The relationship between professional values,ethical sensitivities and caring behaviors among nursing students: A structural equation modeling approach

AimTo examine the relationship between professional values, ethical sensitivity and caring behaviors among nursing students and determine whether professional values play a moderator role in the relationship between ethical sensitivity and caring behaviors among nursing students.BackgroundDeveloping professional nursing values, ethical sensitivity and caring behaviors is critical in nursing programs from the first year to graduation to prepare students for increasingly complex and diverse work environments.DesignA cross‐sectional study using structural equation modeling. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.MethodsThis study was conducted with 189 undergraduate nursing students. The study was conducted in a four-year nursing faculty in the Mediterranean region of Turkey from February to June 2022. Data were collected using a personal information form, the Nurses’ Professional Values Scale, the Moral Sensitivity Questionnaire and the Caring Behaviors Assessment Tool Nursing Version-Short Form.ResultsWe found that nursing students' perceptions of professional values and caring behaviors were high and their ethical sensitivity was moderate. Nursing students who are successful in high school have higher professional values. In addition, it was determined that nursing students who chose the nursing profession because of altruism had higher perceptions of caring behaviors. A positive relationship exists between professional values, ethical sensitivity (r = −0.258, p < 0.001) and caring behaviors (r = 0.431, p < 0.001) (p < 0.05). Professional values have a positive effect on ethical sensitivity and caring behaviors.ConclusionProfessional values, ethical sensitivity and caring behaviors are relationships and professional values positively predict nursing students' ethical sensitivities and caring behaviors. As the professional value perceptions of nursing students increase, their ethical sensitivity and caring behaviors increase. Improving the curricula in a way that will improve professional values may enable nursing students to increase their ethical sensitivity and caring behaviors. The research contributes to a broader understanding of nursing education curriculum content.     

Nursing students' perceptions of the importance of caring behaviors

Title. Nursing students’ perceptions of the importance of caring behaviours Aim. This paper is a report of a study to determine the nursing students’ perceptions of the importance of caring behaviours. Background. Caring has been considered as the essence of nursing. It is believed that caring enhances patients’ health and well‐being and facilitates health promotion. Nursing education has an important role in educating the nurses with adequate caring abilities. Method. Ninety nursing students (response rate 75%) responded to a questionnaire consisting of 55 caring behaviours adapted from items on Caring Assessment Questionnaire (Care‐Q). Behaviours were ranked on a 5‐point Likert‐type scale. The caring behaviours were categorized in seven subscales: ‘accessibles’, ‘monitors and follows through’, ‘explains and facilitates’, ‘comforts’, ‘anticipates’, ‘trusting relationship’ and ‘spiritual care’. Data were collected in Iran in 2003. Findings. The students perceived ‘monitors and follows through’ (mean = 4·33, SD = 0·60) as the most and ‘trusting relationship’ (mean = 3·70, SD = 0·62) as the least important subscales. ‘To give patient’s treatments and medications on time’ and ‘to do voluntarily little things…’ were the most and least important caring behaviours, respectively. ‘Explains and facilitates’ statistically and significantly correlated with age (r = 0·31, P = 0·003) and programme year (r = 0·28, P = 0·025). Gender had no statistically significant influence on students’ perceptions of caring behaviours. Conclusion. Further research is needed, using longitudinal designs, to explore nursing students’ perceptions of caring behaviours in different cultures, as well as evaluation studies of innovations in curriculum and teaching methods to improve learning in relation to cultural competence and caring concepts.     

Comparing undergraduate student nurses' understanding of sustainability in two countries: A mixed method study

AimTo explore sustainability education in nursing students in two countries.DesignMixed methods including a sustainability survey and focus groups.MethodsFirst-year undergraduate nursing students from two countries were invited to participate. 69 students from China and 32 students from England agreed to take part. Data were collected between December 2015 and February 2016. Students completed the Sustainability Attitudes in Nursing Survey (SANS_2) and a purposive sample were invited to participate in focus groups in each country.ResultsAll students had a positive attitude towards sustainability. However, for these four items, the results indicated that Chinese nursing students rate them significantly higher in importance than English students:Climate change is an important issue for nursingIssues about climate change should be included in the nursing curriculumSustainability is an important issue for nursingSustainability should be included in the nursing curriculum.The qualitative data identified four themes:Student nurses' conceptual understanding of sustainability focused mostly on environmental aspects and clinical waste management;Promoting sustainability within nursing education: teaching and learning methods.Promoting sustainability within nursing education: evaluating and certifying learning.Factors to consider when introducing sustainability to nursing education.The paper outlines the similarities and differences between Chinese and English nursing students' perceptions.ConclusionSustainability in nurse education has similar concerns across countries.ImpactSustainability is an important issue for student nurses but strategies promoting incorporation of sustainability issues within nursing curricula are needed.     

The impacts of faculty caring on nursing students’ intent to graduate: A systematic literature review

ObjectivesTo examine the current studies about the impacts of faculty caring on nursing students’ intent to graduate and provide recommendations. The nursing profession continues to face nursing shortages. One of the solutions recognized to alleviate the shortage is increasing the number of students graduating from nursing schools. It lacks a literature review synthesizing the current research about the impacts of faculty caring on nursing students’ intent to graduate and indicate areas for future research.MethodsThis is a systematic literature review. The search of the literature was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Databases searched included MEDLINE via PubMed, CINAHL, PsycINFO, and ProQuest Search. Search terms included ‘attrition,’ ‘dropouts,’ ‘graduation rate,’ ‘faculty,’ ‘instructor,’ ‘professor,’ ‘nursing,’ and ‘caring.’ResultsTen articles met the inclusion criteria. The articles were conducted in the Associate Degree of Nursing and the Bachelor of Science in Nursing programs. Nursing faculties played a significant role in students’ intent to graduate by building students’ confidence, creating a compassionate learning environment, and promoting students’ competence. Faculties’ caring behaviors, including respecting students, showing empathy, and using caring communication skills, were essential characteristics to affect students’ learning environments.ConclusionsThe findings indicate that students’ perceptions of faculty caring can affect their perceptions of the learning environment and sense of belonging, and therefore, impact their intent to graduate. Students’ perceptions of their instructors’ caring behaviors are instrumental in motivating them to continue learning. The capacity of faculty caring plays a significant role in students’ success.     

Nursing students’ experiences with patient death and palliative and end-of-life care: A systematic review and meta-synthesis

AimTo synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settingsBackgroundNurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.DesignA qualitative systematic review and meta-synthesisMethodsPubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012–25 Feb 2023. Qualitative studies of any design reporting nursing students’ experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso’s 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.ResultsThe review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.ConclusionsWhile caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.     

Caring in process: A 3-year qualitative longitudinal study of nursing students

AimThis paper aims to describe caring perceptions and behaviors among student nurses in Italy as they progress through their nursing education.BackgroundAs nursing students are potential nurses of the future, there is an expectation that in addition to appropriate academic qualifications, they will develop appropriate caring behaviors/attitudes. However, there has been some evidence that the educational process does not always modify their caring perceptions/behaviors or that the direction of the change is not always positive.DesignA qualitative longitudinal design with three data collection points, was performed from October 2013 to October 2016 at the University of Verona, Trento Campus.MethodsSemi-structured interviews were conducted at the time of entry into a 3-year bachelor’s degree program in nursing and at the end of the second and third years. Observation of the students during their clinical practice was carried out at the end of each of the three years of education. Thirty students commenced the study and 24 finished. Data were analyzed using a phenomenological approach.ResultsThe iterative process of analyzing interviews and observations resulted in nine themes collectively from all three stages: establishing a trusting relationship with the patient, satisfying the patient’s needs, paying attention, being respectful, being competent, giving time, being concerned with the emotional dimension, acting within context to facilitate caring actions and giving information.ConclusionsAt the end of the third year the students’ concept of caring was enhanced; their initial generic or lay view of caring turned into an intentional, competent, conscious, accountable and realistic caring approach.     

Nursing students’ perceptions towards branching path simulation as an effective interactive learning method

BackgroundBranching path simulation (BPS) is an innovative computer, case scenario-based simulation. Prior to this study, no studies had examined the perceptions of students towards using this innovative learning method in nursing education. Therefore, this study aimed to explore undergraduate nursing students’ perceptions towards using BPS as an effective interactive learning method in nursing education.MethodThe current study had a quantitative evaluative design and a convenience sample of 44 undergraduate nursing students from different academic years. The students were exposed to four case scenarios about pain management in people with dementia (PWD). Data was collected using a paper-based survey developed by the researchers.Results and conclusionThe results showed the nursing students to perceive BPS positively in terms of design, usability, self-confidence in learning, and students’ satisfaction. However, a need was identified for further research which examines BPS as a complementary learning method incorporated into nursing curricula.     

What motivates students to enter nursing? Findings from a cross-sectional study

IntroductionIt is expected that future nurses have high levels of emotional intelligence and empathy, because of their everyday interaction with people in a clinical environment. Thus, nursing students must show interest in nursing studies and in work with people. Moreover, it is desired that they have good communication skills. On the other hand, students who choose nursing as their future career may have high expectations from nursing education. The aim of this study was to explore nursing students' reasons for pursuing nursing studies.MethodsA cross-sectional study was conducted among undergraduate nursing students in Slovenia and Croatia.ResultsA total of 314 students participated in the study. General satisfaction with their studies is higher among those students who are satisfied with their chosen study programme. The most important reasons to enter nursing studies were interest in the subject and good employment possibilities. As the biggest disadvantage of studying nursing, Slovenian students listed crowded schedules, while Croatian students mentioned faculty organization. Students from both countries agreed that the biggest advantage is the ease of finding a job after graduation.DiscussionAs there is a lack of workforce in the healthcare sector, particularly a lack of nurses, universities must adjust their demands and improve study conditions to gain students' attention. Therefore, it is important to notice that nursing students perceive more advantages of studying nursing than disadvantages.ConclusionThere are many different reasons to enter nursing studies. Students perceive many advantages in studying nursing, such as ease of employment, getting many hours of clinical practice and the possibility for promotion. On the other hand, there are some challenges in studying nursing, such as the schedule and organization of lectures, seminars and clinical placement. There is a need for further research in the field of nursing student's motivation, especially due to their decreasing motivation during the studies.     

Student perceptions of older adults after a music intervention: A mixed approach

AimsThe aims of this project were to investigate changes in nursing students’ attitudes and perceptions of older adults after implementing individualized Music and Memory© playlists. In addition, the inquiry sought to compare pre and post survey responses for changes in rankings of caring for the older adult as a career choice. The qualitative inquiry sought to explore students’ perceptions of their experience through narrative journaling for a better understanding of the experience.DesignThis study used an explanatory sequential mixed design.MethodsA pre post-intervention approach was used for quantitative data collection along with a ranking item for career choices. Journal narratives completed within one week following the experience were explored for qualitative themes to better understand students’ experiences. Attitudes and perceptions of students (N = 44) were measured by two tools before and after implementation of Music and Memory© Interventions during a 7-week clinical experience. Student journals were analyzed for themes.ResultsIn the two-tailed paired t-test, nursing students’ attitudes and perceptions of caring for older adults were analyzed for differences. Significance improvement was found in students’ reported interaction scores and other constructs (p ≤ .01). Mean ranking of caring for the older adult improved from 7.6 to 7.0 in the post intervention analysis. Student journals reported the activity as worthwhile and time consuming.ConclusionsAs the baby boomer generation ages the need for residential long-term care is projected to increase significantly. Recruiting and retaining nurses to care for this vulnerable population is challenging. Music and Memory© Interventions have the potential to change student attitudes and perceptions of the older adult that could improve caring for the older adult as a career choice.     

Enhancing students’ preparedness to care for older people: A mixed methods analysis

BackgroundNursing students’ positive attitudes towards ageing and older people are central to developing person-centred care. Perceptions about older people are influenced by social and generational values and beliefs, including a general understanding that older people need to be cared for. Nursing students often undertake early clinical placements in aged care settings, where residents’ needs are complex, yet the nursing experience is often considered ‘basic’ care. Illustrating that older people have rich personal histories and are valuable contributors to society can balance students’ perceptions and expectations and outcomes of clinical placements. Educational interventions using photo-elicitation and in-depth dialogue may surface students’ assumptions and challenge their misperceptions of older people before the first clinical placement.AimTo examine the impact of the innovative Depth of Field: Exploring Ageing © (DOF) resource as preparation for nursing students’ clinical placement in residential aged care facilities.MethodsMixed methods, block randomised controlled study with first year students. Students attending clinical laboratory groups received either usual preparation (control, n = 108) or DOF plus usual preparation (intervention, n = 99). Pre/post surveys included: Geriatric Attitudes Scale (GAS) and demographics. Eight students from the intervention group participated in focus groups post-clinical.FindingsGroups were similar at baseline. There were statistically significant changes following the intervention (p ≤ .05) for 9/13 individual GAS items and difference in overall mean scores (intervention group: M = 0.26; SD = 0.27; control group: M = 0.01; SD = 0.27). Focus group themes included: preconceptions toward older people; feelings of being emotionally unprepared; and perceptions of the DOF intervention in preparing students to connect with the older person.DiscussionThe DOF vignette provided opportunity for students to preflect on ageing. Translation to practice was evidenced with students seeing beyond residents’ physical care requirements to the value of connecting with the older person’s story to facilitate person-centred care.ConclusionsThe DOF intervention assisted students to adopt positive attitudes and a broader perspective of older people, as preparation for placement in residential aged care facilities.     

Australian nursing students’ clinical experiences in residential aged care: Reports from nurse academics

BackgroundNurses are the largest group of registered healthcare professionals and are fundamental to delivering health and aged care in Australia.AimTo explore how nursing students report clinical experiences when caring for older people as part of a larger study investigating how care of the older person content is included in Australian undergraduate nursing curricula.MethodsA population sample of all Australian nursing schools that offered a Bachelor of Nursing degree (n = 35) in 2019. Nurse academics involved in curriculum development or delivery were recruited. A telephone-assisted survey was used, and qualitative content analysis undertaken.ResultsAll schools of nursing participated in the survey, representing a response rate of 100%. The acute care focus of nursing curricula meant clinical experiences for nursing students related to older person's care commonly occurred in residential aged care facilities in the first year of the degree. Student reports of these experiences varied, with a majority of respondents reporting mixed or negative feedback associated with a lack of preparation and inadequate supervision.ConclusionsThis study highlights the: significance of the timing of nursing students’ clinical placements in residential aged care; the selection of appropriate care homes; and the need for the right clinical teaching staff who can supervise high quality learning experiences for students.     

Diabetes knowledge and perceptions among nursing students,and curriculum differences in Japan and Australia: A cross-sectional study

ObjectivesTo investigate the associations between knowledge and perceptions of diabetes mellitus (DM) among nursing students from Japan and Australia; and to compare curriculum differences.Research Design and MethodsCross-sectional study. Convenience sample of students from Japan (N = 78) and Australia (N = 85) in their final year were surveyed. Students reported demographic details, and perceptions towards caring for patients with DM. The 23-item Michigan Diabetes Knowledge Test (MDKT) was used to assess general knowledge, and seven additional questions were used to assess DM-related clinical knowledge (CDKT). Multivariate logistic regression models were used to determine the associations between knowledge and perceptions. The curricula of the two universities were compared through a review of teaching hours on DM, teaching methods, class sizes and self-reported number of DM patients cared for during clinical placement.ResultsAustralian students were more likely to be aware of DM and identified caring for more patients on clinical placement during the course. They also performed better on the CDKT in comparison to the Japanese students (71.43% versus 65.02%). When teaching models were compared, the Japanese curriculum dedicated more hours to didactic classroom teaching on DM and had a smaller teacher to student ratio. While both groups felt they received enough classroom education on DM, the Japanese students self-reported lower perceived competency, self-confidence, and felt less prepared to care for DM patients. However Japanese students performed slightly better on the MDKT than Australian students (74.25% versus 70.03%). Being from Japan was a predictor for high MDKT score (> 73.91%), while perceived preparedness was a predictor for high CDKT score (> 71.43%).ConclusionsStatistically significant differences in DM knowledge (CDKT score) between students were found. There remains room for improvement, particularly a need for increased teaching hours at University and greater clinical practice time caring for patients with DM, to further improve knowledge and skills.     

Validating the Nurse Professional Competence Scale with Australian baccalaureate nursing students

BackgroundProfessional competence is necessary to enhance patients’ quality of care and safety, however not much is known about nursing students’ perceptions of their professional competence at the point of graduation, particularly in the Australian context.AimTo validate the Nurse Professional Competence (NPC) Scale in the Australian context and explore graduating nursing students’ perceptions of their own competence and their suggestions to improve their learning experience.MethodA cross-sectional survey incorporating the NPC Scale was conducted with nursing students at the point of graduation at one large Australian University.ResultsFifty-six graduating nursing students completed the NPC Scale. Scale reliability measured via Cronbach’s alpha was 0.96. Almost 80% of students felt confident with their nursing skills and felt that the nursing program had prepared them for a graduate position as a registered nurse. Students reported their highest competence was in Value-based Nursing Care (m = 89.4) and Documentation & Administration of Nursing Care (m = 86.7), and the lowest were Development, Leadership & Organisation of Nursing Care (m = 80.9) and Care Pedagogy (m = 83.0). Students’ most common suggestion to improve the learning experience was to provide additional clinical workplace experience.DiscussionThe NPC Scale demonstrated excellent reliability in the Australian context. The areas that scored highest and lowest on the NPC were congruent with findings using this instrument in other countries.ConclusionFurther validation of the NPC Scale should include a larger sample that includes both graduating nursing students from multiple universities as well as registered nurses and incorporates confirmatory factor analysis.     

Practices of caring for nursing students: A clinical learning environment

ObjectiveThe purpose of this study was to explore, describe and illuminate nursing students’ best encounters of caring in the clinical learning environment. Caring for nursing students was emphasized and recommendations provided to enhance caring for nursing students within their clinical learning environment.MethodsQualitative data was collected by the researcher using semi-structured individual interviews and an Appreciative Inquiry (AI) methodology. Ten second year nursing students undertaking the bridging course leading to registration as general nurses in terms of Regulation 683 of the South African Nursing Council (SANC) were purposively sampled from 3 private hospitals within the Western Cape. Data was analysed using Giorgi’s method.ResultsThe main theme included the best and ‘least best’ caring practices embedded in the centrality of the heart. The subthemes comprised of the nursing students’ experiences of caring literacy and caring illiteracy. The second theme included the creation of best caring practices within a conducive clinical learning environment. Within this theme, the subthemes comprised of the caring attributes required in reflecting best caring practices, as well the creation of a clinical learning environment to optimise caring.ConclusionsThe significance and necessity of caring for the nursing student were clearly illustrated and confirmed by participants. Caring was equated to the heart as the core to the nursing students’ being. Recommendations for nursing education, management, practice and research were therefore specifically formulated to enhance caring towards nursing students.     

A cross-sectional survey of nursing students' patient safety knowledge

BackgroundKnowledge provides a foundation for safe and effective nursing practice. However, most previous studies have focused on exploring nursing students' self-reported perceptions of, or confidence in, their level of patient safety knowledge, rather than examining their actual levels of knowledge.ObjectiveThe overarching objective of this study was to examine final year nursing students' levels of knowledge about key patient safety concepts.DesignA cross-sectional design was used for this study. Data collection was undertaken during 2018 using a web-based patient safety quiz with 45 multiple choice questions informed by the Patient Safety Competency Framework for Nursing Students. A Modified Angoff approach was used to establish a pass mark or ‘cut score’ for the quiz.Setting and participantsNursing students enrolled in the final year of a pre-registration nursing program in Australia or New Zealand were invited to participate in the study.ResultsIn total, 2011 final year nursing students from 23 educational institutions completed the quiz. Mean quiz scores were 29.35/45 or 65.23% (SD 5.63). Participants achieved highest scores in the domains of person-centred care and therapeutic communication, and lowest scores for infection prevention and control and medication safety.Based on the pass mark of 67.3% determined by the Modified Angoff procedure, 44.7% of students (n = 899) demonstrated passing performance on the quiz. For eight of the institutions, less than half of their students achieved a passing mark.ConclusionsGiven the pivotal role that nurses play in maintaining patient safety, the results from this quiz raise important questions about the preparation of nursing students for safe and effective clinical practice. The institutional results also suggest the need for increased curricula attention to patient safety.     

Nursing students' perceptions of caring for dying people,after one year in nursing school

AimTo describe Swedish nursing students' perceptions of caring for dying people after the first year of a three year in a nursing programme at three university nursing schools in Sweden.MethodsInterviews (n = 17) were undertaken with nursing students at the end of their first year. A phenomenographic approach was used to design and structure the analysis of the nursing students' perceptions.ResultsThe analysis resulted in five categories: 1) from abstract to reality, 2) from scary to natural, 3) increased knowledge can give bad conscience, 4) time limits versus fear of end-of-life conversations, and 5) meeting with relatives.ConclusionNursing students need to be prepared both theoretically and within practice to encounter death and dying and to care for dying persons. By combining their theoretical knowledge of dying and death with their own encounters of death and dying people in practice, the students can be supported to develop an understanding of dying and death as a natural part of life rather than something frightening.