A longitudinal study into the perceptions of caring and nursing among student nurses

A longitudinal study of a cohort of student nurses was undertaken in order to investigate whether changes in perceptions of nursing and caring take place and how perceptions of nursing and caring are related. The Caring Dimensions Inventory (CDI) and the Nursing Dimensions Inventory (NDI) were employed for data collection at entry to nurse education and after 12 months. There were significant changes in the scores of a range of items in both inventories which suggested that student nurses lose some of their idealism about nursing and caring after 12 months in nurse education. While the overall ranking of items in the inventories was very similar, it was possible to distinguish between the inventories at entry to training and to observe a change, particularly in the CDI, over time by means of Mokken scaling. Nursing and caring would appear to become more synonymous to the student nurses after 12 months in nurse education. Factors scores, for factors identified in the CDI in a previous study, were used to investigate whether these scores changed at 12 months into nurse education compared with entry. No significant changes were detected.     

The caring dimensions inventory (CDI): content validity, reliability and scaling

Caring is an elusive phenomenon but this should not prevent the development and validation of reliable quantitative tools for studying this concept in large samples of nurses. The present paper reports on the content analysis of a questionnaire called the Caring Dimensions Inventory (CDI). The CDI was content validated in terms of existing conceptualization of caring and research in this area and also in terms of a nursing taxonomy and its representation in popular United Kingdom nursing publications. The CDI was administered to a large sample of nurses working in Scotland and data were obtained from 1430 qualified and student nurses. The internal consistency of the CDI items related to perceptions of caring was established and the scalability of a sub-set of CDI items was demonstrated. The CDI scale was related to the constructs of age and sex of respondents. Possibilities for further analysis and development of the CDI are discussed.     

A 35-item version of the Caring Dimensions Inventory (CDI-35): multivariate analysis and application to a longitudinal study involving student nurses

The present study was designed to investigate the perceptions of caring among student nurses and how these develop throughout the course of a programme of pre-registration nurse education. A 35-item version of the caring dimensions inventory was administered to a cohort of nursing students in a department of nursing in Scotland at entry to the programme, after 12 months and after 24 months on the programme. Caring was largely perceived through a technical dimension, demonstrated by factor analysis, but other dimensions such as intimacy, support and unnecessary and inappropriate aspects of nursing also became apparent as students progressed through the programme.     

Caring in nursing: a multivariate analysis

The dimensions underlying the perceptions of caring among nurses were investigated using the Edinburgh Caring Dimensions Inventory (CDI). Exploratory and confirmatory factor analysis techniques were used. While there was a general caring factor on which the majority of the items in the CDI loaded, there were two separable major dimensions to caring, namely 'psychosocial aspects' and 'professional and technical aspects'. In addition, two smaller dimensions were identified that were both related to self-giving, and it is postulated that these refer, respectively, to appropriate and inappropriate self-giving in nursing.     

‘Caring? It's the little things we are not supposed to do anymore’

Pearcey P. International Journal of Nursing Practice 2010; 16 : 51–56
‘Caring? It's the little things we are not supposed to do anymore’ This study explored the views of twenty‐five qualified nurses in five hospitals to determine what they perceived as dominant values in clinical nursing work. Aspects of a grounded theory approach were used and this study formed the final one of three. The first two studies had student nurse samples and this study aimed to confirm and validate the data from the students' perceptions. The student nurses had implied that nurses communicated and ‘cared’ for patient's much less than they expected. Findings from this study reaffirm the students' perceptions and suggest that nurses may not be as caring as they would like to be. One significant issue to emerge, in conjunction with the realization that nurses were not being as caring as they would have liked, was that it mattered to them that caring was the ‘little things’ not ‘supposed to be done anymore’.     

Differences and similarities in the perception of caring between Spanish and UK nurses

The aim of the present paper was to compare and contrast perceptions of caring in nursing between Spanish and UK nurses. There are no previous studies comparing directly the perceptions of caring across cultures in nursing. A survey method was used employing the 25-item Caring Dimensions Inventory. Data were Mokken scaled for comparison with data from a previous study and scores for common items on the 25-item Caring Dimension Inventory for Spanish and UK nurses were correlated. There were similarities and differences between Spanish and UK nurses' perceptions of caring: many similar items were incorporated into Mokken scales but the endorsement of items did not correlate. The present work demonstrates that it is possible to measure differences and similarities in perceptions of caring. The study design could be improved and such work could be valuable in cross-cultural work with nurses.     

Lecturers’ and students’ perceptions of portfolios in an English School of Nursing

Aims. This study was aimed at comparing perceptions of portfolios between student nurses at the early and latter stages of their training and how they compare with their lecturers’ perceptions. Background. Portfolios are used widely in nurse education. There has been research into how portfolios are perceived and understood, but there is little evidence into how student nurses and lecturers compare quantitatively in perceptions of portfolio use. Design. Survey. Method. Forty‐eight nursing lecturers and 413 nursing students, from a multi‐centred School of Nursing in the UK, completed a questionnaire. Data were analysed with exploratory factor analysis, varimax rotation of the factor solution, internal consistency analysis, and analysis of variance. Results. Five factors were extracted, which were labelled: (1) portfolios as a means of skills acquisition, (2) other means of teaching and learning beyond using portfolios, (3) processes of showing the portfolio to others, (4) having favourable attitudes towards portfolios and (5) lecturers’ ability to share knowledge about portfolios. Scales developed from these five factors had high levels of internal consistency. Lecturers were the most positive of the three respondent groups in their views of portfolios, whereas third‐ and fourth‐year students were the least positive. There were significant differences between student nurses and their lecturers, concerning how information on portfolios is communicated by the lecturer. Conclusion. There were significant discrepancies between lecturers and student nurses in their views on how portfolios are used. The value of portfolios becomes less salient to student nurses towards the end of their training. Relevance to clinical practice. Lecturers and clinical mentors need to look at students’ perceptions and why some nursing students’ views on portfolios deteriorate. There could be regular discussions with students to see how and why the students begin to see portfolios as less useful for their education and continual professional development.     

Relationships among student and graduate caring ability and professional school climate.

This study represents the second phase in a longitudinal study of the development of caring ability in registered nurses. A nationwide sample of female graduates of US baccalaureate nursing programs was resurveyed 3 years after the phase-one survey taken during nursing school. The purpose of the study was to continue an evaluation of several variables contributing to the development of professional caring ability. Previously validated instruments were used to measure caring ability (Caring Ability Inventory), maternal and paternal care (Parental Bonding Instrument), and the caring climate of the respective nursing schools (Charles F. Kettering Ltd. School Climate Profile). Although parental bonding scores remained unchanged from the initial survey, caring ability scores significantly increased after entry into practice (paired student's t test, P < .001). The strongest predictor of postgraduate caring ability was student caring ability scores (r = .58, P < .001). When student caring ability scores were excluded as a potential predictor during stepwise multiple regression analysis, school climate scores were the strongest predictor of postgraduate caring ability (r = .17, P < .05). This suggests that development of professional caring ability is related to caring school environments. Furthermore, caring ability as a student predicts further development of caring ability after entry into practice.     

Exploring clinical nursing experiences: listening to student nurses

Student nurses spend one half of their educational programme in the clinical area. The success of an educationally sound clinical placement is crucial to forming a professional nursing identity that will encompass the seen and 'unseen' aspects of the nurses' role. The aim of this study was to explore the clinical nursing environment through the perceptions of first year student nurses. Semi-structured interviews were used to collect data from 12 student nurses who each had four weeks clinical experience, representing 21 wards and five hospitals. Results suggest that these student nurses were disillusioned with the reality of clinical nursing and that their expectations of nursing were not realised. They perceived that paperwork, completing tasks and meeting targets were dominant features of nursing work at the expense of patient contact and communication. A majority indicated that nursing was not as caring as they expected and vowed to hold on to their personal values of caring about patients and forming communicative, interpersonal relationships with them.     

Nursing to care or caring to nurse: a qualitative investigation of perceptions of new recruits

This article discusses the perceptions of nine student nurses at the commencement of a 3-year diploma programme in nursing. In particular, it focuses on new recruits' perceptions of nursing. As part of a larger longitudinal study which examines the impact of the nursing curriculum on perceptions of health, data were collected from a sample of students concerning their perceptions of nursing, health, illness and the course. Content analysis of indepth interviews identified four themes concerning perceptions of nursing. These were caring, nurture, healing and self-development. These themes are discussed in relation to the student nurses life experiences and in the context of a notion of health as a central goal for nurse education. The students' perceptions of nursing at the commencement of the course suggest that nursing may be a moral choice as an occupation underpinned by the desire to do something worthwhile, whilst the relationship between nursing and health was not explicit.     

Patients to people

The ideas discussed in this paper are derived from a longitudinal study of student nurse socialization. The emergent views of a cohort of student nurses were explored by the researcher, over a period of 3 years, utilizing the approach referred to as grounded theory. 'Patients to people' represents a continuum of changing perceptions about those whom the students were nursing. It seemed that the cohort had to move along this continuum in order for them to be able to empathize with those they nursed. In the context of the students' changing perceptions, several things were of significance. For example, encounters with individuals who failed to demonstrate the passive and compliant attitude associated with 'typical patients', such as children, challenged the cohort's thinking about those they nursed. During their training the students matured as both nurses and adults and this was also important, as was their recognition of their own 'personhood'. The cohort's emergent views suggested that there was a reciprocity between the way they viewed themselves and the perceptions they held about those they nursed. Such findings are important to people involved in preparing individuals to enter the caring professions. However, it should be noted that the experiences described in this study represent those of 'traditionally' trained rather than of Project 2000 students. The names used to describe people involved in this research are pseudonyms.     

Senior nursing students' and professional nurses' perceptions of effective caring behaviors: a comparative study.

Care forms the basic core of nursing actions. Traditionally nurses have described the acts of administering to patients as care behaviors. Many nurses find it difficult to define these caring behaviors. It is important that nurses have insight into the specific behaviors that patients perceive to be most important. Several studies have examined and compared nurses' and patients' perceptions of effective care behaviors. The literature supports an incongruence of what nurses perceive and what patients perceive as effective. This study identifies and compares student nurses' and professional nurses' perceptions of effective caring behaviors. The Caring Assessment Report Evaluation Q-sort (CARE-Q) was used to obtain the data. The participants included senior baccalaureate nursing students (n = 30) at Thomas Jefferson University, College of Allied Health Sciences, and professional nurses (n = 30) with 1 or more years experience. The significance of the difference between the groups was tested using the Mann Whitney U test. Results indicate agreement between the students and the nurses in all categories except trusting relationship (p = .06). The ages within the groups varied from 21 to 47 years. The difference in ages between the nurses and the students is significant (p = .0002). Findings provide a better understanding of student nurse perceptions of caring behaviors and provide implications for further research for nurse educators.     

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.     

Student nurse perception of the staff nurse role

A survey was undertaken to identify the developing perception of the staff nurse role by student nurses in two health districts of one regional health authority using a questionnaire specially developed for the survey. A sample of 190 was selected from student nurses, staff nurses and sisters, working within those areas used for general nurse teaching at the two districts. The results indicate that first-year student nurses hold perceptions of the importance of the functions of the staff nurse role which are significantly different from the staff nurse whilst second-year students respond in the same way as staff nurses. Third-year student nurses hold a perception of the staff nurse role which does not differ significantly from that held by staff nurses except for the clinical function. Questions relating to performing within these functions were less easily interpreted. The results do not demonstrate a sequential developing perception of the staff nurse role, rather a change over the first year with some areas of performance remaining different throughout the years of training. Possible reasons for these differences are advanced. Difficulties in generalizing the results due to the limitations of the data obtained, questionnaire design and the locations for the study, are identified.     

Evaluating a management of aggression unit for student nurses

BACKGROUND: Workplace violence is acknowledged as a major problem in health care settings and affects staff morale, recruitment, retention and direct health care budgets. Staff training is advocated as the appropriate managerial response, but identifying appropriate training and trainers is difficult and there is little published evidence of training effectiveness. Student nurses are frequent targets of aggression but are less likely to receive specific training. AIMS: The study considered the application of a model of learning to a 3-day learning unit for diploma-level student nurses on the "prevention and management of aggression". It aimed to measure student outcomes of the unit and gain information about more general issues in evaluating training effectiveness. METHODS: A repeated measures longitudinal design was used to obtain data from three cohorts of student nurses (3 x 80 approximately) at four time points over an 8-month period. A questionnaire was administered twice before the unit, at its conclusion and approximately 3 months afterwards, following two clinical placements. RESULTS: Statistically significant changes were demonstrated in a number of areas, including number of risk factors identified, and five "factors" identified from the questionnaire statements. STUDY LIMITATIONS: The results refer to one course for student nurses that had many common elements with popular training courses for qualified staff, including inter-personal and breakaway skills. However, restraint skills were not included. CONCLUSIONS: It is possible to provide training that produces desirable, statistically demonstrable and durable change in knowledge, behaviour, attitudes and confidence using a rigorous longitudinal evaluation research design.     

Nursing students' perceptions of instructor caring: an instrument based on Watson's Theory of Transpersonal Caring

This study describes the development and testing of an instrument to measure nursing students' perceptions of instructor caring. Originally, 69 statements about instructors' caring behaviors, based on Watson's 10 carative factors, were created with Dr. Jean Watson. The Nursing Students' Perceptions of Instructor Caring (NSPIC) instrument uses a 6-point Likert scale for students' responses to the statements. After pretesting the instrument with a small group of nursing students, the NSPIC was tested with 133 baccalaureate nursing students. Based on item analysis, factor analysis, and student comments, the number of statements were reduced to 31. Psychometric testing revealed that the NSPIC is internally consistent (alpha = 0.97) and contains five subscales. Convergent validity was established between the NSPIC and a semantic differential scale of students' perceptions of instructor caring. Predictive validity was assessed with Coates Caring Efficacy Scale. Although the NSPIC is in its early stages of development, its psychometric properties indicate that it is a valid and reliable measure of nursing students' perceptions of instructor caring.     

South African student nurses' experiences of professional nurses' role-modelling of caring

BackgroundStudent nurses are expected to implement a caring practice in order to become professional nurses. Caring has remained the art and science of nursing, which student nurses learn from professional nurses during clinical practice. The South African Nursing Council mandates professional nurses to teach and supervise student nurses to master the art of caring during clinical practice. Caring is taught through role-modelling of daily nursing activities.Research purposeThis study was performed to gain an understanding of South African student nurses' experiences of professional nurses' role-modelling of caring.MethodsPhenomenological, qualitative research. Purposive sampling of fourth-year student nurses. Data collection: focus groups, observations and field notes. The data were analysed using Giorgi's modified Husserlian five-step method. Ethical principles were respected.ResultsThree themes were identified. Theme 1: inconsistency in the clinical environment; Theme 2: effective and ineffective role-modelling of caring and Theme 3: carelessness cascading.ConclusionsThe study facilitated an understanding of student nurses' experiences of professional nurses' role-modelling of caring. Recommendations to facilitate professional nurses' role-modelling of caring in a public hospital were formulated: Mentorship training, recognition system for professional nurses, clinical support for student nurses, open channels of communication, random nurse leader rounds, employee wellness program, workshops and positive learning environment promotion.     

Application and evaluation of a caring code in clinical nursing education

This study evaluated the effectiveness of the Caring Code, a tool for teaching caring to nursing students during clinical practice. An experimental, longitudinal design was used. A sample of 480 students from a 5-year junior nursing college program in Taiwan was randomly divided into experimental and control groups. Each member of the experimental group carried a copy of the Caring Code, the content of which was explained by the clinical instructors at the beginning of clinical practice, and about which reminders were provided weekly. A questionnaire was distributed to the patients during the nursing students' 1-year clinical practice, once prior to the implementation of the Caring Code and twice afterwards, to obtain quantitative data on the caring behaviors of the two student groups. Instructors and nursing students were interviewed for their experiences and perceptions of using the Caring Code. The Caring Code had a statistically significant positive effect on student caring behavior.