Elsevier

Nurse Education Today

Volume 33, Issue 12, December 2013, Pages 1482-1489
Nurse Education Today

Chinese version of the nursing students' perception of instructor caring (C-NSPIC): Assessment of reliability and validity

https://doi.org/10.1016/j.nedt.2013.05.017Get rights and content

Summary

Background

The nursing students' perceptions of instructor caring (NSPIC) is an instrument to assess the influence of caring interactions between students and faculty on students' ability to care. However, the validity and reliability of the Chinese version has not yet been studied.

Objectives

The study aimed to assess the validity and reliability of the Chinese version of NSPIC (C-NSPIC).

Design

This is a cross-sectional study.

Setting

The study was performed in three Tertiary Grade A (top level in China) and teaching hospitals in Shanghai, China.

Participants

The participants of the study are nursing students during clinical practice.

Methods

The English version of nursing students' perception of instructor caring scale was professionally translated into Chinese and a pilot test was undertaken to ensure the equivalence of meaning and cultural appropriateness. The content validity of the C-NSPIC was examined by a panel of eight experts, and test–retest was conducted to assess the item reliabilities of the scale. A convenience sampling method was used to recruit nursing students. A first sample (N = 256) was recruited to explore the factorial structure of the C-NSPIC using exploratory factor analysis (EFA), and a validation sample (N = 358) was recruited to confirm the findings from the EFA using confirmatory factor analysis (CFA). SPSS version 16.0 was used for the EFA and Amos 17.0 was used for the CFA.

Results

The Cronbach's alpha coefficient of the C-NSPIC was 0.933. The test–retest reliability was satisfactory, with the ICC scores for each item ranging from 0.603 to 0.962. The overall content validity index was 0.96. Five factors (control versus flexibility, supportive learning climate, confidence through caring, appreciation of life meaning and respectful sharing) were identified in EFA, which was consistent with that of the original English version, and were confirmed by CFA.

Conclusion

The C-NSPIC can serve as a reliable and valid instrument for assessing the nursing students' perception of instructor caring in China, which may help to improve the nursing students' caring ability in China.

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.

Section snippets

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.

References (39)

  • M.S. Bartlett

    Tests of significance in factor analysis

    British Journal of Psychology

    (1950)
  • D.E. Beaton et al.

    Guidelines for the process of cross-cultural adaptation of self-report measures

    Spine (Phila Pa 1976)

    (2000)
  • W.T. Branch et al.

    Teaching the human dimensions of care in the clinical setting

    Journal of the American Medical Association

    (2001)
  • T.A. Brown

    Confirmatory Factor Analysis for Applied Research

    (2006)
  • A. Favaretto et al.

    Student nurses' percepted evaluation toward on clinical tutors

    Professioni Infermieristiche

    (2010)
  • X.-F. Feng et al.

    Research on the cultivated effect of the humanistic caring ability of nursing undergraduates

    Chinese Medical Ethics

    (2011)
  • A. Field

    Discovering Statistics Using SPSS

    (2005)
  • J. Ford et al.

    The application of factor analysis in applied psychology: a critical review and analysis

    Personnel Psychology

    (1986)
  • G. Garyfallos et al.

    Greek version of the General Health Questionnaire: accuracy of translation and validity

    Acta Psychiatrica Scandinavica

    (1991)
  • Cited by (17)

    • Associate Degree Nursing Students’ Perceptions of Instructor Caring

      2019, Teaching and Learning in Nursing
      Citation Excerpt :

      The 31-item instrument had a Cronbach's alpha of .97, and the five factors had Cronbach's alphas ranging from .72 to .96, indicating internal consistency reliability (Wade & Kasper, 2006). The NSPIC instrument has been used in five additional pre-licensure nursing research studies that have been published in peer reviewed journals (Ali, 2012; Labrague et al., 2016; Li et al., 2013; Meyer, Nel, & Downing, 2016; Zamanzadeh et al., 2015). This instrument has been used multiple times and demonstrates validity and reliability.

    • Student-faculty relationships and its impact on academic outcomes

      2018, Nurse Education Today
      Citation Excerpt :

      Nursing students argue when there is mentorship, and educators are approachable, they not only feel supported but cared for by throughout their studies (Luhanga et al., 2010; McEnroe-Petitte, 2011; McGregor, 2007; Read et al., 2013). In turn, this combination results in improved academic outcomes as evident through students' success and educators' morale (Lee, 2007; Li et al., 2013; McEnroe-Petitte, 2011). Incivility is the largest documented barrier to student-faculty relationships in nursing and is an element associated with students not achieving desired academic outcomes such as increased attrition, disruptive learning climates, and irresponsible behaviours (Clark, 2008; Del Prato, 2013; Ibrahim and Qalawa, 2016; Lasiter et al., 2012; Read et al., 2013).

    • Professional values in Turkish undergraduate nursing students and its reflection on caring behaviour

      2017, Kontakt
      Citation Excerpt :

      Loke et al. [13] identified that compassion and an ability to respond with humanity and kindness to others’ pain, distress, anxiety or needs has long been regarded a critical core professional value of care in nursing profession. Caring is also a vital part of nursing professionalism and capacity of nursing students [11–14]. There have been a number of studies on the content of professional values.

    View all citing articles on Scopus

    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.

    View full text