Nurse Education Today 116 (2022) 105467

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Nurse Education Today

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Research article

Predictors of attitudes towards nursing profession and peer caring

behaviors of the nursing students: A cross-sectional study
Sultan Ayaz-Alkaya a, *, Handan Terzi b
a
Gazi University, Faculty of Health Sciences, Nursing Department, Ankara, Turkey
b
Ufuk University, School of Nursing, Ankara, Turkey

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Professionalization in nursing is interconnected with the acceptance and encouragement of pro­
Evidence-based nursing fessional role model manners and caring approaches among the nursing students.
Nursing education research Objective: To determine the predictors of attitudes towards nursing profession and peer caring behaviors of the
Nursing faculty practice
nursing students.
Professional autonomy
Design: A single-centered, observational, cross-sectional study.
Settings: A university's faculty of health sciences nursing department in Ankara, Turkey.
Participants: The population of the study comprised of second and fourth year nursing students (N = 470). The
study was completed with 390 students.
Methods: The data were collected via a questionnaire, the Attitude Scale for Nursing Profession (ASNP), and the
Peer Caring Measurement (PCM) between September and October 2019. Univariate and multivariable linear
regression analyses were used to predict the data (p < 0.05).
Results: The mean age of the students was 20.41 (SD = 1.34) and 85.1 % of them were female. The total ASNP
mean score was found 160.10 (SD = 15.59). The mean score of the ASNP were higher in females, those whose
income was equal or more than expense, those who preferred nursing school willingly, studying nursing
pleasantly, those who were eager to work as a nurse, and those who planned to advance in nursing career. The
total PCM mean score was 42.10 (SD = 10.45). It was higher in second year students, those whose income was
equal or more than expense, and those who planned to advance in nursing career. There was a positively
moderate correlation between the ASNP and the PCM total scores (r = 0.314, p < 0.001).
Conclusions: Attitudes of the nursing students towards profession and their peer caring behaviors were highly
positive. Improving the attitudes of the nursing students towards the profession via enhancing their peer caring
behaviors, novel approaches, such as internship and mentorship, should be implemented into the nursing
education.

1. Introduction
Professionalization in nursing is described as the symbol of broad,
holistic and human-centered care, and it is the way of implementing the
caregiver role (Shohani and Zamanzadeh, 2017). It is a necessity for
nurses to have critical thinking skills and to apply their competencies in
nursing care in order to actively perform their roles, and use their au­
tonomy effectively within the ever-changing healthcare environment
(Aydin et al., 2022; Kim and Sim, 2020).
The quality of nursing care is affected by the professional attitudes of
nurses. Nurses who develop a positive attitude towards the profession
are known to be more willing to fulfill the requirements of the profes­
sion, provide quality nursing care and contribute to the development of
their colleagues (Kim and Sim, 2020; Pålsson et al., 2022). It is reported
that nurses, whose competencies are enhanced and lifelong learning
motivation is supported, share their experiences with newly graduated
nurses, and their mentorship along with their sociodemographic char­
acteristics improves the commitment to the profession (Aydin et al.,
2022; Fortes et al., 2022; Twidwell et al., 2022). Therefore, the pivotal
role of caring behavior is thought to be promoted by the perceived
professional pride and loyalty of nurses (Aydin et al., 2022; Vikström
and Johansson, 2019). Sharing experience, skills, and knowledge is

* Corresponding author.
E-mail addresses: sultan@gazi.edu.tr (S. Ayaz-Alkaya), handan.terzi@ufuk.edu.tr (H. Terzi).

https://doi.org/10.1016/j.nedt.2022.105467
Received 20 January 2022; Received in revised form 15 June 2022; Accepted 3 July 2022
Available online 7 July 2022
0260-6917/© 2022 Elsevier Ltd. All rights reserved.
S. Ayaz-Alkaya and H. Terzi
known to ease the clinical learning process and enable students to
improve their autonomy (Zwedberg et al., 2021). Thus, profession
preference confidences of nursing students, who encounter brilliant role
models before starting the career, is predicted to positively affect both
their attitudes towards the nursing profession and their peer caring
behaviors (Twidwell et al., 2022).
2. Background
Gaining professional outlook on nursing is stated to be directly
impacted by formal education, students' higher interests towards the
nursing career, supported gender diversity in the nursing profession, and
a positive clinical education environment (Arkan et al., 2018; Subke
et al., 2020; Twidwell et al., 2022). In the literature, the motivation and
passion towards nursing education were found the highest at the initi­
ation of the school among the students, which were stated to be the
facilitators of gaining professional knowledge, ensuring the fruitful
practice environment (Bugaj et al., 2019; Warshawski et al., 2018). In a
study, the majority of the nursing students were found to have positive
attitudes to nursing as an occupation (Mahmoud, 2019). In another
study, the attitude towards nursing was found to be significantly asso­
ciated with the job preference of the students and inclination to be a
nurse (Hatamleh and Sorio, 2017). When the care is considered as the
heart of the nursing, professionalization can also be strongly accepted to
be interconnected with the acceptance and encouragement of profes­
sional role model manners and caring approaches among the nursing
students (Ayaz Alkaya and Terzi, 2021; Mahmoud, 2019; Shohani and
Zamanzadeh, 2017). Therefore, peer-assisted learning is accepted as an
evolving model for the acquisition of professional competences in the
nursing education (Ädel et al., 2021; Ayaz-Alkaya and Öztürk, 2021;
Subke et al., 2020).
Peer-assisted learning; namely peer-mentoring, peer caring, peer
support, near-peer education, has been accepted as an emerging
approach in clinical nursing education (Ädel et al., 2021; Cook et al.,
2021; Cust and Guest, 2020). Since nursing education has prompted to
intellectual, psychomotor and affective learning skills of the students,
interactions with peers in the learning environment are known to in­
crease nursing students' willingness to improve their caring behavior,
academic performance and sense of emotionally supported, and
decrease their burnout (Ayaz-Alkaya et al., 2018; Ayaz-Alkaya and
Öztürk, 2021; Ayaz Alkaya and Terzi, 2021; Kim et al., 2021). In a study,
peer caring behaviors of the fourth year nursing students were found
significantly higher than that of the first year students (Warshawski
et al., 2018). In another study, effective peer caring program was found
to be beneficial for both the first and the fourth year baccalaureate
nursing students' individual and professional improvement (Cust and
Guest, 2020). In a novel study, there was found a positively moderate
significant correlation between caring behaviors of nursing students and
their peers, and peer caring behavior was identified as a contributor of
students' best caring actions towards their patients (Novelina and Kun­
tarti, 2021). Peer support was found to be the key predictor of increasing
student resilience and students' coping skills (Fortes et al., 2022). Peer
caring was also stated as the indicator of increased academic success,
motivation, self-confidence, competence, communication and team
collaboration skills; also reduced stress and acute anxiety levels among
the nursing students (Ädel et al., 2021; Kachaturoff et al., 2020; Kim
et al., 2021; Korkut and Başer, 2020). It is a beneficial strategy in easing
the academic adaptation process to nursing school especially for the first
year nursing students (Kim et al., 2021). There are several studies which
investigate the nursing students' attitudes towards the profession and
their peer caring behaviors in the literature (Ayaz-Alkaya and Öztürk,
2021; Mahmoud, 2019; Warshawski et al., 2018). However, more
research on the predictors of those two important issues for the nursing
education and the profession is needed, and the present study can
contribute to be filled this gap. Therefore, ensuring a deeper under­
standing related to the predictors of the attitudes of nursing students
2
Nurse Education Today 116 (2022) 105467
towards the nursing profession and their peer caring behaviors can also
pave the way for shaping the nursing education standards for the future's
world's demands. It is thought that, more professional and competent
nurses can be cultivated for the future, if and only if caring behaviors,
gained via supportive peer-to-peer interactions, are actively promoted
during the undergraduate nursing education period.
The aim of the present study was to determine the predictors of at­
titudes towards nursing profession and peer caring behaviors of the
nursing students. The research questions were as follows:
1. How is the attitude of nursing students towards the nursing
profession?
2. How is the peer caring behavior of the nursing students?
3. Is there a relationship between the attitudes towards the nursing
profession and perceived peer caring behaviors of the nursing
students?
4. What are the factors related to the attitudes towards the nursing
profession and perceived peer caring behaviors of the nursing
students?
3. Methods
3.1. Study design
A single-centered, observational, cross-sectional study was
undertaken.
3.2. Setting and participants
The present study was conducted at one of the biggest and oldest
universities located in the capital city of Turkey. The population of the
study comprised of second and fourth year nursing students (N = 470).
The sample size was calculated apriori via G*Power 3.1.9.4 according to
the peer caring behavior mean score of a similar research (Warshawski
et al., 2018). The sample size was determined at least 316 with effect
size of 0.37, 0.95 power and alpha 0.05. For the study, 247 participants
from the second year and 223 from the fourth year were recruited.
Overall, the study was completed with 390 nursing students.
Inclusion criteria were: 1) being a second and/or fourth year nursing
student, and 2) being volunteer to participate in this study. Exclusion
criteria were: 1) being a first and third year nursing student, 2) being a
foreign student. First year students were excluded because of not to have
enough awareness related to the nursing profession, and not able to gain
peer caring behaviors at this grade. In addition, clinical practice did not
initiate at the first semester, and they also did not spend enough time
together both at the class and hospital environments. Since the second
year students have just started to their clinical practice, and the fourth
year students have been well versed in the practical education, third
year students were excluded, too.
3.3. Instruments
The data were collected via a questionnaire, the Attitude Scale for
Nursing Profession, and the Peer Caring Measurement.
3.3.1. The questionnaire
It was consisted of nine close-ended questions related to the socio­
demographic characteristics such as age, gender, academic level, in­
come, preference of nursing as a profession, willingness towards nursing
education and working as a nurse in the future, prospective career plan,
and choice of professional position of the students.
3.3.2. The Attitude Scale for Nursing Profession (The ASNP)
The ASNP was developed by Coban and Kasikci (2011). It is a five-
point Likert-type scale with 40 negatively and positively stated items
(1 = strongly disagree_5 = strongly agree for the positive items, and 1 =
S. Ayaz-Alkaya and H. Terzi Nurse Education Today 116 (2022) 105467

strongly agree_5 = strongly disagree for the negative items). It has three
sub-scales, which are; “properties (items 1-18)” “preference (items 19-
31)” and “general position (items 32-40)” of the nursing profession. The
lowest score that can be obtained from the scale is 40, and the highest
score is 200. The scale does not include a cut-off score; the higher score
means the more positive attitudes towards nursing profession. The
Cronbach's alpha coefficient of the total scale was 0.90, and each of the
three sub-scales ranged from 0.98 to 0.99 (Coban and Kasikci, 2011).
The Cronbach's alpha coefficient of the total scale was identified as 0.89,
and each of the three sub-scales ranged from 0.44 to 0.88 in this study.
3.3.3. The Peer Caring Measurement (the PCM)
The PCM was developed by Kuo et al., to assess the sense of peer
caring among the nursing students (Kuo et al., 2007). The PCM is a four-
point Likert-type scale with 17 items (1 = strongly disagree_4 = strongly
agree). The PCM has three sub-scales, which are; “assistant caring (items
1, 2, 3, 4, 5, 6, 7, 12, 13)”, “academic caring (items 8, 9, 10, 17)”, and
“affective caring (items 11, 14, 15, 16)”. The total score of the PMC
differs between 17 and 68, and it does not include a cut-off score. The
higher score means the higher peer caring behaviors. Turkish validity
and reliability of the scale was studied by Çalışkan and Çınar, and the
Cronbach's alpha coefficient of the total scale was found as 0.93, and
each of the three sub-scales ranged from 0.77 to 0.89 (Çalışkan and
Çınar, 2012). The Cronbach's alpha coefficient of the total scale was
0.94, and each of the three sub-scales ranged from 0.76 to 0.90 in this
study.
3.4. Data collection
The data were collected between September and October 2019.
Before the data collection tools were handled to the students, the aim of
the study was explained. Researchers assured that participation or
nonparticipation would not affect their standing in their respective
nursing education. After informed consent was obtained from the stu­
dents who agreed to participate, the instruments were administered and
collected out of their class period. The data collection took about 20 min.
4. Results
Of the recruited students (N = 470), 42 refused to participate, 12
were foreign students, and 22 filled the instruments incompletely or
incorrectly. The participation rate to the present study was 83 % (n =
390).
The mean age of the students was 20.41 (SD = 1.34) and 85.1 % of
them were female. Of the students, 60.8 % chose to study nursing
willingly, 80.8 % stated their willingness to continue their career in
nursing, and 38.2 % expressed to be a nurse educator/academician in
the future (Table 1).
4.1. Attitudes towards nursing profession among the participants
The total ASNP mean score of the students was found 160.10 (SD =
15.59). The mean score for the properties of nursing profession sub-scale
was 79.37 (SD = 7.76), for the preference of nursing profession sub-scale
was 47.07 (SD = 8.43), and for the general position of nursing profession
was 33.65 (SD = 3.33) (Table 2).
The mean differences in ASNP score were noted by gender, academic
level, income, preference to nursing school willingly, pleasantly study­
ing nursing, future career plan in Table 3. The mean ASNP scores of the
students were significantly higher in the second graders compared to
fourth graders, those who were females had higher scores compared to
males, those whose income were more than their expenses had higher
ASNP scores compared to those with equal to or less than their expenses
(p < 0.05). Students who preferred to study nursing willingly, who
studied nursing pleasantly, who were willing to work as a nurse after
graduation, whose future career plan was to advance in nursing, and
who prefer to work as a staff nurse were found to have significantly
higher ASNP mean scores (p < 0.05).
4.2. Peer caring behaviors of the students
The total PCM mean score of the students was found 42.10 (SD =
10.45) (Table 2). The mean score for the assistant caring sub-scale was

Table 1
3.5. Data analysis Sociodemographic characteristics of the nursing students (n = 390).
Sociodemographic characteristics
The data were analyzed via IBM SPSS (Statistical Package for the
Age (Mean, SD) 20.41 (1.34)
Social Sciences, Chicago, Illinois) for Windows version 25.0 program. Frequencies (n, %)
The dependent variables were the attitudes towards nursing profession Academic level
and peer caring measurement. Independent variables of the study were Second year 216 55.4
the sociodemographic characteristics of the nursing students. Socio­ Fourth year 174 44.6
Gender
demographic features were depicted via numbers, percentages, means,
Female 332 85.1
and standard deviations. The normality of the data was assessed via Male 58 14.9
Kolmogorov Smirnov test. Independent sample t-test and One-way Family income
ANOVA were used for the group comparisons. Pearson correlation co­ More than expense 116 29.7
Equal to expense 222 56.9
efficient was used to determine the relationship between the total scores
Less than expense 52 13.3
of the scales. Univariate and multivariable linear regression analyses Preference to nursing school willingly
were used to determine the relations between the total mean scores of Yes 237 60.8
the scales and the independent variables. Variables which were found No 153 39.2
statistically significant in the univariate regression were examined in the Studying nursing pleasantly
Yes 325 83.3
multiple linear regression analysis with backward selection. The statis­
No 65 16.7
tical significance level was accepted as 0.05 (p < 0.05). Willingness to work as a nurse after graduation
Yes 311 79.7
No 79 20.3
3.6. Ethical considerations Future career plan
Advancing in nursing career 315 80.8
Changing the profession 37 9.5
An ethical approval was obtained from the Gazi University Ethics
Other 11 2.8
Commission (2019-044) and the written permission from the dean's Choice of professional position
office was provided to conduct the research. The students were informed Nurse manager 115 29.5
in details about the aim of the study, research process, participation or Staff nurse 109 27.9
leaving rights of the participants. Both verbal and written informed Nurse educator/academician 149 38.2
Other 17 4.4
consents were gathered from the students who agreed to participate.

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S. Ayaz-Alkaya and H. Terzi Nurse Education Today 116 (2022) 105467

Table 2 22.56 (SD = 5.76), for the academic caring sub-scale was 9.74 ± 2.74,
Mean scores of the attitude scale for nursing profession and peer caring be­ and for the affective caring sub-scale was 9.79 (SD = 2.79) (Table 2).
haviors of the students. The mean differences in PCM score were noted by gender, academic
Scales and the sub-scales Mean (SD) Min. Max. level, income, preference to nursing school willingly, pleasantly study­
The Attitudes for Nursing Profession 160.10 (15.59) 102.00 194.00
ing nursing, future career plan in Table 3. The mean PCM mean scores of
Scale the students were significantly higher in the second graders compared to
Properties of nursing profession 79.37 (7.76) 39.00 90.00 fourth graders, those whose income were more than their expenses had
Preference of nursing profession 47.07 (8.43) 19.00 65.00 higher PCM scores compared to those with equal to or less than their
General position of nursing profession 33.65 (3.33) 22.00 42.00
expenses (p < 0.05). Students who preferred to study nursing willingly,
The Peer Caring Measurement 42.10 (10.45) 18.00 68.00
Assistant caring 22.56 (5.76) 9.00 37.00 who studied nursing pleasantly, and whose future career plan was to
Academic caring 9.74 (2.74) 4.00 16.00 advance in nursing were found to have significantly higher PCM scores
Affective caring 9.79 (2.76) 4.00 16.00 (p < 0.05).
There was a positively moderate correlation between the ASNP and
the PCM total scores (r = 0.314, p < 0.001).
Table 3
Mean scores of the attitude scale for nursing profession and peer caring be­ 4.3. Factors associated with the attitude towards nursing profession
haviors according to the sociodemographic characteristics of the students.
Sociodemographic The ASNP The PCM Univariate regression analysis was performed to each independent
characteristics variable before the multiple linear regression analyses for the attitude
Mean (SD) Test, p Mean Test, p
(SD) scale for nursing profession (Table 4). The variables which were statis­
tically significant in univariate regression analysis (age, academic level,
Academic level
Second year 162.13 t= 44.37 t=
gender, income, preference to nursing school willingly, studying nursing
(16.23) 2.885 (9.38) 4.907 pleasantly, willingness to work as a nurse, future career plan, profes­
Fourth year 157.59 p= 39.29 p< sional position preference) were included in multiple linear regression
(14.79) 0.004 (11.03) 0.001 analysis (Table 4). All independent variables except age, academic level,
Gender
and professional position preference were statistically significant in the
Female 161.39 t= 42.11 t=
(14.54) 3.961 (10.35) 0.056 multiple regression model explained approximately 22 % of the variance
Male 152.75 p< 42.03 p= for attitude scale for nursing profession (Adjusted R2 = 0.22, F = 19.213,
(19.18) 0.001 (11.10) 0.956 p < 0.001). The mean score of the attitude scale for nursing profession
Family income were higher in females (β = 0.156), those whose income was equal or
More than expense 162.04 F= 44.19 F=
(14.82) 5.437 (10.38) 6.891
more than expense (β = 0.149), those who preferred nursing school
Equal to expense 160.58 p= 42.01 p= willingly (β = 0.228), those studying nursing pleasantly (β = 0.117),
(14.12) 0.005 (10.68) 0.001 those who were eager to work as a nurse (β = 0.109), and those who
Less than expense 153.75 37.82 planned to advance in the nursing career in the future (β = 0.116).
(21.11) (8.21)
Preference to nursing school
willingly 4.4. Factors associated with the peer caring behaviors
Yes 164.52 t= 43.58 t=
(14.19) 7.426 (10.22) 3.524 Univariate regression analysis was performed for each independent
No 153.26 p< 39.81 p<
variable before the multiple linear regression analyses for peer caring
(15.23) 0.001 (10.42) 0.001
Studying nursing pleasantly
behaviors (Table 5). The variables that were statistically significant in
Yes 162.26 t= 42.81 t= the univariate regression analysis (age, academic level, income, pref­
(15.02) 6.423 (10.25) 3.032 erence to nursing school willingly, studying nursing pleasantly, future
No 149.30 p< 38.55 p= career plan) were included in multiple linear regression analysis
(13.92) 0.001 (10.78) 0.003
(Table 5). Independent variables which were significant (academic
Willingness to work as a nurse
after graduation level, income, future career plan) in the multiple regression model
Yes 162.11 t= 42.59 t= explained approximately 9 % of the variance for peer caring behaviors
(14.84) 5.202 (10.31) 1.853 (Adjusted R2 = 0.09, F = 11.005 p < 0.001). The peer caring behaviors
No 152.21 p< 40.16 p= were higher in second year students (β = 0.198), those whose income
(16.09) 0.001 (10.83) 0.065
Future career plan
was equal or more than expense (β = 0.141), and those who planned to
Advancing in nursing career 162.21 F= 42.88 F= advance in nursing career (β = 0.105).
(14.70) 11.273 (10.33) 3.507
Changing the profession 151.51 p< 38.33 p= 5. Discussion
(17.59) 0.001 (10.74) 0.015
Other 149.67 38.24
(16.64) (10.99) Cultivating nursing students with an exclusive professional knowl­
Choice of professional position edge, increasing their motivation to the profession, and improving their
Staff nurse 163.19 F= 41.88 F= personal and caring competencies are the main goals of the qualified
(13.25) 3.397 (10.53) 0.628 nursing education (Mahmoud, 2019; Warshawski et al., 2018). There­
Nurse educator/academician 160.49 p= 42.93 p=
(14.06) 0.018 (10.89) 0.597
fore, the present research was conducted to determine the predictors of
Nurse manager 157.59 41.50 attitudes towards nursing profession and perceived peer caring behav­
(18.57) (10.18) iors of the nursing students.
Other 153.94 40.29 Professional attitudes and caring behavior are the nucleus of the
(17.01) (7.67)
nursing profession, which are developed during the undergraduate
ASNP: Attitudes Towards Nursing Profession Scale; PCM: Peer Caring nursing education (Cukljek et al., 2017; Warshawski et al., 2018).
Measurement. Therefore, it is remarkable to implement novel practices into the clinical
learning settings, such as peer caring, for increasing the future profes­
sional satisfaction of the nursing students (Cook et al., 2021; Shohani

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S. Ayaz-Alkaya and H. Terzi Nurse Education Today 116 (2022) 105467

Table 4
Predictors of the attitude scale for nursing profession.
Independent variables Simple model Multiple model*

B (95 % CI for B) β p B (95 % CI for B) β p

Age (ref: 21–25 age group) 3.78 (0.68–6.87) 0.121 0.017

Academic level (ref: 4th year) 4.54 (1.44–7.64) 0.145 0.004
Gender (ref: Male) 8.63 (4.35–12.91) 0.197 <0.001 6.85 (2.96–10.74) 0.156 0.001
Income (ref: less than expense) 7.34 (2.82–11.85) 0.160 0.002 6.81 (2.75–10.88) 0.149 0.001
Preference to nursing school willingly (ref: No) 11.26 (8.28–14.24) 0.353 <0.001 7.27 (4.12–10.42) 0.228 <0.001
Studying nursing pleasantly (ref: No) 12.96 (8.99–16.93) 0.310 <0.001 4.91 (0.53–9.28) 0.117 0.028
Willingness to work as a nurse (ref: No) 9.89 (6.16–13.64) 0.255 <0.001 4.22 (0.25–8.19) 0.109 0.037
Future career plan (ref: Changing the profession) 10.98 (7.19–14.77) 0.278 <0.001 4.58 (0.61–8.54) 0.116 0.024
Professional position choice (ref: Nurse manager) 4.28 (0.84–7.72) 0.123 0.015

Ref: reference, B: unstandardized coefficient, β: standardized coefficient, CI: confidence interval.

*
Adjusted R2 = 0.22, F = 19.213, p < 0.001.

Table 5
Predictors of peer caring behaviors.
Independent variables Simple model Multiple model*

B (95 % CI for B) β p B (95 % CI for B) β p

Age (ref: 21–25 age group) 4.55 (2.51–6.59) 0.218 <0.001

Academic level (ref: 4th year) 5.07 (3.04–7.11) 0.242 <0.001 4.15 (2.09–6.21) 0.198 <0.001
Gender (ref: Male) 0.08 (2.84–3.01) 0.003 0.956
Income (ref: less than expense) 4.93 (1.91–7.96) 0.161 0.001 4.33 (1.41–7.26) 0.141 0.004
Preference to nursing school willingly (ref: No) 3.76 (1.66–5.86) 0.176 <0.001
Studying nursing pleasantly (ref: No) 4.26 (1.49–7.02) 0.152 0.003
Willingness to work as a nurse (ref: No) 2.43 (0.14–5.01) 0.094 0.065
Future career plan (ref: Changing the profession) 4.05 (1.44–6.67) 0.153 0.002 2.78 (0.15–5.41) 0.105 0.038
Professional position choice (ref: Nurse manager) 0.31 (− 2.63–2.01) 0.013 0.792

Ref: reference, B: unstandardized coefficient, β: standardized coefficient, CI: confidence Interval.

*
Adjusted R2 = 0.09, F = 11.005 p < 0.001.

and Zamanzadeh, 2017). In the present study, the attitudes of the stu­
dents towards the nursing profession and peer caring behaviors of the
nursing students were found more positive. These finding are supported
by the literature (Ayaz-Alkaya and Öztürk, 2021; Fışkın and Doğan,
2020; Sümen et al., 2021; Yelten et al., 2018). Correspondingly, it was
found a positively moderate correlation between the positive attitudes
towards nursing profession and the peer caring behaviors of the nursing
students in the present study. It is thought that the higher the peer caring
behavior of the nursing students the more professionally committed
nurses act within the healthcare settings in the future.
The current study pointed out that gender, income, preference to
nursing school willingly, studying nursing pleasantly, willingness to
work as a nurse, and career plan in the future were the significant pre­
dictors to the positive professional attitudes of the nursing students.
Students who were females, whose income was more than expense, who
pleased to study nursing, who preferred nursing school willingly, who
planned to work as a nurse after graduation, and who planned to
advance in the profession in the future were found more likely to have
more positive attitudes. In the literature, being woman, preference of
nursing department voluntarily was also found to be related to the
positive attitudes towards nursing profession among the nursing stu­
dents (Arkan et al., 2018; Çalışkan et al., 2021; Mahmoud, 2019). This
may be rooted from the female students have a favorable inclination to
be a nurse, and the male students are still shy to adopt nursing as a
career (Mahmoud, 2019). It is thought that nursing students should be
willing, empathetic, mindful, and highly aware of the others' needs to
improve the quality of nursing care while performing the profession
after graduation. In the midst of a today's healthcare systems' rapid
changes across the globe, the perspectives of the nursing students to­
wards the profession should be enhanced in order to be met the antici­
pations of the students and the authenticities of the nursing profession at
a common point.
Nursing students are known to develop knowledge, skills, values, and
positive attitudes towards nursing profession during the education
period (Ayaz Alkaya and Terzi, 2021; Cukljek et al., 2017; Mahmoud,
2019). In the literature, fourth year nursing students were identified to
have more positive attitudes towards the profession than the other
graders (Cukljek et al., 2017; Çalışkan et al., 2021), and age was stated
to be positively correlated with the positive attitudes (Çalışkan et al.,
2021). Different from the literature, although the second year students
were found to have more positive attitudes towards nursing than the
fourth graders, the age and academic level were insignificant predictors
of the nursing students according to the multiple regression analysis
results in the current study. When the knowledge is increased, the wis­
dom and the prediction levels of the students improve accordingly.
Therefore, these differences can be related to the higher awareness
levels of the fourth graders towards the realities of the nursing and pa­
tient care than that of the second graders.
Encouraging peer interaction among the nursing students has been
declared to make positive impacts on gaining professional knowledge,
skills, and attitudes, including leadership, commitment, and confidence
(Ädel et al., 2021; Cust and Guest, 2020; Twidwell et al., 2022). In the
multiple regression analysis of the present study, academic level, in­
come, and future career plan were found as the predictors of the peer
caring behaviors. Namely, peer caring behaviors of nursing students
were higher in students who were second graders, whose income was
more than expense, and who planned to advance in the nursing career in
this study. Although there were not any exact evidences in the current
literature regarding the predictors of the peer caring behaviors of
nursing students, peer support, as a type of social support, was stated as
the main predictor of endurance and coping abilities of the students,
which were necessary to study nursing pleasantly (Fortes et al., 2022).
Conversely, the mean score of the PCM of the fourth graders was the
highest according the one-way ANOVA test results in a study conducted
in Israel (Warshawski et al., 2018). This difference may stem from the
nursing education systems of the countries, along with the different
characteristics of the learning environments, and the peer support
perceived by the nursing students. As found in the current study, gender

5
S. Ayaz-Alkaya and H. Terzi
was also repeatedly stated as an ineffective predictor of the peer caring
behaviors of the nursing students in the literature (Twidwell et al., 2022;
Yelten et al., 2018). It is notable to recognize the nursing students' needs
related to their educational atmosphere much better to keep their
motivation on top to improve the peer caring behaviors in all grades, and
also for all genders.
5.1. Strengths and limitations
The present study was the first evidence which investigated the
predictors of the attitudes towards nursing profession and peer caring
behaviors of the nursing students, to the best of our knowledge. There
are some limitations. Firstly, the collected data were based on the per­
sonal declarations of the nursing students, thus the data quality may
have been impacted. Secondly, the data were collected under the su­
pervision of the researchers, which may have affected the participants'
comfortable answering. The attitudes of the participants towards the
profession and their peer caring behaviors may vary according to their
own beliefs and the cultural characteristics of the community where
they live. Finally, because of being a single-centered study, the gener­
alizability of the obtained results is limited.
6. Conclusion
The present study revealed that attitudes of the nursing students
towards nursing profession and their peer caring behaviors were highly
positive. There was found a positively moderate correlation between the
positive attitudes towards nursing profession and the peer caring be­
haviors of the nursing students. Gender, income, preference to nursing
school willingly, studying nursing pleasantly, willingness to work as a
nurse, and future career plan were found as the predictors of the positive
attitudes towards nursing profession. Moreover, academic level, income
and future career plan were determined as the predictors of peer caring
behaviors of the nursing students. Improving the attitudes of the nursing
students towards the profession via enhancing their peer caring behav­
iors novel approaches, such as internship and mentorship, should be
implemented both into the nursing theory and practice education. Nurse
educators could support and encourage the practice of peer caring be­
haviors among students as professional means of facilitating future
caring relationships with patients. Further, the nurse educators can be
role models, since the students often internalize them and incorporate
their traits in them. Qualitative studies are recommended to be per­
formed to get deeper insight into the affecting factors of the attitudes
towards nursing profession and the peer caring behaviors of the nursing
students.
Funding
This research did not receive any specific grant from any kind of
funding agencies in the public, commercial, or not-for-profit sectors.
CRediT authorship contribution statement
Sultan Ayaz-Alkaya: Conceptualization, project administration,
methodology, investigation, validation, visualization, formal analysis,
supervision, review & editing. Handan Terzi: Data curation, formal
analysis, visualization, writing – original draft, review & editing.
Declaration of competing interest
All authors declare that they have no competing interests.
Acknowledgements
The authors would like to thank the nursing students who partici­
pated in this study for their very valuable support and collaboration.
6
Nurse Education Today 116 (2022) 105467
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