Contextual Adaptation and Psychometric Evaluation of the Healthcare Professional Humanization Scale for Undergraduate Nursing Students: The HUMAS-E Study

In the high-stakes world of healthcare, the most effective care often extends far beyond the technical mastery of a procedure or the precise administration of medication. It resides in the human connection between the caregiver and the person receiving help. This concept, known as humanization, involves recognizing a patient as a whole person with emotional, social, and ethical needs that exist alongside their physical condition. It is the ability to combine clinical skill with empathy, clear communication, and a genuine therapeutic relationship. While medical technology continues to advance, there is a growing concern that the focus on data and efficiency might push these essential relational qualities to the background. For nurses, who spend the most time with patients, cultivating this human side is not just a soft skill but a core component of professional identity. However, these qualities do not simply appear once a nurse begins working; they are shaped during the years of university education, where students learn to navigate the tension between rigid clinical protocols and the messy, vulnerable reality of human suffering.

To ensure that nursing programs are successfully teaching these vital skills, educators need reliable ways to measure them. For years, researchers have used a specific tool called the Healthcare Professional Humanization Scale to assess how well practicing nurses embody these qualities. This scale breaks down the broad idea of humanization into five distinct areas: a positive and hopeful outlook, the ability to connect socially with others, the capacity to understand the emotions of patients, a sense of confidence in one's own abilities, and the management of one's own emotional reactions to difficult situations. But a significant problem arose when educators tried to use this tool with students. The original questions were written for experienced professionals who make independent decisions and manage complex caseloads. Asking a student who is still learning under strict supervision to answer questions about autonomous practice was like asking a novice driver to rate their performance on a racetrack they have never been allowed to drive on. The questions did not fit their reality, and the results might have been misleading.

A team of researchers from several Spanish universities set out to fix this mismatch. Their goal was to carefully adapt the existing scale so that it reflected the actual experiences of undergraduate nursing students without losing the original meaning of the five key areas. They did not simply translate the words; they rebuilt the context. The process began with a group of fifteen nursing students from different years of their training who reviewed the questions to see if they made sense in a student's world. They pointed out phrases that assumed a level of independence they did not yet possess. A multidisciplinary committee of experts, including psychologists and senior nurses, then reviewed these changes to ensure the core concepts remained intact. Finally, a small group of students tested the new version to check for clarity. The result was a new instrument, called HUMAS-E, designed specifically to capture how students perceive their own growing ability to provide humanized care.

The researchers then put this new tool to the test with a large group of 344 nursing students from public and private universities across Spain. These participants ranged from first-year students to those in their final year of study. The team analyzed the responses to see if the five-part structure of the original scale held up when applied to students. The analysis confirmed that the adapted scale worked well. The five dimensions—hopeful outlook, social connection, emotional understanding, self-confidence, and emotional management—remained distinct and reliable. The students' answers consistently grouped together in the way the researchers had predicted, suggesting that the tool successfully measures what it claims to measure in this specific population. The internal consistency was strong, meaning that the questions within each category were all asking about the same underlying trait in a coherent way.

However, the study also revealed some important nuances that educators must keep in mind when using the results. One of the five areas, which focuses on how students manage their own emotional reactions to distress or anxiety, behaved differently from the others. While it was still a valid part of the scale, it did not correlate as strongly with the other four areas as the researchers had hoped. This suggests that managing one's own feelings is a slightly different skill than understanding the feelings of others or feeling confident in one's abilities. Furthermore, the researchers noticed a widespread tendency for students to choose the most positive answers available. This phenomenon, known as a ceiling effect, was particularly strong in the area of social connection, where nearly two-thirds of the students selected the highest possible rating. This does not necessarily mean the students are perfect; it may simply reflect that they value these traits highly or feel pressure to present themselves in the best possible light. Because so many students scored at the top, the tool might struggle to distinguish between those who are very good and those who are excellent, or to detect small improvements after training.

The researchers also looked at whether the tool worked the same way for students at the beginning of their training compared to those nearing graduation. The structure of the scale appeared stable across both groups, suggesting that the five areas of humanization are relevant throughout the entire educational journey. Yet, because the group of first and second-year students was smaller than the group of seniors, the researchers could not definitively prove that the scores are directly comparable between the two stages. They caution that while the tool is excellent for looking at the overall profile of a group of students, it should not yet be used to make high-stakes decisions about individual students or to claim that a student has definitively mastered a skill based on a single score.

Ultimately, this study provides a validated way for nursing programs to explore the human side of their students' development. It confirms that the five pillars of humanized care identified in experienced professionals are also meaningful for students, provided the questions are phrased to fit their current reality. The tool offers a structured way to see where a group of students feels strong and where they might need more support. But the findings also serve as a reminder that humanization is complex. It is not a single trait that can be summed up in one number, and it is not something that can be measured without considering the context of the student's experience. By using this adapted scale, educators can better understand the emotional and relational landscape of their students, helping to ensure that the next generation of nurses is equipped not just with technical knowledge, but with the human connection that defines truly compassionate care.