ENHANCEMENT OF CARING BEHAVIOR AND CARING COMPETENCY AMONG NURSING STUDENTS
V. DISCUSSION
This study intends to explore the effectiveness of a caring program towards the enhancement of the caring behavior and caring competency among nursing students in a public nursing college. In general, the results provided evidence of an acceptable caring behavior and caring competency score among nursing students. The understanding on pre-nursing students caring knowledge will establish a baseline of understanding of caring knowledge prior to beginning nursing education (Glasser, 2014). At the time of study, the respondents have been exposed to the fundamental of caring knowledge for their notional input through lectures, tutorials and practical sessions. The foundational exposure to professional caring may have provided the impetus for students to begin formulating their own ideas of competent caring and
Enhancement of Caring Behavior and Caring Competency…
to develop self-awareness about their caring interactions with others (Papastavrou, Charalambous, & Efstathiou, 2011).
Based on the findings, Year 3 students scored the highest score in caring behavior and caring competency inventory. Apparently, Year 3 students has been exposed from simple to more complex conditions in clinical settings as to comply with the curricular structure which able to prove that the more they learn and expose on caring element, the better behavior they will possess and the more competent they will be. The students gradually integrate behaviors that represent professional caring into their relationships with patients as the professional knowledge and experience develops throughout the educational process (Papastavrou, Charalambous, & Efstathiou, 2011, Codier et. al.
(2011). Yet, it was noticed that Year 1 students scored higher compared to Year 2 in caring behavior. This might be due to the difference interpretation of caring thus the recent exposure in caring knowledge and the innate caring ability. This finding is analogous to the recent study by Grobbel & Rowe (2014) which the study revealed the effect of innate caring and its influence on caring knowledge.
Table 2.2 Caring Behavior and Caring Competency Score
Measure Pre Intervention Post Intervention
Overall Caring Behavior Score 4.28+0.34 4.99+0.52
Year 1 4.28+0.27 5.05+0.39
Year 2 4.17+0.38 4.78+0.57
Year 3 4.41+0.27 5.20+0.42
Overall Caring Competency Score 3.33+0.28 3.98+0.43
Year 1 3.14+0.32 3.68+0.50
Year 2 3.23+0.20 3.85+0.35
Year 3 3.53+0.24 4.26+0.33
In contrary, the finding triggers our curiosity when Year 2 nursing students yielded a lower score in caring behavior. As the nursing students progress throughout their years of study, the initial belief in delivering care might be tempered by the complexities of nurse-patient relationship with dynamic changes of patient condition. As compared to the findings by Sokola (2013) which has found the similar score in caring ability between first year and fourth year nursing students, the researcher suggested that the probable reasons are that the instrument utilized may not able to measure from a longitudinal perspective and therefore, the score might change with duration of times.
The limited time spend for clinical experience will not be enough for significant change in caring ability (Papastavrou, Charalambous, & Efstathiou, 2011). Therefore, continuous effort should be made by the study setting in general and nurse educators to enhance the caring behavior through their years (Mlinar, 2010).
The evidence provided by Blum, Hickman, Andrew & Locsin (2010) has able to prove on the significant findings on the impact of educational intervention. The
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Challenges in Nursing Education and Research
study by Wilson & Gram (2013) has able to reveal the impact of Caring Groups as a teaching strategy to provide the opportunities for students to learn about caring through personal real-life experience, self-awareness and self-care, positive peer relationships and team building. Students grasp the knowledge information through observation, formal teaching input and role modelling. One of the strategies to improve educational outcomes requires efforts to assist students in regulating their learning using effective learning technique (Sokola, 2013).
Caring Program was implemented in our study with the aims to enhance the caring behavior and caring competency. As hypothesized, the group of respondents involved will gain beneficial impact for their practice with regards to caring behavior and caring competency. Moreover, this study also exposed the strong positive relationship between the pre and post intervention data. The finding is comparable to the study by Blum, Hickman, Andrew & Locsin (2010) which has found the increased caring behavior score post modelling and discussion of nurse caring within simulated human- patient scenarios. Similar finding revealed a higher frequency of caring behavior exhibited by the intervention group exhibited than the comparison group in a quasi- experimental utilizing an Online Caring Curriculum for the enhancement of nurses’
caring behavior in Taiwan (Hsu et al. 2015). However, the caring behavior score in this study merely disclose the caring behavior score as perceived by the individual nursing students. Therefore, it is not able to match the finding by Chan, Chu, Hsiang Yen, &
Chou (2015) which has exposed the effectiveness of a caring educational program towards nurses’ caring behavior that has able to project greater patient satisfaction.
Nevertheless, this study has able to prove the efficacy of educational program such as Caring Program in enhancing the caring behavior of nurses and nursing students as suggested by past studies.
As compared to the pre intervention findings, the descriptive findings on post intervention caring behavior and caring competency score further describe the significant different mean scores across years of training. This indicates that the Caring Program has leaved a great impact to nursing students’ caring behavior regardless on their training years. Even though, it was proved in the pre intervention finding that caring behavior score was satisfactory, it is a crucial need to continuously enhance the caring behavior to meet the patients’ satisfaction. This finding has able to prove that students could constantly grasp the opportunity to learn on caring various approaches e.g. sharing of experience, role modelling and supervision. As caring can be taught, effort should be made by the stakeholders to improve current educational programs to ensure continuing competency for nurses (Dunlosky et al, 2013; Wilson & Gram, 2013).
Hence, the study has able to prove the effectiveness of the implemented Caring Program towards the enhancement of caring behavior and caring competency. The input given during lecture sessions and supervision phase during clinical exposure for 4 weeks has apparently leaves a great impact on the caring competency. It is like the study by Blum et al. (2010) found to be increased on all 42 individuals caring behaviors which exhibited by mean increases from the beginning to the end of the
Enhancement of Caring Behavior and Caring Competency…
caring course. This finding is also parallel to the study by Wilson & Gram (2013) that evidenced the participation in Caring Groups offers the opportunity for students to experience and learn caring through sharing personal experiences, growing in self- awareness and self-care and building relationships. This finding also comparable to the finding by Hsu et al. (2015) which the study found higher frequency of caring behavior exhibited by the intervention group exhibited than the comparison group in a quasi-experimental design with the approach of online audio-visual technologies.
Similarly, increased caring behavior by nurses was displayed post intervention of a caring workshop in a study which was conducted by Tsai et al. (2015). This study has been able to prove that caring can be taught. Competency does not develop in seconds but requires persistent efforts from both students and educators.
The quantitative design might limit the further exploration of caring behavior and caring competency among the study participants. Other limitation includes the time duration that limits the availability of more significant changes in pre and post intervention data. Qualitative or mixed-method design with longitudinal study is recommended to permit the discovery of various elements that facilitate the positive changes in caring practices. In addition, various approach or appropriate methodologies could be utilized in the educational intervention to generate interest of participants and to meet the learning needs of future nurse generations.