Reframing the Kirkpatrick model for evaluating humanistic care training in nursing: a context-sensitive integrative perspective

This perspective article critically examines the application of the Kirkpatrick model (KM) to humanistic care training in hospital-based nursing practice. While KM is widely used as a multi-level evaluation framework, its conventional linear interpretation may be insufficient for assessing relational competencies within complex clinical systems. Drawing on contemporary educational evaluation theory and empirical nursing education research, we argue that KM should be reconceptualized as a context-sensitive and probabilistic framework rather than a deterministic causal sequence. We scrutinize methodological challenges across all four levels—reaction, learning, behavior, and results—with particular emphasis on behavioral transfer, causal attribution, contextual confounding, and the limitations of self-reported measures. To enhance methodological rigor and practical applicability, we propose minimum validity conditions for each level and introduce an operationalized evaluation matrix tailored to humanistic care training. We further discuss the integration of technology-enhanced modalities, including simulation and virtual reality, as tools for strengthening multi-level evaluation. By reframing KM through an integrative health sciences lens, this perspective article provides structured, actionable guidance for designing and interpreting evaluation strategies in real-world nursing environments.