Predictive validity, which measures the ability to predict performance of another instrument, was assessed on the NSPIC by using the Coates Caring Efficacy Scale. This scale is also based on Watson’s carative factors and assesses student nurses’ ability to express caring, and develop a caring relationship with clients. Although statistically significant, Wade & Kasper, (2006:167) reported that the correlation between the NSPIC and the Coates Caring Efficacy Scale was low (r = 0.33, p ≤ 0.01).
3.6.4.3
Reliability of the NSPIC
The reliability of an instrument refers to the consistency with which it measures the target attribute, as well as the ability of an instrument to reflect true scores (Polit & Beck, 2012:331). Internal consistency reliability refers to the extent to which each item in the scale measures the same trait (Polit &Beck, 2012:333). With regard to the NSPIC, this was determined by the designers of the instrument (Wade & Kasper, 2006:167), and subsequently by three other researchers who used the instrument to measure student nurses’ perceptions of instructor caring (Letzkus, 2005:85; Nelson, 2011:106; Roe, 2009:106). Table 3.2 illustrates a comparison of Cronbach’s alpha coefficients reported the designers of the NSPIC and the
aforementioned researchers. Letzkus, (2005: 86) noted that the results of her study were relatively low by comparison, especially for subscale 5 but concluded that, because subscale 5 consisted of only three items, this was acceptable. Roe (20109109) concluded that the significant subscale-to-subscale and subscale-to-total scale correlations of the NSPIC were indicative of an internally consistent scale. Li, Zhou, Zhu, Ku, Zhang and Xu (2013:1485-1486) translated the NSPIC into Chinese (C-NSPIC) by means of translation, back-translation, culture adaptation, and a pilot study. They found the Cronbach’s alpha coefficient to be 0.933 for the total C-NSPIC. The researchers also noted that the tool had high validity, reliability and a 5-factor structure which was identical to findings in the United States of America, and concluded that the NSPIC could be used in different cultures, and that it could serve as a promising instrument for cross-cultural comparisons.
Table 3.2: Comparison of Cronbach's alpha coefficients of the subscales of the NSPIC
Subscale Wade &
Kasper Letzkus Roe Nelson
Instills confidence through caring 0.96 0.88 0.92 0.92
Supportive learning climate 0.94 0.87 0.90 0.89
Appreciation for life’s meaning 0.89 0.79 0.86 0.87
Control vs. flexibility 0.72 0.59 0.58 0.73
Respectful sharing 0.75 0.47 0.41 0.40
3.6.4.4
Adaptation of the NSPIC for this study
The wording of three of the items was changed by the researcher, in order to be suitable to the South African context and the context of the nursing education institution under study. In items 22 and 23 “clinical laboratory” was changed to “simulation laboratory”, the rationale being that the term "simulation laboratory" was used at the nursing education institution for the venue where clinical teaching and learning takes place on the campuses, regardless of the method of teaching and learning which was used. In item 31, the term “grades” was changed to “marks”, because at the nursing education institution under investigation, the term “grades” was not used. Respondents were instructed to think about the clinical instructor with whom they spent most of their time, rather than their current clinical instructors, as indicated in the original instrument, the rationale being that the respondents were receiving clinical instruction from multiple clinical instructors, both at the campuses and at the hospitals where they were placed for their clinical education and training. Consent was received from the designers of the NSPIC to affect these changes (Annexure 3).
3.6.4.5
Pretesting of the research instrument
A pretest is a test that evaluates some aspects of a study such as the usability of the measuring instrument and recording forms (Botma et al., 2010:275). A pretest was conducted by the researcher with ten junior and ten senior student nurses who met the inclusion criterion, in order to test the usability of the instrument, determine whether the potential respondents understood what needed to be done, and whether the length of time to complete the questionnaire was sufficient. Data collected during the pretest was not included in the main study (Botma et al, 2010:275). Respondents who participated in the pretest were not invited to participate in the data collection for the main study. All respondents participating in the pretest completed the questionnaire within 15 minutes. As a result of the findings of the pretest, section 1 of the questionnaire was adapted to instruct respondents to carefully select only one option that best expressed their opinion for every statement, and to circle that option. In section 2, the questionnaire was adapted to simplify it for the respondents to recognise the space for indicating age.
Respondents were requested to complete a pretest evaluation form similar to the instrument used by Letzkus (2005:119), in order to record their assessment of the questionnaire (Annexure 4). All respondents (100%) agreed that the statements in the questionnaire were easy to understand and respond to. One respondent commented that he/she would have liked to have had spaces in section 1 of the questionnaire to motivate his/her choices.
3.6.4.6
Collecting the data
Permission to conduct the study was obtained from the Research Ethics Committee of the Faculty of Health Sciences of the University of Johannesburg (Annexure 7). Permission to conduct the study was also obtained from the Operational Research Committee of the health care institution to which the private nursing education institution was affiliated (Annexure 8).
Respondents were informed verbally and in writing by the researcher by means of an information letter (Annexure 5) about the purpose of the research, as well as the data collection method. In addition, the respondents were informed that no significant foreseeable risk was associated with the study. The potential benefits of the study were explained. Respondents were assured that all information would be kept private and confidential, and that their identities and those of the clinical instructors they would think of while completing section 1 of the questionnaire would remain anonymous in all presentations, reports and
publications. They were informed that they could withdraw from the research at any time without penalty. The researcher offered to answer any pertinent questions with respect to the research. Information was provided in English. Unloaded, unbiased terminology familiar to the respondents was used. Comprehension of the consent information was tested in oral format by the researcher. Written consent was obtained from each respondent. The consent form can be viewed in annexure 6. No compensation was offered to the respondents.
The researcher administered the questionnaire to the respondents in person in their class groups during scheduled lectures. The academic staff members facilitating the classes at the time of data collection were consulted with regard to the most appropriate time during the lecture day for data collection, and agreements were reached. Data was collected from one group of junior student nurses during their last lecture week on campus and from three groups of senior student nurses on three different days. At the time of data collection, the researcher was not coordinating or facilitating any programmes at the nursing education institution and therefore did not have contact with the respondents during the course of their studies. All respondents completed the questionnaire within 15 minutes. The researcher prepared a box with a slot for respondents to drop their questionnaires into. After data collection, all completed questionnaires received a code indicating whether the respondent was a junior or senior student nurse. All completed data collection instruments were locked in a cabinet until handed over for data capturing and analysis by Statkon at the University of Johannesburg. All consent forms were locked in a separate cabinet.
3.6.5
Data Analysis
Following the data collection, a unique number was allocated to every completed questionnaire. The data was captured on an Excel spread sheet by Statkon at the University of Johannesburg. Where obtainable, missing data was added by referring back to the relevant completed questionnaires, in order to have as complete a data set as possible (Grove, Burns & Gray, 2013:532). Both sections of the questionnaire were analysed, using IBM SPSS version 22.0. The responses for the negatively phrased items in section 1 of the questionnaire remained unchanged for all the statistical tests. Figure 4.1 in chapter 4 of this study summarises the data analysis.
3.6.5.1
Descriptive statistics
Descriptive statistics summarise a data set and enables the researcher to present the results in a comprehensible visual format (Botma et al., 2010:148). For section 1 of the questionnaire, frequency tables were created for each of the 31 items using the responses of all respondents. For each of the 31 items, the responses of all the junior student nurses and all the senior student nurses were used. To analyse central tendency and variability, tables were created for the whole sample with the means in descending order, including the standard deviation. This was repeated for the junior and senior student nurse samples separately. The same was repeated with the means in the original order, including the standard deviation.
For section 2 of the questionnaire, frequency tables were created for the whole sample, and for the junior student nurses and the senior student nurses separately for the course the respondents were registered for, gender, ethnicity, the frequency and duration of clinical instructor contact. A contingency table was created to analyse and record the relationship between the course a respondent was registered for and the frequency of clinical contact.
3.6.5.2
Inferential statistics
Inferential statistics are based on the laws of probability and provide a means of drawing conclusions about a population, provided by data from a sample (Polit & Beck, 2012:405).