Gu Bilu, Lv Yiming, Zhu Jiyu, Sun Xiaoling, Li Kun
Department of Outpatient, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.
Front Med (Lausanne). 2025 Jun 11;12:1601951. doi: 10.3389/fmed.2025.1601951. eCollection 2025.
Humanistic care is a good glue for the doctor-patient relationship, and it is a general trend to improve the practice of humanistic care.
A narrative research method was used to conduct semi-structured interviews with 18 master's degree nursing students from China who were in the clinical rotation stage, and the data were content analyzed and explored from the perspective of the learners who were learning about humanistic caring practices using the social learning theory model.
There is a triple tension structure in the practice of humanistic care: At the cognitive level, there is a knowledge-activity rupture, with learners showing theoretical clarity but practical confusion. At the environmental level, it is divided into the dual role of facilitating and inhibiting environments. "rewarding" environments included positive psychological attitudes of patients, caring-friendly departmental environment, perceptually rewarding mindfulness environment, and loving family environment. In contrast, "punishing" environments included patients' irresponsible attitudes toward themselves, poor care experiences, inflexible management mechanisms, missing incentives. At the behavioral level, there is a dialectical game between constructive and alienating practices. "forward" behaviors included personalized care in the details, respect for patient autonomy, proactive communication and empathy, systemic support and teamwork. Conversely, "backward" behaviors included mechanized procedures and emotional detachment, disregard for privacy and dignity, systemic issues that exacerbate apathy.
Based on the framework of social learning theory, this study constructs a learning trajectory model of humanistic care to explain the synergistic mechanism between cognitive dimension and environmental system and its two-way shaping of caring practice behavior. The study finds that there is a "black box" phenomenon in which the theory of humanistic care is clear but the practice of humanistic care is confusing in the cognitive dimension, and in the environmental dimension, there are systematic limitations in the traditional biomedical model. Based on the above two-dimensional analysis, this study proposes an optimization path combining cognitive explicit cultivation and environmental support system reconstruction, which points out the direction for breaking through the dilemma of humanistic care practice.
人文关怀是医患关系的良好黏合剂，改善人文关怀实践是大势所趋。
采用叙事研究方法，对18名处于临床实习阶段的中国护理学硕士研究生进行半结构化访谈，并运用社会学习理论模型，从学习人文关怀实践的学习者角度对数据进行内容分析和探索。
人文关怀实践存在三重张力结构：在认知层面，存在知识 - 行动断裂，学习者理论清晰但实践困惑。在环境层面，分为促进环境和抑制环境的双重作用。“奖励性”环境包括患者积极的心理态度、关爱友好的科室环境、感知上有回报的正念环境和充满爱的家庭环境。相比之下，“惩罚性”环境包括患者对自身不负责任的态度、糟糕的护理体验、僵化的管理机制、缺乏激励措施。在行为层面，建设性实践和疏离性实践之间存在辩证博弈。“正向”行为包括细节中的个性化护理、尊重患者自主权、积极沟通与共情、系统支持与团队合作。相反，“反向”行为包括机械化程序和情感疏离、无视隐私和尊严、加剧冷漠的系统性问题。
本研究基于社会学习理论框架构建了人文关怀学习轨迹模型，以解释认知维度与环境系统之间的协同机制及其对关怀实践行为的双向塑造。研究发现，在认知维度存在人文关怀理论清晰但人文关怀实践困惑的“黑箱”现象，在环境维度，传统生物医学模式存在系统性局限。基于上述二维分析，本研究提出了认知显性培养与环境支持系统重建相结合的优化路径，为突破人文关怀实践困境指明了方向。
