3C Guided Reflection Combined with Scenario Simulation Enhances Humanistic Care Ability Among Nursing Students: A Mixed Methods Study

3C Guided Reflection Combined with Scenario Simulation Enhances Humanistic Care Ability Among Nursing Students: A Mixed Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 3C Guided Reflection Combined with Scenario Simulation Enhances Humanistic Care Ability Among Nursing Students: A Mixed Methods Study Lina Ma, Jimei Luo, Changxiu Li, Yan Wang, Qian Su, Luwen Luo, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9233948/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: Humanistic care is the essence of nursing practice. However, nursing education currently faces challenges including monotonous training methods and disconnection between theory and practice, highlighting the urgent need to explore effective new teaching models. Based on reflective practice theory, this study aims to examine the effects of 3C (Context, Content, Course) guided reflection combined with scenario simulation teaching on the humanistic care ability of undergraduate nursing students. Methods: A sequential explanatory mixed methods design was employed. In the first phase, 350 undergraduate nursing students enrolled in 2024 at a medical university in Guizhou Province were randomly assigned to an experimental group(n=200) or control group(n=150) using cluster random sampling. The experimental group received integrated teaching consisting of " theoretical instruction + scenario simulation + 3C guided reflection," while the control group received traditional theoretical instruction. The Caring Ability Inventory, theoretical knowledge tests, and satisfaction questionnaires were used for outcome evaluation. In the second phase, 40 nursing students were purposively selected from the experimental group for semi-structured in-depth interviews, and data were analyzed using thematic analysis. Results: Following the intervention, the experimental group demonstrated significantly higher total scores of humanistic care ability (194.63±12.85 vs. 173.96±10.58) and scores across all dimensions (understanding, courage, patience) compared to the control group (all P<0.0001). Theoretical test scores were also significantly higher in the experimental group (71.71±18.14 vs. 67.80±20.69, P<0.05), and students reported high levels of classroom satisfaction. Qualitative analysis revealed four core themes: deep awakening of empathy, 3C feedback as a scaffold for cognitive reconstruction, courage cultivation in a safe environment, and internalization of care into professional identity. Conclusion: The 3C guided reflection combined with scenario simulation teaching model, grounded in reflective practice theory, effectively enhances the humanistic care ability and theoretical knowledge of undergraduate nursing students. By constructing a complete "experience-reflection-abstraction" learning cycle, this model promotes the internalization of humanistic care from external requirements into stable professional competencies, providing both theoretical and practical evidence for nursing humanities education reform. 3C guided reflection Scenario simulation Humanistic care ability Reflective practice Mixed methods study Nursing education Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 03 May, 2026 Reviewers agreed at journal 02 May, 2026 Reviews received at journal 01 May, 2026 Reviewers agreed at journal 01 May, 2026 Reviews received at journal 26 Apr, 2026 Reviewers agreed at journal 24 Apr, 2026 Reviews received at journal 24 Apr, 2026 Reviewers agreed at journal 24 Apr, 2026 Reviewers invited by journal 24 Apr, 2026 Editor invited by journal 01 Apr, 2026 Editor assigned by journal 30 Mar, 2026 Submission checks completed at journal 30 Mar, 2026 First submitted to journal 26 Mar, 2026 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. 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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-9233948","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634090698,"identity":"391def65-e48e-41bd-86ec-d5dd39e0639d","order_by":0,"name":"Lina Ma","email":"","orcid":"","institution":"Zunyi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lina","middleName":"","lastName":"Ma","suffix":""},{"id":634090700,"identity":"7e7224eb-ea72-4319-9b9c-267fe223b387","order_by":1,"name":"Jimei Luo","email":"","orcid":"","institution":"The Second Affiliated Hospital of Zunyi Medical 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12:10:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9233948/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9233948/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108804110,"identity":"29aef49c-65f6-4347-b147-19679ef1d883","added_by":"auto","created_at":"2026-05-08 15:15:58","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":474925,"visible":true,"origin":"","legend":"","description":"","filename":"revisedmanuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9233948/v1_covered_fe7bd5e1-515d-40f5-9115-7cdf724c0e1d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"3C Guided Reflection Combined with Scenario Simulation Enhances Humanistic Care Ability Among Nursing Students: A Mixed Methods 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"3C guided reflection, Scenario simulation, Humanistic care ability, Reflective practice, Mixed methods study, Nursing education","lastPublishedDoi":"10.21203/rs.3.rs-9233948/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9233948/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Humanistic care is the essence of nursing practice. However, nursing education currently faces challenges including monotonous training methods and disconnection between theory and practice, highlighting the urgent need to explore effective new teaching models. Based on reflective practice theory, this study aims to examine the effects of 3C (Context, Content, Course) guided reflection combined with scenario simulation teaching on the humanistic care ability of undergraduate nursing students.\u003c/p\u003e\n\u003cp\u003eMethods: A sequential explanatory mixed methods design was employed. In the first phase, 350 undergraduate nursing students enrolled in 2024 at a medical university in Guizhou Province were randomly assigned to an experimental group(n=200) or control group(n=150) using cluster random sampling. The experimental group received integrated teaching consisting of \" theoretical instruction + scenario simulation + 3C guided reflection,\" while the control group received traditional theoretical instruction. The Caring Ability Inventory, theoretical knowledge tests, and satisfaction questionnaires were used for outcome evaluation. In the second phase, 40 nursing students were purposively selected from the experimental group for semi-structured in-depth interviews, and data were analyzed using thematic analysis.\u003c/p\u003e\n\u003cp\u003eResults: Following the intervention, the experimental group demonstrated significantly higher total scores of humanistic care ability (194.63±12.85 vs. 173.96±10.58) and scores across all dimensions (understanding, courage, patience) compared to the control group (all P\u0026lt;0.0001). Theoretical test scores were also significantly higher in the experimental group (71.71±18.14 vs. 67.80±20.69, P\u0026lt;0.05), and students reported high levels of classroom satisfaction. Qualitative analysis revealed four core themes: deep awakening of empathy, 3C feedback as a scaffold for cognitive reconstruction, courage cultivation in a safe environment, and internalization of care into professional identity.\u003c/p\u003e\n\u003cp\u003eConclusion: The 3C guided reflection combined with scenario simulation teaching model, grounded in reflective practice theory, effectively enhances the humanistic care ability and theoretical knowledge of undergraduate nursing students. By constructing a complete \"experience-reflection-abstraction\" learning cycle, this model promotes the internalization of humanistic care from external requirements into stable professional competencies, providing both theoretical and practical evidence for nursing humanities education reform.\u003c/p\u003e","manuscriptTitle":"3C Guided Reflection Combined with Scenario Simulation Enhances Humanistic Care Ability Among Nursing Students: A Mixed Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-05 12:12:03","doi":"10.21203/rs.3.rs-9233948/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-03T04:04:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72014373151887201112205210873755142790","date":"2026-05-03T03:32:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-01T14:52:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"268303023780477420697306753885483773944","date":"2026-05-01T14:39:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-26T23:22:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227429187085197611933777145525564684511","date":"2026-04-24T22:06:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T15:12:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238542761225385737175225935145906740650","date":"2026-04-24T15:03:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-24T11:20:36+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-01T04:51:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-30T13:05:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-30T13:04:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-03-26T12:01:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5549fe6f-0287-423b-a0ae-05908bba08b9","owner":[],"postedDate":"May 5th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-03T04:04:17+00:00","index":51,"fulltext":""},{"type":"reviewerAgreed","content":"72014373151887201112205210873755142790","date":"2026-05-03T03:32:13+00:00","index":50,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-01T14:52:06+00:00","index":49,"fulltext":""},{"type":"reviewerAgreed","content":"268303023780477420697306753885483773944","date":"2026-05-01T14:39:43+00:00","index":48,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T12:12:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-05 12:12:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9233948","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9233948","identity":"rs-9233948","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}