1. Background
Nursing is a profession that plays an effective role in patient care; it is significant to provide compassionate nursing care (1). The cooperation of nurses would improve the health of patients (2); therefore, developing a proper care relationship between the patient and healthcare provider is critical (3). Patient experiences of caring seem to have an influential role in the quality of nursing care (4). One of the tasks of nursing students is to correctly judge what is effective in creating a sense of care in patients under their care (5). In order for the care to be effective, there must be an agreement between the patient and caregiver’s behaviors (6). Increasing the level of awareness and information not only contributes to the provision of proper care, but also leads to the emergence of real needs (7). Also, nursing students need to learn how to act professionally in the clinical setting (8).
Nursing students should consider the aspects of care that are central to creating a sense of caring in patients who were under their care. Studies have shown the importance and understanding of experienced nurses regarding caring behaviors, but this is less true for newcomers and nursing students (6). Disagreement regarding the importance of caring behaviors among patients and nursing students indicates that nurses and nursing students do not pay attention to the latest stages of patient assessment, and therefore, nursing students may create a care plan based on their own assumptions (5). Thus, patients may receive cares that they do not consider appropriate (9), although nowadays, the basis of modern nursing is based on meeting the needs of the client (10).
Caring based on eliminating needs is key to patient satisfaction, increased recovery, and feeling of comfort. This is only possible if there is a consensus between the patient and the nurse about the importance of caring behaviors (11, 12). It is one of the essential parameters in new nursing students’ education (13). However, there is considerable evidence suggesting that there is no agreement in perceptions of patients and nursing students regarding the significance of caring behaviors (14).
Nursing students are not able to communicate with their patients as expected (15). Today, paying attention to the real needs of the client by nursing students is an undeniable necessity in the field of clinical nursing education (16).
2. Objectives
Whether the new nursing education has been able to create the power to correctly identify client needs in nursing students and help them instill their principles of care based on the actual care needs of patients remains unknown. Therefore, the purpose of this study was to evaluate patients and nursing students’ viewpoints about the importance of caring behaviors in a hospital affiliated to Shahrekord University of Medical Sciences in Iran.
3. Methods
3.1. Study Design
In this descriptive and analytic study, patients who were admitted to educational hospitals and internship nursing students included the study population. The participants included 50 patients and 50 nursing students, who were selected based on the convenience and census sampling methods from in wards of the hospital and then paired together. The inclusion criteria for the patients included age 20 to 60 years, reading and writing literacy, being conscious, and not having vision and hearing problem. The inclusion criteria for the nursing students comprised of being in the internship period and participating in at least two shifts in caring for patients who participated in this project.
3.2. Data Gathering
Data were collected by a demographic questionnaire and the caring assessment questionnaire, which was designed by Larson and includes six domains: (1) Availability, (2) explaining and facilitating, (3) providing convenience, (4) predicting, (5) appropriate communication; and (6) Monitoring and follow-up. Both groups completed the questionnaire based on self-report. Although the validity of the care questionnaire was approved by Larson in 1981 (17), we re-evaluated the validity and reliability of the questionnaire. For establishing the content validity, we used the opinions of 10 academics who had a master’s degree in this field. For reliability, the synchronous method was used, which yielded a correlation coefficient of 0.91.
3.3. Implementation
The researcher presented to each of the hospital wards in the morning, evening, and night shifts, after explaining the aim of the research project to the research units and obtaining their approval. Patients meeting the inclusion criteria were selected. Then, the patients and nursing students were matched together. The patients and nursing students were taught how to complete the questionnaire.
The patients were asked which care was more suitable for them and which care behaviors were less important for them. The patient was trained to give each domain a score of 1 to 6, with a score of one indicating most important, a score of two indicating relatively important, a score of three indicating neither important nor insignificant, a score of four indicating relatively insignificant, a score of five indicating less significant, and a score of six indicated insignificant.
Nursing students, on the other hand, were asked which of the caring behaviors was most important to them (patient). Therefore, by thoroughly reading the questionnaire and having complete knowledge of the six domains of caring behaviors, the items were rated from 1 to 6, and each subgroup was given a score of 1 to 6.
3.4. Ethical Consideration
All the participants entered this study with personal consent, and they were assured of the confidentiality of their personal opinions. The ethical approval code was IR. SKUMS. REC537.
3.5. Statistical Analysis
To describe the qualitative variables, frequency and percentage were used, while for quantitative variables (mean ± deviation criterion) normal distribution was assessed. To check for differences between the groups, Fisher’s exact test and chi-square test were run for qualitative variables, and for slightly normal variables independent t-test and paired t-test were used. All the statistical analyses were performed by SPSS version 16. A P-value of less than 0.05 was considered significant.
4. Results
Of the 50 students, 22 were men and 28 were women, all of whom were in the internship stage, and their mean age was 22 ± 2.1 years. Of the 50 patients, 18 were men, and 32 were women. They were admitted to the internal, cardiac, general surgery, and gynecology wards, and their mean age was 41 ± 6.7 years.
There was a significant difference between the students and patients regarding the importance of caring behaviors (Table 1).
| Important Caring Behaviors | Group | |
|---|---|---|
| Nursing Students, No. (%) | Patients, No. (%) | |
| Availability | 9 (18) | 20 (40) |
| Explaining and facilitating | 8 (16) | 11 (22) |
| Providing convenience | 15 (30) | 6 (12) |
| Predicting | 6 (12) | 4 (8) |
| Appropriate communication | 12 (24) | 8 (16) |
| Monitoring and follow-up | 10 (20) | 3 (6) |
| Total | 50 | 50 |
| Fishers’ exact test | P < 0.05 | |
Frequency Distribution of the Most Important Caring Behaviors in the Participants (Students and Patients)a
However, there was no significant difference between the students and patients’ viewpoints in the least important caring behaviors. In other words, both patients and students considered the prediction behavior was unimportant. The patients considered availability, appropriate education, and communication as the most important caring behaviors, but the students reported providing comfort and convenience, proper communication and monitoring, and follow-up as the most significant caring behaviors.
The results showed that the patients and nurses disagreed on the relatively less important behaviors. About 22% of the patients reported explaining and facilitating caring behavior as a relatively important care behavior, while about 24% of the students reported appropriate communication caring behavior as relatively less important. There was a significant difference between the students and patients regarding the relatively less important behaviors (Table 2).
| Important Caring Behaviors | Group | |
|---|---|---|
| Nursing Students, No. (%) | Patients, No. (%) | |
| Availability | 4 (8) | 9 (18) |
| Explaining and facilitating | 7 (14) | 12 (12) |
| Providing convenience | 11 (22) | 11 (11) |
| Predicting | 2 (4) | 2 (4) |
| Appropriate communication | 24 (48) | 11 (22) |
| Monitoring and follow-up | 2 (4) | 5 (10) |
| Total | 50 | 50 |
| Fisher’s exact test | P < 0.05 | |
Frequency Distribution of the Relatively Most Important Caring Behaviors in the Two Groups of Students and Patientsa
The results revealed that the students and patients agreed on the insignificant care behaviors. About 36% of patients reported the predicting caring behavior as an insignificant caring behavior, while about 28% of the students reported predicting caring behavior as an insignificant care behavior. Therefore, there was on significant difference between the students and patients regarding the insignificant caring behaviors (Table 3).
| Important Caring Behaviors | Group | |
|---|---|---|
| Nursing Students, No. (%) | Patients, No. (%) | |
| Availability | 7 (14) | 2 (4) |
| Explaining and facilitating | 6 (12) | 5 (10) |
| Providing convenience | 7 (14) | 13 (26) |
| Predicting | 14 (28) | 17 (34) |
| Appropriate communication | 8 (16) | 5 (10) |
| Monitoring and follow-up | 8 (16) | 8 (16) |
| Total | 50 | 50 |
| Fisher’s exact test | P = 0.26 | |
Frequency Distribution of the Significant Caring Behaviors in the Participants (Students and Patients)a
5. Discussion
Base on the results, the students and patients did not agree on the importance of caring behaviors, but their perceptions of insignificant caring behaviors were in agreement. Eliminating patients’ needs is key for patient satisfaction, increased recovery, and comfortable feeling, and this is only possible if there is a consensus between the patient and the nurse about the importance of caring behaviors (6).
Of the patients, 40% considered availability, 22% explaining and facilitating, and 16% appropriate communication as the most important caring behaviors, while from the students’ viewpoint, 24% deemed providing convenience, 24% appropriate communication, and 20% monitoring and follow-up as the most important caring behaviors. The Fisher’s exact test indicated a significant difference in patients and students’ perceptions about the importance of caring behaviors.
From the patients’ point of view, availability of nurses was more important, because patients are dependent on nursing support. In a study by Mortenson, availability of caring behaviors was given the highest prominence (18). One of the strongest factors underlying the increase in the capacity of the medical team is the improved communication between the patient and the treatment team, as this relationship will not only help identify patients’ needs but also will identify their work capacity (19).
Regarding the caring behavior of explaining and facilitating in the patient group, 26% considered this behavior as the most important, 22% relatively important, and 14% unimportant, whereas in the student group 6% considered this behavior the most important, 28% relatively important, and 18% considered it as unimportant. The chi-square test indicated a significant difference between patients’ and students’ perceptions regarding the importance of this caring behavior. This care behavior in the study of Compton was given the highest prominence, but in the study of Larson, it was in the fourth place (9).
Today, nursing theories have attempted to shape the everyday practices of clinical nurses and patient care, but one of the important factors in this field is giving explanation and information to the patient (20). The importance of this caring behavior lies in the fact that patients are interested in learning about the disease, treatment, and care.
The results indicated that 22% of the patients considered providing convenience as the most important, 36% relatively important, and 10% unimportant, whereas in the student group, 42% considered this behavior the most important, 30% relatively important, and 6% unimportant. Therefore, this caring behavior was equally important for the students and patients. Regarding this factor, there was no significant difference between the viewpoints of the students and patients. On the other hand, the students rated this factor more than patients (42% vs. 22%). This indicates that medical care is more important for patients, and nurses mostly think that in any case, the patient should be comforted. In the Smith and Sullivan study, this behavior ranked seventh in importance (21).
Nursing staff with different educational levels working in home care or in nursing homes endorsed providing palliative care for persons with dementia and others chronic disease at every level (22). Creating comfort and relaxation is part of the nursing care and behaviors that should be considered in the workplace.
The results regarding the patients and students’ viewpoints about the importance of predictive caring behavior showed that 12% of the patients considered this behavior the most important, 8% relatively important, and 6% insignificant, while 4% of the students rated it as the most important, 30% relatively significant, and 0% unimportant. The chi-square test showed a significant difference between the patients and students’ perceptions of the importance of this caring behavior. Perhaps, the reason for the is the fact that patients pay attention to the practical skills of nurses in hospitals because they think they need recovery, and it is necessary for this; therefore, they pay less attention to the predictive caring behavior. In the study of Compton et al. (9), this caring behavior was ranked fifth. In their study, patients paid less attention to this caring behavior, but in the Larson study of cancer patients, this caring behavior was ranked first (5). Therefore, disease diagnosis and prognosis require care based on new technologies.
The patients and students’ viewpoints on the importance of communication caring behaviors were appropriate. The results indicated that 32% of the patients considered this behavior as the most important, 28% relatively significant, and 0% insignificant, while in the students group, 14% considered it the most important, 16% relatively significant, and 4% considered it unimportant, and the chi-square test indicated a significant difference between the patients and students’ perceptions regarding the importance of this caring behavior. The patients paid more attention to the importance of the communication caring behavior than the students did, probably because patients pursue their emotional needs through appropriate communication.
Von Essen and Sjoden (23) indicated that patients’ psychomotor skills were more important to nurses’ than their emotional skills. Zabolypour et al. (24) indicated that nursing authorities in the field of treatment and education, in addition to the knowledge and skills of nurses, should also pay attention to patient education, communication, and ethics.
The results indicated the importance of the monitoring and follow up caring behavior, such that 18% of the patients considered this behavior the most important, 20% relatively important, and 8% insignificant, whereas in the students group, 36% considered it the most important, 22% relatively important, and 8% considered it unimportant, and the chi-square test indicated a significant difference between the patients and students’ perceptions of the importance of this caring behavior.
This behavior was important for the students because one of the central tasks of nurses is to follow up on the care provided (25), but the results of the Rosenthal study indicated that patients are paying more attention to patient care than patient follow-up, and this is especially critical in patients with acute illness (26, 27).
Monitoring is one of the important duties in nursing, especially in cancer patients. These patients have specific needs, including information and education regarding their cancer and potential treatment side-effects. They also have a particular need for long-term psychosocial support and practical advice (28).
Regarding less important care behaviors, 36% of patients and 28% of nurses considered predictive care behavior to be less important, but there was no statistical difference between students’ and patients’ perceptions. The study of Doroszkiewicz and Sierakowska (29) to support independent living of elderly people, healthcare professionals should recognize the situation in the community and carry out interventions aimed at preventing and minimizing disability. The results study of Bragadottir et al. (30) on the correlates and predictors of nursing care errors in hospitals indicated that sufficient nursing staff and enhanced teamwork can minimize nursing errors. Therefore, predicting nursing care behaviors is critical for preventing nursing care errors. Also, understanding patients’ needs and paying attention to their opinions is an effective parameter in reducing patients’ dependence and providing effective nursing care.
5.1. Conclusions
According to the results of this study, there was no significant positive relationship between patients and nursing students’ perceptions of the importance of caring behaviors. Therefore, patient needs should be brought to the core during the theoretical and clinical education of nursing students. The results showed that patients are more interested in education and information than the provision of convenience; therefore, the process of patient education is one of the essential elements of clinical education in nursing. However, in this process, the patient’s values and culture should be considered.
