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Bridging the gap between caring theory and nursing practice: Learning experiences of undergraduate nursing students in a caring behavior course
Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.ORCID iD: 0000-0002-0261-2217
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Healthcare providers are obligated to practice with scientific knowledge in order to deliver high quality and safe care based on patients’ needs. Despite this obligation, complaints from care recipients and their significant others regarding healthcare providers’ lack of compassion and competent care in their professional encounters have increased. In the discipline of nursing, theoretical structures of caring, conceptualized as behaviors, have been established as the heart and core value of guidance in all nursing practice. In nursing education, however, caring has tended to be taught as an intangible aspect of nursing practice, described as hidden curricula, thus, focus more on developing knowledge and psychomotor skills instead of learning caring behaviors. Studies that examine how undergraduate nursing students can learn caring behaviors explicitly are rare. Thus, a stronger emphasis on the learning of caring in the context of a caring behavior course that uses a variety of learning didactics is needed. Without adequate theoretical structures for caring-based observational behavioral instruments assessing verbal and non-verbal caring and non-caring behaviors, there is little evidence to help develop the learning of caring behaviors.

Aim: The overall aim of this thesis was to study how a caring behavior course in undergraduate nursing education influenced students’ learning of caring behaviors.

Method: This thesis was conducted among undergraduate nursing students at a university in Sweden. The participants attended a 7.5-credit (five-week) Caring Behavior Course (the CBC) in semester four during spring and fall 2018 and spring 2019. The CBC was facilitated through a student-centered learning approach intertwined into reflective practice with the learning didactics of narrative pedagogy and simulation; it comprised six voluntary lectures, five mandatory seminars, and two mandatory caring behavior simulation days and examinations. All data were collected from the students participating in the CBC. Two of the four scientific papers constituting this thesis had a qualitative design based on focus group interviews (paper I) and individual written reflections (paper II). Analyses was conducted using qualitative content analysis. One paper had an instrument development design to develop and test an observational behavioral instrument based on Swanson’s Theory of Caring (paper III). Lastly, one paper had a quantitative observational design using the CBCS on video-recorded observational behavioral data collected in the CBC (paper IV). Analyses was conducted using descriptive statistics and Wilcoxon signed rank test (paper IV).

Results: The undergraduate nursing students’ participation in the CBC influenced their learning of caring behaviors. It deepened their understanding and knowledge of caring. The students became aware that learning caring is a task that requires effort because the meaning of caring encompasses nurses’ active engagement in practicing caring behaviors. These findings are also supported through the observational behavioral instrument, through the developed Caring Behavior Coding Scheme based on Swanson’s Theory of Caring; it was found that participation in the CBC influenced the undergraduate nursing students verbal and non-verbal caring and non-caring behaviors.

Conclusions: This thesis demonstrated that bridging the gap between caring theory and nursing practice in the CBC using a variety of learning didactics influenced undergraduate nursing students’ learning of caring behaviors. The results contributed to strengthening the knowledge that caring and learning are parallel processes in the undergraduate nursing students’ development into becoming compassionate and competent caring nurses, with the intended outcome of patient healing and well-being.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2022. , p. 101
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 120
Keywords [en]
Caring, Narrative pedagogy, Observational behavioral instrument, Qualitative method, Quantitative observational method, Reflective practice, Student-centered learning approach, Simulation, Swanson’s Theory of Caring, Undergraduate nursing education
National Category
Nursing Learning
Identifiers
URN: urn:nbn:se:hj:diva-58498ISBN: 978-91-88669-19-3 (print)OAI: oai:DiVA.org:hj-58498DiVA, id: diva2:1696510
Public defence
2022-10-07, Forum Humanum, Hälsohögskolan, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2022-09-16 Created: 2022-09-16 Last updated: 2022-09-19Bibliographically approved
List of papers
1. Undergraduate Nursing Students' Experiences of Learning Caring Using a Variety of Learning Didactics
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2022 (English)In: International journal for human caring, ISSN 1091-5710, Vol. 26, no 3, p. 145-158Article in journal (Refereed) Published
Abstract [en]

This study examines undergraduate nursing students' experiences of participating in a Caring Behavior Course using various learning didactics. Twenty-five students participated in one of five focus group interviews with data analyzed according to qualitative content analysis. The main theme to emerge, an insightful and sudden awakening that caring is not only theoretical words, was further explained with three themes and nine subthemes. The Caring Behavior Course demonstrates effective learning didactics to develop awareness of values that influence caring behaviors and can contribute to patient well-being, particularly relevant for the care challenges in the time of COVID-19 and beyond.

Place, publisher, year, edition, pages
Springer Publishing Company, 2022
Keywords
caring, content analysis, focus group, reflective practice, simulation, undergraduate nursing education
National Category
Nursing Didactics
Identifiers
urn:nbn:se:hj:diva-56262 (URN)10.20467/HumanCaring-D-21-00012 (DOI)2-s2.0-85138724469 (Scopus ID)
Available from: 2022-04-25 Created: 2022-04-25 Last updated: 2022-10-10Bibliographically approved
2. Undergraduate nursing students' experiences of practicing caring behaviours with standardised patients
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2023 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 37, no 1, p. 271-281Article in journal (Refereed) Published
Abstract [en]

Rationale

Undergraduate nursing students' learning opportunities to practice caring behaviours to assure compassionate and competent nursing practice with standardised patients are few. Earlier studies primarily focused on practicing communication skills in relation to mental health or developing psychomotor skills while caring for a patient with a specific diagnosis.

Aim

The study aim was to describe undergraduate nursing students' experiences of practicing caring behaviours with a standardised patient.

Method

A sample of forty-eight undergraduate nursing students in semester four at a school of nursing in southern Sweden, enrolled in a full-time, 5-week, on-campus elective caring behaviour course, were at the first and last week individually video-recorded during two caring behaviour simulations encountering a standardised patient. After observing each of their video-recordings, students completed written reflections focusing on their own compassionate and competent verbal and nonverbal caring behaviour. In total, 96 individual written reflections were analysed using qualitative content analysis to describe the experience.

Results

One main theme emerged: The challenge of being mindfully present in patient encounters. Four themes further described the experience: A challenging but realistic learning experience, learning the impact of nonverbal behaviour, recognising the complexity of verbal behaviour, and learning to be with the patient instead of only doing for the patient.

Conclusion

When caring is intertwined with visible and realistic nursing practice in simulations using standardised patients it facilitates undergraduate nursing students learning compassionate and competent caring behaviour. The learning experience opened the students' eyes to the impact of practicing caring, recognising that being with is not the same as doing for the patient, and thus, how challenging it is to be mindfully present in patient encounters. Designing caring behaviour simulations with standardised patients is a feasible and efficacious educational learning didactic to facilitate students' learning caring behaviour and enhancing patients' experiences.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
caring behaviours, nursing education, qualitative content analysis, reflective practice, simulation, standardised patient, Swanson's Theory of Caring
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-56172 (URN)10.1111/scs.13077 (DOI)000773909300001 ()35348240 (PubMedID)2-s2.0-85127358707 (Scopus ID)HOA;intsam;806056 (Local ID)HOA;intsam;806056 (Archive number)HOA;intsam;806056 (OAI)
Available from: 2022-04-08 Created: 2022-04-08 Last updated: 2023-06-29Bibliographically approved
3. Caring Behavior Coding Scheme based on Swanson’s Theory of Caring – development and testing among undergraduate nursing students
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2021 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 35, no 4, p. 1123-1133Article in journal (Refereed) Published
Abstract [en]

Rationale: To maintain patients’ dignity and well-being and alleviate suffering, it is essential that healthcare providers engage in caring behaviours. Yet, every year patient boards receive an increasing number of complaints from patients and significant others regarding healthcare providers’ non-caring behaviours. Defining and measuring both verbal and nonverbal caring and non-caring behaviour in healthcare delivery is vital to address such complaints. However, no studies were found that incorporated a comprehensive theory of caring to code encounters between healthcare providers and patients.

Aim: The aim was to develop and test a Caring Behavior Coding Scheme based on Swanson’s Theory of Caring.

Method: An instrument development process was used for behavioural coding including observational data from thirty-eight video recordings collected in an undergraduate nursing course at a Swedish University. The observational data involved interactions between undergraduate nursing students and a standardised patient.

Result: The Caring Behavior Coding Scheme (the CBCS), contains seventeen verbal and eight nonverbal behavioural codes, categorised as caring and non-caring in accordance with Swanson’s Theory of Caring. Content and face validity were assessed. Timed-event sequential continuous coding was performed in INTERACT software. The coder achieved excellent agreement with the developed gold standard (k = 0.87) and excellent mean inter-rater reliability (k = 0.82). All domains in Swanson’s Theory of Caring were observed and coded in the interaction.

Discussion/Conclusion: The CBCS is a theory-based instrument that contributes to research on healthcare providers’ behavioural encounters. It uses verbal and nonverbal caring and non-caring behavioural codes to assess the alignment of both the theory and practice of caring. The CBCS can contribute to both development and measurement of interventions focused on improving healthcare providers’ caring behaviour with the intended outcome of patient well-being.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
behavioural coding, caring behaviour, healthcare providers, observational methods, simulation, Swanson’s Theory of Caring, undergraduate nursing student, adult, article, care behavior, face validity, gold standard, health care delivery, human, interrater reliability, nursing student, observational method, outcome assessment, software, theoretical study, videorecording, wellbeing
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-50952 (URN)10.1111/scs.12927 (DOI)000585037300001 ()33124708 (PubMedID)2-s2.0-85094639968 (Scopus ID)HOA;intsam;1499568 (Local ID)HOA;intsam;1499568 (Archive number)HOA;intsam;1499568 (OAI)
Available from: 2020-11-09 Created: 2020-11-09 Last updated: 2022-09-16Bibliographically approved
4. Assessing the impact of a caring behavior course on undergraduate nursing students’ caring behavior
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(English)Manuscript (preprint) (Other academic)
National Category
Nursing Didactics
Identifiers
urn:nbn:se:hj:diva-58495 (URN)
Note

Included in doctoral thesis in manuscript form.

Available from: 2022-09-16 Created: 2022-09-16 Last updated: 2022-09-16Bibliographically approved

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