الفهرس 
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Abstract
Caring is identified as the core and essence of nursing & one of the major criteria of
professional nursing. Therefore, for preparing a high-quality future nursing staff, it is essential
that caring behaviors be measured in nursing education programs. Although the instruments
that measure the cognitive and psychomotor aspects of students’ performance in nursing
education have been well developed in Egypt, no instrument was developed to measure caring
behaviors of nursing students. While a valid and reliable tool to measure the caring behaviors
of nursing students can encourage and enable nursing educators to build caring into their
course content and increase the students’ awareness of caring as part of their education
experrience. Thus, it was important to carry out this methodological study that aimed at the
development and psychometric evaluation of an instrument to measure nursing students’
caring behaviors.
The study was conducted in two phases and five steps. The first phase concerned with
the development of content domains and items, while the second phase focused on the initial
psychometric evaluation and data analysis of the Nursing Students’ Caring Behavior Scale
. CBS).
In phase I, content domains were defined based on the analysis of the findings of a
phenomenological qualitative study that was conducted by the researcher over 3 months from
July to September 2009 in order to examine the meaning of caring in nursing for patients in
Egypt through individual, face to face, in-depth interviews of 22 critically ill patients. Three
themes of caring were identified including: 1) Having a relationship as a human
being /Presencing, 2) Respecting patient’s dignity, and 3) Comforting. Then a total of 39 items
were generated within the three domains by synthesizing items generated from the interview
adta describing each theme with literature review including prior instruments that measure
caring in nursing. In the first domain, 25 items concerned with Having relationship as a
human being/Presencing, in the second domain, 8 items concerned with Preserving patient’s
dignity & in the third domain, 6 items concerned with Comforting. Finally, the NSCBS
version 1.0 was established.
Then the Content Validity Index (Davis, 1992P37) was used by an expert panel in
their review of the NSCBS version 1.0. Based on the I-CVI scores of version 1.0, the NSCBS
version 2.0 was then established with excellent items that were evaluated by the expert panel
as .93 of Item-Content Validity Index being selected. This resulted in a Content Validity
Index (CVI) for version 2.0 of 0.97. The NSCBS version 2.0 comprised of a checklist with
done and not done columns as well as a not applicable column for behaviors that were not
applicable during the student-patient encounter. Then a pre-test of the NSCBS was done using
. NCBS version 2.0 yielding NSCBS version 3.0 with 28 items.
In phase II, The 28-item NSCBS version 3.0 was used to measure the caring
behaviors of a sample of nursing students consisted of all students who registered in the
critical care nursing 11 course in the academic year 2009-2Ql 0 and were assigned to the
researcher as an instructor during the 15\ semester (58 students) and the 2nd semester (54
students) with a total number of 112 students. The derived data was used in the factor analysis
of NSCBS to determine if the items were conceptually and statistically related. Three factors
were identified using principal component analysis with Varimax rotation and Kaiser
normalization, and a cutoff point of .30.
All 28 items had component loadings greater than the .30 cutoff level with three it
(CB52, CB33, CB37) had side loadings. Component I, defined by 15 items, was lab -
Having relationship as a human being/Presencing, with factor loading ranging from .54 to .
The items of component I focused on nurse-patient interactions and reflected a human nu
patient relationship. Component II, defined by 7 items, was called Preserving patient’s dign
with factor loading ranging from .56 to.93. The items of component II focused on respect:
the individual and for human dignity. While component Ill, defined by 6 items, was cal
Comforting, with factor loading ranging from .57 to .89 and focus on ensuring pati -
comfort.
Item analyses were then computed for the overall scale and each of the thr
subscales. The 28-item NSCBS version 3.0 showed an extremely high reliability, with
Cronbach’s alpha of .93 indicating a high internal consistency. The resulting NSCBS ver i
4.0 consists of 28 items in three subscales. Subscale I, contained 15 items and labeled
”Having a relationship as a human being/Presencing”, subscale II contained 7 items and \\
labeled as ”Preserving patient’s dignity, subscale III contained 6 items and was labeled ~
”Comforting” .
The study concluded that the Nursing Students’ Caring Behavior Scale is a reliable
valid instrument to measure caring behaviors of nursing students. Based on the findings of
study, the following recommendations were suggested:
A- Nursing education
• The instrument should be used as an intervention to improve the learning of caring -
cultivating students’ caring behaviors through:
• Using the NSCBS as a map to help the student to understand what caring’
and to learn to put caring knowledge into practice.
• Incorporating the NSCBS into the system of students’ clinical performan
evaluation in order to motivate and encourage nursing students’ cari ~
behaviors.
• Using the NSCBS to provide baseline data about the caring behavior nursing students then using the obtained informatio mme progr
objectives, to demonstrate outcomes, and to refine teachin trategies.
• The National Academic Reference Standard (NARS) for nursing should include ~
reference range for the minimal level of performance of caring behaviors based on th
NSCBS.
B- Nursing research:
• Further research is needed to accumulate evidence for the validity and reliability of th
Nursing Students’ Caring Behavior Scale
• A research is needed to identify factors behind lack of students’ caring behaviors an
to find the appropriate interventions to eliminate this phenomenon.
C-Nursing practice
• The NSCBS should be used as practical behavioral guideline to strengthen the pre-
service behavioral training of nurses as well as a part of ongoing in-service
educational activities of pr act icing nurses.