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.     

Caring behaviors perceived by elderly residents of long-term care facilities: scale development and psychometric assessment

BackgroundTo meet the growing need for relationship-centered nursing practice and for nursing school accreditation in Taiwan, nursing school curricula must include training in care for elderly populations in institutional settings. However, educators lack tools for evaluating student performance in such settings. The few tools currently available for measuring the caring in nurses perceived by elderly residents of long-term care facilities (LTCFs) are either inappropriate for education purposes or are culturally inappropriate for elderly populations in Taiwan.ObjectivesTo develop a scale for measuring the caring behaviors of caregivers or student volunteers as perceived by a Taiwanese population of elderly residents of LTCFs and to establish the psychometric characteristics of the scale.MethodsThis study was conducted in two phases. In Phase 1, the researchers comprehensively reviewed the literature on caring. Based on the review, an Elderly Resident-Perceived Caring Scale (EPCS) was developed to measure the caring behaviors perceived by LTCF residents. To establish content and face validity, the items on the scale were reviewed by six experts in two rounds of Delphi study and by four elderly laypersons. In Phase 2, a convenience sample of 297 elderly residents from 18 representative elderly care facilities (i.e., skilled nursing facilities, independent living facilities, and assisted living facilities) in Taiwan were recruited to test the construct validity and reliability of the EPCS.ResultsThe 14-item, 2-dimension questionnaire developed in this study explained 64.33% of the variance in caring perceived by the residents. Factor I, Comforting, included 11 items. Factor II, Encouraging, included 3 items. Cronbach's α values were .924 for the total scale and .930 and .844 for the Comforting and Encouraging, respectively.ConclusionThe psychometric qualities of the EPCS were supported. However, further testing of the scale is needed to confirm its psychometric properties in a larger sample.     

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.     

Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review

AimThe aim is to explore literature on the influence of the clinical learning environment on caring behaviors of undergraduate nursing students.BackgroundCaring is a fundamental aspect of nursing practice. However, factors of and in clinical learning environment that help shape the caring behaviors of nursing students as part of their education journey remain understudied.DesignA modified version of Cooper’s five-stage integrative review method was used.MethodsFour databases (Cumulative Index of Nursing and Allied Health, PubMed, Scopus and Embase) were searched for research studies published from 2011 to 2021 in peer reviewed journals, written in English and addressing caring behaviors among nursing students in the clinical learning environment. A combination of keywords with Boolean operators was used including: “nursing students OR nursing undergraduates OR student nurses” and “clinical learning environment” AND “caring behaviors”. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.ResultsEmpirical evidence was drawn from 11 studies including seven qualitative designs, three quantitative designs and one mixed method design. The results of this review suggest that factors in the clinical learning environment influence nursing students’ ability to develop caring behaviors. Specifically, the five themes of: [1] role modeling of clinical faculty and professional nurses, [2] creating a conducive clinical learning environment, [3] effective communication skills, [4] positive effect of simulation and [5] alternative clinical placements may facilitate the development of caring behaviors among nursing students.ConclusionThe findings highlight the factors in the clinical learning environment that influence nursing students’ caring behaviors. Improving students’ clinical learning experiences and implementing more effective role modeling and teaching strategies may advance their caring abilities. The information generated from this review provides evidence on how to enhance the clinical learning environment to develop students’ caring behaviors, subsequently leading to more optimal patient outcomes.     

Caring behaviours and stress perception among student nurses in different nursing programmes: A cross-sectional study

Caring is central to providing high-quality nursing. Little research exists concerning the relationship between caring behaviours and stress perception among student nurses. This study aimed to explore this relationship among student nurses in different nursing programmes. A sample of 792 student nurses from three nursing education programmes in one academic institution completed Chinese versions of the Caring Behaviors Scale and the Nurse Stress Checklist to assess participants' caring behaviour and psychosocial responses to work-related stress, respectively. We found a statistically significant negative correlation between caring behaviour and stress perception among participants. The three most frequently reported caring behaviours were related to ‘knowing the patient’: (a) recognising that each patient holds unique values, (b) taking a patient's chief complaints seriously, and (c) stating that the family's best interests should be respected regarding health decisions. Completion of work, time limitations, and lack of personal interactions were sources of stress. Nursing education curricula involve the fundamentals of caring and the preparation of nursing students for clinical practice. The study recommends that nursing faculty and administrators should educate students in stress management in order to foster, support, and promote caring behaviours among nursing professionals.     

护理专业学生关怀能力及其与教育环境的关系研究

目的调查护理专业学生关怀能力现状,并分析教育环境对关怀能力的影响。方法采用关怀能力量表和自设的教育环境问卷,对316名护理专业学生进行问卷调查。结果护理专业学生关怀能力得分为(179.38±20.88)分,低于国外常模(P<0.05)。分层回归结果显示,性别、寝室氛围、同辈关系、志愿者活动的开展对学生的关怀能力有显著影响。结论护理专业学生关怀能力偏低,建议护理教育者和管理者针对其影响因素,改进临床教学方法,改善学习和生活氛围,提高学生的关怀能力。     

The development of a caring curriculum in nursing

Caring is the essence of nursing and the core of nursing education. This paper describes the experience of developing a caring curriculum in a five-year junior college nursing program which included three core courses in caring, in the hope of stimulating further dialogue with fellow educators and cultivating students' caring competencies. The first course was Introduction to Caring, which gave students an understanding of basic concepts of caring, along with the opportunity to practice and experience caring by caring for oneself, one's family and one's peers. The second course was Application of Caring Concepts, which enabled students to learn about caring models, especially the dynamic caring model, and expanded their knowledge of caring behaviors from interpersonal caring to caring for society. The third course was Professional Caring, which explained professional caring and related caring theories, and introduced the caring model used in nursing in Taiwan, showing students how to practice caring in clinical situations. The participating teachers used the action research method to plan, design, implement, and evaluate the caring curriculum. These teachers set the teaching objectives and developed course materials by working together in workshops and participating in teachers' caring groups. They adopted various teaching strategies, such as role modeling, dialogue, caring groups, confirmation, literature, film, caring action projects, reflection, and journaling, which have been proven to be effective at raising students' learning motivation and caring performance.     

Effects of video-recorded role-play and guided reflection on nursing student empathy,caring behavior and competence: A two-group pretest-posttest study

AimThe study examined the differences in nursing student empathy, caring behavior and competence between the experimental and control groups before and after educational intervention and to predict the factors affecting their core competencies.BackgroundEducating nursing students in empathy and caring behaviors before entering clinical practice is challenging.DesignWe used a two-group pretest and post-test quasi-experimental design.MethodsFirst-year nursing students from medical schools in Taiwan participated in our study. Data were collected between March and May 2022. The learning method used with the intervention group was role-playing with videos and guided reflection. The control group was exposed to traditional curriculum. Empathy, caring behavior and competence were measured using the Jefferson Scale of Empathy- Healthcare Providers, the Caring Behaviors Scale and the Nursing Student Competence Scale.ResultA total of 72 participants (40 in the experimental group and 32 in the control group) were included in the final statistical analysis. The response rate was 92%. Statistically significant differences in nursing student empathy, caring behavior and competence were observed between the experimental and control groups (p < .05). The η² effect levels were 0.083, 0.223 and 0.270. Higher caring behavior scores were significantly associated with higher nursing student competence scores (β = 0.81, 95% CI:0.66–0.97).ConclusionsEducation based on video role-play and guided reflection improved empathy, caring behavior and nursing competence in first-year nursing students.     

A Chinese version of the Caring Assessment Report Evaluation Q-sort scale for measuring patients' perception on nurses' caring behaviours: Reliability and validity assessment

A reliable and valid instrument for understanding patients' perceptions of nurses' caring behaviour as well as assessing the quality of nursing care is necessary. The purpose of this study was to assess the reliability and validity of a Chinese version of the Caring Assessment Report Evaluation Q-sort (CARE-Q) Scale for the measurement of patients' perceptions of nurses' caring behaviours. The study sample comprised 250 patients from a medical centre in central Taiwan. Content validity, construct validity, internal consistency and stability reliability were assessed. The Content Validity Index of the Chinese version of CARE-Q was 0.90. Cronbach's alpha indicated good internal consistency reliability. Stability reliabilities for the six subscales ranged from 0.83 to 0.92. The results reveal that the Chinese version of the CARE-Q scale for the measurement of patients' perceptions on nurses' caring behaviours indicates high reliability (internal consistency and stability) and good content validity.     

Action research on the development of a caring curriculum in Taiwan: Part II

This article presents the development, design, implementation, and evaluation of the third-year course of a caring curriculum being developed for a 5-year associate degree nursing program in Taiwan. The course, titled Application of Caring Concepts, was taught to more than 800 students by 16 instructors recruited from various departments. The instructors attended workshops and seminars on caring and then developed the course materials and teaching strategies. Instructional strategies included role modeling, dialogue, discussions, journaling, simulations, readings, and projects that involved students' applying caring skills outside of the classroom. Students were evaluated by patients in clinical practice using the Caring Behavior Measurement, developed in a previous study, and the course was evaluated by qualitative analysis of student feedback. Student responses to course content and instructional strategies were positive. Patients generally indicated that students always or normally performed caring behaviors. The study showed that with an appropriate curriculum and learning strategies, students can learn caring skills.     

The impact of nurse education on the caring behaviours of nursing students

This study aimed to ascertain whether nursing students' perceptions of caring behaviours as part of nursing practice change over a three-year, pre-registration, undergraduate nursing course. Students are expected to have a predisposition to care with nurse education nurturing and developing this into professional caring behaviour. However, there is some evidence that this process inures rather than develops these behaviours. This was a quantitative, single cross section survey of two nursing student cohorts from one Higher Education Institution (HEI) in Wales, United Kingdom (UK). There were two sample groups; sample group A were 80 first year students and sample group B were 94 third year students. Students completed a questionnaire incorporating the caring behaviors inventory (CBI) [Wolf, Z.R., Colahan, M., Costello, A., Warwick, F., Ambrose, M.S., Giardino, E.R., 1994. Dimensions of nurse caring. Journal of Nursing Scholarship 26 (2), 107-111]. The key finding was a statistically significant difference in the means in caring behaviours between first years and third years with third years scoring lower than first years. This was exaggerated for those under 26 and increased further for those under 26 with no previous experience of caring. Caring is a core nursing value and a desirable attribute in nursing students, but the educational process seemed to reduce their caring behaviours.     

护理本科生对护理关怀认知的研究

目的探讨护理本科生对于护理关怀的认知水平及影响因素,为护理本科生关怀能力的培养提供理论依据。方法采用方便抽样对北京某高校护理学院二、三、四年级157名护理本科生进行问卷调查。结果护理本科生在专业技术方面得分高于其他维度,二年级护理本科生在专业技术方面得分高于三、四年级,差异有统计学意义（F=4．679,P〈0．05）。护理本科生对护理关怀重要性的认同、对护理课程的兴趣（社会心理方面、专业技术方面、正确的情感投入）均呈现正相关（P〈0．05）。不同年级护理本科生对关怀行为的认知单项得分比较差异均有统计学意义（P〈0．05）。结论护理本科生对护理关怀行为的认知水平有待提高,学校应通过加强人文关怀教育,运用多种教学手段提高学生对于护理课程的兴趣,帮助学生全面理解关怀的内涵,提高护理本科生护理关怀行为的认知水平。     

护理本科教育中开设照护课程的实践与效果

目的 探讨在护理本科教育中开设照护课程对教学质量和护生满意度的影响,为进一步课程改革提供依据.方法 自编人性照护理论教材和行为指南,对168名本科护生开设照护课程,用修正后的照护行为质量评价表和自编的护生满意度调查表,分别于课程开设前后进行访谈和测评.结果 开设课程前后护生的照护行为和满意度差异具有统计学意义(P＜0.01).结论 本科护生通过学习照护理论,运用照护行为指南,将照护理念融入日常学习和临床实习工作中,有利于提高其照护行为和对护理工作的满意度.     

Caring: its meaning and place in the practice of nursing.

The School of Nursing at which the author is an instructor has decided to revise its curriculum. The new curriculum will use Jean Watson's Theory of Caring as its theoretical base. This qualitative study was undertaken to help clarify the meaning and value of caring in nursing practice as perceived by second-year diploma nursing students. When the data were analyzed, three categories of nurse behaviors emerged that were perceived as caring: giving of self, meeting patients' needs in a timely fashion, and providing comfort measures for patients and their families. The results of this study can be interpreted as a social constructive view of caring in the practice of nursing. These outcomes may help to define and teach caring nurse behaviors in a curriculum based on the Theory of Caring.     

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 pilot study to measure the caring efficacy of baccalaureate nursing students

Caring in professional nursing, often described as the essence of nursing, has gained increasing attention over the past several decades. Many programs claim to be based on a caring philosophy and practice. Despite the expectation that graduates of nursing programs will develop relationships with their patients and practice within a caring framework, evaluation of caring competencies is not well developed. The purpose of this pilot study was to measure the self-reported caring competency of baccalaureate nursing students using the Coates Caring Efficacy Scale (CES) (1). Students from prenursing courses to final semester seniors completed the CES (N = 193). Mean scores in this cross-section of students were higher than those reported by Coates for novice student nurses, but slightly lower than those Coates reported for comparable baccalaureate seniors. Final semester seniors identified their families as making the greatest contribution to their development of caring; only a few reported the influence of the nursing curriculum. This study, while limited to students in one program, provides beginning evaluative data of self-reported caring competencies of nursing students.     

Caring Behaviors Inventory: a reduction of the 42-item instrument

BACKGROUND: Caring traditionally has been at the center of nursing. Effectively measuring the process of nurse caring is vital in nursing research. A short, less burdensome dimensional instrument for patients' use is needed for this purpose. OBJECTIVES: To derive and validate a shorter Caring Behaviors Inventory (CBI) within the context of the 42-item CBI. METHODS: The responses to the 42-item CBI from 362 hospitalized patients were used to develop a short form using factor analysis. A test-retest reliability study was conducted by administering the shortened CBI to new samples of patients (n = 64) and nurses (n = 42). RESULTS: Factor analysis yielded a 24-item short form (CBI-24) that (a) covers the four major dimensions assessed by the 42-item CBI, (b) has internal consistency (alpha =.96) and convergent validity (r =.62) similar to the 42-item CBI, (c) reproduces at least 97% of the variance of the 42 items in patients and nurses, (d) provides statistical conclusions similar to the 42-item CBI on scoring for caring behaviors by patients and nurses, (e) has similar sensitivity in detecting between-patient difference in perceptions, (f) obtains good test-retest reliability (r = .88 for patients and r=.82 for nurses), and (g) confirms high internal consistency (alpha >.95) as a stand-alone instrument administered to the new samples. CONCLUSION: CBI-24 appears to be equivalent to the 42-item CBI in psychometric properties, validity, reliability, and scoring for caring behaviors among patients and nurses. These results recommend the use of CBI-24 to reduce response burden and research costs.