Jordanian Nursing Students' Perceptions of the Compassionate Actions of Their Clinical Instructors: A Mixed-Methods Study

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Haddad, Fatimah S. Tarawneh, Raya Y. Al-Husban, Salam Bani Hani, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6206261/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jul, 2025 Read the published version in BMC Nursing → Version 1 posted 11 You are reading this latest preprint version Abstract Background In helping professions like nursing, caring is recognized as a crucial concept. In addition to identifying caring and non-caring behaviors among nursing students at a public military college in Amman, Jordan, Aim This study sought to understand how Jordanian nursing students perceived the caring behavior of clinical instructors during their clinical training. Method A mixed-methods approach was utilized to recruit data from (n = 200) nursing students using the Nursing Students' Perception of Instructor Caring (NCPIC) developed by Wade and Kasper (2006). Result The findings showed that the average mean score for clinical instructor behaviors perceived by nursing students was at the medium level (M = 3.40 out of 6). Four themes were extracted, namely, communication, professionalism, holistic caring (mothering), and motivation. In contrast, the non-caring behaviors were reflected in poor communication, governing, and unfavorable personal traits of the clinical instructors, as well as acting in a non-professional manner. Conclusion Caring has been emphasized as a key component of nursing education. It should be inherent in the behavior and actions of clinical teachers while they are dealing with nursing students in a clinical setting. Caring Caring behavior Nursing students Professionalism Clinical instructor Non-clinical behavior Introduction Upon completion of the curriculum, nursing education aims to equip students with cognitive, emotional, and psychomotor abilities to bring about change and promote health ( 1 ). Caring behavior is a crucial principle in nursing since it is exhibited in the realm of humanity through transparency and integrity, and it is at the heart of nursing science ( 2 ). Caring experience in nursing relies on nurses' ability and discernment in the human interaction set by the nursing environment ( 3 ). According to Alanazi, Shaban ( 4 ), honesty and transparency in providing humanitarian services are hallmarks of caring behavior, a core nursing value. It is one that consistently offers others comprehensive support since every individual demonstrates compassionate actions in accordance with their personality and spirituality. All healthcare occupations, including nursing, are based on the idea of caring, which enables people to give their life purpose ( 5 ). According to Kozier, Erb ( 6 ), caring implies that things, people, and relationships are important. Besides, Létourneau, Cara ( 7 ) proposed that care for another to help him grow and actualize himself, while Kang, Ma ( 8 ) argued that caring is the core of professional nursing education. Moreover, caring is a multi-dimensional concept, and it is discussed and comprehensively reviewed by nursing theorists and nurse educators in several ways. One of the most important factors in helping people maintain or regain their health is caring, which Leininger ( 9 ) noted has been presented throughout history as nurturing behavior. This led her to propose that "caring is the essence of nursing and the distinct, dominant, central and unifying focus of nursing" (Leininger, 2001, P. 35). Additionally, Watson and Woodward ( 10 ) stated that nursing is morally and functionally based on compassion. Moreover, in nursing, human care encompasses more than just sentiments, worries, attitudes, or altruistic goals. Nursing has a moral ideal of care, which has as its goal conserving, improving, and safeguarding human dignity ( 11 ). However, nursing is an applied science and a discipline based on practice that enables nursing students to acquire skills and knowledge, clinical training is believed to comprise almost 50% of the nursing school curriculum ( 12 ). An essential component of nursing education is clinical training ( 13 ). As a result, clinical instructors direct the great majority of nursing courses, which are hospital-based. To deliver high-quality care to patients, families, and communities to attain optimal well-being, clinical training is also essential to nursing education to promote future caring relationships with patients and their families, nurse educators should simultaneously urge students to adopt peer caring behaviors ( 14 ). The development and acquisition of clinical experiences are mostly dependent on clinical instructors. They must then acquire qualities that make them great teachers, like clinical competence, professional knowledge, and role modeling ( 15 ). Additionally, nurse educators are in a critical position to exemplify the role of caring while including caring as a vital component in the nursing curriculum ( 16 ). Therefore, the quality of clinical instructors’ behavior plays a significant role in the nursing students' learning process, mainly in clinical areas ( 17 ). Several studies reported that caring is the core of the educator–student relationship ( 18 , 19 ). Furthermore, Cáceres and Cáceres ( 20 ) stated that the faculty-student caring relationship in nursing education has been offered to enhance student’s learning experience to care, desire to care for others, and self-actualization. Besides, they emphasized that caring is a teaching-learning process based on relationships between instructors and students as well as moral and human concepts in nursing education ( 21 ). According to Wade and Kasper ( 22 ), five particular caring factors were influential in nursing students’ perception of instructor caring, including (a) instilling confidence through caring, (b) a supportive learning climate, (c) appreciation of life meanings, (d) control versus flexibility and (e) respectful sharing. Clinical instructors spend the majority of their time in the clinical setting with nursing students, so they benefit from their behavior, knowledge, experiences, and variety of abilities. In this line, Beck ( 23 ) noted in this issue that students pick up caring skills by imitating their instructor’s caring behaviors and by experiencing care via their interactions with instructors and other students. The National Council of State Boards of Nursing (2005) endorsed this theme, stating that nursing education and the relationship between nursing students and clinical instructors needed to be improved. The primary element of this relationship is the clinical instructors' compassionate demeanor ( 24 ). Hence, this study focuses on nursing instructors to help nursing students to a higher degree of coherence within body, mind, and spirit to transmit this harmony and caring experience to their patients in their future nursing career through transpersonal caring relationships. The idea of caring, how it can impact nursing practice, and how nursing students perceive the compassionate conduct of their clinical instructors have all been examined by nurse managers and nurse educators in Jordan. Poor care in the healthcare industry is demonstrated globally, and education is necessary to generate nurses who are compassionate and intellectually competent ( 25 ). Also, since the caring behavior of the clinical instructors is one of the most imperative and prominent factors in the field of nursing students’ clinical training, this issue is not well addressed in the literature. Therefore, this study aims to explore Jordanian nursing students’ perspectives of the caring behavior of clinical instructors and identify the caring and non-caring behavior of the instructor as perceived by nursing students at public military colleges in Amman, Jordan. Materials and Methods Design A mixed-methods approach was utilized in this study. This approach integrates both quantitative and qualitative research designs, allowing for a more comprehensive understanding of a research problem. Settings and Sampling The study took place at a military nursing college in Amman, Jordan. Also known as Princess Muna Al-Hussien Military College of Nursing/ Muata University. Graduates earn baccalaureate degrees and work as registered nurses for the Jordanian armed forces. The study included solely female participants, in line with the college's admission policy. For the descriptive cross-sectional part, researchers used a convenience sampling method consisting of second-year (junior) and fourth-year (senior) nursing students, selected based on their experience of completing multiple clinical courses that could help them grasp the clinical instructors’ caring and caring behavior. The total number of students in both years (second and fourth years) was 250. However, (n = 212) agreed to participate in this study, with a response rate of 85%. The sample size was calculated using G*Power 3.0 software ( 26 ). Using a conventional power of 0.80 with α = 0.05 and a 95% confidence level based on a t-test with a medium effect size; 110 students were required. For the qualitative approach, researchers employed a purposeful sampling method by inviting students willing to participate in a structured interview by answering the following open-ended questions: What are the caring behaviors of the clinical instructor as perceived by nursing students? What are the non-caring behaviors of the clinical instructor as perceived by nursing students?” Kindly provide examples of caring and non-caring situations during your clinical training. Instruments Data were collected using the Nursing Students' Perception of Instructor Caring (NCPIC) developed by Wade and Kasper ( 22 ), based on Watson's theory of Transpersonal Caring ( 27 ). It is composed of 31 items organized into five subscales: Instill confidence through caring (11 items); supporting learning climate (10 items); appreciation of life meanings (3 items); control versus flexibility (4 items); and respectful sharing (3 items). Of the 31 items, 19 items were identified in favorable terms and 12 in negative terms, reversed during data analysis. The answers were evaluated using a 6-point Likert scale ranging from ( 1 ) strongly disagree to ( 6 ) strongly agree. Responses from student nurses ranging from slightly agree to strongly agree were combined and reported as more frequently exhibited caring behaviors. Responses from student nurses ranging from slightly disagree to strongly disagree were combined and reported as less commonly exhibited caring behaviors. Both Arabic and English translations were completed by two bilingual translators, and five faculty members who are proficient in both languages verified the translated version's content authenticity. The questionnaire should take ten to fifteen minutes, according to estimates. After the data was gathered, the Arabic version's dependability was evaluated. For this investigation, the Cronbach's alpha score was 0.91. Data Collection Procedure A semi-structured interview was held following the collection of survey data to find out more about the impressions of Jordanian nursing students on the compassionate conduct of clinical teachers during their clinical training. In addition to being told that the interviews were completely confidential and that any verbatim recordings would not identify them by name, the data was classified for secrecy and the interviews were scheduled at a time that was suitable for nursing students. Respondents were also advised that they might withdraw from the study at any time if necessary. The respondents were told that the interview was conducted securely and that only the interviewer had access to the recordings, which were also translated. Each interview was given a set allotment of time—roughly 25 minutes—to gather data. After the data was combined, a theme analysis was conducted. Maintaining the Rigor The ideas that arose from the theme evaluation were subjected to a parallel examination to ensure that they reflected a clear grasp of nurses' experiences and were correct and pertinent in the context of the findings. The inspectors met both participants on the same platform at an opportune moment and had a cordial conversation with them. All pertinent topics were addressed, the interviewer asked the same questions, and no material was left out. Clear verbatim quotes supported the study's conclusions, providing the participants with an authentic voice. Ethical consideration Prior to conducting data collection procedures the researchers obtained written approval to conduct the study from the ethical committee. All participants provided written informed consent before participation in the study. This study was authorized by the Institutional Review Board (IRB) and the research and ethical committee at Princess Muna Al-Hussien Military College of Nursing/ Mutah University and granted approval and clearance with reference number (M/3274/2/32/7). All human research methods were carried out under the ethical norms of the committee responsible for human experimentation (institutional and national), as well as the Helsinki Declaration of 1964, as revised in 2009, and its amendments. Participation in this study was voluntary, and participants were assured that they could withdraw from the study at any time. They signed informed consent and were assured of anonymity and confidentiality. Data analysis Descriptive statistics were used to assess the demographic characteristics of nursing students such as frequency, percentage, mean, and standard deviation. An Independent sample t-test was used to assess the mean difference between the total score of NCPIC based on demographic characteristics as an inferential statistic. Besides, open-ended questions were analyzed utilizing the content analysis. Content analysis is a research methodology that systematically derives meaning from textual, visual, or auditory data. Results Quantitative Analysis Participant’s characteristics Out of 250 nursing students invited to participate at the undergraduate level, 212 engaged in the study, resulting in a response rate of 84%. Because the college only accepts female students from all parts of Jordan, all participants were female. Additionally, enrolled students were living in the university residence halls. Second-year nursing students constituted 55% of the sample, whereas 4 th -year nursing students comprised 45%. With a mean score of 75 and 55% of the sample falling between 70 and 97, the sample's grade point average ranged from 50 to 100. Table 1 Table 1. Demographic Attributes of the Sample (N=212) Characteristics Number (%) College years Second year Fourth-year 116 (57.7) 96 (45.3) Age 19 years 20 years 21 years 77(36.3) 108 (50.9) 27 (12.7) Grade Point Average 50-59 60-69 70-79 80-89 90-100 20 (9.40) 42 (19.8) 117 (55.2) 32 (15.1) 1 (0.50) Perception of instructors' caring behaviors The findings of this study showed that the average mean score for the clinical instructor behaviors as perceived by nursing students was (M=3.40, SD = 1.12), at a medium level. The maximum mean score was related to instilling confidence through the caring subscale (M= 3.55, SD =0.71), while the minimum mean was related to the Supportive learning climate subscale (M=3.27, SD = 0.955). As indicated in Table 2, the highest mean score of the items in each subscale of the five subscales of the NCPIC was as follows: " the Instill confidence through caring subscale” s hows genuine interest in patient care” (M= 4.17, SD = 1.51); Supportive learning climate subscale” inappropriately discloses personal information about me to others (M=4.39, SD =1.77); appreciation of life meanings subscale the highest mean score values go to the item “. Helps me find personal meaning in my experiences" (M=3.34, SD = 1.57); control versus flexibility subscale, ” focuses on completion of patient care tasks rather than the patient’s needs (M=3.42, SD =1.82); Finally, Respectful sharing subscale, the highest mean score belonged to the item” is attentive to me when we communicate” (M=3.58, SD =1.66) students’ perception of instructors' caring behaviors was in the medium level of care. Table 2 Table 2. The mean score of the nursing students' perception of instructors' caring behaviors items (N =212) Items Mean ( SD ) Instills confidence through Caring 3.55 (0.705) Supportive learning climate 3.27 (0.955) Appreciation of life's meaning 3.29 (1.340) Control vs flexibility 3.38 (1.290) Respectful sharing 3.52 (1.33) Average 3.40 (1.12) Qualitative Analysis Caring and non-caring behaviors To gain a deep and thorough understanding of Jordanian nursing students’ perspectives of the caring behavior of the clinical instructors and identify the caring and non-caring behavior of the instructor as perceived by nursing students; open-ended questions were asked as follows: “What are the caring and non-caring behaviors of the clinical instructor as perceived by nursing students? Which were analyzed using content analysis, First of all, every statement was read and read many times then significant statements were extracted, then they translated from Arabic to English and back-translated by a second researcher. Findings reveal that the majority of the students ‘comments focused on communication, caring, motivation, and professionalism. In regards to communications; nursing students want their instructor to be kind, a good listener, compassionate, honest, responsible, have a welcoming smile and a sense of humanity, able to reduce the stress of the students, be flexible, and accept students’ viewpoints. Therefore, they want the clinical instructor to deal with them respectfully, as one student stated: “ The Clinical instructors should respect the students in front of patients so that the patient does not feel mistrust, don’t underestimate or humiliate the students or use frustrating vigilance in front of patients and others” The second most common concept emphasized by the students was “caring”, and the students hoped that the clinical instructor would provide care for them like their mother as represented in the following quotes: “Clinical instructors should provide comprehensive care to the students and pay attention to his /her needs, conduct health condition, and be a mother for us more than being our teacher”. The third concept focused on by the current study is the use of motivation and positive encouragement from the clinical instructor. As one student asked: “I want the clinical instructor (CI) to make me feel that I will be a successful person.” Lastly, another important aspect requested by the nursing students was professionalism as represented by the following required characteristics: knowledge, ethical behavior, loyalty, responsibility, cooperation, adviser, consultant, and role modeling. So, they proclaimed that the CI goal should be focused on enhancing the knowledge and training of the students. Also, they recommended the following from the CI: availability with the students at all times during their practice, demonstration of the required skills, considering the individual differences, encouraging and believing in the abilities of the students, making real expectations according to their level, and not just picking up mistakes, don’t intimidate the students with marks, and having the capability to teach the students, and patient especially during clinical practice, as one of the students stated: “CI should be Patient when faced with students’ mistakes or when they are doing the procedure for the first time.” Communication is an important aspect of the teaching-learning process Nursing students’ answers regarding the non-caring behavior of the CI have revolved again around the importance of avoiding miscommunication such as Lack of respect for the student in front of the patient as the use of embarrassment and mockery in front of everyone, underestimating the student's value and abilities, Jude the students ‘performance according to their previous grade point average, as demonstrated by the following students quotes: “ Some CI use humiliating terms and disrespect the students in front of patients and medical staff, they shouting, screaming, and cursing. They disrespectfully teach us and highlight our mistakes and not allowing us to express our feelings”. Another non-caring- behavior that is stressed by the students is governing others, and the use of intimidation and tyranny, as they expressed: “Some CI imposing compulsory authority, they use marks to control us, and made us apply the skills under stress and fear. Side using admonition and blame which will lead to frustration.” In addition, nursing students emphasized controlling some negative personality characteristics of the CI, for example, they described inflexibility, anger, frown face, loud voice in front of others, lack of dialogue abilities and understanding, impatience, and being inconsiderate as one of the students write: “Some CI gets angry when a student makes a mistake during application of the skill, and sometimes they do not answer our questions and ask us to do many unanswered questions as homework.” Finally, non-professional and Teaching and learning domains were taken under consideration according to the students. CI who is non-professional as represented by the student's words such as CI who are not knowledgeable, and not taking into account individual differences of the nursing students are considered non-caring CI. Discussion This study aimed to explore nursing students' perceptions of their instructors' caring behavior at a Jordanian public military college. For this study, the overall mean value of Nursing Students' Perception of Instructor Caring (NCPIC) was at the medium level. Thus, findings revealed that nursing students valued caring as they perceived and evaluated their nursing instructors. However, the level of care they perceived was at a medium level and it is less than the expected mean score in a comparison with several previous studies that were conducted across different participants' ages, countries, and cultures that used the same instrument, for instance, a previous study conducted in Tabriz, Iran by Zamanzadeh, Jasemi ( 18 ), and the overall mean score of this study was (4.65/ out of 6). Furthermore, a previous study was carried out by Labrague, McEnroe-Petitte ( 28 ) across four different countries, namely: India, Greece, Nigeria, and the Philippines with an overall mean score of (4.057/ out of 6). Therefore, the variation in overall mean score can be explained by the fact that there is still no standardized caring definition globally; since it varies across cultures and countries, and many definitions are in the literature, but there is no one specific definition for the profession to follow. This is obvious for both the nurses who deliver the care and the patients who receive it. For instance, a prior study by Papastavrou, Tsangari ( 29 ) demonstrated that individuals in various countries interpret care and caring activities conducted by nurses differently. As a result, there is a substantial need for standardized caring definitions across the world. This study was conducted in a military nursing college, and it has an internal dormitory that should be supervised by some officers who are the clinical instructors that accompany them to the hospital the next day. Most nursing courses are conducted in hospitals under the supervision of nursing instructors, where nursing students can engage and apply caring if they feel it. However, Salehian, Heydari ( 30 ) pointed out that caring in nursing refers to student-teacher interactions that are formed based on human values and focus on the unique needs of the student. In the same context, Hussein, Al-Hashmi ( 31 ) bring up that clinical instructors must own caring behavior and effective clinical teacher characteristics if they want to enable student admission and learning in the complicated world of clinical practice. It also, mentioned that the success of an educational program on student’s learning is said to be indicated by the quality of an educational environment. Another noteworthy discovery was that nursing students viewed the "instill confidence through caring" subscale as the caring behavior most commonly displayed by their teachers. "Showing genuine interest in patients and their care, displaying kindness, instilling a sense of hopefulness, respecting students as unique individuals, making himself or herself available to students, and helping students to envision themselves as a professional nurse" are some of the criteria included in this subscale. These findings correspond with several previous studies performed by Labrague, McEnroe-Petitte ( 28 ) and Rosser ( 25 ) since these studies' findings ranked the “instills confidence through caring” subscale as the highest subscale. However, this finding is in contrast to the study conducted by Zamanzadeh, Jasemi ( 18 ) outcome since the highest level was related to the respectful sharing subscale. In this study, the appreciation of life's meaning subscale and supportive learning climate subscale ranked as the minimum mean score. This subscale includes several criteria such as instilling in students a sense of hopefulness for the future, caring about students as a person, acknowledging their limitations or mistakes, clearly communicating his or her expectations, and serving as a trusted resource for personal problem-solving. Thus, this finding indicates that nursing instructors have to collaborate more effectively and receive additional training in the area of strengthening the supportive learning climate for nursing students, which emphasizes instilling a sense of hopefulness for the future, being concerned about their students as a person, and maintaining clear communication with students regarding expectations and acknowledging each student’s limitations and restrictions. However, this finding is in contrast to the following studies Parandeh, Khaghanizade ( 11 ) and Zamanzadeh, Jasemi ( 18 ) where the minimum mean score belonged to the control versus flexibility. Therefore, nursing clinical instructor should increase the level of care provided for their student to feel confident and be effective in their future career. In this study, no significant differences in the mean score of the perception of the clinical instructor's caring behavior between the senior and the junior nursing students in three subscales (Instills confidence through caring, supportive learning climate, respectful sharing), therefore, this can be explained that both groups of students are under the supervision of the same officers, who are their clinical instructors. However, this finding is in contrast to the findings of a study by Meyer and Morin ( 32 ) since the result showed that junior student nurses perceived their clinical instructors to least frequently care for them by assisting them in appreciating life’s meaning. On the other hand, the senior student nurses perceived their clinical instructors to least frequently care for them by being flexible. Although the mean scores for the subscales of the NSPIC were higher for junior student nurses than for senior student nurses Students ‘responses to the open-ended questions regarding their perception of caring and non-caring behaviors were discussed in Watson’s Ten Creative Factors. According to Watson’s theory, a humanistic–altruistic system of value, instillation of faith and hope, the development of a helping-trusting, human-caring relationship, cultivation of sensitivity to one’s self and others, and promotion and acceptance of the expression of positive and negative feelings are all represented through the Nursing students demand for good communication, professionalism, caring, and motivation. Therefore, they ask for respect, encouragement, self-confidence, role-modeling, gentle handling, and avoidance of humiliation. Also, the other five factors of Watson’s theory such as the Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment were represented in the student nurses' need for comprehensive, and compassionate care from their CI. Furthermore, nursing students are asked to assume professionalism in teaching that considers individual differences, which is represented in the Watsons’ theory in the factor “Promotion of transpersonal teaching-learning”, and Systematic use of a creative problem-solving, caring process. Implications Nurse educators may be able to evaluate the influence of caring connections on academic outcomes with the use of nursing managers' and nurse educators' empirical evidence of compassionate interactions between nursing students and clinical instructors. The NSPIC, based on Watson’s (1988b) Theory of Transpersonal Caring, is the appropriate measure of nursing students’ perceptions of instructor caring. As this theory measures caring, the NSPIC can be used as a consequence of the teaching process to endorse the impact of caring interactions between students and clinical instructors’ ability to care. Nursing faculty can enhance CL caring behavior by conducting workshops, awards, and the CL of the month. Limitations This study had several drawbacks, including the following: ( 1 ) a self-structured questionnaire was used to collect data, which could introduce bias; and ( 2 ) the study was limited to a particular location, which could limit how broadly the results can be applied. Conclusion A crucial component of nursing education has been highlighted as caring. While interacting with nursing students in a clinical context, it should be implicit in clinical teachers' conduct and actions. The results of this study have implications for education in several ways, including the development of a caring curriculum by nursing administration and nurse educators and the improvement of clinical encounters based on values and the human perspective. Declarations Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Conflicts of interest/Competing interests : All authors declare no conflicts of interest. Ethical approvals and participation consent: All participants provided written informed consent before participation in the study. This study was authorized by the Institutional Review Board (IRB) and the research and ethical committee at Princess Muna Al-Hussien Military College of Nursing/ Mutah University granted approval and clearance with reference number (M/3274/2/32/7). All human research methods were carried out under the ethical norms of the committee responsible for human experimentation (institutional and national), as well as the Helsinki Declaration of 1964, as revised in 2009, and its amendments. Data availability statement: The datasets generated during and/or analyzed during the current study is available from the corresponding author upon reasonable request. Author contributions: RHH: Conceptualization and investigation; FST: Methodology and data curation; RYA: Data curation and formal analysis; SBH: Methodology and writing (review and editing); BKA: Resources and formal analysis; SA: Writing the original draft; AAA, AJA: Supervision and data curation; HQ: Supervision and investigation. Consent for publication: Not applicable Clinical Trial Number: Not applicable. References Yoshida Y, Uno T, Tanaka H, Hakosaki I, Shigeta K, Yano R. Cognitive changes with psychomotor skill acquisition through blended learning among nursing students: A qualitative study. Nurse Educ Pract. 2022;65:103486. Hernon O, McSharry E, MacLaren I, Carr PJ. The use of educational technology in teaching and assessing clinical psychomotor skills in nursing and midwifery education: A state-of-the-art literature review. J Prof Nurs. 2023;45:35–50. Hynnekleiv II, Jensen JK, Giske T, Lausund H, Maeland E, Heggdal K. 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Cite Share Download PDF Status: Published Journal Publication published 17 Jul, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 30 Jun, 2025 Reviews received at journal 15 Jun, 2025 Reviewers agreed at journal 29 May, 2025 Reviewers agreed at journal 25 Apr, 2025 Reviews received at journal 14 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviewers invited by journal 29 Mar, 2025 Editor assigned by journal 25 Mar, 2025 Editor invited by journal 21 Mar, 2025 Submission checks completed at journal 21 Mar, 2025 First submitted to journal 21 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Haddad","email":"","orcid":"","institution":"Philadelphia University","correspondingAuthor":false,"prefix":"","firstName":"Rabia","middleName":"H.","lastName":"Haddad","suffix":""},{"id":443473099,"identity":"da2b560a-493d-42b4-8692-9d15b3f125bf","order_by":1,"name":"Fatimah S. Tarawneh","email":"","orcid":"","institution":"Mutah University","correspondingAuthor":false,"prefix":"","firstName":"Fatimah","middleName":"S.","lastName":"Tarawneh","suffix":""},{"id":443473100,"identity":"a1560f30-ca4d-4721-b189-2b7472bf9aff","order_by":2,"name":"Raya Y. Al-Husban","email":"","orcid":"","institution":"Zarqa University","correspondingAuthor":false,"prefix":"","firstName":"Raya","middleName":"Y.","lastName":"Al-Husban","suffix":""},{"id":443473101,"identity":"a952a223-cb8d-4a33-a536-d8dd62274fbc","order_by":3,"name":"Salam Bani Hani","email":"","orcid":"","institution":"Irbid National University","correspondingAuthor":false,"prefix":"","firstName":"Salam","middleName":"Bani","lastName":"Hani","suffix":""},{"id":443473102,"identity":"5526cb3a-f2bc-475e-9716-9d7468abc28c","order_by":4,"name":"Bushra Kh. Alhusamiah","email":"","orcid":"","institution":"Middle East University","correspondingAuthor":false,"prefix":"","firstName":"Bushra","middleName":"Kh.","lastName":"Alhusamiah","suffix":""},{"id":443473103,"identity":"b85c395f-39a1-4dda-b7d8-0ae2e8d8257c","order_by":5,"name":"Shefa’a Alfraheed","email":"","orcid":"","institution":"University of Jordan","correspondingAuthor":false,"prefix":"","firstName":"Shefa’a","middleName":"","lastName":"Alfraheed","suffix":""},{"id":443473104,"identity":"2bedf7f9-76bf-49b2-878d-dfa3d22ac8db","order_by":6,"name":"Alaa Abu attallah","email":"","orcid":"","institution":"Al-Zaytoonah University of Jordan","correspondingAuthor":false,"prefix":"","firstName":"Alaa","middleName":"Abu","lastName":"attallah","suffix":""},{"id":443473105,"identity":"ba0a25bf-84a3-470f-9997-4e19f3185ca4","order_by":7,"name":"Haya Qattom","email":"","orcid":"","institution":"Mutah University","correspondingAuthor":false,"prefix":"","firstName":"Haya","middleName":"","lastName":"Qattom","suffix":""},{"id":443473106,"identity":"123bf9b2-d45d-461a-a701-3d99ba039c75","order_by":8,"name":"Ashraf Jehad Abuejheisheh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIie2Qv2rDMBCHTxjcRU5WB1r7FWQM7RDIszgY6iUZugRDChEENBW6dsvQF3Dp0lFGYC8Cr1pLILMyeimVl0L/iGYsVB/8kDj0obsDcDj+KBxRiIaLLgHOzUlMvF+VFHxADxIAn6SAUeb0ZGV8/1jX/cus2O22r5TDDI9U/qyhnM6pRQnVIROBzJdV4ydGyfFEXa9CkIVVASWJQMxbVj5c7TV4mKjFJSAmrEqsOl33bFPE7OxoftkMSqrRm10h3R3wgIkMGjw0JgaFhIjalUT5RASsTapmcUM5afFEHlZh1hSpTYk6sT/2bB3H2/aJ8nIdjVqzMX07vbCOH2af+jThJtkPLz8Y86+VbwWHw+H477wDURtl2+oD2K0AAAAASUVORK5CYII=","orcid":"","institution":"Al-Quds University","correspondingAuthor":true,"prefix":"","firstName":"Ashraf","middleName":"Jehad","lastName":"Abuejheisheh","suffix":""}],"badges":[],"createdAt":"2025-03-11 19:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6206261/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6206261/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-03599-4","type":"published","date":"2025-07-17T16:05:04+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88506107,"identity":"474c7342-0f22-4984-bced-546616952211","added_by":"auto","created_at":"2025-08-07 07:31:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":830882,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6206261/v1/f89fcd73-30ef-45df-b07d-1d2a61919864.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Jordanian Nursing Students' Perceptions of the Compassionate Actions of Their Clinical Instructors: A Mixed-Methods Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUpon completion of the curriculum, nursing education aims to equip students with cognitive, emotional, and psychomotor abilities to bring about change and promote health (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Caring behavior is a crucial principle in nursing since it is exhibited in the realm of humanity through transparency and integrity, and it is at the heart of nursing science (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Caring experience in nursing relies on nurses' ability and discernment in the human interaction set by the nursing environment (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). According to Alanazi, Shaban (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), honesty and transparency in providing humanitarian services are hallmarks of caring behavior, a core nursing value. It is one that consistently offers others comprehensive support since every individual demonstrates compassionate actions in accordance with their personality and spirituality.\u003c/p\u003e \u003cp\u003eAll healthcare occupations, including nursing, are based on the idea of caring, which enables people to give their life purpose (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). According to Kozier, Erb (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), caring implies that things, people, and relationships are important. Besides, L\u0026eacute;tourneau, Cara (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) proposed that care for another to help him grow and actualize himself, while Kang, Ma (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) argued that caring is the core of professional nursing education. Moreover, caring is a multi-dimensional concept, and it is discussed and comprehensively reviewed by nursing theorists and nurse educators in several ways. One of the most important factors in helping people maintain or regain their health is caring, which Leininger (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) noted has been presented throughout history as nurturing behavior. This led her to propose that \"caring is the essence of nursing and the distinct, dominant, central and unifying focus of nursing\" (Leininger, 2001, P. 35).\u003c/p\u003e \u003cp\u003eAdditionally, Watson and Woodward (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) stated that nursing is morally and functionally based on compassion. Moreover, in nursing, human care encompasses more than just sentiments, worries, attitudes, or altruistic goals. Nursing has a moral ideal of care, which has as its goal conserving, improving, and safeguarding human dignity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, nursing is an applied science and a discipline based on practice that enables nursing students to acquire skills and knowledge, clinical training is believed to comprise almost 50% of the nursing school curriculum (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn essential component of nursing education is clinical training (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). As a result, clinical instructors direct the great majority of nursing courses, which are hospital-based. To deliver high-quality care to patients, families, and communities to attain optimal well-being, clinical training is also essential to nursing education to promote future caring relationships with patients and their families, nurse educators should simultaneously urge students to adopt peer caring behaviors (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe development and acquisition of clinical experiences are mostly dependent on clinical instructors. They must then acquire qualities that make them great teachers, like clinical competence, professional knowledge, and role modeling (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, nurse educators are in a critical position to exemplify the role of caring while including caring as a vital component in the nursing curriculum (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Therefore, the quality of clinical instructors\u0026rsquo; behavior plays a significant role in the nursing students' learning process, mainly in clinical areas (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral studies reported that caring is the core of the educator\u0026ndash;student relationship (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Furthermore, C\u0026aacute;ceres and C\u0026aacute;ceres (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) stated that the faculty-student caring relationship in nursing education has been offered to enhance student\u0026rsquo;s learning experience to care, desire to care for others, and self-actualization. Besides, they emphasized that caring is a teaching-learning process based on relationships between instructors and students as well as moral and human concepts in nursing education (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to Wade and Kasper (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), five particular caring factors were influential in nursing students\u0026rsquo; perception of instructor caring, including (a) instilling confidence through caring, (b) a supportive learning climate, (c) appreciation of life meanings, (d) control versus flexibility and (e) respectful sharing.\u003c/p\u003e \u003cp\u003eClinical instructors spend the majority of their time in the clinical setting with nursing students, so they benefit from their behavior, knowledge, experiences, and variety of abilities. In this line, Beck (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) noted in this issue that students pick up caring skills by imitating their instructor\u0026rsquo;s caring behaviors and by experiencing care via their interactions with instructors and other students. The National Council of State Boards of Nursing (2005) endorsed this theme, stating that nursing education and the relationship between nursing students and clinical instructors needed to be improved. The primary element of this relationship is the clinical instructors' compassionate demeanor (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Hence, this study focuses on nursing instructors to help nursing students to a higher degree of coherence within body, mind, and spirit to transmit this harmony and caring experience to their patients in their future nursing career through transpersonal caring relationships.\u003c/p\u003e \u003cp\u003eThe idea of caring, how it can impact nursing practice, and how nursing students perceive the compassionate conduct of their clinical instructors have all been examined by nurse managers and nurse educators in Jordan. Poor care in the healthcare industry is demonstrated globally, and education is necessary to generate nurses who are compassionate and intellectually competent (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Also, since the caring behavior of the clinical instructors is one of the most imperative and prominent factors in the field of nursing students\u0026rsquo; clinical training, this issue is not well addressed in the literature. Therefore, this study aims to explore Jordanian nursing students\u0026rsquo; perspectives of the caring behavior of clinical instructors and identify the caring and non-caring behavior of the instructor as perceived by nursing students at public military colleges in Amman, Jordan.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eA mixed-methods approach was utilized in this study. This approach integrates both quantitative and qualitative research designs, allowing for a more comprehensive understanding of a research problem.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSettings and Sampling\u003c/h3\u003e\n\u003cp\u003eThe study took place at a military nursing college in Amman, Jordan. Also known as Princess Muna Al-Hussien Military College of Nursing/ Muata University. Graduates earn baccalaureate degrees and work as registered nurses for the Jordanian armed forces. The study included solely female participants, in line with the college's admission policy. For the descriptive cross-sectional part, researchers used a convenience sampling method consisting of second-year (junior) and fourth-year (senior) nursing students, selected based on their experience of completing multiple clinical courses that could help them grasp the clinical instructors\u0026rsquo; caring and caring behavior. The total number of students in both years (second and fourth years) was 250. However, (n\u0026thinsp;=\u0026thinsp;212) agreed to participate in this study, with a response rate of 85%. The sample size was calculated using G*Power 3.0 software (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Using a conventional power of 0.80 with α\u0026thinsp;=\u0026thinsp;0.05 and a 95% confidence level based on a t-test with a medium effect size; 110 students were required.\u003c/p\u003e \u003cp\u003eFor the qualitative approach, researchers employed a purposeful sampling method by inviting students willing to participate in a structured interview by answering the following open-ended questions:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eWhat are the caring behaviors of the clinical instructor as perceived by nursing students?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhat are the non-caring behaviors of the clinical instructor as perceived by nursing students?\u0026rdquo;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eKindly provide examples of caring and non-caring situations during your clinical training.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eData were collected using the Nursing Students' Perception of Instructor Caring (NCPIC) developed by Wade and Kasper (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), based on Watson's theory of Transpersonal Caring (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). It is composed of 31 items organized into five subscales: Instill confidence through caring (11 items); supporting learning climate (10 items); appreciation of life meanings (3 items); control versus flexibility (4 items); and respectful sharing (3 items). Of the 31 items, 19 items were identified in favorable terms and 12 in negative terms, reversed during data analysis. The answers were evaluated using a 6-point Likert scale ranging from (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) strongly disagree to (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) strongly agree. Responses from student nurses ranging from slightly agree to strongly agree were combined and reported as more frequently exhibited caring behaviors. Responses from student nurses ranging from slightly disagree to strongly disagree were combined and reported as less commonly exhibited caring behaviors.\u003c/p\u003e \u003cp\u003eBoth Arabic and English translations were completed by two bilingual translators, and five faculty members who are proficient in both languages verified the translated version's content authenticity. The questionnaire should take ten to fifteen minutes, according to estimates. After the data was gathered, the Arabic version's dependability was evaluated. For this investigation, the Cronbach's alpha score was 0.91.\u003c/p\u003e\n\u003ch3\u003eData Collection Procedure\u003c/h3\u003e\n\u003cp\u003eA semi-structured interview was held following the collection of survey data to find out more about the impressions of Jordanian nursing students on the compassionate conduct of clinical teachers during their clinical training. In addition to being told that the interviews were completely confidential and that any verbatim recordings would not identify them by name, the data was classified for secrecy and the interviews were scheduled at a time that was suitable for nursing students. Respondents were also advised that they might withdraw from the study at any time if necessary. The respondents were told that the interview was conducted securely and that only the interviewer had access to the recordings, which were also translated. Each interview was given a set allotment of time\u0026mdash;roughly 25 minutes\u0026mdash;to gather data. After the data was combined, a theme analysis was conducted.\u003c/p\u003e\n\u003ch3\u003eMaintaining the Rigor\u003c/h3\u003e\n\u003cp\u003eThe ideas that arose from the theme evaluation were subjected to a parallel examination to ensure that they reflected a clear grasp of nurses' experiences and were correct and pertinent in the context of the findings. The inspectors met both participants on the same platform at an opportune moment and had a cordial conversation with them. All pertinent topics were addressed, the interviewer asked the same questions, and no material was left out. Clear verbatim quotes supported the study's conclusions, providing the participants with an authentic voice.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003ePrior to conducting data collection procedures the researchers obtained written approval to conduct the study from the ethical committee. All participants provided written informed consent before participation in the study. This study was authorized by the Institutional Review Board (IRB) and the research and ethical committee at Princess Muna Al-Hussien Military College of Nursing/ Mutah University and granted approval and clearance with reference number (M/3274/2/32/7). All human research methods were carried out under the ethical norms of the committee responsible for human experimentation (institutional and national), as well as the Helsinki Declaration of 1964, as revised in 2009, and its amendments. Participation in this study was voluntary, and participants were assured that they could withdraw from the study at any time. They signed informed consent and were assured of anonymity and confidentiality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to assess the demographic characteristics of nursing students such as frequency, percentage, mean, and standard deviation. An Independent sample t-test was used to assess the mean difference between the total score of NCPIC based on demographic characteristics as an inferential statistic. Besides, open-ended questions were analyzed utilizing the content analysis. Content analysis is a research methodology that systematically derives meaning from textual, visual, or auditory data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQuantitative Analysis\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant\u0026rsquo;s characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 250 nursing students invited to participate at the undergraduate level, 212 engaged in the study, resulting in a response rate of 84%. Because the college only accepts female students from all parts of Jordan, all participants were female. Additionally, enrolled students were living in the university residence halls. Second-year nursing students constituted 55% of the sample, whereas 4\u003csup\u003eth\u003c/sup\u003e -year nursing students comprised 45%. With a mean score of 75 and 55% of the sample falling between 70 and 97, the sample\u0026apos;s grade point average ranged from 50 to 100. Table 1\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Demographic Attributes of the Sample (N=212)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCollege years\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSecond year\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFourth-year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e116 (57.7)\u003c/p\u003e\n \u003cp\u003e96 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;years\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e20 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e21 years\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;77(36.3)\u003c/p\u003e\n \u003cp\u003e108 (50.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;27 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 215px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade Point Average\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e50-59\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e60-69\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e70-79\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e80-89\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e90-100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;20 (9.40)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;42 (19.8)\u003c/p\u003e\n \u003cp\u003e117 (55.2)\u003c/p\u003e\n \u003cp\u003e32 (15.1)\u003c/p\u003e\n \u003cp\u003e1 (0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerception of instructors\u0026apos; caring behaviors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings of this study showed that the average mean score for the clinical instructor behaviors as perceived by nursing students was (M=3.40, \u003cem\u003eSD\u003c/em\u003e= 1.12), at a medium level. The maximum mean score was related to instilling confidence through the caring subscale (M= 3.55, \u003cem\u003eSD\u003c/em\u003e=0.71), while the minimum mean was related to the Supportive learning climate subscale (M=3.27, \u003cem\u003eSD\u003c/em\u003e= 0.955). As indicated in Table 2, the highest mean score of the items in each subscale of the five subscales of the NCPIC was as follows: \u003cstrong\u003e\u0026quot;\u003cstrong\u003ethe Instill confidence through caring subscale\u0026rdquo;\u003c/strong\u003e s\u003c/strong\u003ehows genuine interest in patient care\u0026rdquo; (M= 4.17, \u003cem\u003eSD\u003c/em\u003e = 1.51);\u003cstrong\u003e\u0026nbsp;Supportive learning climate\u003c/strong\u003e subscale\u0026rdquo; inappropriately discloses personal information about me to others (M=4.39, \u003cem\u003eSD\u003c/em\u003e=1.77);\u003cstrong\u003e\u0026nbsp;appreciation of life meanings\u003c/strong\u003e subscale the highest mean score values go to the item \u0026ldquo;. Helps me find personal meaning in my experiences\u0026quot; (M=3.34, \u003cem\u003eSD\u003c/em\u003e= 1.57); \u003cstrong\u003econtrol versus flexibility subscale,\u003c/strong\u003e\u0026rdquo; focuses on completion of patient care tasks rather than the patient\u0026rsquo;s needs (M=3.42, \u003cem\u003eSD\u003c/em\u003e=1.82); Finally, \u003cstrong\u003eRespectful sharing subscale, the highest mean score belonged to the item\u0026rdquo;\u0026nbsp;\u003c/strong\u003eis attentive to me when we communicate\u0026rdquo; (M=3.58, \u003cem\u003eSD\u003c/em\u003e =1.66) students\u0026rsquo; perception of instructors\u0026apos; caring behaviors was in the medium level of care. Table 2\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eThe mean score of the nursing students\u0026apos; perception of instructors\u0026apos; caring behaviors items (N =212)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 388px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eItems\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (\u003cem\u003eSD\u003c/em\u003e)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 388px;\"\u003e\n \u003cp\u003eInstills confidence through Caring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e3.55 (0.705)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 388px;\"\u003e\n \u003cp\u003eSupportive learning climate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e3.27 (0.955)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 388px;\"\u003e\n \u003cp\u003eAppreciation of life\u0026apos;s meaning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e3.29 (1.340)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 388px;\"\u003e\n \u003cp\u003eControl vs flexibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e3.38 (1.290)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 388px;\"\u003e\n \u003cp\u003eRespectful sharing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e3.52 (1.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 388px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.40 \u0026nbsp; \u0026nbsp; (1.12)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eQualitative Analysis\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCaring and non-caring behaviors\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo gain a deep and thorough understanding of Jordanian\u0026nbsp;nursing students\u0026rsquo; perspectives of the caring behavior of the clinical instructors and identify the caring and non-caring behavior of the instructor as perceived by nursing students; open-ended questions were asked as follows: \u0026ldquo;What are the caring and non-caring behaviors of the clinical instructor as perceived by nursing students? Which were analyzed using content analysis, First of all, every statement was read and read many times then significant statements were extracted, then they translated from Arabic to English and back-translated by a second researcher. Findings reveal that the majority of the students \u0026lsquo;comments focused on communication, caring, motivation, and professionalism. In regards to communications; nursing students want their instructor to be kind, a good listener, compassionate, honest, responsible, have a welcoming smile and a sense of humanity, able to reduce the stress of the students, be flexible, and accept students\u0026rsquo; viewpoints. Therefore, they want the clinical instructor to deal with them respectfully, as one student stated:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eThe Clinical instructors should respect\u003c/em\u003e\u003cem\u003e\u0026nbsp;the students in front of patients so that the patient does not feel mistrust, don\u0026rsquo;t underestimate or humiliate the students or use frustrating\u0026nbsp;\u003c/em\u003e\u003cem\u003evigilance\u003c/em\u003e\u003cem\u003e\u0026nbsp;in front of patients and others\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe second most common concept emphasized by the students was \u0026ldquo;caring\u0026rdquo;, and the students hoped that the clinical instructor would provide care for them like their mother as represented in the following quotes:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Clinical instructors should provide comprehensive care to the students and pay attention to his /her needs, conduct health condition, and be a mother for us more than being our teacher\u0026rdquo;.\u0026nbsp;\u003c/em\u003e The third concept focused on by the current study is the use of\u0026nbsp;motivation and positive encouragement from the clinical instructor.\u0026nbsp;As one student asked:\u0026nbsp;\u0026ldquo;I want the clinical instructor (CI) to make me feel that I will be a successful person.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eLastly, another important aspect requested by the nursing students was professionalism as represented by the following required characteristics: knowledge, ethical behavior, loyalty, responsibility, cooperation, adviser, consultant, and role modeling. So, they proclaimed that the CI goal should be focused on enhancing the knowledge and training of the students. Also, they recommended \u0026nbsp;the following from the CI: availability with the students at all times during their practice, demonstration of the required skills, considering the individual differences, encouraging and believing in the abilities of the students, making real expectations according to their level, and not just picking up mistakes, don\u0026rsquo;t intimidate the students with marks, and having the capability to teach the students, and patient\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eespecially during clinical practice, as one of the students stated:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;CI should be\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ePatient when faced with students\u0026rsquo; mistakes or when they are doing the procedure for the first time.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eCommunication is an important aspect of the teaching-learning process Nursing students\u0026rsquo; answers regarding the non-caring behavior of the CI have revolved again around the importance of avoiding miscommunication such as Lack of respect for the student in front of the patient as the use of embarrassment and mockery in front of everyone, underestimating the student\u0026apos;s value and abilities, Jude the students \u0026lsquo;performance according to their previous grade point average, as demonstrated by the following students quotes: \u003cem\u003e\u0026ldquo;\u003c/em\u003e\u003cem\u003eSome CI use humiliating terms and disrespect the students in front of patients and medical staff, they shouting, screaming, and cursing. They disrespectfully teach us and highlight our mistakes and not allowing us to express our feelings\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAnother non-caring- behavior that is stressed by the students is governing others, and the use of intimidation and tyranny, as they expressed: \u003cem\u003e\u0026ldquo;Some CI imposing compulsory authority, they use marks to control us, and made us apply the skills under stress and fear. Side using admonition and blame which will lead to frustration.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn addition, nursing students emphasized controlling some negative personality characteristics of the CI, for example, they described inflexibility, anger, frown face, loud voice in front of others, lack of dialogue abilities and understanding, impatience, and being inconsiderate as one of the students write:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Some CI gets angry when a student makes a mistake during application of the skill, and sometimes they do not answer our questions and ask us to do many unanswered questions as homework.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eFinally, non-professional and\u0026nbsp;\u0026nbsp;\u0026nbsp;Teaching and learning domains were taken under consideration according to the students. CI who is non-professional as represented by the student\u0026apos;s words such as CI who are not knowledgeable, and\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003enot taking into account individual differences of the nursing students are considered non-caring CI.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to explore nursing students' perceptions of their instructors' caring behavior at a Jordanian public military college. For this study, the overall mean value of Nursing Students' Perception of Instructor Caring (NCPIC) was at the medium level. Thus, findings revealed that nursing students valued caring as they perceived and evaluated their nursing instructors. However, the level of care they perceived was at a medium level and it is less than the expected mean score in a comparison with several previous studies that were conducted across different participants' ages, countries, and cultures that used the same instrument, for instance, a previous study conducted in Tabriz, Iran by Zamanzadeh, Jasemi (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), and the overall mean score of this study was (4.65/ out of 6). Furthermore, a previous study was carried out by Labrague, McEnroe-Petitte (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) across four different countries, namely: India, Greece, Nigeria, and the Philippines with an overall mean score of (4.057/ out of 6). Therefore, the variation in overall mean score can be explained by the fact that there is still no standardized caring definition globally; since it varies across cultures and countries, and many definitions are in the literature, but there is no one specific definition for the profession to follow. This is obvious for both the nurses who deliver the care and the patients who receive it. For instance, a prior study by Papastavrou, Tsangari (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) demonstrated that individuals in various countries interpret care and caring activities conducted by nurses differently. As a result, there is a substantial need for standardized caring definitions across the world.\u003c/p\u003e \u003cp\u003eThis study was conducted in a military nursing college, and it has an internal dormitory that should be supervised by some officers who are the clinical instructors that accompany them to the hospital the next day. Most nursing courses are conducted in hospitals under the supervision of nursing instructors, where nursing students can engage and apply caring if they feel it. However, Salehian, Heydari (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) pointed out that caring in nursing refers to student-teacher interactions that are formed based on human values and focus on the unique needs of the student. In the same context, Hussein, Al-Hashmi (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) bring up that clinical instructors must own caring behavior and effective clinical teacher characteristics if they want to enable student admission and learning in the complicated world of clinical practice. It also, mentioned that the success of an educational program on student\u0026rsquo;s learning is said to be indicated by the quality of an educational environment.\u003c/p\u003e \u003cp\u003eAnother noteworthy discovery was that nursing students viewed the \"instill confidence through caring\" subscale as the caring behavior most commonly displayed by their teachers. \"Showing genuine interest in patients and their care, displaying kindness, instilling a sense of hopefulness, respecting students as unique individuals, making himself or herself available to students, and helping students to envision themselves as a professional nurse\" are some of the criteria included in this subscale. These findings correspond with several previous studies performed by Labrague, McEnroe-Petitte (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and Rosser (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) since these studies' findings ranked the \u0026ldquo;instills confidence through caring\u0026rdquo; subscale as the highest subscale. However, this finding is in contrast to the study conducted by Zamanzadeh, Jasemi (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) outcome since the highest level was related to the respectful sharing subscale.\u003c/p\u003e \u003cp\u003eIn this study, the appreciation of life's meaning subscale and supportive learning climate subscale ranked as the minimum mean score. This subscale includes several criteria such as instilling in students a sense of hopefulness for the future, caring about students as a person, acknowledging their limitations or mistakes, clearly communicating his or her expectations, and serving as a trusted resource for personal problem-solving. Thus, this finding indicates that nursing instructors have to collaborate more effectively and receive additional training in the area of strengthening the supportive learning climate for nursing students, which emphasizes instilling a sense of hopefulness for the future, being concerned about their students as a person, and maintaining clear communication with students regarding expectations and acknowledging each student\u0026rsquo;s limitations and restrictions. However, this finding is in contrast to the following studies Parandeh, Khaghanizade (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) and Zamanzadeh, Jasemi (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) where the minimum mean score belonged to the control versus flexibility. Therefore, nursing clinical instructor should increase the level of care provided for their student to feel confident and be effective in their future career.\u003c/p\u003e \u003cp\u003eIn this study, no significant differences in the mean score of the perception of the clinical instructor's caring behavior between the senior and the junior nursing students in three subscales (Instills confidence through caring, supportive learning climate, respectful sharing), therefore, this can be explained that both groups of students are under the supervision of the same officers, who are their clinical instructors. However, this finding is in contrast to the findings of a study by Meyer and Morin (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) since the result showed that junior student nurses perceived their clinical instructors to least frequently care for them by assisting them in appreciating life\u0026rsquo;s meaning. On the other hand, the senior student nurses perceived their clinical instructors to least frequently care for them by being flexible. Although the mean scores for the subscales of the NSPIC were higher for junior student nurses than for senior student nurses\u003c/p\u003e \u003cp\u003eStudents \u0026lsquo;responses to the open-ended questions regarding their perception of caring and non-caring behaviors were discussed in Watson\u0026rsquo;s Ten Creative Factors. According to Watson\u0026rsquo;s theory, a humanistic\u0026ndash;altruistic system of value, instillation of faith and hope, the development of a helping-trusting, human-caring relationship, cultivation of sensitivity to one\u0026rsquo;s self and others, and promotion and acceptance of the expression of positive and negative feelings are all represented through the Nursing students demand for good communication, professionalism, caring, and motivation. Therefore, they ask for respect, encouragement, self-confidence, role-modeling, gentle handling, and avoidance of humiliation. Also, the other five factors of Watson\u0026rsquo;s theory such as the Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment were represented in the student nurses' need for comprehensive, and compassionate care from their CI. Furthermore, nursing students are asked to assume professionalism in teaching that considers individual differences, which is represented in the Watsons\u0026rsquo; theory in the factor \u0026ldquo;Promotion of transpersonal teaching-learning\u0026rdquo;, and Systematic use of a creative problem-solving, caring process.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eImplications\u003c/h2\u003e \u003cp\u003eNurse educators may be able to evaluate the influence of caring connections on academic outcomes with the use of nursing managers' and nurse educators' empirical evidence of compassionate interactions between nursing students and clinical instructors. The NSPIC, based on Watson\u0026rsquo;s (1988b) Theory of Transpersonal Caring, is the appropriate measure of nursing students\u0026rsquo; perceptions of instructor caring. As this theory measures caring, the NSPIC can be used as a consequence of the teaching process to endorse the impact of caring interactions between students and clinical instructors\u0026rsquo; ability to care. Nursing faculty can enhance CL caring behavior by conducting workshops, awards, and the CL of the month.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study had several drawbacks, including the following: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) a self-structured questionnaire was used to collect data, which could introduce bias; and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) the study was limited to a particular location, which could limit how broadly the results can be applied.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA crucial component of nursing education has been highlighted as caring. While interacting with nursing students in a clinical context, it should be implicit in clinical teachers' conduct and actions. The results of this study have implications for education in several ways, including the development of a caring curriculum by nursing administration and nurse educators and the improvement of clinical encounters based on values and the human perspective.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e: All authors declare no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approvals and participation consent:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent before participation in the study. This study was authorized by the Institutional Review Board (IRB) and the research and ethical committee at Princess Muna Al-Hussien Military College of Nursing/ Mutah University granted approval and clearance with reference number (M/3274/2/32/7). All human research methods were carried out under the ethical norms of the committee responsible for human experimentation (institutional and national), as well as the Helsinki Declaration of 1964, as revised in 2009, and its amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eThe datasets generated during and/or analyzed during the current study is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRHH: Conceptualization and investigation; FST: Methodology and data curation; RYA: Data curation and formal analysis; SBH: Methodology and writing (review and editing); BKA: Resources and formal analysis; SA: Writing the original draft; AAA, AJA: Supervision and data curation; HQ: Supervision and investigation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYoshida Y, Uno T, Tanaka H, Hakosaki I, Shigeta K, Yano R. Cognitive changes with psychomotor skill acquisition through blended learning among nursing students: A qualitative study. Nurse Educ Pract. 2022;65:103486.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHernon O, McSharry E, MacLaren I, Carr PJ. The use of educational technology in teaching and assessing clinical psychomotor skills in nursing and midwifery education: A state-of-the-art literature review. J Prof Nurs. 2023;45:35\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHynnekleiv II, Jensen JK, Giske T, Lausund H, Maeland E, Heggdal K. Patients' and Nurses' experiences of caring in nursing: An integrative literature review across clinical practices. J Clin Nurs. 2024;33(4):1233\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlanazi MA, Shaban MM, Ramadan OME, Zaky ME, Mohammed HH, Amer FGM, et al. Navigating end-of-life decision-making in nursing: a systematic review of ethical challenges and palliative care practices. BMC Nurs. 2024;23(1):467.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlasdell ND. The meaning of caring in nursing practice. Int J Nurs Clin Pract. 2017;4(238):2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKozier B, Erb G, Berman A, Snyder SJ, Buck M, Yiu L et al. Fundamentals of Canadian nursing. Concepts, Process, and Practice-Pearson. 2018:1096\u0026thinsp;\u0026ndash;\u0026thinsp;119.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026eacute;tourneau D, Cara C, Goudreau J. Humanizing nursing care: An analysis of caring theories through the lens of humanism. Int J Hum Caring. 2017;21(1):32\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKang L, Ma S, Chen M, Yang J, Wang Y, Li R, et al. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain Behav Immun. 2020;87:11\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeininger M. Essential transcultural nursing care concepts, principles, examples, and policy statements. Transcultural nursing: Concepts, theories, research, and practice. 2002:45\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatson J, Woodward T. Jean Watson\u0026rsquo;s theory of human caring. Nurs Theor Nurs Pract. 2010;3:351\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParandeh A, Khaghanizade M, Mohammadi E, Mokhtari-Nouri J. Nurses\u0026rsquo; human dignity in education and practice: An integrated literature review. Iran J Nurs midwifery Res. 2016;21(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeeber AS, Palmer C, Waldrop J, Lynn MR, Jones CB. The role of doctor of nursing practice-prepared nurses in practice settings. Nurs Outlook. 2019;67(4):354\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalah AA, Aljerjawy M, Salama A. Gap between theory and practice in the nursing education: the role of clinical setting. Emergency. 2018;24(1718):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarshawski S, Itzhaki M, Barnoy S. The associations between peer caring behaviors and social support to nurse students' caring perceptions. Nurse Educ Pract. 2018;31:88\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkram AS, Mohamad A, Akram S. The role of clinical instructor in bridging the gap between theory and practice in nursing education. Int J Caring Sci. 2018;11(2):876\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Rae A, Langille J, Li A, Sealock K, Rutherford G. The evolving role of a clinical instructor in an integrated undergraduate nursing curriculum. J Nurs Educ Pract. 2017;7(4):87\u0026ndash;95.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNiederriter JE, Eyth D, Thoman J. Nursing students\u0026rsquo; perceptions on characteristics of an effective clinical instructor. SAGE Open Nurs. 2017;3:2377960816685571.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZamanzadeh V, Jasemi M, Valizadeh L, Keogh B, Taleghani F. Effective factors in providing holistic care: a qualitative study. Indian J Palliat Care. 2015;21(2):214.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan ZC, Chien WT, Henderson S. Metaphorical interpretations of the educator-student relationship: An innovation in nursing educational research. Nurse Educ Pract. 2018;28:46\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eC\u0026aacute;ceres A, C\u0026aacute;ceres S. Principales plantas medicinales disponibles en Guatemala con actividad contra virus respiratorios que infectan al ser humano\u0026ndash;Revisi\u0026oacute;n narrativa. Ciencia, Tecnolog\u0026iacute;a y Salud. 2020;7(3):412\u0026thinsp;\u0026ndash;\u0026thinsp;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollier AD. Characteristics of an effective nursing clinical instructor: The state of the science. J Clin Nurs. 2018;27(1\u0026ndash;2):363\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWade GH, Kasper N. Nursing students' perceptions of instructor caring: an instrument based on Watson's Theory of Transpersonal Caring. J Nurs Educ. 2006;45(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeck CT. Caring within nursing education: A metasynthesis. SLACK Incorporated Thorofare, NJ; 2001. pp. 101\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinclair S, Norris JM, McConnell SJ, Chochinov HM, Hack TF, Hagen NA, et al. Compassion: a scoping review of the healthcare literature. BMC Palliat care. 2016;15:1\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosser BA. Intolerance of uncertainty as a transdiagnostic mechanism of psychological difficulties: A systematic review of evidence pertaining to causality and temporal precedence. Cogn therapy Res. 2019;43(2):438\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatson J. Theory of transpersonal caring. J George, J(Ed) Nursing theories: The base for professional nursing practice. 2011:454\u0026thinsp;\u0026ndash;\u0026thinsp;78.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLabrague L, McEnroe-Petitte D, Al Amri M, Fronda D, Obeidat A. An integrative review on coping skills in nursing students: implications for policymaking. Int Nurs Rev. 2018;65(2):279\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapastavrou E, Tsangari H, Karayiannis G, Papacostas S, Efstathiou G, Sourtzi P. Caring and coping: The dementia caregivers. Aging Ment Health. 2011;15(6):702\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalehian M, Heydari A, Moonaghi HK, Aghebati N. Developing the concept of caring in nursing education. Electron physician. 2017;9(5):4425.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHussein R, Al-Hashmi A, Momani A, Hani SB. Assessing the educational environment of baccalaureate nursing program as perceived by nursing students. Int J Educ. 2023;11(3):602\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer JP, Morin AJ. A person-centered approach to commitment research: Theory, research, and methodology. J organizational Behav. 2016;37(4):584\u0026ndash;612.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Caring, Caring behavior, Nursing students, Professionalism, Clinical instructor, Non-clinical behavior","lastPublishedDoi":"10.21203/rs.3.rs-6206261/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6206261/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn helping professions like nursing, caring is recognized as a crucial concept. In addition to identifying caring and non-caring behaviors among nursing students at a public military college in Amman, Jordan,\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study sought to understand how Jordanian nursing students perceived the caring behavior of clinical instructors during their clinical training.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eA mixed-methods approach was utilized to recruit data from (n\u0026thinsp;=\u0026thinsp;200) nursing students using the Nursing Students' Perception of Instructor Caring (NCPIC) developed by Wade and Kasper (2006).\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eThe findings showed that the average mean score for clinical instructor behaviors perceived by nursing students was at the medium level (M\u0026thinsp;=\u0026thinsp;3.40 out of 6). Four themes were extracted, namely, communication, professionalism, holistic caring (mothering), and motivation. In contrast, the non-caring behaviors were reflected in poor communication, governing, and unfavorable personal traits of the clinical instructors, as well as acting in a non-professional manner.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCaring has been emphasized as a key component of nursing education. It should be inherent in the behavior and actions of clinical teachers while they are dealing with nursing students in a clinical setting.\u003c/p\u003e","manuscriptTitle":"Jordanian Nursing Students' Perceptions of the Compassionate Actions of Their Clinical Instructors: A Mixed-Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-18 15:11:36","doi":"10.21203/rs.3.rs-6206261/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-30T07:24:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-15T17:59:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66333246813598610777302252956649656816","date":"2025-05-29T06:29:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235864710851734156784067182228957033951","date":"2025-04-25T07:44:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T07:40:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5606556577063366896193915579822934132","date":"2025-04-07T14:34:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-29T16:20:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-25T16:19:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-21T12:19:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-21T10:33:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-03-21T10:32:39+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"679fe36a-4f55-4fef-aea1-1cf564198dd7","owner":[],"postedDate":"April 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-07T07:12:41+00:00","versionOfRecord":{"articleIdentity":"rs-6206261","link":"https://doi.org/10.1186/s12912-025-03599-4","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-07-17 16:05:04","publishedOnDateReadable":"July 17th, 2025"},"versionCreatedAt":"2025-04-18 15:11:36","video":"","vorDoi":"10.1186/s12912-025-03599-4","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03599-4","workflowStages":[]},"version":"v1","identity":"rs-6206261","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6206261","identity":"rs-6206261","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}