Knowledge, attitudes and practices levels of clinical nurses towards humanistic caring: the first nationwide multi-centre cross-sectional survey in China.

backgroundHumanistic caring in China has developed rapidly in recent years; however, patients’ satisfaction with nurses’ humanistic caring remains moderate. To date, there has been no nationwide, multi-centre, large-sample survey exploring nurses’ knowledge, attitudes, and practices (KAP) regarding humanistic caring, which limits the identification of gaps and evidence-based strategies for improvement.

aimThis study aimed to assess the levels of knowledge, attitude, and practices regarding humanistic caring among nurses in tertiary hospitals across China, and to analyze the associated influencing factors, thereby providing a data-driven foundation and practical evidence for developing targeted improvement strategies.

methodA multi-centre cross-sectional survey was conducted from July to August 2022 in 25 provinces (cities and districts) across China. Nurses meeting the inclusion and exclusion criteria were recruited through convenience sampling in tertiary hospitals. Data were collected using a self-developed demographic questionnaire and The Knowledge, Attitudes and Practices of Clinical Nursing Staff on Humanistic Care Questionnaire developed by Li Yuqin. The original scale demonstrated excellent reliability and validity (content validity index = 0.980; Cronbach’s α = 0.982; test–retest reliability = 0.983), and the Cronbach’s α in the present study was 0.991 (P < 0.001). Questionnaires were distributed and collected via the online platform Questionnaire Star. A total of 14,305 valid responses were obtained, yielding an effective response rate of 99.72%. Data were analyzed using SPSS version 26.0 for descriptive and inferential statistics.

resultAmong the 14,305 participants from 25 provinces, 95.48% were female, with a mean age of 32.37 ± 6.62 years; 85.53% held at least a bachelor’s degree. Notably, 42.17% had never received humanistic caring training. The mean scores for knowledge, attitude, and practice were 80.24%, 83.62%, and 87.95%, respectively, with practice scoring highest and knowledge lowest. Significant differences in KAP scores were observed across gender, region, department, professional title, work experience, and job-related factors (all P < 0.05). Nurses who expressed love for nursing, engaged in self-caring, received family support, and were satisfied with their work and salary or had undergone humanistic caring training achieved significantly higher scores in all three dimensions (P < 0.001). Stepwise multiple regression identified job and salary satisfaction, enthusiasm for nursing, self-caring awareness, and prior training as major positive predictors of knowledge and attitude, whereas knowledge and attitude significantly predicted humanistic caring practices. Correlation analysis confirmed strong positive associations among the three dimensions (r = 0.636–0.827, P < 0.001), aligning with the KAP theoretical model.

conclusionChinese clinical nurses demonstrate moderate levels of knowledge and attitudes toward humanistic caring but relatively strong humanistic caring behaviors. Training programs should be strengthened, with content emphasizing the concept, significance, and core competencies of humanistic caring. Hospitals are encouraged to integrate humanistic values into organizational management and promote a supportive humanistic caring culture to enhance nurses’ humanistic practice.