Date Published: February 28, 2019
Publisher: Public Library of Science
Author(s): Macarena Romero-Martín, Juan Gómez-Salgado, Máximo de la Fuente-Ginés, Juana Macías-Seda, Alejandro García-Díaz, José Antonio Ponce-Blandón, Terry L. Derting.
The care that clinical instructors demonstrate to students is essential for their education, considering the strong impact it has on their future relationships with patients, relatives, and other health professionals. Nursing Students’ Perceptions of Instructor Caring (NSPIC) is an instrument designed to assess nursing students’ perceptions of instructor’s caring behaviors. A trans-cultural, conceptual, and psychometric validation study was conducted with 315 nursing students at the University of Seville during their clinical practices in three regional hospitals. The NSPIC was translated and adapted to Spanish. The content validity was established by a panel of experts. To assess concurrent validity the culturally adapted Spanish version of the Clinical Placement Evaluation Tool (CPET) was used as a gold standard. The construct validity was determined by an exploratory factor analysis to identify the internal structure of the NSPIC-S. The internal consistency was established by Cronbach’s α and the intra-observer reliability for each item was established by test-retest. The content validity index varied between 0.53 and 0.93 and the correlation to the CPET was moderate. The factor analysis revealed a structure of five factors, one of which differed from the original scale. The value of Cronbach’s α was 0.95 and intraclass correlation coefficients varied between 0.5 and 0.89. Our study provided a culturally adapted version of the NSPIC, valid and reliable to be used in the Spanish context, the NSPIC-S.
Caring is considered the core concept of nursing, the essence that guides nursing theory, practice and research . Since caring is a fundamental value in nursing, the ability to care should be an aspiration for all nursing students . Nursing curricula should be focused on caring and should offer students a general appreciation of caring so that they will be capable of performing their professional roles as caregivers . However, given its subjective, ambiguous and complex nature, teaching the practice of caring is a difficult challenge. According to Watson, care occurs through an inter-subjective and transpersonal relationship, understood as a spiritual interconnection of mutual transformation between the caregiver and the person being cared for, which transcends both people to affect their realities and enrich their vision of the world . Under this approach, and considering that the instructor-student relationship is based on caring, this relationship could be a valuable opportunity to learn how to care, since both incorporate new experiences and meanings to their spiritual dimension.
Of the 315 surveys collected, 310 were considered valid, and 4 were excluded, since they referred to practices during international exchange, and one for being completed incorrectly. Nursing students who made their clinical practice abroad were excluded because we aimed to validate the NSPIC within the Spanish culture, and their answers would refer to a different context. The final response rate was 98.4%. The socio-demographic characteristics of the participants are shown in Table 1. Sample was predominantly female, mean age 22.38, Standard Deviation 3.53.
The results revealed a culturally adapted version of the NSPIC, valid and reliable to be used in the Spanish context, the NSPIC-S.With respect to content validity, items 12 (i.e., does not reveal any of his or her personal side) and 16 (i.e., serves as a trusted resource for personal problem solving) had an insufficient CVI-I, which represents a disagreement in the relevancy of the item among the panel of experts. Both items refer to an approach at a personal level between the instructor and the student. This discrepancy could be explained if instructor-student relationship is interpreted as learning and growing processes that develop only at a professional level for both. In the power relationship between instructor and student, instructors are aware of their position of superiority  which can place a barrier that impedes theinstructor-student relationship from advancing in the personal realm. Moreover, the demonstration of procedural-type practical abilities is valued by both, instructors and students , which infers instructor-student relationship with more of a professional nature rather than personal. Some authors suggest previous education for students about how to establish professional relationships with instructors to improve the quality of their learning experience .
We pursued the trans-cultural adaptation of the NSPIC to the Spanish context. In light of the results, we concluded that the NSPIC-S had satisfactory values of validity and reliability and it was a suitable instrument for the evaluation of students´ perception of instructor caring behaviors. The resulting version of the scale consists of 29 items grouped into 5 factors: confidence through caring (13 items), supportive learning climate (5 items), appreciation of life meaning (3 items), control versus flexibility (4 items) and professional nurse autonomy (4 items). The use of the NSPIC-S in studies that evaluate education in a clinical environment could help in grasping the model of care that students are receiving and the identity of the role they are interiorizing. The results of the studies using the NSPIC-S can help improve educational work of clinical instructors, giving them a deeper understanding and raising their awareness about the impact and scope of the relationship they establish with students and promoting caring behaviors that serve as a learning model. In addition, using the NSPIC-S in future research will allow us to design strategies to improve practices that are in line with the students´ perception that contribute to improve learning outcomes.
Firstly, the convenience sampling method limited generalization of the results to the Spanish nursing students population. All participants were students at the same university and therefore, may not be representative of the Spanish population of nursing students. Secondly, exploratory factor analysis was used to identify associations between variables when studied in the Spanish cultural context, without considering the original NSPIC structure as a starting point. Because the results describe a structure different from the original, performance of a confirmatory factor analysis is needed to substantiate the structure of the NSPIC-S that we obtained. We recommend further study with a larger population that includes Spanish students from multiple universities to conduct a confirmatory factor analysis. The resulting internal structure would be more reliable and valid for the Spanish context. Thirdly, our study sample was not homogeneous with regard to gender, with a majority of female students and a majority of female staff at the hospitals where the practices were carried out. Performing multicenter randomized studies with a homogeneous sample of participants is recommended.