Exploring the Difference of Patient-Centered Care Awareness Between Novice and More Experienced Nurses in China: A Mixed-Method Study Using Eye-Tracking and Semiotic Analysis

Within China's distinctive healthcare landscape, both education and practice of patient-centered care (PCC) encounter substantial challenges. Grounded in social semiotic theory, this study investigated Chinese nurses' symbolic interaction processes during multimodal learning and their subsequent impact on PCC awareness. Through a mixed-methods design incorporating eye-tracking technology and interview analysis, we uncovered distinct differences in meaning construction among nurses with varying levels of professional experience. Eye-tracking data revealed that experienced nurses predominantly focused on facial expressions and interactive symbols during multimodal learning, while novice nurses primarily attended to textual and visual elements. Qualitative data revealed important findings from a semiotic perspective. More experienced nurses constructed "observer power" relationships. They positioned themselves as professional observers capable of identifying patients as "ill others." Novice nurses demonstrated more egalitarian relationships but exhibited limited PCC awareness. They prioritized procedural accuracy and displayed more rigid learning patterns. Overall, this study uncovered conflicts between standardization requirements in Chinese nursing education and PCC implementation. Our findings contribute localized evidence supporting the urgent need to enhance PCC education among Chinese nurses.