The Perceptions of Nurse Educa

INFORMATION TO USERS
This manuscript has been reproduced from the microfilm master. UMI
films the text directly from the original or copy submitted. Thus, some
thesis and dissertation copies are in typewriter face, while others may be
from any type o f computer printer.
The quality of this reproduction is dependent upon the quality of the

copy submitted. Broken or indistinct print, colored or poor quality
illustrations and photographs, print bleedthrough, substandard margins,
and improper alignment can adversely afreet reproduction.
In the unlikely event that the author did not send UMI a complete
manuscript and there are missing pages, these will be noted. Also, if
unauthorized copyright material had to be removed, a note will indicate
the deletion.
Oversize materials (e.g., maps, drawings, charts) are reproduced by

sectioning the original, beginning at the upper left-hand comer and
continuing from left to right in equal sections with small overlaps. Each
original is also photographed in one exposure and is included in reduced
form at the back o f the book.
Photographs included in the original manuscript have been reproduced

xerographically in this copy. Higher quality 6” x 9” black and white
photographic prints are available for any photographs or illustrations
appearing in this copy for an additional charge. Contact UMI directly to
order.
UMI
A Bell & Howell Information Company
300 North Zeeb Road, Ann Arbor MI 48106-1346 USA
313/761-4700 800/521-0600
R ep ro d u ced with p erm ission o f th e copyright ow ner. Further reproduction prohibited w ithout perm ission.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
THE PERCEPTIONS OF NURSE EDUCATORS AND
STUDENT NURSES OF CARING BEHAVIORS
by
Allison. Morrison
A Master's Thesis
Submitted to the Faculty of the
Al l a n & Donna Lansing School of Nursing
in partial fulfillment of the requirements
for the degree of
Master of Science in Nursing
Program of Graduate Nursing

Bellarmine College
Louisville, Kentucky
April, 19 97
R ep ro d u ced with p erm ission o f th e copyright ow ner. Further reproduction prohibited w ithout p erm ission .
UMI Number; 1383993
Copyright 1998 by
Morrison, Allison Sue
All rights reserved.
UMI Microform 1383993

Copyright 1998, by UMI Company. All rights reserved.
This microform edition is protected against unauthorized

copying under Title 17, United States Code.
UMI
300 North Zeeb Road
Ann Arbor, MI 48103
R ep ro d u ced with p erm ission o f the copyright ow ner. Further reproduction prohibited w ithout perm ission.
The thesis entitled,"The Perceptions of Nurse Educators and Student
Nurses of Caring Behaviors" is accepted by the faculty of the A l lan
& Donna Lansing School of Nursing, Bellarmine College, in p artial
fulfillment of the requirements for the Degree of Master cf Science
in Nursing.
Ccmmi
terser.
a
n
Date
11
R ep ro d u ced with p erm ission o f the copyright ow ner. Further reproduction prohibited w ithout p erm ission.
Dedication
This thesis is dedicated to Ti m who taught me the true meaning
of caring. Also, my family and a very special friend, Donna C r u m ,
for their continued guidance, support, and encourage- e n t .
R ep ro d u ced with p erm ission of the copyright ow ner. Further reproduction prohibited w ithout p erm ission.
Acknowledgements
I would like to acknowledge my thesis c o m m i t s =e chairman,
Karen Cassidy, for her support and assistance in the rtmpleticn of
this thesis. I would also like to thank my thesi .3 c o m m icl6s
members, Mag g i e Miller and Linda Cain for thsi:r cime and
involvement, an d Dr. Steven Banks of Marshall Qniver:iLzv for his
assistance w i t h the statistical analysis of the data.
Vita
A l l i s o n S. M o r r i s o n
9 Peartree Lane
Lesage, West Virginia 25537
EDUCATION:
1991 B a c helor of Science in Nursing, West Virginia
University, Morgantown, West Virginia.
1986 Diploma in Nursing, St. Mary's School of

Nursing, Huntington, West Virginia.
EXPERIENCE:
1 / 9 4 -Present A s h l a n d Comm u n i t y College Associate Degree
Nursing Program, 1400 College Drive, Ashland,
Kentucky.
Assistant Professor of Nursing
2/1990-1/94 St. M a r y ' s Hospital, 2900 First Avenue,

Huntington, West Virginia.
Staff nurse, Coron a r y Intensive Care Unit and
Cardiac C a t h e t e r i z a t i o n Laboratory
6/89-2/90 Cabell H u n t i n g t o n Hospital, 1340 Hal Greer

Boulavard, Huntington, West Virginia.
Staff Nurse, U r o l o g y Unit
6/37-4/87 St. M a r y ' s Hospital, 2900 First Avenue,

Huntington, West Virginia.
Staff nurse, Cardiac Stepdcwn Unit
HONORS: National Collegiate Nursing Award, 1996
PROFESSIONAL ORGANIZATIONS :
Sigma T h e t a Tau National Honor Society of N u r s i n g

Lambda Psi Chapter
Pinnacle Honor Society
Abstract
The p u r p o s e of this study was to examine the differences of
nurse educators' and nursing students' perceptions of caring
behaviors. The Caring Assessment Instrument (CARE-Q v/as u s e d in
this study. Nursing students (N=S2) and nurse educators (N=8! from
an Associate Degree Nursing Program in eastern K e n tucky
participated in the study. The participants completed an informed
consent and demographic data sheet. Using Q-methodoicgy, the
participants were asked to rank caring behaviors frcm most
important to least important. Statistical procedures included
means, standard deviations, and t-tests. Statistically significant
differences were demonstrated in the subscales of .Vcnitors and
vi
R ep ro d u ced with p erm ission o f the copyright ow ner. Further reproduction prohibited w ithout perm ission.
Table of Contents
Title Page
Committee approval p a g e ...................
Dedication..................................
Acknowle d g e m e n t s ..................................
Vita
Abstract •
. , .vi
Table of C o n t e n t s ................................. .. .Vii
List of t a b l e s .................................... . , vi* *
Chapter 1 ~ Dimensions of the P r o b l e m .......... . . .2
Chapter 2 - Review of :i t e r a t u r e ................ . . .5
Chapter 3 - M e t h o d ................................ i-
Chapter 4 - R e s u l t s ...............................
Chapter 5 - D i s c u s s i o n ........................... 27
References. 3C
Appendix A - Informed C o n s e n t ................... 33
Appendix 3 - Request to utilize institution.... . . .34
Appendix C - Nurse educator demographic s h e e t .. . . .35
Appendix D - Nursing student demographic sheet. . . .35
Appendix E - CARE-Q inst-nnment..................
vii
List of Tables
Table 1. Demographic Data ......................................... 2
Table 2. Nursing Students Ten High Mean Score CARE-C I t e m s ..... 2
Table 3. Nurse .■Educators Ten High Mean Score CARE-0 I t e m s ...... 2
Table 4. Scores on Subscales of C a r i n g ............................ 2
Table 5. Most Important CARE-C Items Agreed on by Students
and E d u c a t o r s...............................................2
viii
R ep ro d u ced with p erm ission o f th e copyright ow ner. Further reproduction prohibited w ithout p erm ission .
2
Chapter I
DIMENSIONS O F THE PROBLEM
Introduction
This study investigated the perceptions of caring behaviors
of nurse educators an d student n u r s e s . Car i n g is the vital
component of nursing. It is the unifying d o m a i n for nursing.
Nursing is synonymous with helping others, w h i c h is accomplished
through caring. Historically, humans have n e e d e d caring for the
development and survival throughout their life span (Leininger,
1981). It is critical that nurses execute effective caring during
their professional career.
There are few studies on the perception of caring that focus
on nurse educators a n d nursing students. One w a y that caring is
learned is through role-modeling (Nelms, Jones, & Gray, 1993).
Therefore, it is important to investigate the relationship
between the p e r c eption of caring in nurse educators and the
perception of caring in nursing s t u d e n t s .
Statement of Purpose
The purpose of this study was to examine the differences of
nurse educators' a n d nursing students' perceptions of caring
b e h a v i o r s . The i nformation obtained will help enhance the
knowledge and u nderstanding of the phenomenon of caring in the
educational setting.
Significance
This study is significant because the identification of
essential caring b ehaviors will assist nurse educators in
providing an environment in which nursing students can gain
necessary skills to provide human caring. The identification of
essential caring behaviors is needed to teach caring. Only a few
nursing programs have d e v e l o p e d curricular frameworks based on
the concept of caring. In order to graduate caring nurses into
the profession, the concept of caring must be displayed and
experienced by both students and faculty.
Caring has been d e s c r i b e d as the "essence of nursing and the
central, dominant, and u n i f y i n g feature of nursing" leininger,
1SS8, p. 152) . Caring a n d the relationship of caring to nursing
care is unclear in research, teaching, and practice. Komoritc,
Doehring, & Hirchert (IS91) discovered that the perceptions of
managers, advanced practitioners, and nurse educators were not
consistent with p a t i e n t s ' perceptions of caring. Nurse educators
and nursing students may also have different perceptions of nurse
caring behaviors. Therefore, it is important to investigate the
perceived importance of n u r s e caring behaviors of these two
groups.
Research Question
The research question for this study is: What are the
differences between nurse educators' and nursing students'
perceptions of important nurse caring behaviors?
Definitions of Terms
Caring
Conceptual d e f i n i t i o n - a process by which the nurse is
responsive to another p e r s o n as a unique individual, perceives
R ep ro d u ced with perm ission of th e copyright ow ner. Further reproduction prohibited without p erm ission.
Che other's feelings and sets chat person aparc frcrr. the o r d i n a r y
(Wacson, 1985) .
Operational definition - The Caring Assessment Report
Evaluation Q-Sort 'CARE-Q) (Larson, 1984).
Percept ions - awareness that is obtained free, an
experience which results in knowledge or a belief about the
experience (Watson, 1985).
Assumptions
1. Nursing students' perceptions of caring behaviors are
influenced by nursing faculties' perceptions of caring behaviors.
2. Behaviors m a y be used to describe caring.
Chapter II
REVIEW OF LITERATURE
The 1989 National Caring Conference focused specifically on
the caring imperative in education. If nursing schools do not
include distinctive teaching and practice opportunities of
caring, faculty cannot be assured that their graduates will
practice cari n g behaviors later in their careers (Leminger,
1980). Hseih and Knowles (1990) suggested that implementation of
a helping relationship and application of caring concepts enhance
personal and professional growth.
in a qualitative study, Miller, Haber, and Byrne (1990)
found four m a j o r parallel themes derived from faculty and
student interviews. The first theme was holistic concern.
Holistic regard for individuals was viewed by both faculty a n d
students as a fundamental quality of caring. The second theme,
teacner ways of being, revealed that faculty were consciously
aware of pro v i d i n g a supportive climate. Student ways of being,
the third theme, indicated that students described the dimensions
of a supportive climate as part of the caring process. Both
faculty and students identified growth, empowerment, and hope for
the future as student outcomes of caring interactions with
faculty. The fourth theme, mutual simultaneous dimensions,
indicated sharing, trust, and respect as important aspects of the
caring interaction by both faculty and students. The reciprocal
learning experience was view e d by both nursing students and
nursing faculty as an integral part of the caring process.
5
3eck (1991) conducted a phenomenological s t udy which
identified five characteristics of caring that junior and senior
nursing students perceive about faculty. These included
compassion, competence, confidence, conscience, an d commitment.
Compassion involved sensitivity and participation in another
person's experiences. This included sharing the pain, sorrow,
joys, and accomplishments of another person. Competence e n t a i l e d
the faculty sharing their knowledge and expertise with the
students. Confidence included mutual trust and respect that
fostered a trusting relationship. Conscience involved a moral
awareness. Students portrayed how caring faculty valued them as
individuals. Commitment was used frequently by the students to
describe caring faculty members. Commitment entailed investing
one's time in a person, a task, or a career.
In another phenomenological study, Appleton (1991)
identified the meaning of human care and the experience of carinc
in a university school of nursing. The participants were two
doctoral students of a NLN-accredited university school of
nursing. The findings suggested that the experiences of h u man
caring evolve into three aspects. Expressions of caring involved
respect, understanding the other's interdependence, and a ssisting
the other to g r o w and become. Caring was reported as a process of
involvement, commitment, and belonging. The environmental
dimensions of the experience were described as occurring w i t h i n
space, place, and time in an organizational structure. The
findings also suggested that caring stems from an attitude of
compassion.
Halldorsdottir (1990) studied the phenomena of caring and
uncaring in nursing education as perceived by former s t u d e n t s .
The participants included nine graduate nurses. Four students ha
a baccalaureate degree, four had a master's degree, and one was
working toward a PhD. The results indicated that a caring
encounter entails four basic components. The first component, th
teacher's professional caring approach, included professional
competence, genuine concern, professional commitment, and
positive personal characteristics such as personal integrity,
flexibility, attentiveness, and humor. The second component was
mutual trust. Development of a professional teacher-student
working relationship while keeping a respectful distance was
identified as the third component. The last component, positive
student responses to professional caring involved four major
themes. The themes were identified as sense of acceptance and
self-worth, personal and professional growth and mcctvation,
appreciation, role modeling, and long-term gratitude and respect
The essential components of an uncaring encounter included the
teacher's lack of professional caring, lack of trust, teacher-
student detachment, and negative student responses.
In a descriptive study, Nelms et al.(1993) reported that
students learn about caring from faculty role-modeling in
clinical and classroom settings, as well as from relationships
with patients, staff, and other students. These relationships
facilitated the students' abilities to engage in caring for
others. This study supports the idea that students look to
faculty and various members of the health care team to roie-mcdel
caring. Findings imply that students obtain knowledge about
caring through experiencing both caring and noncaring.
An analysis of ethical student-faculty interacttons was
performed by Schaffer and Juarz (1993). Twenty-two senior nursing
students responded to journal questions that explored ho w their
learning experiences affected their self concept and growth as
nursing students. The results shewed that the students p e r c e i v e d
faculty behaviors as uncaring, unfair, and decreasing one's
autonomy. These authors suggested tnat the caring perspective be
a guide for faculty and student behavior, thus increasing
positive faculty-student relationships.
The is (1988) conducted a study which investigated nu r s i n g
students' perspectives of unethical teaching behaviors. The
participants consisted of 204 senior baccalaureate nursing
students from three NLN-accreaited nursing programs. The findings
revealed that the dominant unethical teaching behavior in
clinical and classroom settings was a violation of respect for
persons. The second unethical teaching behavior identified was
violation of the principle of justice. Violation of the principle
of beneficience was the third unethical teaching behavior. The
results of this study regarding lack of respect are profound
because e d u c a t o r s ' behaviors have an impact on students a n d the
manner in which they respond to o t h e r s .
9
Mangold (1991) performed a comparative study of senior
nursing s t u d e n t s ' and professional n u r s e s ' perceptions of
effective c a ring behaviors. The participants included 30 senior
baccalaureate nursing students and 3 0 professional nurses with
one or more years experience. The instrument used was the Caring
Assessment Instrument(CARE-Q)(Larson, 1984). The mosn important
behavior that both the professional nurses and nursing students
agreed o n was "listens to the patient". The behavior viewed as
the least important by the professional nurses was "is
professional in appearance". The least important behavior
identified b y the nursing students was "puts the patient first no
matter what". Mangold suggested that the si m i l a r i t y in the
students' an d nurses' perceptions of effective c aring behaviors
may be because these perceptions develop during the educational
process.
Komcrit a et al. (1991) studied perceptions of caring by nurse
educators. The CARE-Q was given to 113 nurses with a master's
degree or those in the final stage of graduate s c h o o l . The
findings indicated that "listening to patients" was perceived as
the most important caring behavior. Additional behaviors viewed
as important included "allowing patient to express feelings,"
"touches patient," and "teaches patient".
In summary, the literature suggested that b o t h students and
faculty v i e w e d mutual trust and respect as essential components
of the caring process. These components were also identified as
assisting in the development of a supportive climate as well as
R ep ro d u ced with perm ission of th e copyright ow ner. Further reproduction prohibited without p erm ission.
10
increasing Che students' self confidence and self-worth. Nurse
educators who involve students in the learning process assist
students to g r o w and b e c o m e professional nurses. Researchers also
found that students learn from faculty role modeling. Students
that experience caring behaviors dur i n g the educational setting
will have a positive impact on the caring behaviors they will
display in their career as a professional nurse.
Further studies u s i n g the CARE-Q instrument revealed that
"listens to patients" and "allowing patient to express feelings"
were the most important c a r i n g behaviors. "Touches patient" and
"teaches patient" were a l s o identified as important caring
behaviors. The least important caring behavior identified was "is
professional in a p p e a r a n c e " .
Theoretical Framework
The theoretical framework used in this study was Watson's
(1985) science of caring. This theory emphasizes human caring as
the basis for nursing education, research, and clinical practice.
Watson proposed that ca r i n g is a humanistic and interpersonal
process, whereby carative factors are the basis for the delivery
of health care. She deve l o p e d ten carative factors from a
humanistic philosophy, f o unded on a scientific basis that is
central to caring for a n o t h e r human being.
Some of the basic assumptions for the science of caring in
nursing include:
1. Caring can be effectively demonstrated and
practiced only i n t e r p e r s o n a l l y .
2. Caring consists of carative factors that
result in the satisfaction of certain
human n e e d s .
3. Effective c a r i n g promotes health and
individual or f a m i l y growth.
4. Caring responses accept a person not only
as he or she is n o w but as what he or she nay
become.
5. A caring environment is one that offers
the development of potential while
allowing the p e r s o n to choose the best
action for himself or herself at a given
point in time.
6. Caring is more "healthogenic" than is
curing. The p r a c t i c e cf caring integrates
biophysical knowledge with knowledge of
human behavior to generate or promote
health and to pr o v i d e ministrations to
those who are ill. A science of caring is
therefore complementary to the science of
curing.
7. The practice of caring is central to
nursing (Watson, 1985, p. 8).
Human care requires actions that allow another to g r o w a
solve problems. The human care process requires "an intention
will, a relationship, and actions" (Watson, 1985, p. 74) . T h e
12
human care theory is based on ten carative factors. These factors
are:
1. Humanistic-altruistic system of values
2. Faith-hope
3. Sensitivity to self and others
4. Helping-trusting, human care relationship
5. Expressing positive and negative feelings
6. Creative problem-solving caring process
7. Transpersonal teaching-learning
3. Supportive, protective, and/or corrective mental,
physical, societal, and spiritual environment
9. Human needs assistance
10. Existential-phenomenolcgical-spiritual forces
(Watson, 1988, p. 75}.
Individuals develop a value system early in life. As
individuals mature, values grow and become more meaningful. "The
natural development of humanistic values can be facilitated
through the exchange of attitudes and beliefs and of the learning
and role modeling that occur between the student nurse and the
nursing educator" (Watson, 1988, p. 10) .
The carative factor, development of a h e l p i n g - t r u s t m g
relationship, is related to the carative factor, promotion of
interpersonal teaching-learning. Watson (1985) stated, "the
effectiveness of teaching is affected by the assessment of the
patient's perceptions and attitudinal qualities that facilitate
learning" (p. 75). The qualities necessary for effective teaching
13
and an effective helping relationship include empathy,
congruence, and nor.possessive warmth. These three qualities
provide a trusting atmosphere for learning and growth. The
carative factor, promotion of interpersonal teaching-learning is
necessary in the majority of encounters that nurses have with
other human beings (Watson, 193 5) .
Human needs consist of the need to be loved and cared for,
the need for positive regard, and the need to be accepted,
understood, and valued. In nursing, the art of caring is
experienced when the nurse joins another with a feeling of
concern and care and expresses the feeling through external
indications (Watson, 1985) . Watson describes this event as a
transpersonal caring relationship.
According to Watson (1985), in order to care there must be
an underlying value, a moral commitment, and a will. Tor nursing
to meet the needs of society, both the health care delivery
system and nursing education must be based on human values and
the welfare of others. The teaching of a caring ideology will
result in caring outcomes in research, theory, and practice.
One foundation that can be u s e d to incorporate caring
practices into nursing curricula is Watson's theory. Each of the
ten carative factors relate to the caring process that needs to
be the focus of nursing education. For nursing to be a truly
caring profession, caring behaviors must be displayed by
professional nurses. The natural development of humanistic values
can be enhanced through the exchange of beliefs and attitudes and
14
through the learning and role modeling that occur between the
nursing student and the n u r s e educator (Watson, 1985..
Chapter III
METHOD
Design and Approach
A comparative descriptive design was used in this study. Th
comparative descriptive design is used to describe and e x amine
differences in variables in two or more groups that occur
naturally in the setting (Burns & Grove, 1993) . This appro a c h is
appropriate for this study of examining nurse e d u c a t o r s ' and
student n u r s e s ' perceptions of nurse caring b e h a v i o r s .
Settinc and Sample
The setting for this study was an academic environment. The
classroom was used for collecting data relative to the n u r s i n g
students. Data collection from the nurse educators took p l a c e in
each one's individual office.
The sample consisted of eight nurse educators from an
associate degree nursing program in Kentucky and 62 associate
degree nursing (ADN) students enrolled in the fourth semester of
the same associate degree nursing program. Participation in this
study was voluntary. Informed consent was obtained through a
written consent form that included the purpose, risks, an d
benefits of the study (see Appendix A ) . Anonymity and
confidentiality was preserved. Grades were not affected b y
whether subjects participated in the study. Permission from the
nursing program was obtained through a letter stating the
purpose, risks, and benefits of the study (see Appendix B ) .
IS
Instrument:
The Caring Assessment Instrument(CARE-Q)(Larson,1984) was
used to measure the perceived importance of nurse caring
behaviors of nurse educators and nursing students. The CARE-Q was
developed in two major phases. The first phase focused on the
identification of nurse caring behaviors. These were obtained
through two preliminary studies involving nurses, patients,
literature on caring, and the author's experience in nursing. The
final CARE-Q instrument consisted of 50 behavioral items ordered
in six subscales of caring and ranked by importance that measures
perceptions of nurse caring behaviors. The following are the six
subscales of caring: Accessible (6 i t e m s ) ; Explains and
facilitates (6 items) ; Comforts (9 items) ,- Anticipates (5 items) ;
Trusting relationship (16 items); an d Monitors and follows
through (8 i t e m s ) . The most important item was coded 7. The four
fairly important items were coded 6, and the 10 somewhat
important items were coded 5. The 20 items identified as neither
important or unimportant were coded 4, the 10 somewhat
unimportant items were coded 3, the four unimportant items were
coded 2, and the least important item was coded 1.
Validit y and reliability were addressed in phase II. Face
and content validity of the instrument were supported by two
review panels and psychometric consultations. Behavioral items
were identified in two separate studies, and were verified b y a
nurse panel an d patient panel. Reliability was initially tested
using nine undergraduate nursing students in a test-retest study,
17
resulting in r=l-00 on the items selected as the one most
important and one least important item. The second test-retest
study consisted of 32 registered nurse members of a national
organization of oncology nurses. The item ranking consistency of
the five most important CARE-Q items was 79.1% between Test I and
Test II. For the five least important items, the consistency
ranking was 63.4%.
Demographic information for the nurse educators included
age, gender, education, and work experience (see Appendix C ) . The
demographic variables for the nursing students included age,
gender, work experience in the nursing field, and years of
education following high school or GED (see Appendix Dj .
Procedure
Permission to use the CARE-Q Sort instrument tool was
obtained from Dr. Larson (see Appendix E ) . A letter was sent to
the educational institution seeking permission to conduct the
study. Consent forms were distributed to ail nursing faculty and
nursing student participants. The participants were assured that
the information obtained w o uld be kept confidential and that
deciding not to participate would not affect the students'
grades. Upon completion of the consent forms, the demographic
data sheets and the CARE-Q instrument was distributed to the
nurse educator a n d nursing student participants. The participants
were given f i fty 3 by 5 -inch cards e a c h containing a behavioral
statement. Each participant was also given seven envelopes
identifying one most important and one least important behavioral
18
item, four fairly important and four unimportant items, 10
somewhat important and 10 somewhat unimportant items, and 2 0
items that are neither important or unimportant. The participants
were instructed to place the items in the designated c a t e g o r i e s .
Data collection from nurse educators and nursing students was
obtained in separate group settings.
Data Analysis
Frequency distributions were used to measure items of the
instrument. T-tests were used for differences between students
and educators on demographic data and subscale scores.
Correlations of continuous level demographic data with subscales
were also used.
Chapter IV
RESULTS
Description of Sample
The sample consisted of 62 associate degree nursing students
from an associate degree nursing program in eastern Kentucky and
eight nurse educators from the same nursing program. The students
were enrolled in their final semester of nursing. The
participants voluntarily completed the demographic data and the
CARE-Q. The nursing student sample consisted of 55 females ;94%)
and four males (6%). Their ages ranged from 19 years to 5 2 years
M=32.76. Years of work experience in health care ranged from 1 to
12 years M=l-2. The nurse educator sample consisted of eight
females. Their ages ranged from 32 years to 51 years 11=43.63.
Years of work experience in health care ranged from 11 years to
38 years M = 2 2 .5 . The nursing students' previous health care
experience included three licensed practical nurses, three nurses
aides, 32 nurse externs, and one operating room technician.
Twenty-three of the nursing students had no previous health care
experience. The nursing students years of education following
high school ranged from 1 year to 6 years M=3.61. All of the
nurse educators were master's prepared nurses. All had six years
of education.
An independent t-test was used to examine significant
differences between the two groups' demographic characteristics
of age, years of experience, and years of education. As expected,
there were significant differences between the groups. Nurse
educators were significantly older than nursing students, £.=3.42,
£=.001. T he y also had more years of experience and
education,£=16.45 and 6.41, £<.0001, respectively. See Table 1.
Table 1
T-Test Results for Age, Years of Experience, and Years of

Education of Nurse educators and Nursing students
Mean SD t-Score p -Value
Nurse educator (N=3)
Age 43 .63 9 .531 3 .42 .3011
Years of Experience 22 .5 8 .713 16 .45 .3001

o
o
Years of Education 6 .0 6.41 .3001
Nursing Students ;N=62)
Age 32 .76 3 .321
Years of Experience 1.2 2 .120
Years of Educaticn 3 .61 1. 046
Analysis of Research Question
The research question for this study w a s : What are the
differences between nurse educators' and nursing students'
perceptions of important nurse caring behaviors? There were no
significant differences between the two groups on the Accessible,
Explains, Comforts, and Anticipates subscales. Closer examination
of individual items revealed that the nursing students ranked,
"gives the p a t i e n t ’s treatments and medications on time,"
M = 5 .371,£ Q = 1 .016 from the Accessible subscale as the most
important caring behavior. The second and third highest ranked
behaviors w e r e "knows how Co give shots, etc.", M = 5 .75 0.S D = Q .8 71.
from the Monitors subscale and "listens to the patient",
22=5.032,55=0.78 8, from the Comfort subscale. The nursing students
ranked "asks the patient what name he/she prefers to be c a l l e d " ,
22=2.322,55=1.261, from the Trusts subscale as the least important
caring behavior. The sec o n d and third lowest ranked behaviors
were "is professional in appearance", M = 3 .0 64.S D = i .2 77. from the
Monitors subscale and "suggests questions for the patient to ask
his/her doctor", 22=3.03 0,512=1-090, from the Explains subscale
(Table 2).
Nurse educators ran k e d "listens to the patient",
22=6 .250 ,55=1.165 , from the Comforts subscale as the most
important c a r i n g behavior. The second and third highest r a n k e d
behaviors we r e "touches the patient when he/she needs
comforting", 22=5 .500 ,512= •634, from the Comforts subscale an d "is
perceptive of patient's needs, etc., 22=5 .375 ,512=1.18", from the
Anticipates s u b s c a i e . The least important caring behavior
identified b y the nurse educators was "is professional in
appearance", 22=2 .375 ,55=1 •407, from the Monitors subscale. Th e
second and t h i r d lowest ranked behaviors were "volunteers tc do
little things for patient", 22=2.750,512=1-035, from the Accessible
subscale and "is cheerful", 22=2.750,55=1-03 5, from the Comforts
subscale (Table 3).
Other Findings
There w e r e significant differences between the two g r o u p s in
two of the C A R E - Q subscales. Pearson correlation procedures were
22
performed to identify relationships between age, years of
experience, years of education, and subscale scores. There were
significant w e a k inverse relationships between years of
experience and both education, jz= -.3 07, p=<.0l, and also the
Monitors subscale, r= -.279, p=<.05. These with less experience
and education ranked m o n i toring behaviors higher than those with
more experience and education. Students valued monitoring
behaviors more than the nurse edu c a t o r s . There was also a
significant weak positive relationship between years of educatior.
and the Trusts subscale, £ = . 2 S 3 ,p < .05. Those w i t h mere education
ranked trust behaviors hi g h e r than those with less education.
Nurse educators valued the Trusts items significantly more than
the students. The results are illustrated in Table 4.
There were six items that both nurse educators and nursing
students agreed on as being the most important caring b e h a v i o r s .
3ehaviors categorized in the Accessible subscale were "gives
treatments and medications on time," "checks on patient
frequently," and "gives q u i c k response to patient's call." The
behavior "is honest with patient about medical condition" was
from the Explains subscale. The Comforts subscale included the
following behaviors, "listens to the patient" and "touches
patient" (Table 5).
Table 2
Students /.N=62) perceptions of the most important caring

behaviors; The ten high mean score CARE-0 items
Item Mean SD
Accessible Subscale
Gives treatment and meds on time 5.3710 1.016*
Gives quick response 4.6129 1.1067
Checks on patient frequently 4 .5806 1.0483
Explains Subscale
Is honest with patient 4 .5161 1.0 3 25
Comforts Subscale
Listens to patient 5 .0323 0.7886
Touches patient 4 .5323 0.9871
Anticipates Subscale
Is perceptive of patient needs 4 .7253 0.9779
Trusts Subscale
Puts patient first 4.9677 1.5 573
Monitors Subscale
Knows now to give shots, etc. 5.7903 0.8 710
Gives good physical care 4.7419 1.129?
24
Table 3
Nurse Educators (N=8) perceptions of the roosc important car i n g

behaviors: The ten high mean score CARE-0 items
It era Mean SD
Accessible Subscale
Gives treatments and meds on time 5 .0000 1 .3092
Checks on patient frequently 5.0000 0.9255
Gives quick response to call 4 .8750 0.3536
Explains Subscale
Is honest with patienc 4 .6250 0.9161
Comforts Subscale
Listens to patient 6 .2500 1 . 165C
Touches patient 5.5000 0.5345
Talks to patient 4.6250 0.5175
Anticipates Subscale
Is perceptive of needs 5.3750 1.1877
Trusts Subscale
Concentrates only on that patient 4.7500 0.8864
Helps patient with goals 4.7500 0.7071
Monitors Subscale
None noted
25
Table 4
T-Test Results on Scores o n Subscales of Caring
Subscale Mean SD t-Score p-Value
Accessibility
Nurse Educator 26 .00 3 .02 .872 .3855
Nursing Student 27 .11 3 .43
Explains
Nurse Educator 24 .50 3 .21 .985 3280
Nursing Student 23.39 2 .98
Comforts
Nurse Educator 35.88 2 .10 .000 .9448
Anticipates
Nurse Educator 19 .88 1.89 .500 .6177
Nursing Student 19 .44 2.38
Trusts
Nurse Educator 62 .88 3 .04 2 .124 .0374 *
Monitors
Nurse Educator 29 .88 2.42 2 .383 .0199 *
♦Significant differences
26
Table 5
Most Important CARE-0 Items Agreed on by Students fN=52) and

Educators fN~=3t
Item Students Educ a t o r s

Mean SD Mean SD
Accessible Subscale
Gives treatments 5 .3710 1.0150 5 .occ: 1 .3093
and meds on time
Checks on patient 4 .5806 1.0438 5 .ooo: C .9258
frequently
Gives quick response 4 .6129 1.1067 4 .875G 0.3535
Explains Subscale
Is honest with 4 .5151 1.0825 4.6250 0.9161
patient
Comfort Subscale
Listens to patient 5.0323 0.7886 6.25C 0 1.1650
Touches patient 4.5323 0 . S871 5 .5000 0 .5345
27
Chapter V
Discussion
The results cf this study indicate that b o t h similarities
and differences of important caring behaviors exist between nurse
educators and nursing students. Six behavioral items were ranked
as important caring behaviors by both nurse educators and nursing
stud e n t s . Two areas of disagreement occurred in the subscales of
"Trusts" and "Monitors." The nurse educators ranked those caring
behaviors categorized in the "Trusts" subscale higher while the
nursing students ranked those caring behaviors categorized in the
"Monitors" subscale higher. The results also indicated that the
more years of experience and education the lower the score in the
Monitors s u b s c a l e . Findings also indicated that the more years of
education the higher the score in the Trusts subscale. The
similarities of the nurse educators' and nursing students'
perceptions of important nurse caring behaviors m a y be the result
of learning "caring" through role modeling during the educational
process. The nursing students ranked the behavior,"gives
treatments and medications on time" as the most important caring
behavior. The nursing students also ranked the behavior "listens
to the patient" as one of the three most important caring
behaviors. Mangold's (1991) study also found that nursing
students valued "listens to the patient" as the most important
caring behavior. The nurse educators ranked the behavior,
"listens to the patient," as the most important caring behavior.
A study by Komorito et a l . (1991) also found that nurse educators
23
educators value 11listens to the patient" as the most important
caring behavior.
Limitations
A convenience sample from an associate degree nursing
program located in eastern Kentucky was used; therefore, the
results of this study cannot be generalized to a population. The
small nurse educator sample produced unequal sample sizes to
compare the two groups. The setting for the school was the
researcher's place of employment which may have possi b l y caused
some b i a s e s .
Implications for Nursing
It is evident from the literature that caring is learned by
experiencing caring behaviors as well as uncaring behaviors. The
findings from this study provide insight into nursing students'
perceptions of caring behaviors and this information is
beneficial to nurse educators who teach caring as part of their
curricula. It is essential that nurse educators instill caring
behaviors in their students that will enable them to effectively
care for their patients during their professional career.
Recommendations for Future Research
Based on the findings of this study, five recommendations
for future nursing research include:
1. Implementation of studies comparing nursing students'
perceptions of caring at the time of enrollment to perceptions of
caring at the time of graduation.
2. Study nursing students' perceptions of caring after the
23
completion of e a c h clinical rotation. Experiences ir. a s p e c i f i c
clinical set t i n g may influence perceptions of effective c a r i n g
behaviors.
3. Replication of this study u s ing samples from other
associate d e g r e e programs, diploma programs, and 3SI7 programs.
4. Studies to examine if students' achievement and k n o w l e d g e
increased w h e n they experienced caring behaviors during t h e i r
education.
5. Identification of geographic location affecting
perceptions of caring.
In conclusion, the differences in nurse educators' and
nursing students' perceptions of caring behaviors warrant f u r t h e r
explanation to provide clarification of important caring
behaviors. The concept of caring also needs to be included in
both curricula an d the evaluation of the student's clinical
performance. In addition, caring must be e x e c u t e d by both n u r s e
educators and nursing students if caring is to remain one v i t a l
component of nursing.
30
References
Appleton, C. (1990). The meaning of human care and the
experience of caring in a university school of nursing. In M.
Leininger & J. Watson ( E d s ) , The caring Imperative in
education (pp. 77-93). N e w York: National League for
Nursing.
Beck, C. (1991). H o w students perceive faculty oaring: A
phenomenological study. N u r s e Educator, 1 6 '5). 18-22.
Burns, N. &= Grove, S. (1993). The practice of nursing
research: conduct, critique & u t i l i z a t i o n . Philadelphia: W.3.
Saunders C o m p a n y .
Halldor s d o t t i r , S. (1990). The essential structure of a
caring and an uncaring enco u n t e r w ith a teacher: The perspective
of the nursing student. In M. Leininger & J. W a t s o n .Eds.),
The caring imperative in education (pp. 95-103). New York:
National League for Nursing.
Hseih, N.C. & Knowles, D.W. (1990) . Instructor facilitation
of the preceptorship relationship in nursing education.
Journal of N u r s i n g Education. 2 9 (6). 262-253.
Komorita, N.I., Doehring, K.M., & H i r c h e r t , P.W. (1991).
Perceptions of caring by n u r s e e d u c a t o r s . Journal of Nursing
Education. 3 0 (1). 23-29.
Larson, P. (1984). Important nurse caring behaviors
perceived by patients w i t h cancer. Oncology N u r s i n g Forum. 1 1 (6).
46-50.
Leininger, M. (1980). Caring: A central focus cn nursing
health care services. Nursing and Health Care. 1 . 13 5-143.
Leininger, M.M. (1981) . Caring: An essential human need.
Thorcfare, NJ: Slack.
Leininger, M.M. (1988) . Leininger's theory of nursing:
Cultural care diversity and universality. Nursing Science
Quarterly. 1. 152-160.
Mangold, A.M. (1991). Senior n ursing students' and
professional nurses' perceptions of effective caring behaviors
comparative study. Journal of Nursing Education. 3 0 (3:,
134-139.
Miller, 3.K., Haber, J . , & Byrne, M.W. (1390). The
experience of caring in the teaching learning process of nursi
education: Student and teacher perspectives. In M.
Leininger & J. W a t s o n ( E d s . ) , The caring imperative in
education (pp. 125-13 5). New York: National League for
Nursing.
Nelms, T.P., Jones, J.M., Sc Gray, D.P. (19 93) . Role
Modeling: A Method for Teaching Caring in Nursing Education.
Journal of Nursing Education. 3 2 (1) . 18-23.
Schaffer, M.A. Sc Juarez, M. (1993) . An ethical analysis o
student-faculty interactions. Nurse Educator, 1 8 (3). 25-28.
Theis, C. (19S3). Nursing Students' Perspectives of
Unethical Teaching Behaviors. Journal of Nursing Education.
27(3), 102-106.
32
Watson, J. (1335). Nursing: The philosophy and science of
c a r e . Colorado: Colorado Associated University Press.
Watson, J. (1388) . Nursing: Human science and hu?.an care. A
theory of nursing. New York: National League for Nursing.
Appendix A
INFORMED CONSENT FOR RESEARCH PARTICIPATION
Appendix A
INFORMED CONSENT FOR RESEARCH PARTICIPATION
Study Title: N u r s e Educators' and N u r s i n g Students' Perceptions

of Nurse Caring Behaviors
Investigator: A l l i s o n Morrison, R . N . , B.S.N.
Allison M o r r i s o n is a registered nurse studying nurse

educators' and nursing students' perceptions of nurse caring
behaviors. A l t h o u g h this s t u d y will not benefit y o u directly, it
will provide information regarding the perceived impcrcant nurse
caring behaviors of nurse educators a n d nursing students, thus
assisting nurse educators in teaching caring behaviors.
The study a n d its procedures have been approved by the
appropriate people and r e v i e w boards at Bellarmine College in
Louisville, Kentucky. The s t u d y procedures involve no foreseeabl
risks or harm to you. The procedures include: (1) responding to
questionnaire about caring behaviors, and (2) completing a
demographic data sheet. Participation in this s t u d y will take
approximately 45 minutes. Y o u are free to ask a n y questions abou
the study and may call Ms. Morrison at (506)329-2959 (work) if
you have further q u e s t i o n s .
Your participation in thus study is voluntary; you are unde
no obligation to participate. You have the right to withdraw at
an y time and y our grade in nursing wil l not be affected.
The study dat a will be coded so the y will not be linked to
your name. Your identity w ill not be revealed w h i l e the study is
being conducted or when the study is reported. A l l study data
will be collected by’ Ms. Morrison, s t o r e d in a secure place, and
not shared with any other person without your permission.
I have read this consent form a n d volun t a r i l y consent to
participate in this study.
Subject's Signature Date
I have explained this study to the above subject and have sought
his/her understanding for informed consent.
Investigator's Signature Date
34
Appendix B
REQUEST TO UTILIZE INSTITUTION
Appendix B
REQUEST TO UTILIZE INSTITUTION
October 1, 1996
Janie Kitchen, RN, MSN

Nursing Coordinator
1400 College Drive
Ashland, Kentucky 41101
Dear Mrs. Kitchen:
I am a graduate student at the Lansing School of Nursing at

Beilarmir.e College in Louisville, Kentucky. I am investigating
nurse e d u c a t o r s 1 and student n u r s e s ' perceptions of nurse caring
behaviors. The sample will consist of nurse educators and n u rsing
students from two associate degree nursing p r o g r a m s . I am
requesting permission to utilize your facility for this study.
Participants will be asked to complete a questionnaire that
ranks nurse caring behaviors. The information should take
approximately 30 minutes to complete. Participation will be
voluntary. The p a r t i c i p a n t s 1 responses as well as the institution
will be kept anonymous.
I will contact you by the end of the week to make
arrangements should your institution chccse to participate. A
copy of the instrument and demographic data sheets are enclosed
for your review. Thank you for your cooperation.
Sincerely,
[Lil
Allison Morrison, R.N., B.S.N.
35
Appendix C
NURSE EDUCATOR DEMOGRAPHIC DATA SHEET
Appendix C
NURSE E D U C A T O R DEMOGRAPHIC DATA SHEET
SUBJECT IDS_______
A . Ace ___
3. Sex (Check one) Male
Female
C. Basic Nursing Education
ADN Diploma BSN____
D. Highest Educational A t t a inment
BSN MSN FhD O t h e r ____
E. Number of years in n u r s i n g profession
F. Number of years in n u r s i n g education
Thank you. Your time and contribution to this research activ

are sincerely appreciated.
35
Appendix D
NURSING STUDENT DEMOGRAPHIC DATA SHEET
Ap p endix D
NUR S I N G STUDENT DEMOGRAPHIC DATA SHEET
SUBJECT ID#
A . Age ______
3. Sex (Check one) Male_
Female_
C. Experience working in health care (Check one) LPN
NA
Extern
Other
D. Number of years working in health care
S. Number of years of education following

high school or GED
Thank you. Your time and contribution to this research a c t i v i t y

are sincerely appreciated.
37
Appendix E
CARE-Q INSTRUMENT
oci ci Musing University of California. San F ran cisco ...A Hea;:n S cien ces C a m p u s
lartmenr of Physiological
sing, M 511Y — Box G610
FrancSCO. CA 94143-0610
: (415) 476-3899
March 13, 1996
Allison Morrison BSN, RN

P.O. Box 218
Lesage, WV 25537
Dear Ms. Morrison:
Thank you for your interest in my work on caring. I am enclosing the information on:
1) the description of the derivation of the CARE-Q I items and scales; and 2) the
evolved CARE/SAT as detailed in the attached article.
To use the CARE/SAT, ah questionnaires must be xeroxed from the enclosed copy.
Tliis is to ensure that the visual analog line remains a constant 100mm line (apparently
xeroxing from copies causes the line to be enlarged in length). To gain the patients’
response, use a metric ruler and measure at the mid-point of the "X". If the patient
makes two "X’s," ross a coin to select one. If the patient marks an "X" beyond the line,
consider it 100; if below, it is then ranked as O. The CARE-Q in its present form does
not generate a total score.
You are welcome to use either instrument. If you want to change the content or format
of either instrument, please be aware that it will be important that the psychometric
properties of the changed instrument will need to be addressed. If you decide to use one
or both, please let me know and provide me with an abstract of the study’s findings upon
completion. I would also appreciate your acknowledgement of my authorship of the
instrument.
If I can be of further assistance, please let me know.
Sincerely,
Patricia J. Larson, RN, DNSc, FAAN

Associate Professor and Director of the Oncology Program
American Cancer Society Professor in Oncology Nursing
Director, Center for Symptom Management
PL/cem
Enclosures
IMAGE EVALUATION
TEST TARGET (Q A -3 )
✓
<b.
w
.b . f/
*
1.0 K& l£
|M 12.2
l£ IAO 12.0
U
l.l
1.8
1.25 1.4 1.6
150mm
APPLIED A IIVWGE . Inc

1653 East Main Street
Rochester. NY 14609 USA
Phone: 716/482-0300
= Fax: 716/288-5989
0 1993. Applied Image. Inc. All Rights Reserved
with p erm ission o f the copyright ow ner. Further reproduction prohibited w ithout p erm ission.

The Perceptions of Nurse Educa

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The Perceptions of Nurse Educa

Uploaded by

Copyright:

Available Formats

INFORMATION TO USERS

The quality of this reproduction is dependent upon the quality of the

Oversize materials (e.g., maps, drawings, charts) are reproduced by

Photographs included in the original manuscript have been reproduced

STUDENT NURSES OF CARING BEHAVIORS

Master of Science in Nursing

Program of Graduate Nursing

UMI Microform 1383993

This microform edition is protected against unauthorized

Nurses of Caring Behaviors" is accepted by the faculty of the A l lan

& Donna Lansing School of Nursing, Bellarmine College, in p artial

fulfillment of the requirements for the Degree of Master cf Science

This thesis is dedicated to Ti m who taught me the true meaning

of caring. Also, my family and a very special friend, Donna C r u m ,

for their continued guidance, support, and encourage- e n t .

I would like to acknowledge my thesis c o m m i t s =e chairman,

Karen Cassidy, for her support and assistance in the rtmpleticn of

this thesis. I would also like to thank my thesi .3 c o m m icl6s

involvement, an d Dr. Steven Banks of Marshall Qniver:iLzv for his

assistance w i t h the statistical analysis of the data.

1986 Diploma in Nursing, St. Mary's School of

2/1990-1/94 St. M a r y ' s Hospital, 2900 First Avenue,

6/89-2/90 Cabell H u n t i n g t o n Hospital, 1340 Hal Greer

6/37-4/87 St. M a r y ' s Hospital, 2900 First Avenue,

HONORS: National Collegiate Nursing Award, 1996

Sigma T h e t a Tau National Honor Society of N u r s i n g

Pinnacle Honor Society

The p u r p o s e of this study was to examine the differences of

nurse educators' and nursing students' perceptions of caring

behaviors. The Caring Assessment Instrument (CARE-Q v/as u s e d in

an Associate Degree Nursing Program in eastern K e n tucky

participated in the study. The participants completed an informed

consent and demographic data sheet. Using Q-methodoicgy, the

participants were asked to rank caring behaviors frcm most

important to least important. Statistical procedures included

means, standard deviations, and t-tests. Statistically significant

differences were demonstrated in the subscales of .Vcnitors and

Committee approval p a g e ...................

Table of C o n t e n t s ................................. .. .Vii

List of t a b l e s .................................... . , vi* *

Chapter 1 ~ Dimensions of the P r o b l e m .......... . . .2

Chapter 2 - Review of :i t e r a t u r e ................ . . .5

Appendix A - Informed C o n s e n t ................... 33

Appendix 3 - Request to utilize institution.... . . .34

Appendix C - Nurse educator demographic s h e e t .. . . .35

Appendix D - Nursing student demographic sheet. . . .35

Appendix E - CARE-Q inst-nnment..................

Table 1. Demographic Data ......................................... 2

Table 2. Nursing Students Ten High Mean Score CARE-C I t e m s ..... 2

Table 3. Nurse .■Educators Ten High Mean Score CARE-0 I t e m s ...... 2

Table 4. Scores on Subscales of C a r i n g ............................ 2

Table 5. Most Important CARE-C Items Agreed on by Students

DIMENSIONS O F THE PROBLEM

This study investigated the perceptions of caring behaviors

of nurse educators an d student n u r s e s . Car i n g is the vital

component of nursing. It is the unifying d o m a i n for nursing.

Nursing is synonymous with helping others, w h i c h is accomplished

through caring. Historically, humans have n e e d e d caring for the

development and survival throughout their life span (Leininger,

1981). It is critical that nurses execute effective caring during

their professional career.

There are few studies on the perception of caring that focus

on nurse educators a n d nursing students. One w a y that caring is