Caring Competency for Undergraduate Nursing Students:

A Systematic Review with Implication for Nurse Educators in

Teaching Caring

Setiawan, Dewi Elizadiani Suza and Fahrizal Alwi

Faculty of Nursing, Universitas Sumatera Utara (USU), Medan, Indonesia

Keywords: Caring Competency, Undergraduate Nursing Student.

Abstract: Caring is essential in nursing. It has been considered as primary component and a foundation for quality

nursing education. Caring competency is requirement needed by professional nurses, which is expected by

patients and families when seeking nursing service. The purpose of this systematic review was to evaluate

existing evidence with aim of identifying caring competency for undergraduate nursing students. Methods:

Literature review was conducted by selecting appropriate articles which were published between year 2012

to 2017. Various database used were CINAHL, Proquest, Pubmed, MEDLINE, Science Direct, and Gale.

Keywords used were caring competency, undergraduate nursing student, and nursing education. This search

found 31 related articles. Of 31 articles, there were only 16 articles which focus on caring competency. Nine

of 16 focused articles provide full texts of important information on caring competency and caring experiences

in undergraduate nursing students. Results: From a total of 31 articles related to caring competency for

undergraduate nursing students, nine were retrieve as the final step. The articles consisted quantitative and

qualitative research which revealed important caring competency for undergraduate nursing student which

named as fundamental caring competency of the student: provision of appropriate care, personal

quality/character, helping attitude, communication skills, and relationship building ability. Besides the

competency, this systematic review also found factors influencing students in study caring: learning milieu,

motivation, personality, and cultural competence. Conclusion: Caring competency is very important for

undergraduate nursing students to apply into practice since it is the essence or foundation for nursing

intervention. Caring competency can be studied and measured through nursing education system. Nursing

education institutions and nurse educators have obligation to ensure that their students equipped with caring

competency for their professional practice.

1 BACKGROUND

Caring is related to values, attitude, and behaviors

considered as primary component of professional

nursing education (American Association of Colleges

of Nursing [AACN], 1998). It is the essence of

nursing and foundation for quality nursing education

(Watson, 2002). It is also expected by patients and

their families and primary word used by nurses and

student nurses to describe identity of nursing practice

(Duffy, 2003). Daggett, Butts, and Smith (2002)

revealed that evidence-based clinical practice and

values of education are related. Value of education

can be measured and used as basis for improving

nurse competencies. As the results, improved nurse

competencies would contribute to quality nursing

care.

Caring in nursing practice implied in day by day

nurses’ job and its purposes are of well-being and

healing (Duffy, 2002). Nurse’s caring competency as

known as clinical caring process represents value,

attitude, and behavior which create “being cared of”

by recipients of care (Watson, 2002). Clinical caring

process is centred on relationship and combine

physical actions with interaction, connected, and

knowing others (Duffy, 2003). Furthermore, caring is

considered to have benefit for patients in term of well-

being, dignity, healing process, knowing the patient,

and also benefits for nurses (Watson, 1985).

Setiawan, ., Suza, D. and Alwi, F.

Caring Competency for Undergraduate Nursing Students: A Systematic Review with Implication for Nurse Educators in Teaching Caring.

DOI: 10.5220/0008329506050609

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 605-609

ISBN: 978-989-758-336-0

605

Little is known regarding caring competency for

undergraduate nursing students. Most of studies focus

on caring of students or competency of professional

nurses. Therefore, by identifying caring competency

of undergraduate nursing students, the faculty can

develop strategies in teaching learning process which

will facilitate their students in embracing caring

behaviours.

Nursing education has important roles in teaching

nursing students with proper caring abilities.

Woodward (2003) stated that caring could be learned,

practised, and measured through nursing education

system. Woodward believes that modelling and role

play approach can be used to train nursing students in

order to improve their caring competency.

Meanwhile, Carlson, Kotze, and Rooyen (2003)

stated that clinical learning environment creates a lot

of opportunities for students to learn and develop

caring competencies. The purpose of this systematic

review was to evaluate existing evidence with the aim

of identifying caring competency for undergraduate

nursing students.

2 METHODS

Literature review was conducted by selecting

appropriate articles which were published between

year 2012 to 2017. Searching strategy included using

of electronic databases such as CINAHL, Proquest,

Pubmed, MEDLINE, Science Direct, and Gale. The

keywords used were caring competency,

undergraduate nursing student, and nursing

education. Inclusive criteria was of articles which

published original data. Unpublished articles,

abstracts, dissertation, thesis, and book were excluded

from this review.

3 RESULTS

From a total of 31 articles related to caring

competency for undergraduate nursing students, 9

were retrieved as the final step. The articles consisted

quantitative and qualitative research which revealed

important caring competency for undergraduate

nursing student which named as fundamental caring

competency of the student. Besides the competency,

this systematic review also found factors influencing

students in study caring.

3.1 Fundamental Caring Competency

of The Student

Nurses have to show their caring behaviours to

patients and their families. Therefore, caring

competency needs to be taught for nursing students

during their study period. Research studies found that

caring competency for undergraduate nursing

students includes (1) provision of appropriate care,

(2) personal quality/character, (3) helping attitude, (4)

communication skills, and (5) relationship building

ability.

Provision of appropriate care means that students

should have abilities to carry out appropriate clinical

procedures, doing tasks, and provide basic needs of a

patient (Phillips, et al., 2015); and know how to give

shots, IVs, give treatments and medications on time

(Labrague, 2012). This caring competency is

essential for nurses in providing nursing care to their

patients.

Another caring competency that students should

have is personal quality or character. Nursing

students have to possess attributes such as kind and

considerate (Labrague, 2012). It also covers

compassion and empathy (Phillips, et al., 2015).

Helping attitude is another important caring

competency for nursing students. It becomes one of

competency that expected by the patients when

receiving nursing care. This helping attitude may

include guiding, advising, appreciating, giving moral

support (Begum & Slavin, 2012) and helping a patient

feels good about his/herself (Labrague, 2012).

Several study found that communication skills

were one of caring competency that expected from

Figure 1: Flow of articles selection process

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

606

the students (Begum & Slavin, 2012; Grobbel &

Rowe, 2014; Phillips, et al., 2015). This

communication skills include how to communicate an

understanding of a person's needs (Phillips, et al.,

2015) and how to share information, to keep patient

informed, educated, or coordinated care (Grobbel &

Rowe, 2014).

Relationship building ability is also one of caring

competency needed by undergraduate nursing

students. It is a compulsory because of the nature of

nursing work both in hospital and another setting

which need collaboration with another health

discipline. Relationship building ability competency

for nursing may comprise of treat a patient with

respect and dignity, provide hope, and treat a patient

as individual (Grobbel & Rowe, 2014).

3.2 Factors Influencing Students in

Study Caring

The purpose of undergraduate nursing students in

study caring is to be a caring nurse who possesses

caring behaviours which they need when they become

a real nurse. In the process of having caring

behaviours, undergraduate nursing students is

definitely influenced by many factors. Factors that

can influence their caring behavior are learning

milieu, motivation, personality, and cultural

competence.

Learning milieu or environment is important

factor for undergraduate nursing students in study

caring. In term of how students learning caring, Ma,

et al. (2014) found that nursing students need to

learning caring by role model and conducive learning

environment to facilitate students to learning caring.

They also found factors for student in study caring

that are directive substantive way of learning.

Motivation is another pivotal factor for

undergraduate nursing students in learning caring and

mastering caring behaviours. This factor may include

need for affiliation, need for power, and need for

achievement (Nursalam et al., 2015).

Personality can be considered as strong factor for

undergraduate nursing students in study caring. A

student with good personality may have prominent

caring behaviors. Cuadra and Famadico (2013) found

that emotional intelligence will have influence on

caring behaviours. Akta and Karabulut (2017) also

found that professional values of nursing students

also would affect their caring behaviors. Finally,

Nursalam et al. (2015) revealed that extraversion and

conscientiousness would have influence caring

behaviours of undergraduate nursing students.

Finally, factor influencing students in study caring

is cultural competence. Ma et al. (2014) in study of

learning about caring in China found that their

participant had cultural issues during the practice and

learning process of caring. Students need to have

adequate knowledge on cultural diversity so that they

could behave appropriately to patients whom they

served. When they lack of knowledge on cultural

diversity they will experience more complicated in

the learning about caring.

4 DISCUSSION

The results show that fundamental caring competence

is more clearly on act of caring in providing

appropriate care which means that students should

have abilities to carry out appropriate clinical

procedures or demonstrating skills with patients, and

so on. This is because the student have taught that as

nursing students they should have the necessary

professional nursing skills to provide safe nursing

procedures (Labrague, 2012). They need to be

equipped with nursing intervention procedures which

is included in quality nursing care in best interest for

their patients.

Besides seen as act of caring, caring competency

for undergraduate nursing students involve personal

quality/character, a helping attitude, communication

skills, and relationship building ability. These mean

that nursing students also need other type of caring

expression in giving nursing care to their clients. With

this expression, relationship with their client will be

established and trust will be gained.

There were several factors which influence

undergraduate nursing students in study caring. They

were learning milieu, motivation, personality, and

cultural competence. Conducive learning

environment becomes incentive for students in

learning about caring (Ma, et al., 2014). Nursing

program and faculties could support this conducive

learning environment by creating caring

environment. Caring environment can be used as a

means to facilitate students in learning about caring.

Caring environment combined with caring lecturers

and caring clinical instructors as role models both in

class and clinical settings will have great impact for

student in fostering caring behaviors.

Motivation and personality are internal factors for

students which drive their effort to master caring

behaviors during their study period. Strong

motivation would have significant effect on the way

the student embrace the caring behaviours. Good

personality combining with strong motivation for

Caring Competency for Undergraduate Nursing Students: A Systematic Review with Implication for Nurse Educators in Teaching Caring

607

sure will improve students’ ability in learning and

implement caring behaviours. They would gradually

learn how to enhance their basic caring skills into the

professional caring behaviour. In addition, with use

of their values and experience, the students also will

experience transition into professional roles. They

would gradually feel more caring, gain self-confident,

intuitive knowing, and professionalism (Alligood,

2010). The findings support Watson's (2008) belief

that through self-awareness the innate values and

technical skills combine to create authenticity within

the transpersonal relationship.

One important factor that influences students in

study caring is cultural competence. Nursing students

who equipped with cultural competence will be

sensitive with patient’s health beliefs and they will

more adaptive to care of patients related to his/her

culture and religion. By doing so, the students could

provide appropriate care to patients and would have

impact on quality nursing care.

This study findings of fundamental caring

competency and factors influencing students in study

caring have implication for nurse educators. Nurse

educators should emphasize at least five caring

competency for their students to be embraced in order

to be a caring student and further to be professional

caring nurse. They also should be aware of factors

influencing students in study caring and try to handle

these since the early stage of study period.

5 CONCLUSIONS

Caring competency is very important for

undergraduate nursing students to apply into practice

since it is the essence or foundation for nursing

intervention. There are five fundamental caring

competency for undergraduate nursing students:

provision of appropriate care, personal

quality/character, helping attitude, communication

skills, and relationship building ability. In addition,

there are four important factors which influence

undergraduate nursing students in study caring:

learning milieu, motivation, personality, and cultural

competence.

Caring competency can be studied and measured

through nursing education system. Nursing education

institutions have obligation to ensure that their

students equipped with caring competency for their

professional practice. It is recommended that faculties

of undergraduate nursing program identify caring

competency of their students and put it in curriculum

content so that their students will embrace caring

behaviours.

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