunteer activities, sustained participation supported by guided reflection is more likely to transform caring experiences into enduring professional values that are reflected across multiple dimensions of humanistic caring.

Students with experience serving as leaders at the school, faculty, or class level reported significantly higher perceptions of humanistic caring. Significant differences were observed in the overall NSPHCQ score and in three of its four dimensions (all P < 0.05), except for caring in the school environment. Previous studies have suggested that leadership experiences within educational settings contribute to the development of communication skills, interpersonal competence, and professional engagement among nursing students [42, 43]. In this study, leadership roles may have provided students with more opportunities to communicate, collaborate, and assume responsibility within group settings, strengthening their perceptions of caring. The absence of a significant difference in caring in the school environment dimension may reflect the relatively consistent educational environment students experience in vocational nursing programs, resulting in limited variability in perceptions of this aspect of caring. These results suggest that encouraging student participation in leadership roles, collaborative activities, and reflective learning experiences may further reinforce students’ perceptions of humanistic caring while supporting their humanistic development.

These results suggest that a combination of sociodemographic factors, personal life experiences, professional attitudes, interpersonal support, and social practice experiences influences nursing students’ perceptions of humanistic caring. Humanistic caring, therefore, appears to develop through the interaction of educational, experiential, and social factors rather than through formal curriculum alone. These results highlight the value of adopting comprehensive educational strategies that extend beyond classroom instruction. Integrating experiential learning, professional identity development, supportive interpersonal environments, service-learning activities, and leadership opportunities into nursing education may further strengthen students’ perceptions and experiences of humanistic caring and better prepare them to deliver compassionate, person-centered nursing care in future clinical practice.

Limitations

This study has several limitations that should be considered when interpreting the findings. First, data were collected using self-administered questionnaires that relied on participants’ subjective perceptions and were therefore susceptible to social desirability and recall biases. As a result, the reported perceptions of humanistic caring may not fully reflect participants’ actual experiences.

Second, the exclusive use of a quantitative approach may have limited a comprehensive understanding of nursing students’ nuanced and context-dependent perceptions of humanistic caring. Although standardized questionnaires allow comparisons across individuals and groups, they cannot fully capture the complexity of students’ lived educational experiences. Future research would benefit from incorporating qualitative methods, such as in-depth interviews or focus group discussions, to provide richer and more contextually grounded insights.

Third, the cross-sectional design prevented the examination of changes in perceptions of humanistic caring over time and precluded any inference of causal relationships. Longitudinal studies are therefore needed to better understand how perceptions of humanistic caring develop and evolve throughout nursing education.

Despite these limitations, this study provides valuable baseline evidence regarding nursing students’ perceptions of humanistic caring in Chinese vocational colleges. The findings offer an important foundation for future research using more diverse methodologies and longitudinal study designs to further advance understanding of humanistic caring in nursing education.

Conclusion

This study demonstrates that nursing students reported a relatively high level of perceived humanistic caring, with caring from teachers receiving the highest scores, followed by caring from peers. In comparison, lower scores for caring in school management and caring in the school environment highlight specific areas requiring further attention and improvement. Significant differences in perceived humanistic caring were observed across several background characteristics, including household registration status, reasons for choosing nursing as a major, harmonious relationships with peers and teachers, participation in volunteer activities, experience serving as a student leader at the school, college, or class level, willingness to pursue a nursing career, and prior caregiving experience. These results suggest that fostering humanistic caring among nursing students requires a comprehensive educational approach that extends beyond formal curriculum. Humanistic caring should be supported through an educational ecosystem that integrates supportive institutional environments, professional identity formation, positive interpersonal relationships, and meaningful experiential learning. By embedding these elements throughout nursing education, which may help cultivate a more sustainable, holistic caring culture within nursing education to enhance humanistic caring in vocational nursing education.

Author contributions

Yufeng Liao and Jieyu Wang contributed equally to the conception and design of the study, analysis and interpretation of the data, and drafting of the manuscript. Sai Yang contributed to the conception and design of the study and critically revised the manuscript for important intellectual content. Rui Chen and Xiao Peng were responsible for data collection and data analysis and contributed to critical revision of the manuscript. Chunyan Guan and Shuang Wang contributed to data collection. Ruixia Xie and Ronghua Wang contributed to critical revision of the manuscript for important intellectual content. Qian Chen and Yilan Liu provided study supervision and contributed to critical revision of the manuscript. All authors read and approved the final manuscript.

Funding

The research was supported by Teaching Quality and Teaching Reform Project of Shenzhen Polytechnic University (2026) (No.33), Shenzhen Polytechnic University Research Fund (No.6025310010 S) and Yangtze University’s Key Project for Teaching Reform Research (No. JY2024019).

Data availability

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

Declarations

Ethical approval and consent to participate

The study strictly followed the guidelines of the Declaration of Helsinki, and ethics approval was obtained from the Medical Ethics Committee of Shenzhen Polytechnic University (20251014) No. 12 (Approval No. 20251014-12). Informed consent was obtained from all participants prior to data collection.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.