An Examination of Caring in One Associate Degree Nursing Program

Monday, 9 November 2015

Deborah A. Ain, MS, RN
Nursing, College of Southern Nevada, Las Vegas, NV, USA
Sherrilyn Coffman, PhD, RN
School of Nursing, Nevada State College, Henderson, NV, USA

The importance of caring in nursing practice and nursing education is well documented.  Several significant milestones have thrust caring into the forefront of nursing including Watson’s theory of caring or caring science that emerged with the publication of Nursing:  The Philosophy and Science of Caringin 1979.  Caring science was described as a combination of scientific knowledge and humanistic values (Watson, 1979).  She advocated for the use of caring science to transform nursing education and she called upon nursing to change its educational framework from the medical model to caring science.  She claimed that the medical model was “not adequate for addressing the phenomenon of human care in nursing and human response to actual or potential health problems” (Watson, 1985, pp. 18-19).  In 1986 the National League for Nursing (NLN) called for curriculum reform in nursing education (Tanner, 1990).  Tanner claimed that one of the major themes of the curriculum revolution was “the centrality of caring” (p. 297).

Again, in 2005, the NLN called for transformation in nursing education.  The endeavor to change nursing curricula continues today.  Caring is a core value of nursing practice and one of the concepts used to define the competency of professional identity (NLN, 2010).  While nursing identifies the importance of caring, the balance between humanism and science, or the art and science of nursing, is not always evident.

Studies have been conducted to describe caring and non-caring nursing behaviors, using both qualitative and quantitative research methodologies, from various perspectives including patients, nurses, and nursing students.  Culture and gender have also been considered in studies.  Five themes emerged from the exploratory study conducted by Begum and Slavin (2012) in Pakistan with senior nursing students.  These themes included:  (a) caring as a mothering relationship, (b) caring as a helping attitude, (c) caring as limit setting, (d) caring as communication, and (e) caring as a source of empowerment and development (p. 333).  Tools have been developed to measuring caring.  DiNapoli and Nelson (2010) conducted an exploratory and principal component factor analyses to develop a survey for measuring caritas.  What emerged was a reliable 10-item caring factor survey.  Each item represented one of the caritas processes.

In addition to research in nursing practice, research in nursing education has been conducted.  Numerous articles have been published describing the transformation of nursing curricula and the addition of the concept of caring in nursing education.  A study by Curtis and Jensen (2010) used confluent educative strategies to explore learning experience.  The strategies included “reflective writing, reading, and discussing contemporary literature and films, along with clinical experiences, field trips, and guest lecturers” (p. 52).  Four themes emerged “(a) challenging assumptions and gaining knowledge and insight, (b) developing caring and empathy, (c) moving to action, and (d) transformational learning” (pp. 50-51).  With the emergence of high-fidelity simulation and its use in place of actual clinical practicums, caring in the simulation setting has been studied.  Caring was explored in simulated emergency situations by Eggenberger, Keller, and Locsin (2010) using focus group research.  The study demonstrated that caring behavior could be valued and evaluated in simulated situations. 

How well schools of nursing are incorporating caring into the curriculum continues to be unclear.  The purpose of this study was to examine to what extent the concept of caring has been incorporated into an associate degree nursing (ADN) program at one community college.  The research question was “How is the concept of caring incorporated in an associate degree nursing program at one community college?”  The sub-questions include the following:

  • How is caring defined?
  • What terminology is used related to caring?
  • How is caring represented in program documents?
  • How is caring taught?
  • How is caring assessed?

A holistic case study design was used to explore in-depth how the concept of caring was included in the curriculum of one associate degree nursing program in a community college located in southwestern United States (U.S.).  Yin (2009) stated that a researcher “would use case study method because you wanted to understand a real-life phenomenon in depth” (p. 18).  The single case-study was used because the case represents an everyday situation in this nursing program, while the holistic design was used to examine the global nature of the program (Yin, 2009, p. 50).  Data was collected using a review of ADN program documents, informal interviews with nursing instructors, and formal group interviews with nursing students representing each semester of the 2-year program.  The program documents reviewed include the mission, philosophy, values statements, educational learning outcomes, course syllabi, and clinical evaluation tools of the most recently completed semester of the ADN program.  The documentation review included a computer search and reading to determine how and where caring was taught and how and where caring was assessed in nursing students.  The findings were recorded on a data collection sheet.  Following the documentation review, informal interviews were conducted with faculties representing the program and the courses to clarify and validate document review findings prior to interviewing students. 

Ten formal group interviews were conducted with a total of 25 volunteer nursing students representing each of the 4 semesters between December 2013 and May 2014.  Guiding questions were used during the interview:

  • Tell me what caring means to you.
  • How did you learn about caring?
  • Have you taken any courses that taught you about caring? Can you give me an example?
  • How and where did this occur?
  • How has caring been assessed or evaluated in the courses you have taken? Can you give me an example?
  • How and where did this occur?

The computer search for caring and similar terminology using the Microsoft office word search program was analyzed for where caring was represented in the ADN program.  Comments made while reading the documents were analyzed to understand the context of the terminology, the teaching/learning strategies, and the assessment of caring in nursing students.  The formal group interviews were recorded and transcribed verbatim.  The transcriptions are being analyzed for themes and patterns using the Descriptive Coding method.