Skip to main content
Download PDF
  • Research article
  • Open access
  • Published:

Italian version of Nursing Students’ Perception of Instructor Caring (I-NSPIC): assessment of reliability and validity

BMC Medical Education volume 17, Article number: 218 (2017) Cite this article

Abstract

Background

Clinical experience is an essential component of nursing education since it provides students with the opportunity to construct and develop clinical competencies. Instructor caring is a pivotal facilitator at the forefront of clinical education, playing a key and complex educating role in clinical sectors. For these reasons the aims of this study was to assess the validity and reliability of the Italian version of NSPIC (I-NSPIC).

Methods

A validation multicentre study was conducted in three different Italian universities. A total of 333 nursing students were enrolled in the 2014/2015 academic year. Exploratory factor analysis (EFA) with oblique rotation was performed to test the construct validity of I-NSPIC. The Cronbach’s alpha coefficient and test retest via Intraclass Correlation Coefficient (ICC) analyses were done to assess the internal consistency and stability of the scale. A Spearman’s correlation with another scale (CLES-T) was used to examine the concurrent validities.

Results

Four factors (control versus flexibility, supportive learning climate, confidence through caring, appreciation of life meaning and respectful sharing) were identified in EFA. The Cronbach’s alpha value showed that I-NSPIC was a reliable instrument (α = 0.94) and the ICC coefficient was satisfactory.

Conclusion

The I-NSPIC is a valid instrument for assessing the perception of instructor caring in Italian nursing students. It may also prove helpful in promoting the caring ability of nursing students and in increasing the caring interactions in the relationship between instructor and nursing students.

The knowledge emerged from this study provide important insight in developing effective training strategies in the clinical training of undergraduate nursing students.

Peer Review reports

Background

In nursing education clinical learning and competency development are essential parts of the nursing curriculum. Clinical experience is an essential component of nursing education since it provides students with the opportunity to construct and develop clinical competencies and apply assistance to a real-world context, thereby allowing students to transfer theory into practice [1,2,3,4,5,6,7]. In recent years, caring is gaining scientific dignity and operational relevance and is believed to be a core component of nursing education [8,9,10,11,12,13,14].

Jean-Watson’s studies in interpersonal care emphasize that patients experience greater emotional and spiritual well-being, improved healing, and greater confidence in their relationship with health professionals when they experience a careful and participative care relationship [11].

The philosophy of the humanist paradigm is put into effect in the constructs of care, learning, participation and reflection. The movement toward this paradigm requires a transformation to a more egalitarian student-teacher relationship, thereby supporting the development of both partners, in order to understand students and facilitate their learning [15]. Therefore, instructor caring is a pivotal facilitator of clinical education [16, 17], serving as a model for the student [18, 19] and playing a key and complex educating role in clinical sectors involving many personal, interpersonal and organizational aspects [20, 21]. Moreover, instructors’ caring facilitates the transition from the students’ role to the nurse role [22, 23], where the instructor works with students on their learning experiences as a coach and mentor [15].

Students award a fundamental value on the clinical environment in terms of their professional development, and their instructor caring relationship, important elements for the success of their internship [16, 20, 24,25,26].

Emphasis on caring theories should be placed in nursing education and their application in nursing practice. Watson’s theoretical framework, which focuses on interpersonal and transpersonal processes in human care, presents an effective model in understanding the concept of caring.

Watson argued that caring is the main concept in nursing education. The aim of the caring based curriculum is to provide students an overall view of caring, so that they will be able to care for the health of the individual as nurses [8, 11, 13].

Wade and Kasper [27], feel that nursing education is an ideal place to promote and develop student caring because this is where personal involvement with others occurs.

Wade & Kasper [27] argue that the NSPIC, based on Watson’s Theory of Transpersonal Caring, is an extremely valid and reliable tool to evaluate students’ perception of instructor caring. Moreover, they believe this tool can be used as an outcome of the educational process to validate the influence of support interactions between students and instructors caring about the students’ caring capabilities. Caring interactions between teachers and students reflect the same nature of the nurse-patient relationship [15, 28]; therefore, nursing students’ perceptions of instructor caring can reveal how nursing students learn to care for their patients. If students perceive an educational environment based on care, they will learn to become professionals [8, 25, 27].

Caring clinical environment improves well-being in nursing students, self-confidence, motivation and decreases anxiety associated with the clinical setting, facilitating the learning [8, 29,30,31]. Providing for a high-quality clinical environment is a determining factor in improving the quality of health services [31, 32].

The Nursing Students’ Perception of Instructor Caring (NSPIC) instrument, based on Watson’s Theory of Transpersonal Caring, was developed to evaluate nursing students’ perception of instructor caring in the clinical setting in the U.S.A. [27] and subsequently validated in China [33] and Iran [34]; it was used in Italy but not validated. However, in Italy, currently no studies exist investigating the impact of instructor caring on nursing students; therefore, in this study we are interested to validate the NSPIC in Italy for assessing the perception of instructor caring among Italian nursing students. The use of this tool could help to identify the critical issues that need work to improve the quality of the nursing students’ clinical learning.

The aims of this study were to translate NSPIC into Italian and to examine the reliability and validity of Italian version of NSPIC (I-NSPIC) in nursing students during clinical practice, to obtain a tool that allows us to evaluate students’ perceptions of their tutor to improve the quality of clinical training in the Italian context.

Methods

Study design, participants and setting

We conducted a validation multicentre study. A sample of 333 junior (I and II years) and senior (III year) nursing students in bachelor’s degree nursing programs, enrolled in the academic year 2014/2015, was randomly selected from three different Italian universities: Pavia, Roma Campus Biomedico and Roma Tor Vergata. Researchers who administered I-NSPIC were not the same as those that evaluated students in clinical laboratories. Students completed a questionnaire in a university classroom.

Description of the original instrument

NSPIC is an English questionnaire composed of 31 items divided into five dimensions: instills confidence through caring, supportive learning climate, appreciation of life’s meanings, control vs flexibility, and respectful sharing. Each item is assessed on a 6-point Likert scale (responses ranged from 1 “strongly disagree” to 6 “strongly agree”). To explore the structure of the questionnaire an Exploratory Factor Analysis (EFA) was utilized; five factors were identified which explained 71.7% of the variability. NSPIC and its subscales showed very good internal consistency (NSPIC’S Cronbach alpha = 0.97, factor 1 α = 0.96, factor 2 α = 0.94, factor 3 α = 0.89, factor 4 α = 0.72 e factor 5 α = 0.75). The total NSPIC score ranges from 31 to 186, with higher scores representing greater perceptions of instructor caring.

The screening scale translation process

A forward-backward translation procedure was applied to establish content validity of the NSPIC scale. Firstly, the NSPIC was translated into Italian and submitted to an expert panel (four expert nurses in nursing education and research) that compared the original English version with the Italian one to ensure the semantic and cultural coherence of the items. Secondly, an English lecturer translated the Italian version back into English as a blind. Finally, the back-translate instrument and the original one were compared by the NSPIC’s authors to establish the content validity of the double translated instrument (Additional file 1). The authors agreed that the Italian version was identical in meaning to the English version [35].

Ethical considerations

We obtained permission to validate the Italian version of the NSPIC from the authors of the original questionnaire, whom we contacted by e-mail. This study was given written approval by the University Academic Committee. All of the participants were given detailed information regarding the study aims and methodologies. The questionnaire used in this study was anonymous, and verbal consensus was obtained before its compilation.

Statistical analysis

To identify the required sample size we applied the n:p rule of thumb [36]; the n:p is the minimum recommended ratio of sample size (n) to number of variables being analysed (p). Everitt [37] recommended that the n:p ratio should be at least 10. In the present study, in which n = 333 and p = 31, it was 10.74, so our final sample size was in the recommended value.

Quantitative variables were summarized as mean values, standard deviations, median and interquartile range (Iqr), and qualitative variables as percentage frequencies. We assessed the factorial structure of the questionnaire by EFA, a multivariate statistical technique [38]. To determine the number of factors to retain we applied Kaiser – Guttman “Eigenvalues greater than one” criterion [39,40,41] and Cattell’s scree plot [42]. Oblique rotation (promax rotation) was used in the EFA because the factors were expected to correlate [43]. Factor loadings ≥0.4 were considered as significant and were entered in the final questionnaires [44]. In order to test unidimensionality of the subscales we again ran a factor analysis. We created a score for the I-NSPIC questionnaire (sum of the responses of 31 items) and for its subscales (sum of the responses related to each dimension). Normality distribution was assessed using the Shapiro-Wilk test. To compare scores between groups we used a parametric Student T test for independent data or corresponding non-parametric test (Mann-Whitney or Kruskal-Wallis test); for all the analyses we considered as a significant level p < 0.05. All analyses were conducted using STATA/SE for Windows, version 12.1 (StataCorp, college Station, TX, U.S.A.).

Validity and reliability

The validity of a questionnaire represents the degree to which it measures what it is meant to measure. There are different types of validity; criterion-related validation investigates possible associations between the examined scale and external criteria or other validated measures. Therefore, we correlate the I-NSPIC score using Spearman’s correlation coefficient with the Italian version of “Clinical Learning Environment and Supervision plus nurse Teacher scale” (CLES-T) and its subscale “Supervisory relationship” (related to the content of the supervisory relationship between tutor and student) [5], which represents a gold standard Additional file 2. Prior to data collection, permission to use the CLES-T was granted by its authors through email.

Internal consistency was determined by calculating Cronbach’s alpha coefficient [45]. Test-retest reliability between two subsequent administrations of the questionnaire, separated by an interval of 30 days, was assessed in a subset of the sample (25 students) using an intraclass correlation coefficient (ICC) [46].

Results

NSPIC scale and back-translation process were successful.

The demographic characteristics of the sample are summarized in Table 1.

Table 1 Sample characteristics
Full size table

Factorial structure

The number of eigenvalues >1 computed by EFA totaled four. The percentage of cumulative variability explained by a model with four dimensions is 62.92%: Factor 1 explains 42.5% of variability with an eigenvalue of 13.17 (Table 2). The subscales were unidimensional; therefore, each subscale measured only one construct. In addition, Table 2 shows factor loadings for each item.

Table 2 Exploratory factor analysis results for NSPIC (N = 333)
Full size table

Validity

In references to criterion-validation, Table 3 shows the Spearman’s correlation coefficients between the score of I-NSPIC and its subscales and the CLES-T questionnaire and its subscale “Supervisory relationship”. All the coefficients were significantly different from 0 (p < 0.05) (Table 3).

Table 3 Spearman correlation coefficients between the scores of the NSPIC and its subscales and between the CLES-T gold standard questionnaire and its subscale Supervisory Relationship
Full size table

The mean score for I-NSPIC is 113.63 (sd 19.09, range 31–186). Table 4 shows mean score, standard deviation, median and Iqr of I-NSPIC by sex, university and education.

Table 4 Mean, sd, median and Iqr of NSPIC by sex, university, and junior and senior students
Full size table

The differences between categories in the study were all statistically significant.

Reliability

The final version of the I-NSPIC had a Cronbach’s alpha coefficient of 0.94. Table 5 shows the Cronbach’s alpha values for each of the four subscales. Test–retest analysis in 25 students showed a high degree of reliability for I-NSPIC: ICC = 0.93, p < 0.001.

Table 5 Reliability: Cronbach’s alpha values for NSPIC and its subscale
Full size table

Discussion

The aim of the current study was to analyze the validity and reliability of the Italian version of the Nursing Students’ Perception of Instructor Caring (I-NSPIC).

The results of our study show that the factor structure in the original English version cannot be assumed in Italy; in our study we highlight a four-factor structure, rather than five as in the original study and in the Chinese version. The factor that is not confirmed in our study is Appreciation of life’s meanings. In addition, some items were loaded onto different factors compared with the original version.

The items related to Appreciation of life’s meanings (“Helps me find personal meaning in my experiences”, “Encourages me to see others’ perspectives about life”, and “Helps me to understand the spiritual dimensions of life”) were loaded in Supportive learning climate. The possible explanation is that the tutorial style and learning methods in Italy direct the phenomenon of care and the idea of human caring through characteristic traits of good care, such as paying attention to others, to feel empathic about the presence and the emotions “Dasein” [47], observing a respectful silence when faced with anguish, in addition to considering the spiritual dimension.

The factor Supportive learning climate explains the highest percentage of variability and includes 12 items: six items (“Acknowledge his or her own limitations or mistakes”, “Clearly communicates his or her expectations”, “Serves as a trusted resource for personal problem-solving”, “Offers support during stressful times, Accepts my negative feelings, while helping me to see the positive”, “Allows me to express my true feelings”) are the same as in the original version; three items were loaded from Appreciation of life’s meanings and three items from Instill confidence through caring (“Instills in me a sense of hopefulness for the future”, “Cares about me as a person”, and “Inspires me to continue the development of knowledge and skills”). We think that in the student’s mind there is no clear subdivision of these three domains (Supportive learning climate, Appreciation of life’s meanings, Instill confidence through caring), moreover, the Italian nursing education does not orient the student to understand the appreciation of life’s meanings and the student converts these items into one domain “Supportive learning climate”. These differences are mainly determinated by the caring instructor style adopted in the clinical training and its perception among students [5]. In the Italian culture, the tutorial style refers not only to the student’s cognitive processes, but also to the person in its entirety [48, 49].

In fact, as Watson states [50], learning is much more than just acquiring information, facts or data; it implies a meaningful and trusting relationship which is intersubjective. The nature of the relationship, along with the learning form and context, influences the process and demands respect for the individual. In fact, caring interactions between teachers and students reflect the very nature of the professional-client relationship [28]. As Wade and Kasper [27] maintain, nursing students perceptions of their instructors caring can reveal the often unapparent aspects of how nursing students learn to care for their patients. If students perceive an educational climate based on caring, they learn to become professionals.

The factor Instill confidence through caring includes seven items: four items (“Shows genuine interest in patients and their care”, “Displays kindness to me and others”, “Makes me feel that I can be successful”, “Helps me envision myself as a professional nurse”) are the same as in the original version; two items (“Respects me as a unique individual” and “Is attentive to me when we communicate”) were loaded from Respectful sharing; and one item was loaded from Supportive learning climate (“Makes herself/himself available to me”). A possible explanation could be the theoretical assumptions of the andragogy that is well-outlined by Knowless [51] and analyzed in a book in Italian by Franco Angeli, who represents an important reference point for Italian nursing education culture from the 1990s.

The factor, Respectful Sharing, includes seven items. In this case only one item is the same as in the original version (12 Does not reveal any of his or her personal side). The remaining items (“Makes me feel like a failure”, “Does not believe in me”, “Makes me nervous in the clinical laboratory”, and “Does not trust my judgment in the clinical laboratory”) were loaded from Instill confidence through caring and from Supportive learning climate (“Discourages independent problem solving” and “Seems caught up in her/his own priorities rather than responding to my needs”). This result expresses the experience of students who see the importance of instilling respect in the relationship with the clinical tutor. Dynamics probably occur in the relationship between student and clinical tutor, not only at the professional level but the personal one as well, and the student feels it is important to also share personal information with the tutor if this is appropriate and relevant for clinical learning, a factor that has been reported by several authors [15, 20, 21, 24, 26].

The factor Control vs Flexibility confirms the original version but includes an other item: “Inappropriately discloses personal information about me to others” loaded from Supportive Learnig climate. In EFA, this last item had a factor loading smaller than the a priori determined cutoff, but we decided to preserve it in the final questionnaire version because it contributed to construct a factor’s internal reliability.

In the student’s mind this behavior of caring instructors is experienced as an element of rigidity rather than as an element of supportive learning. We think that this attitude of instructors caring is perceived by the student as a prejudice that may influence the student’s evaluation process [52].

In other studies as well from other countries [33, 50, 53] with different cultures, which assessed instruments in nursing education, differences have emerged in the factors or the items contained in the model. These results support the explanations in our study.

The inspection of I-NSPIC’s median score revealed that senior students perceived their instructors as caring more than junior students did (median score 118 vs 114 respectively, p = 0.0253). Probably senior students perceived their instructors significantly more positively because they have a complete academic experience; therefore they are more confident and aware, unlike junior students who are living in a period of continuous transition. Perhaps the one-to-one relationship in the third year promotes a privileged relationship that improves the interpersonal relationship and facilitates caring and socialization in the profession. In our study, the mean score of the I-NSPIC (113.63) is smaller than the Chinese version C-NSPIC (150.03); therefore the internal consistency of the four factors, except for Control vs flexibility, is higher with respect to the C-NSPIC.

Study limitations

We are aware that our study has some limitations. In this study, we used EFA for exploring the relationships among the variables and we does not have an a priori fixed number of factors; a CFA tests whether a known factor model can predict a set of observed data [54]. Researchers use CFA to verify or confirm hypotheses or theory [55, 56]. In our case, we performed only EFA because we focused our attention on cultural context differences, in fact, our result does not confirm original structure questionnaire. Therefore, our actual work is obtaining more data to implement CFA to confirm or reject the measurement theory get out in this work. Furthermore, in our sample there is no homogenous distribution of males and females (females 80.78%), and thus it is hard to perform subgroup analyses. In addition, the study has a limited geographical representativeness with regard to Italian nursing students (Central and Northern Italy); the participants were limited to nursing students in degree nursing programs. In our opinion, it would be important to know the perception of instructor caring also in diverse several samples such as master’s degree nursing programs and with a sample representing all Italian geographic areas.

Conclusions

This is the first study to evaluate the psychometric properties of NSPIC in Italy; we have showed that the I-NSPIC has satisfactory reliability and validity. Unlike what is found in the literature [27, 33], our questionnaire presents a four-dimensional structure. We conclude that the I-NSPIC is an effective and valid instrument for assessing the perception of instructor caring in Italian undergraduate nursing students; furthermore it may also prove helpful in promoting the caring ability of nursing students and in increasing the caring interactions in the relationship between instructor and nursing students.

Regarding future research, we feel it is fundamental to use the I-NSPIC questionnaire at the end of each clinical internship that lasts an entire academic year, so as to identify strengths and urgent issues to address regarding the individual tutors in the various internship areas. Moreover, future validation research can expand these findings by testing the psychometric properties of the I-NSPIC on a larger sample from several universities distributed throughout the country, north, centre and sud Italy.

Abbreviations

C- NSPIC:

Chinese version of the Nursing Students’ Perception of Instructor Caring

CLES-T:

Clinical Learning Environment and Supervision plus nurse Teacher scale

EFA:

Exploratory Factor Analysis

ICC:

Intraclass correlation coefficient

I-NSPIC:

Italian version of the Nursing Students’ Perception of Instructor Caring

NSPIC:

Nursing Students’ Perception of Instructor Caring

References

  1. Dunn SV, Burnett P. The development of a clinical learning environment scale. J Adv Nurs. 1995;22(6):1166–73.

    Article  Google Scholar 

  2. Chan D. Development of the clinical learning environment inventory: using the theoretical framework of learning environment studies to assess nursing students’ perceptions of the hospital as a learning environment. J Nurs Educ. 2002;41(2):69–75.

    Google Scholar 

  3. Henderson A, Twentyman M, Heel A, Lloyd B. Students’ perception of the psycho-social clinical learning environment: an evaluation of placement models. Nurse Educ Today. 2006;26(7):564–71.

    Article  Google Scholar 

  4. Karayurt O, Mert H, Beser A. A study on development of a scale to assess nursing students’ performance in clinical settings. J Clin Nurs. 2009;18(8):1123–30.

    Article  Google Scholar 

  5. Tomietto M, Saiani L, Palese A, Cunico L, Cicolini G, Watson P, Saarikoski M. Clinical learning environment and supervision plus nurse teacher (CLES+T) scale: testing the psychometric characteristics of the Italian version. G Ital Med Lav Ergon. 2012;34(2):B72–80.

    Google Scholar 

  6. Bisholt B, Ohlsson U, Engström A, Johansson A, Gustafsson M. Nursing students’ assessment of the learning environment in different clinical settings. Nurse Educ Pract. 2014;14(3):304–10.

    Article  Google Scholar 

  7. Arrigoni C, Grugnetti AM, Caruso R, Gallotti ML, Borrelli P, Puci M. Nursing students’ clinical competencies: a survey on clinical education objectives. Ann Ig. 2017;29(3):179–88.

    Google Scholar 

  8. Labrague LJ, McEnroe-Petitte DM, Papathanasiou IV, Edet OB, Arulappan J. Impact of instructors’ caring on students’ perceptions of their own caring behaviors. J Nurs Scholarsh. 2015;47(4):338–46.

    Article  Google Scholar 

  9. Benner P, Wrubel J. The primacy of caring: stress and coping in health and illness. Menlo Park: Addison-Wesley Publishing; 1989.

    Google Scholar 

  10. Leininger M, Watson J. The caring imperative in education. New York: National League of Nursing; 1990.

    Google Scholar 

  11. Watson J. Assessing and measuring caring in nursing and health science. 2nd ed. New York: Springer; 2008.

    Google Scholar 

  12. Smith MC. Caring and the science of unitary human beings. Adv Nurs Sci. 1999;21(4):14–28.

    Article  Google Scholar 

  13. Watson J, Smith MC. Caring science and the science of unitary human beings: a trans-theoretical discourse for nursing knowledge development. J Adv Nurs. 2002;37(5):452–61.

    Article  Google Scholar 

  14. Watson J, Foster R. The attending nurse caring model: integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice. J Clin Nurs. 2003;12(3):360–5.

    Article  Google Scholar 

  15. Gillespie M. Student-teacher connection in clinical nursing education. J Adv Nurs. 2002;37(6):566–76.

    Article  Google Scholar 

  16. Carlson E, Christine W, Ewa P. Teaching during clinical practice: strategies and techniques used by preceptors in nursing education. Nurse Educ Today. 2009;29(5):522–6.

    Article  Google Scholar 

  17. Kristofferzon ML, Mårtensson G, Mamhidir A, Löfmark A. Nursing students’ perceptions of clinical supervision: the contributions of preceptors, head preceptors and clinical lecturers. Nurse Educ Today. 2013;33(10):1252–7.

    Article  Google Scholar 

  18. Usher K, Nolan C, Reser P, Owens J, Tollefson J. An exploration of the preceptor role: preceptors’ perceptions of benefits, rewards, supports and commitment to the preceptor role. J Adv Nurs. 1999;29(2):506–14.

    Article  Google Scholar 

  19. Lillibridge J. Using clinical nurses as preceptors to teach leadership and management to senior nursing students: a qualitative descriptive study. Nurse Educ Pract. 2007;7(1):44–52.

    Article  Google Scholar 

  20. McClure E, Black L. The role of the clinical preceptor: an integrative literature review. J Nurs Educ. 2013;52(6):335–41.

    Article  Google Scholar 

  21. Trede F, Sutton K, Bernoth M. Conceptualisations and perceptions of the nurse preceptor’s role: a scoping review. Nurse Educ Today. 2016;36:268–74.

    Article  Google Scholar 

  22. Altmann TK. Preceptor selection, orientation, and evaluation in baccalaureate nursing. Education. Int J Nurs Educ Scholarsh. 2006;3:1–16.

    Article  Google Scholar 

  23. Luhanga LF, Billay D, Grundy Q, Myrick F, Yonge O. The one-to-one relationship: is it really key to an effective Preceptorship experience? A review of the literature. Int J Nurs Educ Scholarsh. 2010;7(1):1–15.

    Google Scholar 

  24. Saarikoski M, Leino-Kilpi H. The clinical learning environment and supervision by staff nurses: developing the instrument. Int J Nurs Stud. 2002;39(3):259–67.

    Article  Google Scholar 

  25. Hosoda Y. Development and testing of a clinical learning environment diagnostic inventory for baccalaureate nursing students. J Adv Nurs. 2006;56(5):480–90.

    Article  Google Scholar 

  26. Brammer J. A phenomenographic study of registered nurses’ understanding of their role in student learning-an Australian perspective. Int J Nurs Stud. 2006;43(8):963–73.

    Article  Google Scholar 

  27. Wade G, Kasper N. Nursing students’ perceptions of instructor caring: an instrument based on Watson’s theory of transpersonal caring. J Nurs Educ. 2006;45(5):162–8.

    Google Scholar 

  28. Watson J. Human caring as moral context for nursing education. Nurs Health Care. 1988;9(8):422–5.

    Google Scholar 

  29. Saarikoski M, Isoaho H, Warne T, Leino-Kilpi H. The nurse teacher in clinical practice: developing the new sub-dimension to the clinical learning environment and supervision (CLES) scale. Int J Nurs Stud. 2008;45(8):1233–7.

    Article  Google Scholar 

  30. Arrigoni C, Miazza D, Gerra MT. Prevention in the workplace and training of personnel: new methodological approaches. J Prev Med Hyg. 2012;16(1):33–9.

    Google Scholar 

  31. Lovecchio CP, Di Mattio MJ, Hudacek S. Predictors of undergraduate nursing student satisfaction with clinical learning environment: a secondary analysis. Nurs Educ Perspect. 2015;36(4):252–4.

    Article  Google Scholar 

  32. Arrigoni C, Micheletti P, Grugnetti AM, Ferrari P, Borrelli P, Montomoli C, Pelissero G. The students’ reasons to choose a nursing degree program: an Italian exploratory study. Ann Ig. 2014;26(6):570–7.

    Google Scholar 

  33. Li J, Zhou L, Zhu D, Hu C, Zhang X, Xu Y. Chinese version of the nursing students’ perception of instructor caring (C-NSPIC): assessment of reliability and validity. Nurse Educ Today. 2013;33(12):1482–9.

    Article  Google Scholar 

  34. Zamanzadeh V, Valizadeh L, Azimzadeh R, Aminaie N, Yousefzadeh S. First and fourth-year student’s perceptions about importance of nursing care behaviors: socialization toward caring. J Caring Sci. 2014;3(2):93–101.

    Google Scholar 

  35. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186–91.

    Article  Google Scholar 

  36. MacCallum RC, Widaman KF, Zhang S, Hong S. Sample size in factor analysis. Psychol Methods. 1999;4:84–99.

    Article  Google Scholar 

  37. Everitt B. Multivariate analysis: the need for data, and other problems. Br J Psychiatry. 1975;126(3):237-40.

  38. Bartholomew D. Latent variable models and factor analysis. New YorK: Oxford University Press; 1987.

    Google Scholar 

  39. Guttman L. Some necessary conditions for common-factor analysis. Psychometrika. 1954;19(2):49–161.

    Article  Google Scholar 

  40. Kaiser HF. The application of electronic computers to factor analysis. Educ Psychol Meas. 1960;20(1):141–51.

    Article  Google Scholar 

  41. Kaiser HF. A second generation little jiffy. Psychometrika. 1970;35(4):401–15.

    Article  Google Scholar 

  42. Cattell RB. The Scree test for the number of factors. Multivar Behav Res. 1966;1(2):245–76.

    Article  Google Scholar 

  43. Lewis-Beck MS. Factor analysis and related techniques. London: Sage; 1994.

    Google Scholar 

  44. Costello A, Osborne J. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. PARE. 2005;10(7):1–9.

    Google Scholar 

  45. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16(3):297–334.

    Article  Google Scholar 

  46. Bartko JJ. The intraclass correlation coefficient as a measure of reliability. Psychol Rep. 1966;19(1):3–11.

    Article  Google Scholar 

  47. Being HM, Time A. Translated by Joan Stambaugh. Albany: State University of New York Press; 1996.

    Google Scholar 

  48. Binetti P, Pontalti I, Santini D. Il Tutorato, Modelli ed esperienze nella didattica universitaria. Roma: Società Editirice Universo; 1996. p. 46.

    Google Scholar 

  49. Brugnolli A, Saiani L, Palese A. Percezione degli studenti infermieri delle strategie tutoriali nell’apprendimento clinico. Tutor. 2008;8(3):124–31.

    Google Scholar 

  50. Watson J, Sironi C. Assistenza infermieristica. Milano: Cea; 2013.

    Google Scholar 

  51. Knowles M, Holton EF, Swanson RA. The adult learner: the definitive classic in adult education and human resource development. 7th ed. New York: Routledge; 2012.

    Google Scholar 

  52. Zannini L, Randon G, Saiani L. The contribution of clinical approaches to qualitative research on hidden curriculum a participative research with a sample of Italian nursing faculty. Medic. 2016;24(1):53–65.

    Google Scholar 

  53. Fisher MJ, King J. The self-directed learning readiness scale for nursing education revisited: a confirmatory factor analysis. Nurse Educ Today. 2010;30(1):44–8.

    Article  Google Scholar 

  54. DeCoster J. Overview of Factor Analysis. 1998. Retrieved from http://stat-help.com/factor.pdf. Accessed 24 Mar 2015.

  55. Ruscio J, Roche B. Determining the number of factors to retain in an exploratory factor analysis using. Pract Assess Res Eval. 2012;18(8):14. Courtney; EFA Factors using SPSS & R

    Google Scholar 

  56. Schmitt TA. Current methodological considerations in exploratory and confirmatory factor analysis. J Psychoeduc Assess. 2011;29(4):304–21.

    Article  Google Scholar 

Download references

Acknowledgements

We thank G. Wade and N. Kasper for giving us the permission to use their questionnaire, and we also thank Robert Ponzini for language editing as well as the students who participated in this study. We thank the Reviewers Dr. Melih Elcin and Dr. Sherry Dahke for their preciouses suggestions that helped us to improve our manuscript.

Funding

This research has not received any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Availability of data and materials

The Italian version of datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Author information

Authors and Affiliations

  1. Department of Public Health, Experimental and Forensic Medicine, Unit of Hygiene, University of Pavia, Via Forlanini, 2-27100, Pavia, Italy

    C. Arrigoni & A. M. Grugnetti

  2. Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Via Forlanini, 2-27100, Pavia, Italy

    M. Puci & P. Borrelli

  3. IRCCS Policlinic San Matteo Foundation Pavia, Via Forlanini, 2-27100, Pavia, Italy

    A. M. Grugnetti

  4. Azienda Ospedaliera di Pavia, Corso Milano, 19, Vigevano, Pavia, Italy

    L. Collivasone

  5. Tor Vergata University, Faculty of Medicine, Via Montpellier, 1, 00133, Rome, Italy

    E. Fenizia, E. Vellone & R. Alvaro

  6. Research Unit Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo, 21-00128, Rome, Italy

    M. Piredda & M. G. De Marinis

Authors
  1. C. Arrigoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Puci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. M. Grugnetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Collivasone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Fenizia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Borrelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Vellone
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. Alvaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Piredda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. G. De Marinis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CA, MGDM, AMG and MP contributed to the original conception and the development of the Study. CA, AMG, LC, EF, EV and RA performed the data collection. MP and PB performed data analysis. CA, AMG, MP and PB contributed to the final version of the paper. CA supervised the study. All the authors read and approved the final manuscript.

Corresponding authors

Correspondence to C. Arrigoni or A. M. Grugnetti.

Ethics declarations

Authors’ information

Cristina Arrigoni

Degrees and certification: Masters Degree in Educational Sciences, Università Cattolica del Sacro Cuore of Milan, Italy & Post Graduate Courses in Health Education and design, University of Pavia, Faculty of Medicine and Surgery.

Mariangela Puci

Degrees and certification: Masters Degree in Nursing and Midwifery Science, University of Pavia.

Anna Maria Grugnetti

Degrees and certification: Masters Degree in Nursing and Midwifery Science, University of Pavia & Ph.D in Nursing Research, Faculty of Health Science, University of Genoa, Italy.

Lucia Collivasone

Degrees and certification: Masters Degree in Nursing and Midwifery Science, University of Pavia.

Elisa Fenizia

Degrees and certification: Master Degree in Nursing and Midwifery, Tor Vergata University Rome.

Paola Borrelli

Degrees and certification: PhD-equivalent in Medical Statistics, School of Medical Statistics & PhD in Public Health and Education, School of Public Health, University of Pavia, Pavia, Italy.

Ercole Vellone

Degrees and certification: PhD Nursing Science Tor Vergata University, Rome.

Rosaria Alvaro

Degrees and certification: Master Degree in Nursing Sciences and Midwifery, Tor Vergata University, Rome.

Michela Piredda

Degrees and certification: PhD Nursing Science Tor Vergata University, Master in Nursing Science Tor Vergata University, Master in Nursing Research King’s College University of London, Master Degree in Biology University of Palermo, Registered Nurse University of Navarra, Spain.

Maria Grazia De Marinis

Degrees and certification: Masters Degree in Education Sciences, Sapienza University of Rome, Italy. Masters Degree in Nursing, Faculty of Health Sciences, University of Rome Tor Vergata, Italy.

Ethics approval and consent to participate

This study was given written approval by the University Academic Commettee. Students are not required written consent, since consent was implicit in filling out the questionnaire.

The students received detailed information about the purpose and methods of the study and anonymity was guaranteed. The students were also informed that the data would be confidential and they would have been collected and analyzed anonymously. Participation was voluntary.

Students were reassured regarding the lack of participation in the study would have no impact on their training.

Consent for publication

Not applicable.

Competing interests

The authors of this manuscript declare that they have no competing interests as defined by the Editorial Policy of BMC Medical Education. Moreother they have no other interests that may have influenced the results and the discussion of this paper.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional files

Additional file 1:

Questionario “Le percezioni degli studenti infermieri del rapporto con il tutor clinico” (I-NSPIC). (DOCX 27 kb)

Additional file 2:

Questionario “Clinical Learning Environment and Supervision plus Nurse Teacher Scale” (CLES-T). (DOC 77 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arrigoni, C., Puci, M., Grugnetti, A.M. et al. Italian version of Nursing Students’ Perception of Instructor Caring (I-NSPIC): assessment of reliability and validity. BMC Med Educ 17, 218 (2017). https://doi.org/10.1186/s12909-017-1032-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12909-017-1032-y

Keywords

BMC Medical Education

ISSN: 1472-6920

Contact us