3C-guided reflection combined with scenario simulation for humanistic care education among nursing students: a mixed methods study

Abstract Background Humanistic care is essential to nursing practice and directly influences patient outcomes. Since nursing students constitute the future clinical workforce, cultivating humanistic care competencies is an educational responsibility rather than a solely clinical issue. However, current training often faces challenges such as disconnection between theory and practice, highlighting the need for effective teaching models. Based on reflective practice theory, this study evaluates a multicomponent educational intervention integrating 3 C (Context, Content, Course) guided reflection with scenario simulation for humanistic care education among undergraduate nursing students. Methods A sequential explanatory mixed methods design was employed. In the first phase, all seven intact classes of first-year nursing students (total n = 350) from a medical university in Guizhou Province were included and randomly assigned using a random number table at the class level to either the intervention group (4 classes, n = 200) or the control group (3 classes, n = 150). The intervention group received a single, integrated 160-minute classroom-based session consisting of 40 min of theoretical instruction, 40 min of scenario simulation, 40 min of 3 C-guided reflection, and 40 min of summary and assessment activities, whereas the control group received traditional theoretical instruction within a 160-minute session that also included assessment activities. Outcomes were assessed using the Caring Ability Inventory, theoretical knowledge tests, and satisfaction questionnaires. Quantitative outcomes were analyzed using linear mixed-effects models accounting for class-level clustering; CAI models additionally adjusted for the corresponding baseline scores. In the second phase, 40 nursing students were purposively selected from the intervention group for semi-structured in-depth interviews, and data were analyzed thematically. Results The intervention group had a higher immediate post-intervention score on the self-report Caring Ability Inventory (CAI) than the control group (adjusted mean difference = 19.68 points, 95% CI 17.04–22.33; standardized effect size = 1.65; P < 0.001). Higher self-reported CAI scores were also observed for the Understanding, Courage, and Patience subscales. The intervention group also had a higher immediate post-intervention theoretical knowledge score (mean difference = 4.80 points, 95% CI 0.72–8.88, P = 0.021). Learner evaluations of the intervention were generally favorable. Qualitative analysis revealed four themes: empathy awakening, cognitive reconstruction through structured reflection, courage cultivation, and conceptual shift toward professional caring. Conclusion This sequential explanatory mixed methods study (a cluster randomized trial plus qualitative interviews) provides preliminary evidence that the multicomponent 3 C-guided scenario simulation model is associated with higher immediate post-intervention self-reported CAI scores and theoretical knowledge scores among undergraduate nursing students following a single-session intervention. Qualitative findings provided complementary insights into students’ experiences; however, the study design cannot establish long-term causality or sustained competency development. The independent contribution of 3C-guided reflection cannot be determined from this multicomponent intervention. The potential role of the “experience–reflection–abstraction” cycle warrants further investigation through multi-center, longitudinal studies incorporating objective behavioral assessments.