Chinese version of the nursing students' perception of instructor caring (C-NSPIC): Assessment of reliability and validity☆
Introduction
Caring has been endorsed as a core value in nursing education and practice by both the National League of Nursing (NLN) and the American Association of Colleges of Nursing (AACN) (American Association of Colleges of Nursing, 1998, Tanner, 1990). Pew Health Professions Commission recognized the centrality of caring–healing relationships as a basis for all health professional education (1995). Chinese nursing educators also reached a consensus that caring was a vital part of nursing professionalism and capacity of nursing students (Zeng et al., 2010, Shen et al., 2012). In 2010 Ministry of Health of China initiated The Project of High Quality Nursing Care, declaring that caring was the core of nursing service (Ministry of Health of China, 2010). Caring can be learned by experiencing caring interactions with faculty in an environment supported by caring faculty–student relationships theoretically (Gaines and Baldwin, 1996), and it is a multidimensional nursing concept that can be actualized within the nursing curriculum through purposeful teaching and student-centered learning of core values (Fahrenwald et al., 2005, Feng et al., 2011). These caring abilities can also be fostered in the clinical teaching environment using techniques such as role-modeling, review of seminal events and focusing on the hidden curricula (Branch et al., 2001). When students perceive the climate of nursing education as caring, they learn a professional way of being. Caring interactions between faculty and students reflect the very nature of the professional–client relationship (Watson, 1988). If the nursing students can integrate caring into their clinical practice, they will be more likely to become a qualified nurse and will provide better nursing service.
The nursing students' perceptions of instructor caring (NSPIC), based on Watson's Theory of Transpersonal Caring, was initially developed to assess the nursing students' perceptions of instructor caring in clinical environment in the United States of America (Wade and Kasper, 2006) and later in Italy (Favaretto et al., 2010). NSPIC can be used to assess the outcome of the educational process, so as to validate the influence of caring interactions between faculty and students on students' ability to care.
Since 2004 Chinese government has increased the number of nursing students due to nurse shortage. One hundred fifty thousand nursing students have been trained annually since then (Ministry of Education of China, 2004). Nursing students in China are required to complete at least an 8-month clinical practice before registration (The State Council of China, 2008). Caring abilities are also very important for nursing students in China and they can be learned in the caring interaction between instructors and students in clinical settings. However, studies on nursing students' perceptions of instructor caring were rarely found in mainland China.
The aims of this study were to translate NSPIC into Chinese and to examine the reliability and validity of Chinese version of NSPIC (C-NSPIC) in nursing students during clinical practice, hoping to lay a foundation for developing a new instrument that can sufficiently reflect the nursing students' perceptions of instructor caring cater to Chinese culture.
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Participants
A convenience sampling method was used to recruit nursing students in clinical practice from Changhai Hospital, Changzheng Hospital (both affiliated to Second Military Medical University) and the Tenth People Hospital of Shanghai (affiliated to Tongji University) during Jan. 2010 to Aug. 2012. Nursing students aged 18 or older were eligible to participate in the study. The students were informed of the purpose of our study at the beginning of study. The data of this study will be used only for
Demographic Data
The demographic characteristics of the samples are summarized in Table 1. The majority of nursing students in first sample and the validation sample were females. The two samples had similar distributions of age, gender, major, personal experience with hospitalization, and if any family members or relatives are medical staff. The first sample had a lower ratio of baccalaureate nursing students than the validation sample.
Descriptive Statistics of the Scale Items
The mean score of the NSPIC was 150.03 (SD 20.96; range 96–186). The means
Discussion
NSPIC is an instrument to assess the influence of caring interactions between faculty and nursing students on students' ability to care, and it has been used in America and Italia (Wade and Kasper, 2006, Favaretto et al., 2010). In this study, we translated NSPIC into Chinese by translation, back-translation, culture adaptation, and pilot study. And we also examined the reliability and validity of C-NSPIC using Cronbach's alpha coefficient, Guttman Split-half Coefficient, test–retest
Conclusions
To the best of our knowledge, this is the first study to evaluate the psychometric properties of NSPIC in China. We have demonstrated that the C-NSPIC has satisfactory reliability and validity for nursing students in mainland China. Our findings confirmed five factors in the C-NSPIC, including control versus flexibility, supportive learning climate, confidence through caring, appreciation of life's meanings, and respectful sharing. The C-NSPIC can be readily used to assess the nursing students'
Limitations
This study has the following limitations. First, the method of convenience sampling limited the capacity to extrapolate findings. The participants in this study were limited to nursing students in Tertiary Grade A and teaching hospitals in Shanghai, and they may not well represent the general nursing students in China. Further studies should be conducted in class-II hospitals, community health service centers in Shanghai and other cities in China. So we could conduct multi-group modeling to
Conflict of Interest
None declared.
Ethical Approval
This study received ethical approval from the Ethical Committee of Second Military Medical University.
Acknowledgments
We would like to acknowledge the excellent cooperation from the Changhai Hospital, Changzheng Hospital, and the Tenth People Hospital in Shanghai for their support. We also thank all the participants in this study.
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This research was supported by Shanghai Leading Academic Discipline Project (No. B903), and Key Curriculum Construction Program of Shanghai Municipal Education Commission (No. [2011]-48-277), the Shanghai Natural Science Funding (No. 11ZR1447100) and Teaching Research and Reform Project in Nursing School of Second Military Medical University (No. 2012-35-2). There is no conflict of interest.