As professional disciplines based on scientific evidence, the scientific rigor of medicine and nursing is unquestionable. However, the objects of medical treatment and care are “people.” Therefore, emphasis has been given to humanistic education of medical and nursing students in medical schools internationally, hoping to nurture students to expand their medical work from examining the patients’ bodies to taking care of them at the psychological, social, and economic levels with humanistic quality [1].
“Caring” is emphasized in humanism because it is the essence of good human nature [2, 3]. For a long time, most nursing personnel have started to reconceptualized and infused caring behavior with empathy. However, analyzing the issue from caring theories, “empathy” is only one aspect of caring [4]. In addition, when examining the entire healthcare system from the perspective of establishing and maintaining a doctor-patient relationship, the treatment by doctors and the care by nurses are the realization of establishing and maintaining a caring relationship. Therefore, how to infuse the humanistic competence in the training of healthcare professionals is the only way to achieve medical humanities that “takes patients as the center,” and the interdisciplinary cooperation between medical education and other fields is necessary before this can be realized [5].
Pan et al. (2004) designed the “Questionnaire on Humanistic Care Provided by Medical Students” to examine how 461 medical students of 3 domestic medical universities provide humanistic care [6]. The questionnaire included 10 questions in four dimensions, namely “passion for helping others,” “care for patients,” “professional physician responsibility,” and “willingness to serve the society.” The internal consistency reliability (Cronbach’s α) was 0.77. The results showed that medical students in junior levels had higher passion and willingness to serve society than the students in senior levels; this could be partly attributed to the fact that most medical humanities courses were arranged at junior levels. At the same time, the students in senior levels were in closer contact with the workplace and were more pragmatic as they were affected by the utilitarianism of society.
To bridge the gap of Pan et al.’s study, Kao et al. [7] used a longitudinal research method on the first-year students from the medical departments of seven medical schools, using the Patient-Practitioner Orientation Scale (PPOS) designed by Krupat et al. [8] to measure the changes in medical students’ patient-centered attitude in treatment at four time points. There are 18 questions in the PPOS, divided into the two dimensions of sharing and caring. After five years of follow-up, the study obtained 372 valid samples and found that when the students moved to upper grades and were exposed to more medical knowledge, they tended to be more physician-centered. Furthermore, the female students generally preferred patient-centered medical care and were more positive than male students in sharing information and co-decision-making, and showed a higher degree of warmth and support toward the patients. The above results are also similar to the findings of related foreign studies [9, 10].
“Caring” has gradually been taken as the core and essence of medical professions [5]. From 1975 to 1979, Jean Watson developed the human caring theory that covers ten caring-related factors [11], while Kristen Swanson outlined five processes of caring: knowing, being with, doing for, enabling, and maintaining belief, in 1995 [12]. Scholars have introduced both theories and used them in clinical practice because good-quality and professional care can raise patients’ hope and speed their recovery [4, 5]. Considering the cultural differences between the East and the West,, Lin’s qualitative study develops a caring behaviors scale that includes three dimensions: (1) 16 questions concerning helping patients through the rocky process of fighting the disease; (2) 7 questions concerning protecting the rights and interests of patients; (3) 5 questions concerning understanding the needs of patients [13]. To explore the clinical differences between different types of patients and medical situations, as well as the needs and contributions to caring behaviors of nursing personnel and patients, Lee et al. used the scale of the caring behavior designed by Lin to analyze the differences and correlations between nurses’ performances and patients’ feelings about caring behaviors [14]. The result showed that: The nurses’ feelings for their caring behaviors were significantly weaker than that of the patients, but when the nurses’ rates on their own caring behaviors were higher, the patients’ feelings also improved.
The above-mentioned studies show that the humanistic quality of medical and nursing students has become an important issue in medical education. In particular, as Confucianism influences Chinese communities, the interactions between “one and oneself,” “one and others,” as well as “one and the society and the environment” are emphasized in the connotation of humanistic education [15]. This serves the basis for designing and categorizing the initial question pools in this study, with an aim to provide a reference for relevant units to practice the use of assessment tools to measure the effectiveness of the education of humanistic caring competence among medical and nursing students.