| Background and significance of the study'To Cure Sometimes,To Relieve Often,To Comfort Always' which was the epitaph of doctor Trudeau indicated that medical science is human science which originated from the nature of human care needs[1].Nursing science is one of the important subjects of medical science since established by Nightingale and caring is the eternal theme of nursing[4].Chinese and foreign scholars commonly agree that nursing science is the most closely related to caring.Nursing science should be based on'care',not 'cure'.'Care' is the core and essence of nursing!At present,the National Health and Family Planning Commission of the People's Republic of China clearly put forward that the current efforts should be made to enhance the caring ability of nursing staff in the Chinese Nursing Development Program(2015-2016).Caring ability as a special ability,which could not be separated from postnatal education.Nursing students would be the new and important reserve forces of professional nursing practice.Therefore,the study focusing on caring ability of nursing students is a research as an important proposition given by current times.In conclusion,this study has important theoretical significance and practical value.ObjectivesTo describe the status of the caring ability of Chinese nursing students,to analyze the influencing factors associated with their caring ability and to evaluate the effects of educational intervention on the caring ability of nursing students.Subjects and Methods1.A cross-sectional study aimed at describing the present overall status of caring ability of nursing students in China.This study put forward the theoretical model of influencing factors of humanistic caring ability among nursing students based on the literature research.A nationwide stratified sample of nursing students was recruited via 25 universities in seven major administrative regions in China.The evaluation instruments,including the Caring Ability Inventory(CAI),the Emotional Intelligence Scale(EIS),the Supportive Communicative Scale(SCS)etc.,and a self-designed social-demographic questionnaire were used in the nationwide survey.Influencing factors on the nursing students' caring ability were analyzed.2.An educational intervention study on the nursing students' caring ability was conducted at a medical university in Guangzhou city,China.The education mode of improving the caring ability among nursing students was designed according to preliminary researches.A total of 153 first semester nursing students enrolled in a 4-year,full-time Bachelor of Science in School of nursing were invited to be the intervention group.The course of 'Humanity Cultivation for Nurses'was delivered to improve the 'caring ability' by conducting 32-hours of education intervention during six weeks.The control group had no intervention.3.Data collection and analysisData were entered using EpiData3.1 software and statistical software SPSS 20.0 was used for analysis.The methods included descriptive statistical analysis;Chi-square test,one-sample t-test,paired t-test,F test,LSD test for multiple comparison;Pearson correlation analysis,multiple linear regression analysis,repeated measurement of analysis of variance(ANOVA).AMOS20.0 was used to construct a structural equation model of influencing factors of humanistic caring ability of nursing students.All tests were two-tailed tests at P<0.05.Results1.The results of the cross-sectional study of caring ability of Chinese nursing studentsThe total CAI score for 8574 Chinese nursing students was 191.04(SD 19.49).These scores and subscales scores were significantly lower than foreign norms(P<0.001).2.The norms of the caring ability inventory(CAI)among nursing studentsBased on 25 universities in seven major administrative regions in China,the norm of total CAI score for 8574 Chinese nursing students was 191.04(SD 19.49)and the norm scores of subscales of CAI-knowing,CAI-courage and CAI-patience were,respectively,73.22(SD 9.82),59.31(SD 10.43),and 58.51(SD 6.17).3.The results of overall status and influencing factors on caring ability of Chinese nursing studentsThe total scores of CAI for different demographic characteristics,different family backgrounds,professions,caring atmosphere,health conditions and caring experiences,training experiences etc.,were significantly different(P<0.05).The score for CAI of females was significantly higher than those of males(P<0.001).The score of CAI for freshmen was significantly higher than those in higher grades(P<0.001).The score of CAI for nursing students who were class cadres and Communist Youth League members were significantly higher than those who were not(P<0.001).The score of CAI and the three subscales scores for associate degree students were significantly higher than those for undergraduates(P<0.05);The scores of CAI for students with stable professional beliefs were significantly higherthan those with other attitudes(P<0.05).The score of CAI and the three subscales scores for students who were in a good family caring atmosphere,had good parental and maternal caring,and a caring school atmosphere,caring teachers,caring roommates and caring friends' were significantly higher than those who did not(P<0.05).The total scores of CAI of students who were in good health and whose family members were in good health were significantly higher than those who were not(P<0.05).The total scores of CAI of students were significantly higher than those without caring experiences(P<0.001).The total mean score of CAI of students who had attended humanistic caring training were significantly higher than those who had not(P<0.001).There were no significant differences in students' caring ability for different nationalities,different family residences,different family financial conditions or different professional and educational background of parents.Whether they were the only child in their families,or they were literature or science students,or they had experiences of hospitalizations had no significant influence on the CAI scores(P>0.05).The score of CAI and the three subscales scores of students who perceived high organization atmosphere,high emotional intelligence and high communication competence were significantly higher than others(P<0.05).Correlation analysis of influencing factors of caring ability in nursing students showedthe total scores of EIS had the most positive correlation with CAI total score(r=0.594).Multiple stepwise regression analysis showed that the self-control of emotion of EIS was the best predictive variable which could explain 31.1%of variance in the humanistic caring ability.4.The theoretical model of the caring ability among nursing students and the verification resultsThe contexts of the theoretical model of influencing factors of nursing students'humanistic caring ability:"caring atmosphere" as the main external environmental factors,"emotional intelligence" as the main individual internal factors,"interpersonal communication competence" as the interaction between the individual and the environment,which played an important role in humanistic caring ability among nursing students.The structural equation model of influencing factors on caring ability fitted well and the variance for each variable was positive and significant(P<0.001).The mediating effect of caring atmosphere between interpersonal communication competence,emotional intelligence and caring ability was 0.146,which accounted for 77.47%of the overall effect of total effect in caring ability.5.Constructing the education mode of promoting the care ability of nursing studentsThe theoretical framework of the teaching model was based on the preliminary researches about theoretical model of the influencing factors,which taken the special curriculum of nursing humanities 'Humanity Cultivation for Nurses' as the educational platform,aimed at the training of the humanistic caring ability,adopted the team-based learning method in the whole course,emphasized the teaching strategy of cognition,experience and practice during the whole teaching process,which as well as highlighted the construction of the caring atmosphere and the cultivation of emotional intelligence and interpersonal communication competence among nursing students.6.The results of the educational intervention study on improving caring ability of nursing studentsBoth groups were comparable at baseline.The results of repeated measurements ANOVA showed that the interaction effect of group and time were significant(P<0.01).The scores of CAI and the three subscales for nursing students in the intervention group were significantly higher than the control group(P<0.001).The pre-and post-intervention comparison results in the intervention group indicated that the mean scores of the EIS total and subscales as well as the mean scores of the SCS and subscales after intervention were significantly higher than those before intervention.One hundred percent of the students were satisfied with the curriculum and 100%students thought they had mastered some methods of caring.Moreover,the nursing students who experiences enhanced caring awareness and caring ability were 98.6%and 98.0%,respectively.Conclusions1.The overall status of nursing students' caring ability in China were lower than for foreign norms.As for the three different subscales in descending score order were CAI-patience,CAI-knowing and CAI-courage.Therefore,it is necessary to strengthen nursing students' caring ability in China.2.The national survey data of this study were in accordance with the requirements of the norm sample,therefore,the results of the scores of CAI of 8574 Chinese nursing students could be used as the domestic reference standard norms of CAI instrument.3.The influencing factors for caring ability of nursing students were complicated,involving demographic information,family backgrounds,professional factors,etc,.The direct effects of caring atmosphere,emotional intelligence and interpersonal communication competence on caring ability of nursing students were significant.The mediating effects of them were greater than the direct effects in the multiple influencing mechanism between caring atmosphere and caring ability of nursing students.4.The caring ability of nursing students was significantly improved by the humanistic curriculum.The total mean scores and three subscales of CAI were significantly improved,particularly in the subscale of knowing.The educational model emphasizing the teaching strategies of cognition,experience and practice during teaching is worth promoting and applying. |
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