Nitasha Sharma ,Karobi Das ,Minakshi Thakur,Gurleen Kaur,Monkka Chauhan,Preetinder Kiaur,Radha Kumari ,Shivani Rrahi
Vol-12, No. 1, January 2016
Peer caring Behaviour among nursing students
https://doi.org/10.33698/NRF0198
Nitasha Sharma, Karobi Das, Minakshi Thakur, Gurleen Kaur, Monika Chauhan, Preetinder Kaur, Radha Kumari, Shivani Rahi
Abstract : Caring is instrumental to professional nursing practice. Nurses are expected to integrate unconditional caring in their personal as well as professional conduct. While some individuals have this trait within inherently while others integrate it during years of formal education. The present study aimed to investigate peer caring behaviour among the nursing students. It was a cross sectional investigation using self administered questionnaire. Study sample included 306 nursing students. The ratings on each item of the peer caring behaviour scale and mean rating on each item is presented in results. Almost 65% of study participants had average levels of peer caring. Further, the peer caring was compared across various groups revealing statistically significant difference between groups. The present study highlights the need to capitalize on promotion of peer caring during years of training.
Keywords
Caring, Nursing, Peer
Correspondence at Dr Nitasha Sharma Clinical Instructor,National Institute of Nursing Education., PGIMER, Chandigarh
Introduction
Caring is instrumental to human existence. Caring can be viewed as a science as well as an art specifically in context of professional nursing. Caring comprises of two major domains: The psychosocial domain of caring and an action domain of caring. While the psychological expression of feelings like love, acceptance, trust, empathic concern, genuineness are the components of psychosocial domain of caring; the action domain of caring involve expressing professionally expected behaviour, fulfilling needs of clients, offering self, using self as a therapeutic tool, rendering appropriate support and providing conducive environment.1 Nurses are expected to integrate unconditional caring in their personal as well as professional conduct. Such deep sense of caring does not develop by itself in nurses rather a great deal of commitment is required at personal, social and spiritual levels.2 According to Watson, whenever a nurse comes in contact with a client, her caring behaviour is reflected through her dealings, her verbal language, her non verbal expressions of body language, gestures, her affective tone, movements and intuitions.3 Such aptitude of caring can be inherent in some of the nursing students which motivates them to opt for the profession while others tend to develop it over the years of training.
There is outsized literature on caring in nursing. The foundation of such literature is grounded in qualitative studies on ‘perception of caring among nursing students’. One of such study revealed that caring has two components: professional/helping relationship and technical competency.4 Beck conducted a meta-analytical study on caring within nursing education. Using a meta- ethnographic report, the authors reported that caring centred on reciprocal relationship that comprised of presencing, sharing, supporting, competence and uplifting the effects of caring.5 In another phenomenological study the meaning of caring was explored in nursing students. The findings outlined four major constituents of a caring experience: Authentic presencing, selfless caring, fortifying support and enriching effects.6
Further, Khademian conducted an empirical investigation to explore the perception of importance of caring behaviour in nursing students wherein caring was conceptualized in seven subscales: accessible, monitors and follows through, explains and facilitates, trusting relationship and spiritual care.7
Beck (1992) postulated that when nursing students experience caring from fellow nursing students, they learn caring. 6 Caring theorists also argue that caring begins with the self and those closest to the self.8 During the years of formal training, the degree of peer caring behaviour of nursing students can serve as an indirect measure of students nurse’s development of caring abilities and aptitude. On such grounds a phenomenological study was conducted to provide an understanding and description of the caring group experience for nursing students. The researcher conducted unstructured face to face interviews using emergent design. Constitutive patterns and relational themes were identified from the data. The three patterns that emerged were creating the Caring Community; Experiencing the Reciprocity of Caring; Being Transformed. 9
Such insights among the nursing researchers have led to development of various valid instruments to measure peer caring behaviour among nursing students. Kuo et al developed a culture sensitive valid and reliable instrument to measure peer caring among nursing students.10 The technique of factor analysis revealed three major factors of peer caring viz. assistant caring, academic caring and affective caring. Assistive caring involved the caring by offering assistance and suggestions as required; academic caring comprised of study related information sharing; and
affective caring pertained to caring
behaviours like listening, sharing, encouraging and supporting. Udomluck constructed a psychometrically sound Caring behaviour scale for Thai nurses using the factor analytical technique. The developed instrument consisted of 6 dimensions of caring viz. effective communication; respect; support; being with; doing for; and, utilizing professional knowledge and skills.2 Taking into account, the importance of caring in nursing profession, it deems necessary to assess such attributes among nursing students during formal training years.
Objective
To assess the peer caring behaviour among the nursing students.
Methodology
It was a descriptive study with cross sectional research design. Study was conducted at a National level Institute of Nursing in North India. A total of 306 subjects were enrolled in the study using the convenience sampling technique. The study was approved by the ethics committee of the institute. The written informed consent was obtained from each subject and the purpose of study was explained to them. The ‘peer caring behaviour’ of the subject was assessed using a ‘Peer caring Behaviour Scale’ which is a 22 item 5 point rating scale ranging from 1-5 with total score ranging from 22- 110. The total scores for each subject were obtained by summating the scores on individual items. The subjects were classified in the categories of high, average and low peer caring based upon mean score of the group and standard deviations. The summative score between 74.4- 91.3 was labelled as average peer caring. The scores above 91.3 were categorised as high peer caring while scores
below 74.4 were categorised as low peer caring. The items of the scale are in interrogative form, for example ‘Whenever any classmate encounters any difficulty do you notice’ to which the subjects have to respond from any of the given five options. The ‘Peer caring Behaviour Scale’ used in the present study is a modified version of ‘Peer Caring Measurement Questionaire’10. Some of the items of the original scale were eliminated and reworded to make the scale appropriate to Indian context. The data was collected using self administered questionnaires. The subjects were duly explained about the purpose of study and they were given liberty to clarify any doubts before rating the items on scale. The data was collected in group settings in classrooms using self administered questionnaires. The analysis was done using spss version 20. The frequencies, means and standard deviations and ANOVA were computed. The findings of the study are presented in the form of tables.
Results
Table 1 depicts the socio-demographic profile of 306 subjects (N = 306 ) in which almost similar number of subjects were enrolled from each of B.Sc. Nursing class. Out of total sample, 56% of them were from urban habitat. Half of subjects were followers of Hindu religion mounting up to 51% followed by 43% Sikh and rest of subjects belonged to other religions. Three fourth of them hailed from nuclear type of family. 73.2 % of subjects were residing in hostel while rest were coming from home or were residing as paying guests.
Table 1 : Socio-demographic Profile of subjects
(N=306)
| Variables | n (%) |
| Class | |
| · B.Sc. Nursing 1st year | 88(28.8) |
| · B.Sc. Nursing 2nd year | 73(23.9) |
| · B.Sc. Nursing 3rd year | 76(24.8) |
| · B.Sc. Nursing 4th year | 69(22.5) |
| Habitat | |
| · Rural | 134(43.8) |
| · Urban | 172(56.2) |
| Religion | |
| · Hindu | 156(51.0) |
| · Sikh | 133(43.5) |
| · Muslim | 3 (1.0) |
| · Christian | 10 (3.3) |
| · Others | 4 (1.2) |
| Family type | |
| · Nuclear | 239 (78.1) |
| · Joint | 67 (21.9) |
| Living arrangement | |
| · Hostel | 224(73.2) |
| · Home | 36(11.8) |
| · Paying Guest | 46(15.0) |
Table 2 depicts the ratings on the items of ‘Peer care Behaviour Scale’ in which almost half of subjects agreed to have noticed whenever any classmate encounter any difficulty and 43% agree that others also notice the same. Sixty percent have given strong affirmation to extend help whenever
their classmate asks for. Majority have responded that they are willing to give company to their classmates when they feel lonely. Only 12% strongly agreed to praise classmates. Also, it was only 15 % who were not in favour of helping classmates financially.
Table 2 Ratings on the items of ‘Peer caring Behaviour Scale’
| Sr. Description of the item No. | Strongly disagree | Disagree | Neither agreee nor disagree | Agree | Strongly agree | Mean Rating |
| 1. Whenever any classmate encounters any | 1(0.3) | 5(1.6) | 74(24.2) | 139(45.4) | 87(28.4) | 4.0 |
| difficulty do you notice? | ||||||
| 2. Whenever any classmate encounters any | 1(0.3) | 24(7.8) | 94(30.7) | 131(43.0) | 56(18.3) | 3.7 |
| difficulty, do others notice? | ||||||
| 3. Whenever any classmate asks for help, | – | – | 30(9.0) | 95(31.0) | 181(59.2) | 4.4 |
| are you ready to help. | ||||||
| 4. Whenever any classmate is lonely, are you | – | 4(1.3) | 39(12.7) | 94(30.7) | 196(55.2) | 4.3 |
| willing to give company? | ||||||
| 5. Class mates praise each other? | 4(1.3) | 39(12.7) | 107(35.0) | 118(38.6) | 38(12.4) | 3.4 |
| 6. Do you help your classmates financially? | 4(1.3) | 48(15.7) | 116(38.0) | 90(29.4) | 48(15.7) | 3.4 |
| 7. Are your classmates concerned with each | – | 17(5.6) | 61(20.0) | 105(34.3) | 123(40.2) | 4.0 |
| others’ health | ||||||
| 8. When any classmate is sick do you | 3(1.0) | 13(4.2) | 68(22.2) | 119(39.0) | 103(33.7) | 4.0 |
| accompany her to get medical help? | ||||||
| 9. Do you help your classmates in | 9(2.9) | 36(11.8) | 117(38.2) | 90(29.4) | 54(17.6) | 3.4 |
| making assignments? | ||||||
| 10. If there is any conflict among classmates, | 3(1.0) | 36(11.8) | 123(40.0) | 91(29.4) | 53(17.3) | 3.5 |
| do you help to make things smooth? | ||||||
| 11. Do you help your classmates in solving | – | 8(2.6) | 77(25.2) | 126(41.2) | 95(31.0) | 4.0 |
| their problems? | ||||||
| 12. Do you share your notes and references? | 3(1.0) | 21(6.9) | 74(24.2) | 98(32.0) | 110(35.9) | 3.9 |
| 13. Do you guide your classmate when he/she | 1(0.3) | 15(5) | 66(2.6) | 91(29.7) | 133(43.5) | 4.1 |
| is going on wrong path? | ||||||
| 14. Do you break your promise? | 2(0.7) | 24(7.8) | 101(33.0) | 132(43.1) | 47(15.4) | 3.6 |
| 15. Do you praise your classmates for good | 1(0.3) | 3(1.0) | 25(8.2) | 89(29.1) | 188(61.4) | 4.5 |
| deeds? | ||||||
| 16. Have you been helped financially by your | 39(12.7) | 49(16) | 95(31.0) | 68(22.2) | 55(18.0) | 3.1 |
| Classmate | ||||||
| 17. Do your classmates offer suggestion | 4(1.3) | 35(11.4) | 101(33.0) | 115(37.6) | 51(16.7) | 3.5 |
| for the good of specific individual | ||||||
| 18. Do your classmates encourage each other | – | 24(7.8) | 88(28.8) | 109(35.6) | 85(27.8) | 3.8 |
| 19. Do your classmates discuss with | 2(0.7) | 29(9.5) | 110(36) | 89(29.1) | 76(24.8) | 3.6 |
| each other . | ||||||
| 20. Classmates have someone to share | 4(1.3) | 21(7.0) | 66(21.6) | 119(39) | 96(31.4) | 3.9 |
| their problems. | ||||||
| 21. Classmates respect diverse opinions | 6(2.0) | 34(11.0) | 132(43) | 116(38) | 18(5.9) | 3.3 |
| of others | ||||||
| 22. Is there is negative competition among all. | 33(10.8) | 108(35.3) | 94(30.7) | 59(19.3) | 12(3.9) | 2.7 |
Forty percent subjects strongly agreed to show concern to each other’s health and help them to seek medical help. It was only 29% of subjects who showed their interest in clearing conflicts between classmates while 40 % helped their classmates in solving their problems.43% strongly agreed to guide classmates and refrain them from going on wrong path. Only 8% agreed of not breaking promises. Almost equal number of subjects agreed and disagreed to receiving financial help from classmates. It was around 37.6% students who offered suggestions to classmates for their improvement. One third of them agreed that classmates encourage each other.
Table 3 depicts the frequency distribution of subjects on the basis of mean
Table 3: Peer caring behaviour of study subjects
Table 4 gives the comparison of peer caring Behaviour in various groups. As depicted in Table there was statistically significant difference between groups as classified on the basis of their class they were enrolled in as determined by one – way ANOVA (F(3,302)= 8.436, p<0.01) . A
Turkey post- hoc test revealed that first year students (85.60±8.01) had significantly higher scores than second year (82.19±8.27), p = 0.04 & third year students (79.43±9.14), p<0.01. There were no significant differences between second year and third year peer caring behaviour (p= 0.18) & between first year and fourth year students (p= 0.80). The group did not reveal significant differences when compared on the basis of type of family and living arrangement.
| Peer caring Behavior Score | n (%) |
| Above average (>91.4) | 51(16.6) |
| Average (74.4-91.3) | 206(65) |
| Below Average (<74.4) | 49(16) |
Mean Score ± SD = 82.9 ± 8.5
peer caring behaviour scores. The mean score of the group was 82.9 with standard deviation of 8.5. It was seen that 16% of subjects had above average score i. e. total score greater than Mean ±1
S.D. i.e. 91.4, while 65% subjects had average score i.e. score within range of mean ± 1 S.D. i.e. (74.4- 91.3). It was observed that
16 % of subjects had below average caring behaviour whose peer caring scores fall one S.D below mean i.e. < 74.4.
|
Table 4 : Group comparison in Peer caring Behaviour
Discussion
The word ‘peer’ is an acronym which actually refers to people who are equal in age, rank, education, social class, background etc. Peer refers to one who is a companion or an associate. Peer plays a very significant role in shaping adolescents view and their attitude towards coping. Peer group tends to provide an environment where caring is observed, felt and thus learned. Relationships with the peers enable individuals to explore important skills such as reciprocity, self disclosure, trust and conflict resolution. Caring forms an integral and unifying component of professional nursing. Beck postulated that when nursing students experience caring from fellow nursing students, they learn caring.6 Caring can emerge during student’s interactions with other students and during their interactions with educators. The present study aimed to investigate the peer caring behaviour among nursing students.
Considering the importance of caring in nursing, various researchers have validated the importance of understanding meaning of care from student’s perspectives. Karaoz conducted a qualitative study to understand caring among nursing students. The thematic analysis revealed two major themes of caring: professional / helping relationship and technical competency.4 A similar yet unique meta-synthesis by Beck unfolded five metaphor of care in nursing viz. presencing, sharing, supporting, competence and uplifting effects of caring. 5 The present investigation explored the peer caring behaviour of nursing students during the years of formal education. The caring was assessed in terms of individual acts of
caring and an overall group caring. While the individual caring behaviour was assessed using items which directly asked the respondents caring behaviour e.g. ‘Whenever any classmate encounters any difficulty do you notice?’, group caring was assessed by taking opinion on group behaviour e.g. ‘Whenever any classmate encounters any difficulty, do others notice?’ The caring was assessed in various themes viz. academic help of peers, showing sensitivity to the problems of peers, rendering instrumental help and support, providing financial support and offering emotional support.
The item which reflected maximum mean rating on peer caring was “Do you praise your classmates for good deeds”. Another item in which caring was on higher side was ‘Whenever any classmate encounters any difficulty do you notice?’ & ‘Do you guide your classmate when he/she is going on wrong path?’ Most of the items where caring was high depicted mainly affective and assistive caring. Kuo et al have also described these two important components of caring. As per Kuo et al, assistive caring is offering assistance and suggestion when needed. Assistive caring is more or less like giving an instrumental support and help.10 The affective caring is more of emotional aspect of caring. It involves behaviours like listening, sharing, encouraging and supporting. The third dimension of caring is academic caring reflected in care by providing or sharing notes or helping in completing assignments. The scores on academic caring were though less than affective and assistive caring yet majority of subjects reported average scores on items of
academic caring.
It is presumed that caring grows with experience. The cross sectional comparison of caring among students depicted statistically significant differences among four classes with first year students scoring highest. Such findings are contrary to what is expected. Another study by Murphy also had similar report of reduction in mean scores of caring behaviours between first
personality of an individual is very significant predictor of traits like caring which was not taken in consideration.
References
- Jane Lee- Hsieh, Chien –Lin Kuo, Hung –Fu Development of an instrument to measure peer caring behaviours in nursing students in Taiwan. International Journal of Nursing Studies 2005; 42:
year and third year.11
Such finding is an
579-88.
alarm for nurse educators and educational policy makers to identify and rectify such parts of curriculum which are inhibiting the growth of caring. This also indicates need reflect upon the following: Is it that the curriculum is not congenial to let caring bloom or the teachers are not optimal role models practicing caring while dealing with students or maybe caring is temperamental and inherent. Nevertheless, the literature clearly validates that caring is a learned behaviour, and curriculum and teachers do have a significant role in its development.
The present study highlights the need to capitalize on promotion of peer caring during years of training. This peer caring is likely to get transformed into patient caring as caring begins from self and close ones to further extend to many others. There is need to develop strategies to enhance such pro social behaviours. One might have to think of innovations in curriculum to promote caring, using group works can be one. Further, the nurse educators can play a key role in this by being role models. The students often introject them and incorporate their traits in them.
The limitation of the study was that caring behaviour was assessed solely on self reports. The true caring behaviour observation was not done. Moreover, the
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