The phenomenon of care has been called the essence of nursing (Leininger, 1986). Research has generated a body of knowledge regarding care that educators are using to plan and develop nursing curricula. Nodding ( 1984) believes that the primary aim of nursing education should be the maintenance and enhancement of caring. If nursing educators want to be models of caring and understand the role of human caring in education, they must first become knowledgeable about caring from the students' perspective (HaIldorsdottir, 1990). The purpose of this article is to explain the development of a tool used to measure students' perception of instructor caring.
The concept of care has been associated with nursing since the Nightingale era (Leininger, 1981). Nursing scholars in the last three decades have increased their knowledge about caring from the social sciences, humanities, and existential philosophies. Buber's (1958) philosophical framework has influenced nursing scholars in developing the unique perspective of human caring.
According to Leininger (1986), nursing faculty must be explicit in teaching and practicing care components with students. She identifies the need for role-model experiences for students to facilitate positive care actions. Watson (1988) says the concrete action of caring is transcending and can be contagious, at both the individual and systemic levels. Watson further states that caring outcomes in practice, research, and theory are dependent on the teaching of a caring ideology. According to Miller, Haber, and Byrne (1990), limited research exists concerning caring in the educational setting. Their research identifies caring as a crucial dimension of the educational phenomenon. Halldorsdottir (1990) has researched and identified the essential structure of a caring encounter with a teacher from the nursing student's perspective. However, review of the literature revealed no tool for measuring students' perceptions of instructor caring.
Student surveys are one method of determining students' opinions regarding the qualities of an effective teacher. The inherent weaknesses of this method are the individual learning styles, goals, and personal needs of the student (DeYoung, 1990). Despite these weaknesses, research utilizing the survey method has provided useful information regarding the qualities of a good teacher (DeYoungX
The psychometric approach assumes that attitudes and values are psychological constructs that can be measured (King, 1984). The evaluation tool is based on the semantic differential scale proposed by Osgood in 1952. The semantic differential is a generalizable technique of measurement that must be adapted to the concept being measured (Osgood, Suci, & Tannenbaum, 1975). According to King (1984), the semantic differential survey can be completed quickly, is not too difficult to construct, can provide useful information, and is an acceptable assessment tool for attitude concepts. Attitudes are learned and can be ascribed to some basic bipolar continuum implying both direction and intensity. Semantic measurements appear to identify and localize attitudes (Osgood et al.
There are five basic steps in the construction of a semantic differential (King, 1984). The first step is determination of the attitude object to be assessed. Student perceptions of instructor caring is the concept being assessed. The second step is selection of appropriate adjective pairs. Characteristics of a caring instructor are derived from Watson (1988), Leininger (1986), Miller et al. (1990), and Halldorsdottir (1990). The third step in the construction of a semantic differential is writing directions. The completeness of the directions contributes to the validity and reliability of the results of the measurement tool (DeYoung, 1990). Providing random polarity - listing pairs so that positive responses may fall at either end of the scale - is the next step in developing a semantic differential. The last step of the process is computing the students' scores. Although interpretation of the score is somewhat subjective, both positive and negative attitudes may be determined.
The semantic differential scale developed to measure student perceptions of instructor caring is a seven-point scale. Osgood et al. (1975) believe that seven points are optimum. Fewer divisions tend to irritate those being surveyed and more divisions produce unsatisfactory divisions. The seven-point scale will allow respondents to select a neutral position, an option that most researchers advocate (King, 1984). The students were asked to evaluate faculty members' caring qualities on a scale with ranges such as flexible-rigid, competent-incompetent, judgmental-nonjudgmental, considerate-inconsiderate, sensitive-insensitive, and genuine-superficial. A copy of the 16-item tool is available from the author.
Several limitations of attitude measures must be considered when developing and interpreting the semantic differential scale (King, 1984). An inconsistency may exist between measured attitudes and behavior of the instructor. Tools to measure attitude have relatively weak predictive validity. Response bias may occur if the respondent does not remain anonymous. Fluctuations of the respondent's mood may affect the reliability of the attitude measure. Individual interpretation of the resuits may also be considered a limitation of the attitude measure. According to King, even though limitations exist, the development and measurement of affective behaviors should be of concern to educators because such behaviors are essential in the helping professions.
The concept of care is examined in a comprehensive manner in the semantic differential scale. Aspects of care to be evaluated are derived from experts (Leininger, 1986; Watson, 1990). Current research (Halldorsdottir, 1990; Miller et al., 1990) regarding the experience and structure of care is also utilized to develop the evaluation tool.
All items of the semantic differential scale are mutually exclusive. This survey attempts to provide an exhaustive list of caring attitudes gleaned from research and published authorities. Input from experienced educators served to validate the completeness of the tool.
An instrument is considered valid when it measures that which it is designed to measure (Osgood et al., 1975). The semantic differential is an instrument that measures meaning. A commonly accepted quantitative criterion of meaning does not exist, so the face validity of the tool must be judged. An instrument has face validity when the distinctions it provides correspond with observations made without the tool (Osgood et al.). King (1984) identifies response bias - replies based on social desirability rather than true feelings - as a source of invalidity of semantic differential scales. This bias is a limitation inherent in all tools that assess attitudes.
The reliability of an instrument measures the degree to which the score can be reproduced when the same objects are measured repeatedly (Osgood et al., 1975). Research cited in King (1984) indicated high test/retest reliability of the semantic differential scale. Research using splithalf reliability - a widely used procedure for estimating reliability - indicates correlation between scores and providee a measure of reliability of the tool. The tool was implemented in a pilot study and further subjective validation of reliability of the instrument was obtained.
Examination of the concept of care from the nursing students' perspective may be considered a care facilitator. Leininger (1986) identified care facilitators as conditions that enhance or enable nurses to discover the meaning and uses of care in their thinking and work. Student evaluations of caring behaviors of faculty may generate personal insight for faculty members. Faculty development can focus on strategies to enhance caring behaviors. Leininger (1986) recommends promotions and rewards to facilitate care and to reinforce the value of care. Student surveys are one method of identifying caring educators who encourage caring in their students.
- Buber, M. (1958). I and thou (2nd ed.). New York: Charles Scribnerfc Sons.
- DeYoung, S. (1990). Teaching nursing. Redwood City, CA: Addi son- Wesley.
- Halldorsdottir, S. (1990). The essential structure of a caring and an uncaring encounter with a teacher: The perspective of the nursing student. In M. Leininger & J. Watson (Eds.), The caring imperative in education (pp. 95-108). New York; National League for Nursing.
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- Leininger, M.M. (1981). The phenomenon of caring: Importance, research questions, and theoretical considerations . In M.M. Leininger (Ed.), Caring: An essential human need. Thorofare, NJ: Slack.
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- Nodding, N. (1984). Caring: A feminine approach to ethics and moral education. Berkeley, CA: University of California Press.
- Osgood, C.E., Suci, G.J., & Tannenbaum, P.H. (1975). The measurement of meaning. Chicago: University of Illinois Press.
- Watson, J. (1988). Nursing: Human science and human care. New York: National League for Nursing.