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Integrating value-based reflection into the 7E teaching model in nursing rounds: Effects on nursing students’empathy, moral sensitivity, humanistic care, and patient safety—A quasi-experimental study

This quasi-experimental study demonstrates that integrating value-based reflection into the 7E teaching model for nursing rounds significantly enhances nursing students' empathy, moral sensitivity, humanistic care, and patient safety competence compared to traditional instruction.

Original authors: Na Zhang, Xue Zhang, Chenlin Yu, Hanyu Li, Shaoli Zhang, Junfan Zhou, Minling Mo

Published 2026-07-14

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CC BY 4.0

Original authors: Na Zhang, Xue Zhang, Chenlin Yu, Hanyu Li, Shaoli Zhang, Junfan Zhou, Minling Mo

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine nursing school as a giant, high-stakes video game where the goal isn't just to press the right buttons to fix a patient's heart rate, but to actually feel what the player character (the patient) is going through. For a long time, the "old school" way of teaching this game was like watching a speedrun tutorial: a teacher stood at the front, recited the rules and the map, and the students just nodded along, waiting for the next instruction. It was efficient for memorizing facts, but it often left students feeling like they were just following a script, missing the emotional texture of the game.

A team of researchers at Shanghai Sixth People's Hospital decided to try a different "game mode." They took 119 nursing students (55 in the old-school group and 64 in the new group) and tested a new teaching strategy called the 7E model, but with a secret sauce: value-based reflection. Think of this not as a simple upgrade, but as adding a "moral compass" and an "empathy engine" directly into the game's code.

The New Game Mode: The 7E Loop
Instead of just listening, the new method takes students through seven distinct stages, like levels in a quest:

Elicit: The teacher drops a real-life mystery case (like a patient with liver issues acting strangely) and asks, "What's wrong?" but also, "How does this patient feel right now?"
Engagement: Students go to the bedside (or simulate it) to interview the "player" and family, learning to listen not just for symptoms, but for fear and confusion.
Exploration: They debate solutions. It's not just "give this medicine," but "if we are short on staff, how do we decide who gets help first without being unfair?"
Explain: The teacher fills in the gaps, showing the "why" behind the rules.
Elaborate: This is the boss battle. Students run high-fidelity simulations where a patient gets agitated. They have to practice restraining them safely while respecting their dignity—a tricky balance of "keep them safe" vs. "respect their freedom."
Evaluate: Everyone stops to review. "Did I sound like a robot or a human?"
Extend: Students write a diary and create health guides for the community, realizing their job doesn't end at the hospital door.

The Result: Leveling Up
The researchers measured four specific "stats" before and after the training: Empathy (how well you understand others), Moral Sensitivity (spotting ethical dilemmas), Humanistic Care (treating people with kindness), and Patient Safety Competence (keeping patients from getting hurt).

Before the training, both groups were on the exact same level. But after the intervention, the group using the 7E model with the "moral compass" showed a massive jump. They scored significantly higher in all four categories compared to the traditional group.

Empathy: They got much better at "perspective taking" (seeing the world through the patient's eyes) and "compassionate care." Interestingly, one tiny part of empathy called "standing in the patient's shoes" didn't show a huge statistical change. The authors suggest this might be because that specific trait is like a deep-seated personality habit that takes longer to change than a skill you can learn in a few weeks.
Moral Sensitivity: The new group became much better at spotting ethical traps, like when a patient's safety clashes with their right to say "no."
Humanistic Care: They moved from just "doing tasks" to actually connecting with patients, helping them feel hope and understood.
Patient Safety: This is the big one. The new group didn't just learn how to be safe; they learned why safety matters. By linking safety to human dignity (e.g., "we check this bandage not just because it's a rule, but because it protects this person's dignity"), they became much better at preventing errors.

What This Doesn't Mean
It's important to note what the paper doesn't say. The researchers didn't claim this is a magic pill that fixes everything forever. They only tested this in one hospital in Shanghai. They also didn't follow the students for years to see if they kept these skills after they graduated and started working full-time. The study measured the immediate effect right after the training, so while the results are strong, we don't know yet if the "empathy engine" stays running for a decade.

The Bottom Line
The study suggests that when you mix a structured, problem-solving teaching style (the 7E model) with deep, guided reflection on values, nursing students don't just become better technicians; they become more human, more ethical, and safer caregivers. It's like realizing that to win the game, you have to care about the characters, not just the score. The traditional "listen and repeat" method wasn't wrong, but it was missing the extra layer that turns a student into a truly compassionate nurse.

Technical Summary: Integrating Value-Based Reflection into the 7E Teaching Model in Nursing Rounds

Problem Statement
Contemporary nursing practice requires the integration of professional competence with value judgments, particularly in complex clinical environments where safeguarding patient safety, addressing ethical dilemmas, and providing humanistic care are paramount. However, traditional nursing rounds education often relies on a teacher-centered, one-way transmission of knowledge. This approach emphasizes mechanical recitation and passive listening, neglecting the cultivation of self-directed learning, critical thinking, and deep value-based reflection. Consequently, a significant gap exists between the educational goal of producing well-rounded nursing professionals and the current reality of teaching, where humanistic care is often addressed superficially, and students struggle to engage with multidimensional clinical situations involving ethical conflicts. While inquiry-based models like the 7E teaching model (Elicit, Engagement, Exploration, Explain, Elaborate, Evaluate, Extend) have shown promise in improving critical thinking and clinical skills, their application in nursing rounds has not yet systematically integrated value-based reflection to specifically target empathy, moral sensitivity, and patient safety competence.

Methodology
This study employed a quasi-experimental design to evaluate the effectiveness of a 7E teaching model integrated with value-based reflection.

Participants: A convenience sampling method was used to recruit nursing students from a tertiary hospital in Shanghai. The control group consisted of 55 students who completed their clinical internship from June 2024 to March 2025 and received traditional nursing rounds instruction. The experimental group consisted of 64 students who completed their internship from June 2025 to March 2026 and received the intervention.
Intervention: The experimental group underwent nursing rounds based on the 7E model, where guided, structured reflections on patient safety, ethical dilemmas, and humanistic care were embedded into each stage:
- Elicit: Case introduction with questions prompting reflection on patient dignity.
- Engagement: Bedside interviews and literature reviews focusing on communication and empathy.
- Exploration: Group discussions and debates on nursing priorities, addressing resource allocation and ethical trade-offs.
- Explain: Systematic instruction emphasizing rigor, truthfulness, and safety.
- Elaborate: High-fidelity scenario simulations (e.g., managing agitation) requiring ethical decision-making and balancing safety with autonomy.
- Evaluate: Multi-source feedback (self, peer, teacher) including emotional sharing and reflection on professional mission.
- Extend: Reflective diary writing and community health education to expand professional responsibility.
Measures: Data were collected before and after the intervention using four validated instruments: the Jefferson Scale of Physician Empathy for Nursing Students (JSPE-NS), the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS), the Humanistic Caring Ability of Nursing Undergraduates Assessment Scale, and the Patient Safety Competency Nurse Evaluation Scale (PSCNES).
Analysis: Data were analyzed using SPSS version 27.0. Independent samples t-tests and chi-square tests were used for between-group comparisons, while paired t-tests assessed intra-group changes.

Key Results
Before the intervention, no statistically significant differences were observed between the control and experimental groups regarding empathy, moral sensitivity, humanistic care ability, or patient safety competence ( $P > 0.05$ ). Following the intervention, the experimental group demonstrated significantly higher scores than the control group across all four outcome measures and their respective dimensions ( $P < 0.05$ ).

Empathy: The experimental group showed significant improvements in total scores, perspective taking, and compassionate care ( $P < 0.001$ ). The control group showed no significant changes.
Moral Sensitivity: The experimental group significantly improved in protecting patient safety, respecting individuals, and maintaining confidentiality ( $P < 0.001$ ), whereas the control group showed no significant changes.
Humanistic Care: The experimental group significantly improved in all eight dimensions and total scores ( $P < 0.001$ ). The control group showed significant but smaller improvements in four dimensions (instilling faith/hope, health education, altruistic values, and scientific problem solving).
Patient Safety Competence: The experimental group significantly outperformed the control group in all seven dimensions and total scores ( $P < 0.001$ ). While the control group improved in three dimensions, the magnitude of improvement was lower than that of the experimental group.

Key Contributions
The study contributes to clinical nursing education by empirically validating a teaching protocol that systematically embeds value-based reflection into the structured 7E inquiry cycle. Unlike previous applications of the 7E model that focused primarily on cognitive and skill acquisition, this research demonstrates that integrating specific reflective prompts at each stage (from case elicitation to community extension) effectively enhances soft skills and ethical competencies. The study provides a concrete framework for transforming nursing rounds from passive knowledge transmission into an active, value-laden learning experience that addresses the "gap" between clinical skills and professional values.

Significance and Claims
The authors claim that the 7E teaching model integrated with value-based reflection is an effective strategy for enhancing nursing students' empathy ability, moral sensitivity, humanistic care ability, and patient safety competence. They posit that by embedding ethical reflection as an implicit thread throughout the clinical learning process—rather than isolating it in separate ethics courses—students can better internalize professional values and translate them into practice. The study suggests that this approach helps students move from understanding concepts to applying them in complex, real-world scenarios, thereby cultivating nursing professionals with comprehensive competencies.

Limitations and Modesty
The authors acknowledge several limitations. The study was conducted in a single tertiary hospital, which may limit the generalizability of the findings due to potential selection bias and variations in teaching environments across different regions. Additionally, the outcome assessments were conducted immediately post-intervention; the study did not include longitudinal follow-up to determine the sustainability of these effects once students entered independent clinical practice. The authors note that the lack of significant change in the "standing in the patient's shoes" dimension of the empathy scale may be due to the small number of items in that subscale or the need for longer intervention periods to alter deep-seated cognitive tendencies. Future research is suggested to employ multicenter randomized controlled trials and longitudinal designs to further validate these findings.

Technical Summary: Integrating Value-Based Reflection into the 7E Teaching Model in Nursing Rounds

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