Humanistic care and older adults: A concept analysis using the Walker and Avant method

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The lack of an analytical and structured definition has made it difficult to design care interventions, professional training, and empirical assessment of this concept. Objective: This study aimed to analyze and clarify the concept of "humanistic care in the older adults " based on the approach of Walker and Avant. Methods Concept analysis was performed using Walker and Avant's eight-step method. A comprehensive search was conducted in Persian (SID, MagIran) and international (PubMed, Embase, Scopus, Web of Science) databases without time limits until November 2025 with relevant keywords validated with MeSH/Emtree. After systematic screening, 12 relevant studies were included in the final analysis. Findings: Humanistic care in the older adults is a multidimensional, dynamic concept rooted in the philosophy of humanism. Its defining characteristics include respect for the individuality of the elderly, empathy, authentic communication, participation in decision-making, conscious presence of the caregiver, and simultaneous attention to the physical, psychological, social, and spiritual dimensions of the older adults life. The antecedents of this concept at the individual, organizational, and structural levels and its consequences at the psychological, physical, and social levels were identified. Conclusion The findings of this analysis provide a clearer conceptual framework of humanistic care in the older adults, which can serve as a basis for developing nursing education, designing care interventions, and constructing valid measurement tools in the field of aging. Analysis Concept formation Humanism Aged Figures Figure 1 Introduction Aging is a natural, progressive, spontaneous, and irreversible physiological change in which both physical and mental capacities decline significantly [ 1 , 2 ]. Conventionally, aging begins with the onset of 65 years of age. Old age refers to the gradual deterioration in the structure and organism of the body that occurs due to aging and in changes in the structure and function of various body organs [ 3 ]. With advances in modern medical science, the population of older adults is increasing markedly [ 4 ]. According to reports by the World Health Organization (WHO), by the late 2050, the number of individuals aged over 60 years will exceed 2 billion [ 5 , 6 ]. Meanwhile, the increase in the older population will create challenges for the healthcare system, including greater needs for care related to chronic diseases, rehabilitation, and psychosocial interventions [ 7 ]. Therefore, given the rapid growth in the number of older adults, issues related to hygiene, health, and ensuring their comfort and welfare in society are assuming new and broader dimensions each day, indicating the importance of paying attention to the older adult population [ 8 ]. Humanistic care is regarded as the principle and essence of caring for older adults [ 9 ]. In general, care encompasses belief in every human feeling, including value and humanity [ 10 ]. Care is defined as a human science and the caregiver’s conscious presence with an individual, accompanying the individual’s life and growth [ 11 ]. Watson states that care is a science that encompasses humanity, represents experiences in care, and includes art and humanity [ 12 ]. Care is an art that is continuously growing and evolving [ 13 ]. In the theory of humanistic care, care involves interactions between two individuals with different life conditions and phenomenological domains. Care is an ethical ideal and entails the unique use of the self through movements, feelings, and touch to create unity between two individuals, within which healing, inner strength, and self-control of the care recipient can flourish [ 12 ]. Experts, academics, and researchers in the field of gerontological nursing critically examine the research and writings of this discipline based on their philosophical foundations and methodologies [ 14 ]. Clear definitions of concepts make it possible to measure and apply them in research and practice; the outcome of this process is the production of theoretical foundations for the development of gerontological nursing and the analysis of its concepts [ 15 , 16 ]. Concept analysis studies, when derived from nursing practice, research, or theories, can contribute to the expansion of nursing knowledge [ 17 ]. Moreover, in gerontological nursing sciences, concept analysis is a prerequisite for the development and advancement of research [ 18 ]. On the other hand, to expand nursing science through research in a scientific and logical manner, the use of concept analysis is essential [ 17 ]. Concept analysis leads to consensus and agreement on the meanings of gerontological nursing practice, knowledge, development, evolution, and research [ 19 ]. Given that concept development is considered an important prerequisite for the progress and advancement of knowledge, various methods are used for concept development. One of these methods is concept analysis, which is recognized as a clear approach. There are various approaches to concept analysis, including those of Rogers, Wilson, Morse, and Walker and Avant. Among these, the Walker and Avant approach has characteristics such as triangulation, precise critical analysis, and relatively simple steps [ 20 ]. Concept analysis is also one of the useful study methods employed in the development and clarification of professional concepts, particularly in nursing, and among the diverse approaches to concept analysis, the Walker and Avant approach has proven useful for analyzing concepts related to nursing [ 21 ]. Despite the frequent use of this concept in nursing texts, a literature review shows that “humanistic care in the older adult” is often used descriptively, intuitively, or in relation to specific clinical contexts, and lacks a clear analytical definition, distinguishing features, and clear conceptual boundaries. This conceptual ambiguity has limited the possibility of operationalization, structured training, and empirical measurement of this concept. Accordingly, conducting a systematic concept analysis seems necessary to clarify the characteristics, antecedents, consequences, and empirical indicators of humanistic care in the older adult. The present study, using the approach of Walker and Avant, seeks to answer the following question: What are the characteristics of the concept of humanistic care in the older adult, under what conditions does it emerge, and what consequences does it entail? Methods This study was conducted in 2025 with the aim of clarifying the concept of humanistic care in older adults and determining its dimensions based on the Walker and Avant approach [ 22 ]. In this approach, the process of analyzing a concept is undertaken to achieve a better understanding. This approach consists of eight steps: (1) selecting the concept, (2) determining the purpose of analysis, (3) identifying all uses of the concept under analysis, (4) determining the defining attributes of the concept, (5) identifying a model case, (6) identifying borderline and contrary cases, (7) identifying antecedents and consequences of the concept, and (8) defining empirical referents. Study Search In order to identify published articles relevant to the research objective, Persian databases SID ( https://www.sid.ir ) and MagIran ( https://www.magiran.com ), as well as the international databases PubMed, Embase, Scopus, and Web of Science (WoS), were searched. Searches in these databases were conducted using the keywords “Humanist*,” “Old*,” “Geriat*,” “Elderlys,” “Elderlies,” “Elderly,” and “Aged.” Keyword validation was performed using MeSH in PubMed and Emtree in Embase. The searches were conducted in combination using the OR and AND operators. The search period covered from the inception of the aforementioned databases up to November 2025 in order to retrieve all potentially relevant studies. The search engines Google Scholar and Google, as well as the reference lists of all relevant articles and review studies, were also manually examined to maximize the comprehensiveness of the search. For example, the search strategy in the PubMed database was defined as follows: (Humanist*) AND (((((((Elderly[Title/Abstract]) OR (Old*[Title/Abstract])) OR (Geriat*[Title/Abstract])) OR (Elderlys[Title/Abstract])) OR (Elderlies[Title/Abstract])) OR (Aged[Title/Abstract])) OR (Aged[MeSH Terms])) Two researchers independently performed the study procedures, and in cases of disagreement, the issue was discussed in face-to-face meetings. The initial search and screening of articles were conducted based on author name, title, and year of publication, and duplicate records were removed. In the next stage, article abstracts and subsequently full texts were reviewed, and articles that met the study objectives were included in the final analysis. Inclusion Criteria The inclusion criteria were as follows: articles published in Persian or English, relevance to the concept of humanistic care in older adults, and availability of the full text. Exclusion Criteria The exclusion criteria included studies published in languages other than Persian and English, letters to editor, conference studies, animal studies, and lack of access to the full text after three email attempts to contact the corresponding author. Results Summary of the study selection process Using the search strategies across various databases, a total of 4,035 studies were identified, of which 1,236 duplicate and overlapping records across databases were removed. Of the remaining 2,799 studies, 2,717 articles were excluded through title and abstract evaluation due to irrelevance to the topic. Subsequently, of the remaining 82 studies, 70 articles were excluded after full-text review because they did not meet the inclusion criteria. Therefore, 12 articles that met the inclusion criteria were included in the analysis (Figure 1). General characteristics of the studies Overall, 12 studies published in English were included in the analysis. In total, there were five qualitative studies, three review studies, two interventional studies, and two descriptive studies (Table 1). Table 1. General characteristics of the studies Results Study type First author and year The use of human care factors had the greatest impact on emotions, particularly with regard to interaction, followed by gentleness. Grounded theory Zhou et al. (2023) [23] Humanistic care in older adults may lead to active aging, successful aging, productive aging, optimal aging, and vitality aging. Review Cheng (2020) [9] A total of 12 subthemes were extracted. Structural level: rationalization of human resources, caring hospital environment, system and responsibilities; process level: caring communication, identification of individual needs, medication safety, prevention of high-risk patients, medical–nursing collaboration, and humanistic literacy of nursing staff; outcome level: satisfaction, patient outcomes, and occurrence of adverse outcomes. Qualitative Yuan et al. (2025) [24] The use of lifelong learning as a means to promote physical and mental well-being is highly needed within the “concept of learning” from a humanistic perspective. Descriptive Sarma and Bhagawati (2015) [25] Individualized nursing combined with humanistic care can significantly improve clinical outcomes, enhance quality of life, and reduce adverse psychological conditions in patients with gastric ulcers. Interventional Cai et al. (2020) [26] The results of sleep quality assessment scales, negative emotions, quality of life, and level of hope showed that, in the preoperative period, the overall effect of standard and humanistic nursing care throughout the entire period was significantly improved. Interventional Ou et al. (2021) [27] Important elements of humanistic care in caring for older adults residing in nursing homes include a friendly environment, comprehensive care, empathy, individualization, independence, participation in decision-making, appropriate use of tools, and serious consideration of clients’ opinions. Qualitative Lee and Wang (2014) [28] Factors influencing humanistic care among nurses in the care of older adults included level of education, marital status, personality, reason for employment, and the level of perceived care from colleagues (P < 0.05). Descriptive Zhang et al. (2023) [29] The therapeutic effectiveness of humanistic care in older adults was classified into two main categories: (a) therapist characteristics (“being”); and (b) therapist behaviors (“doing”). The “being” category encompasses both attitudes, referring to therapists’ perceptions of the frameworks and clinical roles they adopted that were most conducive to successful therapy, and embodiments, describing the positions and characteristics perceived by study participants as most effective. The “doing” category, in turn, includes both strategies, referring to the conceptualization of effective therapeutic approaches, and interventions, which describe the actual implementation of such approaches. Qualitative Spalding and Khalsa (2010) [30] Two core beliefs are inherent in humanistic perspectives on aging: (1) the importance of self-concept and self-esteem throughout the life course, regardless of an individual’s economic or health status; and (2) the constructive role of the older person within an integrated intergenerational social matrix. Review Charise and Eginton (2018) [31] Landscape architectural design does not originate solely from humanistic thought and existence nor does it merely embody humanistic thought in landscape architecture design; however, its various aspects can be classified into two main directions: the embodiment of humanistic culture and the embodiment of humanistic care. Thus, both in actual design and in the perception of landscape architecture, attention is given to human thought and the humanistic spirit through these two pathways. Qualitative Xing (2015) [32] Themes of psychotherapy, presence, spirituality, and meaning are effective in the humanistic care of older adults. Review Suri (2010) [33] Step one: Concept selection Care can be considered the core of clinical practice and the most vital and complex component of nursing knowledge. Valuing human beings constitutes the foundation of the nursing profession and the essence of care. Therefore, humanism in care is a fundamental necessity and a global priority for improving the quality of care [34]. Researchers and theorists have extensively explained the importance of the humanistic approach in gerontological nursing care. Paterson and Zderad regard it as a factor for the mutual growth of personality and the cultivation of humanity in both care recipients and nurses [35]. Parse considers humanistic behavior toward care recipients to be a fundamental factor in improving quality of life [36]. Watson states that care is a science that encompasses humanity, represents experiences and phenomena in care, and includes art and humanity [12]. Care is an art that is continuously growing and evolving [13]. In the theory of humanistic care, care involves interactions between two individuals with different life conditions and phenomenological domains. Care is an ethical ideal and entails the unique use of the self through movements, feelings, and touch in order to create unity between two individuals, within which healing, inner strength, and self-control of the care recipient can flourish [12]. The concept of humanistic care is considered an unavoidable aspect of caring for older adults, and there are varying degrees of unfamiliarity with humanistic care among all caregivers of older adults. Therefore, the present study can contribute to clarifying the concept of humanistic care and, consequently, to improving care for older adults. Step two: Determining the purpose of analysis Concept analysis, in addition to clarifying ambiguous and confusing concepts, can elucidate frequently used concepts, distinguish a concept from similar yet different concepts, and provide a foundation for concept development [37]. The concept of humanistic care in older adults is one that requires clarification, as various interpretations may be derived from its apparent meaning. By applying the eight-step approach of Walker and Avant [20], the present study examines the meanings and characteristics of the concept of humanistic care in older adults. This process can lead to clarification of the concept and assist in identifying the presence or absence of humanistic care in older adults within caregiving situations, thereby enhancing caregivers’ understanding. Step three: Identifying uses of the concept This step pertains to the defining attributes of the concept. Each concept may have more than one defining attribute. Appropriate characteristics and attributes of the concept must be considered in concept analysis [37]. Humanistic care for older adults refers to a type of care that is designed based on human principles and values, such as respect for dignity, as well as the needs and individual experiences of older adults [23, 24]. These attributes distinguish the concept of humanistic care from other forms of care, such as task-oriented and biologically focused care [38]. This type of care typically emphasizes emotional communication, empathy, and attention to the personality and life history of each individual [28]. In other words, humanistic care aims to support older adults in a holistic and comprehensive manner, addressing not only their physical needs but also their psychological, social, and spiritual needs [24, 32]. Step four: Determining the defining attributes of the concept The defining attributes of a concept are the characteristics and features that best explain the concept and play an important role in distinguishing the analyzed concept from similar concepts [37]. In general, humanistic care in older adults includes: (1) Respect for individuality: each older adult is regarded as a person with a unique history and specific experiences; (2) Empathy and emotional connection: establishing an interactive and emotional relationship that strengthens feelings of worth and belonging in older adults; (3) Inclusion in decision-making: older adults, as individuals with awareness and valuable experiences, participate in decisions related to their own lives; and (4) Attention to comprehensive needs: care involves consideration of the physical, psychological, social, and spiritual needs of older adults [24, 28, 32, 34]. Accordingly, humanistic care in older adults refers to the provision of services that, through attention to human characteristics and respect for the dignity of older adults, contribute to improving their quality of life [26, 27, 33]. Step five: Identification of a model case A model case should include all the defining attributes of the concept and represent a pure example of the concept under analysis [37]. The following model is presented to facilitate understanding of this concept: Model case The care recipient is a 72-year-old older woman who has been transferred to a long-term care facility due to memory decline and physical problems. Her nurse, a 35-year-old man with four years of experience in caring for older adults, adopts a humanistic approach and initially spends a considerable amount of time listening to the older adult’s words, experiences, and feelings, thereby gaining a deep understanding of her needs and preferences. The nurse then decides to respect the older adult’s wishes. For example, the older adult prefers to spend most of her time outdoors in the facility’s garden and to wear clothing of her own choosing. Accordingly, the nurse involves her in daily decision-making and allows her to determine how activities are carried out and which options she selects. In addition, by establishing an emotional connection and demonstrating empathy, the nurse strengthens the older adult’s sense of safety and trust. Rather than relying on rigid and restrictive methods, the nurse seeks to incorporate human interaction, respect, and kindness into the care process. As a result of this approach, the older adult feels valued, respected, and a sense of belonging, and her quality of life and well-being in the long-term care facility improve, as all care is provided based on respect for her personality and individual needs. Step six: Identification of borderline and contrary cases Borderline case: A borderline case includes some, but not all, of the defining attributes of the concept and may differ from the target concept in one or more attributes [37]. The care recipient is an 80-year-old older woman with moderate dementia, mobility problems, and mild depression who is residing in a long-term care facility. She is highly anxious and distressed, feels unsafe, and may at times feel that her personality and identity are overlooked. At the same time, she desires to maintain relative independence in her daily activities; however, her physical limitations and memory impairment restrict her ability to perform personal tasks. In providing comprehensive care, the nurse disregards some of the older adult’s preferences, yet demonstrates empathy and respect in carrying out nursing interventions. Contrary Case: A contrary case can be described as something that is not recognized as the core concept [37]. The care recipient is a 78-year-old man with severe dementia, physical disability, and inability to establish effective communication. The youngest son of the family is responsible for his care. The son manages the older adult without considering his personal preferences and without regard for his feelings, wishes, or unique personality. In this approach, caregivers often provide care in a directive and controlling manner, without attention to the older adult’s emotional and psychological needs. For example, the older adult is forced to wear clothes he does not want or to engage in activities in which he has no interest. This type of care is contrary to the principles of humanistic care in older adults, leads to a reduction in the older adult’s sense of worth, trust, and satisfaction, and may create feelings of tension, anxiety, and insecurity. Step seven: Identification of antecedents and consequences Antecedents: Antecedents include activities, conditions, or events that occur prior to the manifestation of the concept [37]. Before implementing humanistic care in older adults, it is necessary to establish activities, conditions, and events that provide the essential foundations for delivering humane, respectful, and person-centered care. These include: 1. Comprehensive assessment of the older adult’s needs and individual status: • Collection of life history: Information regarding family background, preferences, interests, and personal values of the older adult [24]. • Assessment of physical and mental health: Evaluation of physical, psychological, social, and spiritual status to identify strengths and specific needs [31-33]. • Identification of personal needs and preferences: Understanding the older adult’s inclinations and wishes regarding activities, environment, communication, and care [23, 28]. 2. Creating an appropriate and safe environment: • Preparation of space and equipment: A calm, safe, and comfortable environment in which respect for privacy and individual characteristics of the older adult is ensured [24, 28]. • Facilitating effective communication: Provision of necessary tools and resources to enable easy communication, such as adapted methods for older adults with speech and hearing limitations [24, 29]. 3. Education and preparation of the caregiving team: • Training in humanistic care principles: Caregivers should become familiar with the principles of respect, empathy, valuing, and participation [25, 28]. • Training in active listening and human interaction: Development of communicative and empathic skills when interacting with older adults [24, 29]. 4. Collaborative planning: • Consultation with the older adult and family: Involving them in decision-making whenever possible and incorporating individual wishes and needs into the care plan [23, 28, 30]. • Setting individualized goals: Defining care goals based on the older adult’s needs and preferences while respecting their personality and rights [28]. 5. Development of guidelines and policies: • Formulation of practical guidelines: Guidelines related to the implementation of humanistic care principles, including methods of communication, participation, respect, and individualized care. • Clarification of roles and responsibilities: Assigning of duties within the caregiving team based on principles of respect and humaneness [23, 24, 28]. 6. Provision of emotional and psychological infrastructure: • Psychological support: Creating opportunities for older adults to express their feelings and needs [28]. • Establishing a sense of safety: Strengthening trust and fostering positive human relationships within the care environment [24, 28]. Overall, before initiating humanistic care in older adults, all of these conditions and activities must be established to ensure that person-centered, respectful, and effective care is provided and that the older adult feels safe and valued throughout the caregiving process. Consequences: Consequences are events that occur following the manifestation of the concept [37]. The consequences of humanistic care can be examined at three levels: Psychological consequences • Reduction of depression and anxiety: When older adults feel respected and cared for, levels of stress and feelings of worthlessness decrease. • Increased sense of social belonging: Human interaction enables older adults to feel that they are still part of society and the family. • Increased life satisfaction: Humanistic care in older adults enhances the quality of daily experiences and prevents loneliness and neglect [9]. • Strengthening self-esteem: Respectful treatment and involving older adults in decision-making reinforce their sense of worth [26, 27]. 2. Physical and general health consequences • Improved physical condition and increased longevity: Research indicates that emotional support and human connection have a direct impact on the immune system [39, 40]. • Increased adherence to treatments: With trust and empathy, older adults are more likely to follow medical recommendations [24]. • Reduced physical burnout among nurses and caregivers: In a humanistic environment, positive and reciprocal relationships help maintain caregiving motivation [30]. 3. Social and ethical consequences • Strengthening the quality of intergenerational relationships: A humanistic approach facilitates the transfer of older adults’ experiences and knowledge to younger generations [41, 42]. • Promotion of a culture of respect for aging in society: It provides a model for a more ethical and humane approach within families and care institutions [28]. • Reduction of ageism: Focusing on the human dignity of older adults helps correct instrumental or negative attitudes toward aging [41]. Overall, humanistic care in older adults leads to improved quality of life, satisfaction, and mental and physical health among older adults, while enhancing human relationships and professional ethics within care systems. Step eight: Empirical manifestation Empirical manifestation indicates how a concept is measured and the extent to which a definition is useful in measuring the concept and establishing its validity [37]. Instruments for measuring humanistic care in older adults assess the extent to which caregivers, nurses, or family members attend to the emotional, human, and personal values of older adults. These instruments are typically in the form of questionnaires, attitude scales, or care quality scales and are used across physical, psychological, social, and ethical domains. The most important and valid instruments for measuring humanistic care in older adults include the Watson Human Caring Questionnaire (CNPI), which aims to assess the extent to which caring behaviors based on compassion, empathy, respect, and human presence are demonstrated in care [43]. The Nursing Presence Instrument Scale (NPIS), designed to measure the quality of interaction between nurses and older adults in terms of communication, respect, empathy, and participation in decision-making [44]. The Patient Dignity Inventory (PDI), which focuses on the psychological and existential aspects of humanistic care, particularly in older adults and patients with chronic conditions [45]. The Listening, Empathy, and Presence Scale (LEP), assesses caregivers’ abilities in mindful presence, listening, and genuine empathy toward older adults [46]. The Humanistic Care Evaluation Tool (HCET), intended to provide an overall assessment of the quality of humanistic care in nursing homes or care facilities [47]. Iranian localized instruments (such as the Persian versions of the Watson scale and the PDI). Valid instruments for assessing humanistic care in older adults generally focus on three main domains: human communication and empathy, respect for dignity and individual autonomy, and attention to the emotional and spiritual dimensions of care. These instruments are applied in nursing, psychology, gerontology research, and in the evaluation of service quality in elder care facilities. Discussion The aim of the study was to provide a comprehensive definition of the concept of humanistic care in older adults and to identify its defining attributes using the eight-step Walker and Avant approach. The construction and identification of related model, borderline, and contrary cases contributed to clearer delineation and description of the concept. The findings of the concept analysis of humanistic care in older adults indicated that this concept is multidimensional and dynamic, rooted in the philosophy of humanism, and emphasizes value, dignity, autonomy, and authentic relationships between the caregiver and the older adult. Components such as respect for the individuality of the older adult, empathy, nonjudgmental acceptance, the caregiver’s active presence, and strengthening a sense of meaning in life were identified as core principles of humanistic care. These attributes distinguish the concept of humanistic care from other forms of care, such as task-oriented and biologically focused care [ 38 ]. The findings are consistent with Watson’s perspective in the theory of caring science, which views care as a human, ethical, and interpersonal phenomenon rather than merely a set of technical activities [ 12 ]. In the context of elder care, the realization of such care requires a deep understanding of the older adult’s lived experience and a focus on preserving meaning, independence, and connection to personal and social values [ 33 ]. In line with other studies, humanistic care is regarded as the heart of the nursing profession [ 48 , 49 ]. This type of care moves away from mechanical and purely task-oriented models and emphasizes the human relationship between the caregiver and the care recipient; a relationship in which the older adult is seen not merely as a patient, but as a human being with a history, values, and psychosocial needs [ 38 ]. In the context of caring for older adults, the importance of humanism is even more pronounced, as this age group often faces feelings of loneliness, reduced self-esteem, and fear of dependency or uselessness [ 50 , 51 ]. Humanistic care can enhance quality of life and satisfaction with care by fostering a sense of respect and belonging [ 26 , 27 ]. Particularly in care settings such as nursing homes, the human presence of the nurse—beyond mere physical presence—can play a decisive role in the lived experiences of older adults [ 28 ]. The concept analysis revealed that humanistic care in older adults is not merely a behavior but an attitude and professional disposition that arises from a deep understanding of human nature and the ethical values of nursing [ 33 ]. Therefore, to institutionalize this concept, the education of nurses and caregivers should be designed based on the philosophical and psychological foundations of humanism [ 25 ]. Moreover, managers and policymakers should provide supportive environmental and organizational conditions that enable the manifestation of humanistic behaviors such as dialogue, empathy, and mutual respect. Examination of the antecedents showed that the presence of a humanistic attitude in caregivers, education grounded in the philosophy of humanism, and a supportive environment are essential factors for the emergence of humanistic behaviors [ 23 , 28 , 30 ]. In addition, sufficient time for communication, skills in active listening, and emotional reflection are among the conditions that facilitate the implementation of humanistic care [ 30 ]. In contrast, workload pressure, staff shortages, and an instrumental view of older adults are considered barriers to the realization of this model [ 28 ]. Ultimately, this study emphasized that humanism in the care of older adults was not an option but an ethical and professional necessity. Its implementation leads to improved mental health indicators, increased life satisfaction, and enhanced human dignity among older adults [ 9 ]. Limitations and future directions The present study had several limitations, including lack of access to the full text of some articles and limited access of the researchers to certain databases. It appears that this study has taken the first step, namely concept exploration. Therefore, it is recommended that nursing researchers conduct further qualitative studies in this area in the future. In addition, future research may focus on developing instruments to measure humanistic behaviors in clinical settings and on examining the effects of educational interventions in this field. Conclusion Humanistic care in the elderly is a multidimensional and dynamic concept that is rooted in the philosophy of humanism and provides a distinctive framework for elderly care by emphasizing dignity, authentic connection, and holistic approach. By providing a structured definition of this concept, the present analysis paves the way for the development of nursing education, the design of care interventions, and future research in the field of aging. Declarations Acknowledgments This study is the result of research project No. 401400414 approved by the Student Research Committee of Kermanshah University of Medical Sciences. We would like to thank the esteemed officials of that center for accepting the financial expenses of this study. Author’s contributions M.K, R.J and A.J contributed to the design, M.K and R.J participated in most of the study steps. M.K, A.A and P.A prepared the manuscript M.K and M.G assisted in designing the study, and helped in the, interpretation of the study. All authors have read and approved the content of the manuscript. Funding By Deputy for Research and Technology, Kermanshah University of Medical Sciences (IR) (401400414). This deputy has no role in the study process. Availability of data and materials Datasets are available through the corresponding author upon reasonable request. Ethics approval and consent to participate Ethics approval was received from the ethics committee of deputy of research and technology, Kermanshah University of Medical Sciences (401400414). The study design strictly adhered to the ethical principles of the Declaration of Helsinki (including beneficence, non-maleficence, autonomy, and justice). Consent for publication Not applicable. Competing interests The authors declare that they have no conflict of interest. Clinical trial number Not applicable. Consent to Participante declaration Not applicable. References Li Z, et al. Aging and age-related diseases: from mechanisms to therapeutic strategies. Biogerontology. 2021;22(2):165–87. 10.1007/s10522-021-09910-5 . Tenchov R, et al. Aging Hallmarks and Progression and Age-Related Diseases: A Landscape View of Research Advancement. ACS Chem Neurosci. 2024;15(1):1–30. 10.1021/acschemneuro.3c00531 . Wasserman MR, et al. Geriatric Medicine. Springer; 2019. Kallestrup-Lamb M, et al. Aging populations and expenditures on health. J Econ Ageing. 2024;29:100518. https://doi.org/10.1016/j.jeoa.2024.100518 . Cidre E. Active (and healthy) ageing in the built environment. 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Beyond the classics: A comprehensive look at concept analysis methods in nursing education and research. Belitung Nurs J. 2023;9(5):406–10. 10.33546/bnj.2544 . Beckwith S, Dickinson A, Kendall S. The con of concept analysis: A discussion paper which explores and critiques the ontological focus, reliability and antecedents of concept analysis frameworks. International Journal of Nursing Studies, 2008. 45(12): pp. 1831–1841. https://doi.org/10.1016/j.ijnurstu.2008.06.011 Rodgers B, Jacelon C, Knafl K. Concept Analysis and the Advance of Nursing Knowledge: State of the Science. J Nurs Scholarsh. 2018;50. 10.1111/jnu.12386 . Khoshbakht Pishkhani M, et al. Spiritual health in iranian elderly: a concept analysis by walker and avant’s approach. Iran J Ageing. 2019;14(1):96–113. Walker LO, Avant KC. Strategies for theory construction in nursing. Volume 4. Pearson/Prentice Hall Upper Saddle River, NJ; 2005. Tang J et al. Treatment adherence: A Concept Analysis Using the Walker & Avant Method. Patient preference and adherence, 2024: pp. 2067–2075. Zhou Z et al. A humanistic-care factors application hierarchical design-model for intelligent elderly products. Heliyon, 2023. 9(3). Yuan J, et al. Qualitative study on the evaluation of humanistic care quality in geriatric nursing based on three-dimensional quality structure theory. Front Med. 2025;12:1678646. Sarma P, Bhagawati B. Geriatric Care Through Life Long Learning: A Humanistic Approach. Middle East J Age Ageing, 2015. 12(3). Cai F-L, Chen X-F, Wang Y-X. Analysis of the Effect of Individualized Nursing Combined with Humanistic Care on Elderly Patients with Gastric Ulcer. Int J Clin Experimental Med Res, 2020. 4(3). Ou Y-Y, et al. Effects of whole-course standardized nursing and humanistic care on the sleep condition and quality of life of elderly patients undergoing hysterectomy for cervical cancer. Eur J Gynaecol Oncol. 2021;42(1):154–60. Lee I, Wang H-H. Preliminary development of humanistic care indicators for residents in nursing homes: A Delphi technique. Asian Nurs Res. 2014;8(1):75–81. Zhang T, et al. Level of humanistic care ability and its influencing factors among nursing aides in long-term care facilities. Geriatr Nurs. 2023;52:56–62. Spalding M, Khalsa P. Aging matters: humanistic and transpersonal approaches to psychotherapy with elders with dementia. J Humanistic Psychol. 2010;50(2):142–74. Charise A, Eginton ML. Humanistic Perspectives: Arts and the Aging Mind. The Wiley Handbook on the Aging Mind and Brain, 2018: pp. 78–99. Xing C. Landscape Design in Aging Society Construction of Humanistic Care Consciousness . in 2015 International Forum on Energy, Environment Science and Materials . Atlantis; 2015. Suri R. Working with the elderly: An existential—humanistic approach. J Humanistic Psychol. 2010;50(2):175–86. Sebrant L, Jong M. What’s the meaning of the concept of caring? a meta-synthesis. Scand J Caring Sci. 2021;35(2):353–65. Paterson J, Zderad L. Humanistic nursing New York. NY: National League for Nursing; 1988. pp. 21–33. Parse RR. Illuminations: The human becoming theory in practice and research. Volume 15. Jones & Bartlett Learning; 1999. Yi M, et al. A review study on the strategies for concept analysis. J Korean Acad Nurs. 2006;36(3):493–502. Taghinezhad F, et al. Humanistic Care in Nursing: concept analysis using Rodgers' evolutionary approach. Iran J Nurs midwifery Res. 2022;27(2):83–91. Brod S, et al. As above, so below’examining the interplay between emotion and the immune system. Immunology. 2014;143(3):311–8. Masih J, Belschak F, Verbeke JW. Mood configurations and their relationship to immune system responses: Exploring the relationship between moods, immune system responses, thyroid hormones, and social support. PLoS ONE. 2019;14(5):e0216232. Kwong AN, Yan EC. The role of quality of face-to-face intergenerational contact in reducing ageism: The perspectives of young people. J Intergenerational Relationships. 2023;21(1):136–51. Sun Q, et al. The effectiveness of the young–old link and growth intergenerational program in reducing age stereotypes. Res Social Work Pract. 2019;29(5):519–28. Bahreini A, et al. Translation and validation of the Persian version of the caring nurse-patient interaction scale (CNPI-23). BMC Nurs. 2023;22(1):393. Haugan G, Innstrand ST, Moksnes UK. The effect of nurse–patient interaction on anxiety and depression in cognitively intact nursing home patients. J Clin Nurs. 2013;22(15–16):2192–205. Grassi L, et al. Dignity and Psychosocial-Related variables in advanced and nonadvanced cancer patients by using the patient dignity Inventory-Italian version. J Pain Symptom Manag. 2017;53(2):279–87. Weng LC, Ku Y-L. Scale of self-perceived listening, empathy, and presence (LEP) abilities in associate degree nursing students for aging care. Geriatr Nurs. 2024;60:265–9. Wang X et al. Design and initial validation of a humanistic care evaluation tool. J Multidisciplinary Healthc, 2021: pp. 2307–13. Brousseau S, Cara CM, Biais R. A Humanistic Caring Quality of Work Life Model in Nursing Administration Based on Watson's Philosophy. Int J Hum Caring, 2017. 21(1). Zhang Y, et al. Framework of humanistic care for patients in the ICU: a preliminary study. Nurs Crit Care. 2024;29(1):125–33. Ryszewska-Łabędzka D et al. The association of self-esteem with the level of independent functioning and the primary demographic factors in persons over 60 years of age. International journal of environmental research and public health, 2022. 19(4): p. 1996. Ulfiana E, Saelindra M, Suyatmana SH. Level of independence towards self-esteem in the elderly . in 8th International Nursing Conference on Education, Practice and Research Development in Nursing (INC 2017 ). 2017. Atlantis Press. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8837471","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":597104190,"identity":"a3980eb5-f0fb-498f-9df4-476d70640820","order_by":0,"name":"Rostam Jalali","email":"","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Rostam","middleName":"","lastName":"Jalali","suffix":""},{"id":597104191,"identity":"f2c77abe-f471-4414-890a-1afb0a7bb4ef","order_by":1,"name":"Alireza Abdi","email":"","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Alireza","middleName":"","lastName":"Abdi","suffix":""},{"id":597104192,"identity":"9fbed3e7-c39e-4a12-a372-db7255b91f57","order_by":2,"name":"Parvin Abbasi","email":"","orcid":"","institution":"Kermanshah University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Parvin","middleName":"","lastName":"Abbasi","suffix":""},{"id":597104193,"identity":"fe60bae4-cc1f-4c5e-bc04-b10563516a77","order_by":3,"name":"Amir Jalali","email":"","orcid":"","institution":"Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah","correspondingAuthor":false,"prefix":"","firstName":"Amir","middleName":"","lastName":"Jalali","suffix":""},{"id":597104194,"identity":"11ae68cd-9f67-4d49-9a66-90c65ed87566","order_by":4,"name":"Mohammadrasool Ghasemianrad","email":"","orcid":"","institution":"Student Research committee, Kermanshah University of Medical Science, Kermanshah,","correspondingAuthor":false,"prefix":"","firstName":"Mohammadrasool","middleName":"","lastName":"Ghasemianrad","suffix":""},{"id":597104195,"identity":"debd47d7-c96e-4cbd-b368-6d6dfdde45ec","order_by":5,"name":"Mohsen Kazeminia","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDACHjApwcDGwHzwwQcgk42deC1syYYzQFqYidMCZqlJgzmEtOj2HH784WOORR4f+xk2aZtf2+T5mBkYgSK4tZidbTMwnLlNopiNJ/ewdW7fbcM2ZgZmyZnb8Gg5z2CQzLtNIrGNIS/xdm7PbUagFjZmXrxa2D8c/gvSwv/GQNqy57Y9YS1newybGUFaJHKMpBl+3E4krOXMmWLGXrCWZ8mGvQ23k9uYGZvx++VM+uYPP7fVJc7vTz744Mef27bz25sPfviIRwsqYGwDkw3EqgeBP6QoHgWjYBSMgpECACcAULI298thAAAAAElFTkSuQmCC","orcid":"","institution":"Zanjan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Mohsen","middleName":"","lastName":"Kazeminia","suffix":""}],"badges":[],"createdAt":"2026-02-10 06:56:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8837471/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8837471/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104006805,"identity":"bdbabe4a-a43a-4d81-ab43-a12feb98ce7f","added_by":"auto","created_at":"2026-03-05 15:11:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74168,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of study inclusion in the analysis\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8837471/v1/a4221b9ce766dbeb86f9e0d6.png"},{"id":107983423,"identity":"1cc6dde9-c3e3-480c-b78d-800249dc98f0","added_by":"auto","created_at":"2026-04-28 08:56:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":332759,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8837471/v1/5cac0f63-4188-4e7e-954a-816a3039363a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Humanistic care and older adults: A concept analysis using the Walker and Avant method","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAging is a natural, progressive, spontaneous, and irreversible physiological change in which both physical and mental capacities decline significantly [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Conventionally, aging begins with the onset of 65 years of age. Old age refers to the gradual deterioration in the structure and organism of the body that occurs due to aging and in changes in the structure and function of various body organs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith advances in modern medical science, the population of older adults is increasing markedly [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. According to reports by the World Health Organization (WHO), by the late 2050, the number of individuals aged over 60 years will exceed 2\u0026nbsp;billion [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Meanwhile, the increase in the older population will create challenges for the healthcare system, including greater needs for care related to chronic diseases, rehabilitation, and psychosocial interventions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, given the rapid growth in the number of older adults, issues related to hygiene, health, and ensuring their comfort and welfare in society are assuming new and broader dimensions each day, indicating the importance of paying attention to the older adult population [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHumanistic care is regarded as the principle and essence of caring for older adults [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In general, care encompasses belief in every human feeling, including value and humanity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Care is defined as a human science and the caregiver\u0026rsquo;s conscious presence with an individual, accompanying the individual\u0026rsquo;s life and growth [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Watson states that care is a science that encompasses humanity, represents experiences in care, and includes art and humanity [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Care is an art that is continuously growing and evolving [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In the theory of humanistic care, care involves interactions between two individuals with different life conditions and phenomenological domains. Care is an ethical ideal and entails the unique use of the self through movements, feelings, and touch to create unity between two individuals, within which healing, inner strength, and self-control of the care recipient can flourish [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExperts, academics, and researchers in the field of gerontological nursing critically examine the research and writings of this discipline based on their philosophical foundations and methodologies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Clear definitions of concepts make it possible to measure and apply them in research and practice; the outcome of this process is the production of theoretical foundations for the development of gerontological nursing and the analysis of its concepts [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Concept analysis studies, when derived from nursing practice, research, or theories, can contribute to the expansion of nursing knowledge [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Moreover, in gerontological nursing sciences, concept analysis is a prerequisite for the development and advancement of research [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. On the other hand, to expand nursing science through research in a scientific and logical manner, the use of concept analysis is essential [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Concept analysis leads to consensus and agreement on the meanings of gerontological nursing practice, knowledge, development, evolution, and research [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven that concept development is considered an important prerequisite for the progress and advancement of knowledge, various methods are used for concept development. One of these methods is concept analysis, which is recognized as a clear approach. There are various approaches to concept analysis, including those of Rogers, Wilson, Morse, and Walker and Avant. Among these, the Walker and Avant approach has characteristics such as triangulation, precise critical analysis, and relatively simple steps [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Concept analysis is also one of the useful study methods employed in the development and clarification of professional concepts, particularly in nursing, and among the diverse approaches to concept analysis, the Walker and Avant approach has proven useful for analyzing concepts related to nursing [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Despite the frequent use of this concept in nursing texts, a literature review shows that \u0026ldquo;humanistic care in the older adult\u0026rdquo; is often used descriptively, intuitively, or in relation to specific clinical contexts, and lacks a clear analytical definition, distinguishing features, and clear conceptual boundaries. This conceptual ambiguity has limited the possibility of operationalization, structured training, and empirical measurement of this concept. Accordingly, conducting a systematic concept analysis seems necessary to clarify the characteristics, antecedents, consequences, and empirical indicators of humanistic care in the older adult. The present study, using the approach of Walker and Avant, seeks to answer the following question: What are the characteristics of the concept of humanistic care in the older adult, under what conditions does it emerge, and what consequences does it entail?\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was conducted in 2025 with the aim of clarifying the concept of humanistic care in older adults and determining its dimensions based on the Walker and Avant approach [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In this approach, the process of analyzing a concept is undertaken to achieve a better understanding. This approach consists of eight steps: (1) selecting the concept, (2) determining the purpose of analysis, (3) identifying all uses of the concept under analysis, (4) determining the defining attributes of the concept, (5) identifying a model case, (6) identifying borderline and contrary cases, (7) identifying antecedents and consequences of the concept, and (8) defining empirical referents.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Search\u003c/h2\u003e \u003cp\u003eIn order to identify published articles relevant to the research objective, Persian databases SID (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sid.ir\u003c/span\u003e\u003cspan address=\"https://www.sid.ir\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) and MagIran (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.magiran.com\u003c/span\u003e\u003cspan address=\"https://www.magiran.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), as well as the international databases PubMed, Embase, Scopus, and Web of Science (WoS), were searched. Searches in these databases were conducted using the keywords \u0026ldquo;Humanist*,\u0026rdquo; \u0026ldquo;Old*,\u0026rdquo; \u0026ldquo;Geriat*,\u0026rdquo; \u0026ldquo;Elderlys,\u0026rdquo; \u0026ldquo;Elderlies,\u0026rdquo; \u0026ldquo;Elderly,\u0026rdquo; and \u0026ldquo;Aged.\u0026rdquo; Keyword validation was performed using MeSH in PubMed and Emtree in Embase. The searches were conducted in combination using the OR and AND operators. The search period covered from the inception of the aforementioned databases up to November 2025 in order to retrieve all potentially relevant studies. The search engines Google Scholar and Google, as well as the reference lists of all relevant articles and review studies, were also manually examined to maximize the comprehensiveness of the search. For example, the search strategy in the PubMed database was defined as follows:\u003c/p\u003e \u003cp\u003e(Humanist*) AND (((((((Elderly[Title/Abstract]) OR (Old*[Title/Abstract])) OR (Geriat*[Title/Abstract])) OR (Elderlys[Title/Abstract])) OR (Elderlies[Title/Abstract])) OR (Aged[Title/Abstract])) OR (Aged[MeSH Terms]))\u003c/p\u003e \u003cp\u003eTwo researchers independently performed the study procedures, and in cases of disagreement, the issue was discussed in face-to-face meetings. The initial search and screening of articles were conducted based on author name, title, and year of publication, and duplicate records were removed. In the next stage, article abstracts and subsequently full texts were reviewed, and articles that met the study objectives were included in the final analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe inclusion criteria were as follows: articles published in Persian or English, relevance to the concept of humanistic care in older adults, and availability of the full text.\u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe exclusion criteria included studies published in languages other than Persian and English, letters to editor, conference studies, animal studies, and lack of access to the full text after three email attempts to contact the corresponding author.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSummary of the study selection process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing the search strategies across various databases, a total of 4,035 studies were identified, of which 1,236 duplicate and overlapping records across databases were removed. Of the remaining 2,799 studies, 2,717 articles were excluded through title and abstract evaluation due to irrelevance to the topic. Subsequently, of the remaining 82 studies, 70 articles were excluded after full-text review because they did not meet the inclusion criteria. Therefore, 12 articles that met the inclusion criteria were included in the analysis (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral characteristics of the studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 12 studies published in English were included in the analysis. In total, there were five qualitative studies, three review studies, two interventional studies, and two descriptive studies (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. General characteristics of the studies\u003c/strong\u003e\u003c/p\u003e\n \u003ctable dir=\"rtl\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"766\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eResults\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eStudy type\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cstrong\u003e\u003cspan dir=\"LTR\"\u003eFirst author and year\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eThe use of human care factors had the greatest impact on emotions, particularly with regard to interaction, followed by gentleness.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eGrounded theory\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"LTR\"\u003eZhou et al. (2023) [23]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHumanistic care in older adults may lead to active aging, successful aging, productive aging, optimal aging, and vitality aging. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eReview\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eCheng (2020)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[9]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eA total of 12 subthemes were extracted. Structural level: rationalization of human resources, caring hospital environment, system and responsibilities; process level: caring communication, identification of individual needs, medication safety, prevention of high-risk patients, medical\u0026ndash;nursing collaboration, and humanistic literacy of nursing staff; outcome level: satisfaction, patient outcomes, and occurrence of adverse outcomes. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eQualitative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eYuan et al. (2025)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[24]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eThe use of lifelong learning as a means to promote physical and mental well-being is highly needed within the \u0026ldquo;concept of learning\u0026rdquo; from a humanistic perspective.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eDescriptive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eSarma and Bhagawati (2015)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[25]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eIndividualized nursing combined with humanistic care can significantly improve clinical outcomes, enhance quality of life, and reduce adverse psychological conditions in patients with gastric ulcers. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eInterventional\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eCai et al. (2020)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[26]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eThe results of sleep quality assessment scales, negative emotions, quality of life, and level of hope showed that, in the preoperative period, the overall effect of standard and humanistic nursing care throughout the entire period was significantly improved. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eInterventional\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eOu et al. (2021)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[27]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eImportant elements of humanistic care in caring for older adults residing in nursing homes include a friendly environment, comprehensive care, empathy, individualization, independence, participation in decision-making, appropriate use of tools, and serious consideration of clients\u0026rsquo; opinions.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eQualitative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eLee and Wang (2014)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[28]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eFactors influencing humanistic care among nurses in the care of older adults included level of education, marital status, personality, reason for employment, and the level of perceived care from colleagues (P \u0026lt; 0.05).\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eDescriptive\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eZhang et al. (2023)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[29]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eThe therapeutic effectiveness of humanistic care in older adults was classified into two main categories: (a) therapist characteristics (\u0026ldquo;being\u0026rdquo;); and (b) therapist behaviors (\u0026ldquo;doing\u0026rdquo;). The \u0026ldquo;being\u0026rdquo; category encompasses both attitudes, referring to therapists\u0026rsquo; perceptions of the frameworks and clinical roles they adopted that were most conducive to successful therapy, and embodiments, describing the positions and characteristics perceived by study participants as most effective. The \u0026ldquo;doing\u0026rdquo; category, in turn, includes both strategies, referring to the conceptualization of effective therapeutic approaches, and interventions, which describe the actual implementation of such approaches.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eQualitative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"LTR\"\u003eSpalding and Khalsa (2010) [30]\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTwo core beliefs are inherent in humanistic perspectives on aging: (1) the importance of self-concept and self-esteem throughout the life course, regardless of an individual\u0026rsquo;s economic or health status; and (2) the constructive role of the older person within an integrated intergenerational social matrix.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eReview\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eCharise and Eginton (2018)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[31]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eLandscape architectural design does not originate solely from humanistic thought and existence nor does it merely embody humanistic thought in landscape architecture design; however, its various aspects can be classified into two main directions: the embodiment of humanistic culture and the embodiment of humanistic care. Thus, both in actual design and in the perception of landscape architecture, attention is given to human thought and the humanistic spirit through these two pathways.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eQualitative\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eXing (2015)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[32]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 465px;\"\u003e\n \u003cp dir=\"LTR\"\u003eThemes of psychotherapy, presence, spirituality, and meaning are effective in the humanistic care of older adults.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eReview\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 196px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eSuri (2010)\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\"\u003e[33]\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\u003cbr\u003e\n\u003cp\u003e\u003cstrong\u003eStep one: Concept selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCare can be considered the core of clinical practice and the most vital and complex component of nursing knowledge. Valuing human beings constitutes the foundation of the nursing profession and the essence of care. Therefore, humanism in care is a fundamental necessity and a global priority for improving the quality of care [34]. Researchers and theorists have extensively explained the importance of the humanistic approach in gerontological nursing care. Paterson and Zderad regard it as a factor for the mutual growth of personality and the cultivation of humanity in both care recipients and nurses [35]. Parse considers humanistic behavior toward care recipients to be a fundamental factor in improving quality of life [36]. Watson states that care is a science that encompasses humanity, represents experiences and phenomena in care, and includes art and humanity [12]. Care is an art that is continuously growing and evolving [13]. In the theory of humanistic care, care involves interactions between two individuals with different life conditions and phenomenological domains. Care is an ethical ideal and entails the unique use of the self through movements, feelings, and touch in order to create unity between two individuals, within which healing, inner strength, and self-control of the care recipient can flourish [12]. The concept of humanistic care is considered an unavoidable aspect of caring for older adults, and there are varying degrees of unfamiliarity with humanistic care among all caregivers of older adults. Therefore, the present study can contribute to clarifying the concept of humanistic care and, consequently, to improving care for older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStep two: Determining the purpose of analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConcept analysis, in addition to clarifying ambiguous and confusing concepts, can elucidate frequently used concepts, distinguish a concept from similar yet different concepts, and provide a foundation for concept development [37]. The concept of humanistic care in older adults is one that requires clarification, as various interpretations may be derived from its apparent meaning. By applying the eight-step approach of Walker and Avant [20], the present study examines the meanings and characteristics of the concept of humanistic care in older adults. This process can lead to clarification of the concept and assist in identifying the presence or absence of humanistic care in older adults within caregiving situations, thereby enhancing caregivers\u0026rsquo; understanding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStep three: Identifying uses of the concept\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis step pertains to the defining attributes of the concept. Each concept may have more than one defining attribute. Appropriate characteristics and attributes of the concept must be considered in concept analysis [37]. Humanistic care for older adults refers to a type of care that is designed based on human principles and values, such as respect for dignity, as well as the needs and individual experiences of older adults [23, 24]. These attributes distinguish the concept of humanistic care from other forms of care, such as task-oriented and biologically focused care [38]. This type of care typically emphasizes emotional communication, empathy, and attention to the personality and life history of each individual [28]. In other words, humanistic care aims to support older adults in a holistic and comprehensive manner, addressing not only their physical needs but also their psychological, social, and spiritual needs [24, 32].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStep four: Determining the defining attributes of the concept\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe defining attributes of a concept are the characteristics and features that best explain the concept and play an important role in distinguishing the analyzed concept from similar concepts [37]. In general, humanistic care in older adults includes: (1) Respect for individuality: each older adult is regarded as a person with a unique history and specific experiences; (2) Empathy and emotional connection: establishing an interactive and emotional relationship that strengthens feelings of worth and belonging in older adults; (3) Inclusion in decision-making: older adults, as individuals with awareness and valuable experiences, participate in decisions related to their own lives; and (4) Attention to comprehensive needs: care involves consideration of the physical, psychological, social, and spiritual needs of older adults [24, 28, 32, 34]. Accordingly, humanistic care in older adults refers to the provision of services that, through attention to human characteristics and respect for the dignity of older adults, contribute to improving their quality of life [26, 27, 33].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStep five: Identification of a model case\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA model case should include all the defining attributes of the concept and represent a pure example of the concept under analysis [37]. The following model is presented to facilitate understanding of this concept:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModel case\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe care recipient is a 72-year-old older woman who has been transferred to a long-term care facility due to memory decline and physical problems. Her nurse, a 35-year-old man with four years of experience in caring for older adults, adopts a humanistic approach and initially spends a considerable amount of time listening to the older adult\u0026rsquo;s words, experiences, and feelings, thereby gaining a deep understanding of her needs and preferences. The nurse then decides to respect the older adult\u0026rsquo;s wishes. For example, the older adult prefers to spend most of her time outdoors in the facility\u0026rsquo;s garden and to wear clothing of her own choosing. Accordingly, the nurse involves her in daily decision-making and allows her to determine how activities are carried out and which options she selects. In addition, by establishing an emotional connection and demonstrating empathy, the nurse strengthens the older adult\u0026rsquo;s sense of safety and trust. Rather than relying on rigid and restrictive methods, the nurse seeks to incorporate human interaction, respect, and kindness into the care process. As a result of this approach, the older adult feels valued, respected, and a sense of belonging, and her quality of life and well-being in the long-term care facility improve, as all care is provided based on respect for her personality and individual needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStep six: Identification of borderline and contrary cases\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBorderline case:\u003c/strong\u003e A borderline case includes some, but not all, of the defining attributes of the concept and may differ from the target concept in one or more attributes [37]. The care recipient is an 80-year-old older woman with moderate dementia, mobility problems, and mild depression who is residing in a long-term care facility. She is highly anxious and distressed, feels unsafe, and may at times feel that her personality and identity are overlooked. At the same time, she desires to maintain relative independence in her daily activities; however, her physical limitations and memory impairment restrict her ability to perform personal tasks. In providing comprehensive care, the nurse disregards some of the older adult\u0026rsquo;s preferences, yet demonstrates empathy and respect in carrying out nursing interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContrary Case:\u003c/strong\u003e A contrary case can be described as something that is not recognized as the core concept [37]. The care recipient is a 78-year-old man with severe dementia, physical disability, and inability to establish effective communication. The youngest son of the family is responsible for his care. The son manages the older adult without considering his personal preferences and without regard for his feelings, wishes, or unique personality. In this approach, caregivers often provide care in a directive and controlling manner, without attention to the older adult\u0026rsquo;s emotional and psychological needs. For example, the older adult is forced to wear clothes he does not want or to engage in activities in which he has no interest. This type of care is contrary to the principles of humanistic care in older adults, leads to a reduction in the older adult\u0026rsquo;s sense of worth, trust, and satisfaction, and may create feelings of tension, anxiety, and insecurity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStep seven: Identification of antecedents and consequences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAntecedents:\u003c/strong\u003e Antecedents include activities, conditions, or events that occur prior to the manifestation of the concept [37]. Before implementing humanistic care in older adults, it is necessary to establish activities, conditions, and events that provide the essential foundations for delivering humane, respectful, and person-centered care. These include:\u003c/p\u003e\n\u003cp\u003e1. \u003cstrong\u003eComprehensive assessment of the older adult\u0026rsquo;s needs and individual status:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp;\u003cstrong\u003eCollection of life history:\u003c/strong\u003e Information regarding family background, preferences, interests, and personal values of the older adult [24].\u003cbr\u003e\u0026bull;\u0026nbsp;\u003cstrong\u003eAssessment of physical and mental health:\u003c/strong\u003e Evaluation of physical, psychological, social, and spiritual status to identify strengths and specific needs [31-33].\u003cbr\u003e\u0026bull; \u003cstrong\u003eIdentification of personal needs and preferences:\u003c/strong\u003e Understanding the older adult\u0026rsquo;s inclinations and wishes regarding activities, environment, communication, and care [23, 28].\u003c/p\u003e\n\u003cp\u003e2. \u003cstrong\u003eCreating an appropriate and safe environment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp;\u003cstrong\u003ePreparation of space and equipment:\u003c/strong\u003e A calm, safe, and comfortable environment in which respect for privacy and individual characteristics of the older adult is ensured [24, 28].\u003cbr\u003e\u0026bull; \u003cstrong\u003eFacilitating effective communication:\u003c/strong\u003e Provision of necessary tools and resources to enable easy communication, such as adapted methods for older adults with speech and hearing limitations [24, 29].\u003c/p\u003e\n\u003cp\u003e3. \u003cstrong\u003eEducation and preparation of the caregiving team:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull;\u0026nbsp;\u003cstrong\u003eTraining in humanistic care principles:\u003c/strong\u003e Caregivers should become familiar with the principles of respect, empathy, valuing, and participation [25, 28].\u003cbr\u003e\u0026bull; \u003cstrong\u003eTraining in active listening and human interaction:\u003c/strong\u003e Development of communicative and empathic skills when interacting with older adults [24, 29].\u003c/p\u003e\n\u003cp\u003e4. \u003cstrong\u003eCollaborative planning:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eConsultation with the older adult and family:\u003c/strong\u003e Involving them in decision-making whenever possible and incorporating individual wishes and needs into the care plan [23, 28, 30].\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eSetting individualized goals:\u003c/strong\u003e Defining care goals based on the older adult\u0026rsquo;s needs and preferences while respecting their personality and rights [28].\u003c/p\u003e\n\u003cp\u003e5. \u003cstrong\u003eDevelopment of guidelines and policies:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eFormulation of practical guidelines:\u003c/strong\u003e Guidelines related to the implementation of humanistic care principles, including methods of communication, participation, respect, and individualized care.\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eClarification of roles and responsibilities:\u003c/strong\u003e Assigning of duties within the caregiving team based on principles of respect and humaneness [23, 24, 28].\u003c/p\u003e\n\u003cp\u003e6. \u003cstrong\u003eProvision of emotional and psychological infrastructure:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003ePsychological support:\u003c/strong\u003e Creating opportunities for older adults to express their feelings and needs [28].\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eEstablishing a sense of safety:\u003c/strong\u003e Strengthening trust and fostering positive human relationships within the care environment [24, 28].\u003c/p\u003e\n\u003cp\u003eOverall, before initiating humanistic care in older adults, all of these conditions and activities must be established to ensure that person-centered, respectful, and effective care is provided and that the older adult feels safe and valued throughout the caregiving process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsequences:\u003c/strong\u003e Consequences are events that occur following the manifestation of the concept [37]. The consequences of humanistic care can be examined at three levels:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychological consequences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eReduction of depression and anxiety:\u003c/strong\u003e When older adults feel respected and cared for, levels of stress and feelings of worthlessness decrease.\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eIncreased sense of social belonging:\u003c/strong\u003e Human interaction enables older adults to feel that they are still part of society and the family.\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eIncreased life satisfaction:\u003c/strong\u003e Humanistic care in older adults enhances the quality of daily experiences and prevents loneliness and neglect [9].\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eStrengthening self-esteem:\u003c/strong\u003e Respectful treatment and involving older adults in decision-making reinforce their sense of worth [26, 27].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Physical and general health consequences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eImproved physical condition and increased longevity:\u003c/strong\u003e Research indicates that emotional support and human connection have a direct impact on the immune system [39, 40].\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eIncreased adherence to treatments:\u003c/strong\u003e With trust and empathy, older adults are more likely to follow medical recommendations [24].\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eReduced physical burnout among nurses and caregivers:\u003c/strong\u003e In a humanistic environment, positive and reciprocal relationships help maintain caregiving motivation [30].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Social and ethical consequences\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eStrengthening the quality of intergenerational relationships:\u003c/strong\u003e A humanistic approach facilitates the transfer of older adults\u0026rsquo; experiences and knowledge to younger generations [41, 42].\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003ePromotion of a culture of respect for aging in society:\u003c/strong\u003e It provides a model for a more ethical and humane approach within families and care institutions [28].\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eReduction of ageism:\u003c/strong\u003e Focusing on the human dignity of older adults helps correct instrumental or negative attitudes toward aging [41].\u003c/p\u003e\n\u003cp\u003eOverall, humanistic care in older adults leads to improved quality of life, satisfaction, and mental and physical health among older adults, while enhancing human relationships and professional ethics within care systems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStep eight: Empirical manifestation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEmpirical manifestation indicates how a concept is measured and the extent to which a definition is useful in measuring the concept and establishing its validity [37]. Instruments for measuring humanistic care in older adults assess the extent to which caregivers, nurses, or family members attend to the emotional, human, and personal values of older adults. These instruments are typically in the form of questionnaires, attitude scales, or care quality scales and are used across physical, psychological, social, and ethical domains. The most important and valid instruments for measuring humanistic care in older adults include the Watson Human Caring Questionnaire (CNPI), which aims to assess the extent to which caring behaviors based on compassion, empathy, respect, and human presence are demonstrated in care [43]. The Nursing Presence Instrument Scale (NPIS), designed to measure the quality of interaction between nurses and older adults in terms of communication, respect, empathy, and participation in decision-making [44]. The Patient Dignity Inventory (PDI), which focuses on the psychological and existential aspects of humanistic care, particularly in older adults and patients with chronic conditions [45]. The Listening, Empathy, and Presence Scale (LEP), assesses caregivers\u0026rsquo; abilities in mindful presence, listening, and genuine empathy toward older adults [46]. The Humanistic Care Evaluation Tool (HCET), intended to provide an overall assessment of the quality of humanistic care in nursing homes or care facilities [47]. Iranian localized instruments (such as the Persian versions of the Watson scale and the PDI). Valid instruments for assessing humanistic care in older adults generally focus on three main domains: human communication and empathy, respect for dignity and individual autonomy, and attention to the emotional and spiritual dimensions of care. These instruments are applied in nursing, psychology, gerontology research, and in the evaluation of service quality in elder care facilities.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of the study was to provide a comprehensive definition of the concept of humanistic care in older adults and to identify its defining attributes using the eight-step Walker and Avant approach. The construction and identification of related model, borderline, and contrary cases contributed to clearer delineation and description of the concept. The findings of the concept analysis of humanistic care in older adults indicated that this concept is multidimensional and dynamic, rooted in the philosophy of humanism, and emphasizes value, dignity, autonomy, and authentic relationships between the caregiver and the older adult. Components such as respect for the individuality of the older adult, empathy, nonjudgmental acceptance, the caregiver\u0026rsquo;s active presence, and strengthening a sense of meaning in life were identified as core principles of humanistic care.\u003c/p\u003e \u003cp\u003eThese attributes distinguish the concept of humanistic care from other forms of care, such as task-oriented and biologically focused care [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The findings are consistent with Watson\u0026rsquo;s perspective in the theory of caring science, which views care as a human, ethical, and interpersonal phenomenon rather than merely a set of technical activities [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the context of elder care, the realization of such care requires a deep understanding of the older adult\u0026rsquo;s lived experience and a focus on preserving meaning, independence, and connection to personal and social values [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn line with other studies, humanistic care is regarded as the heart of the nursing profession [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. This type of care moves away from mechanical and purely task-oriented models and emphasizes the human relationship between the caregiver and the care recipient; a relationship in which the older adult is seen not merely as a patient, but as a human being with a history, values, and psychosocial needs [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the context of caring for older adults, the importance of humanism is even more pronounced, as this age group often faces feelings of loneliness, reduced self-esteem, and fear of dependency or uselessness [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Humanistic care can enhance quality of life and satisfaction with care by fostering a sense of respect and belonging [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Particularly in care settings such as nursing homes, the human presence of the nurse\u0026mdash;beyond mere physical presence\u0026mdash;can play a decisive role in the lived experiences of older adults [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe concept analysis revealed that humanistic care in older adults is not merely a behavior but an attitude and professional disposition that arises from a deep understanding of human nature and the ethical values of nursing [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Therefore, to institutionalize this concept, the education of nurses and caregivers should be designed based on the philosophical and psychological foundations of humanism [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Moreover, managers and policymakers should provide supportive environmental and organizational conditions that enable the manifestation of humanistic behaviors such as dialogue, empathy, and mutual respect.\u003c/p\u003e \u003cp\u003eExamination of the antecedents showed that the presence of a humanistic attitude in caregivers, education grounded in the philosophy of humanism, and a supportive environment are essential factors for the emergence of humanistic behaviors [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In addition, sufficient time for communication, skills in active listening, and emotional reflection are among the conditions that facilitate the implementation of humanistic care [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In contrast, workload pressure, staff shortages, and an instrumental view of older adults are considered barriers to the realization of this model [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Ultimately, this study emphasized that humanism in the care of older adults was not an option but an ethical and professional necessity. Its implementation leads to improved mental health indicators, increased life satisfaction, and enhanced human dignity among older adults [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and future directions\u003c/h2\u003e \u003cp\u003eThe present study had several limitations, including lack of access to the full text of some articles and limited access of the researchers to certain databases. It appears that this study has taken the first step, namely concept exploration. Therefore, it is recommended that nursing researchers conduct further qualitative studies in this area in the future. In addition, future research may focus on developing instruments to measure humanistic behaviors in clinical settings and on examining the effects of educational interventions in this field.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHumanistic care in the elderly is a multidimensional and dynamic concept that is rooted in the philosophy of humanism and provides a distinctive framework for elderly care by emphasizing dignity, authentic connection, and holistic approach. By providing a structured definition of this concept, the present analysis paves the way for the development of nursing education, the design of care interventions, and future research in the field of aging.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is the result of research project No. 401400414 approved by the Student Research Committee of Kermanshah University of Medical Sciences. We would like to thank the esteemed officials of that center for accepting the financial expenses of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM.K, R.J and A.J contributed to the design, M.K and R.J participated in most of the study steps. M.K, A.A and P.A prepared the manuscript M.K and M.G assisted in designing the study, and helped in the, interpretation of the study. All authors have read and approved the content of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBy Deputy for Research and Technology, Kermanshah University of Medical Sciences (IR) (401400414). This deputy has no role in the study process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDatasets are available through the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was received from the ethics committee of deputy of research and technology, Kermanshah University of Medical Sciences (401400414). The study design strictly adhered to the ethical principles of the Declaration of Helsinki (including beneficence, non-maleficence, autonomy, and justice).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participante declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLi Z, et al. Aging and age-related diseases: from mechanisms to therapeutic strategies. 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Nurs Crit Care. 2024;29(1):125\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyszewska-Łabędzka D et al. \u003cem\u003eThe association of self-esteem with the level of independent functioning and the primary demographic factors in persons over 60 years of age.\u003c/em\u003e International journal of environmental research and public health, 2022. 19(4): p. 1996.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlfiana E, Saelindra M, Suyatmana SH. \u003cem\u003eLevel of independence towards self-esteem in the elderly\u003c/em\u003e. in \u003cem\u003e8th International Nursing Conference on Education, Practice and Research Development in Nursing (INC 2017\u003c/em\u003e). 2017. Atlantis Press.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Analysis, Concept formation, Humanism, Aged","lastPublishedDoi":"10.21203/rs.3.rs-8837471/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8837471/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eHumanistic care is considered one of the central concepts in geriatric nursing; however, the application of this concept in scientific literature is accompanied by multiple definitions, heterogeneous perceptions, and unclear conceptual boundaries. The lack of an analytical and structured definition has made it difficult to design care interventions, professional training, and empirical assessment of this concept. Objective: This study aimed to analyze and clarify the concept of \"humanistic care in the older adults \" based on the approach of Walker and Avant.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eConcept analysis was performed using Walker and Avant's eight-step method. A comprehensive search was conducted in Persian (SID, MagIran) and international (PubMed, Embase, Scopus, Web of Science) databases without time limits until November 2025 with relevant keywords validated with MeSH/Emtree. After systematic screening, 12 relevant studies were included in the final analysis.\u003c/p\u003e\u003ch2\u003eFindings:\u003c/h2\u003e \u003cp\u003eHumanistic care in the older adults is a multidimensional, dynamic concept rooted in the philosophy of humanism. Its defining characteristics include respect for the individuality of the elderly, empathy, authentic communication, participation in decision-making, conscious presence of the caregiver, and simultaneous attention to the physical, psychological, social, and spiritual dimensions of the older adults life. The antecedents of this concept at the individual, organizational, and structural levels and its consequences at the psychological, physical, and social levels were identified.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings of this analysis provide a clearer conceptual framework of humanistic care in the older adults, which can serve as a basis for developing nursing education, designing care interventions, and constructing valid measurement tools in the field of aging.\u003c/p\u003e","manuscriptTitle":"Humanistic care and older adults: A concept analysis using the Walker and Avant method","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-05 15:08:19","doi":"10.21203/rs.3.rs-8837471/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"11fed095-6746-47f2-9b3f-74d132774eda","owner":[],"postedDate":"March 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T08:54:33+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-05 15:08:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8837471","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8837471","identity":"rs-8837471","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}