Enfermería Clínica 31 (2021) S105---S108

www.elsevier.es/enfermeriaclinica

The relationship between peer caring behaviour and

nursing students’ caring behaviour towards patients: A
cross-sectional study夽
Nahla Savira Novelina, Kuntarti Kuntarti ∗

Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia

Received 15 September 2020; accepted 21 September 2020

KEYWORDS Abstract Peer is one of the contributing factors in developing nursing students’ caring
Caring behaviour; behaviour. This research aims to determine the relationship between peers caring behaviour and
Caring culture; nursing students’ caring behaviour. The cross-sectional study recruited 94 students from two
Nursing student; nursing undergraduate programmes in Jakarta and Depok who selected using the simple random
Peer caring sampling technique. The study used the Peer-Group Caring Interaction Scale (PGCIS) and Caring
behaviour; Behaviours Inventory (CBI-24). Pearson test results showed a relationship between peer and
Peer-group student caring behaviours to patients (p < 0.001) with a positive correlation (r = 0.415). There-
fore, better peer caring behaviour leads to an increased relationship between nursing internship
students and patients. The study also found that modelling and positive connectedness needed
to be improved in peer and student caring behaviour towards patients, respectively. Nursing
education institutions needs to empower peers in developing a caring culture integrated with
the curriculum and student activities.
© 2020 Elsevier España, S.L.U. All rights reserved.

Introduction in assisting patients. Previous research stated that profes-

sional nurses possess poor caring behaviour, and according
Caring behaviour needs to be embraced as a culture by nurs- to academic advisers, students pay less attention to the
ing students during their education due to its crucial role needs of patients and are less able to explain their condition
thoroughly.1 One of the achievements of professional nurses
is the daily practice of care for patients.2
夽 Peer-review under responsibility of the scientific committee of A qualitative study through a focus group discussion (FGD)
the 4th International Conference for Global Health (ICGH) in con- found peers as a contributing factor to the developing stu-
junction with the 7th Asian International Conference in Humanized dents caring behavior.3 The interaction that occurs in peer
Health Care (AIC-HHC). Full-text and the content of it is under groups is a form of peer’s caring behaviour. Peer’s caring
responsibility of authors of the article. behaviours mentioned can help individuals in dealing with
∗ Corresponding author.
painful times and help instill a sense of caring in individuals.4
E-mail address: kuntarti@ui.ac.id (K. Kuntarti). Peers contribute to developing caring behaviour through the

https://doi.org/10.1016/j.enfcli.2020.12.001
1130-8621/© 2020 Elsevier España, S.L.U. All rights reserved.
 N.S. Novelina and K. Kuntarti

mentoring process and model.5 There is limited research the Pearson test, analyzed the ethical principles such as
related to this topic. Based on those factors, this study respecting human dignity/values, privacy/confidentiality,
aimed to determine the relationship between peers and fairness/inclusiveness, and taking into account the bene-
nursing students’ caring behaviour towards patients. fits as well as losses incurred.7 The researcher has given
informed consent guarantee protection of respondents’
rights to privacy, confidantiality, justice, and freedom from
Method
coercion before their participation in this research. Also,
this research has participated in the process ethics test at
This is a quantitative study with a cross-sectional approach the Ethic Committee Faculty of Nursing Universitas Indone-
used to obtain data from a total of 94 undergraduate nurs- sia with number: SK-181/UN2.F12.D1.2.1/ETIK.FIK.2019.
ing students in Jakarta and Depok selected using simple
random sampling techniques. In addition, the Peer-Group
Sampling Interaction Scale (PGCIS) and Caring Behaviour Results
Inventory 24 (CBI-24) were used to measure the variables.5
PGCIS consists of 16 items, divided into assistants and The demographic data of the study sample showed the char-
modelling subscales with questionnaires using 6 likert acteristics of nursing students consist of age, gender, and
scales, namely 1 = strongly disagree, 2 = moderately dis- origin of the programme. Also, Table 1 shows that the aver-
agree, 3 = slightly disagree, 4 = slightly agree, 5 = moderately age age of students is 23 (21---39) years old, while Table 2
agree, and 6 = strongly agree.5 Meanwhile, CBI-24 con- shows that the majority and least respondents were regular
sists of 24 items with four subscales, namely respectful female (59.6%) and male students (6.4%), respectively. The
deference, assurance of human presence, positive connect- total number of regular programme nursing undergraduate
edness, and professional knowledge/skills.6 It is measured students (66%) is greater than the extension (34%). The reg-
using the following 6 likert scales 1 = never, 2 = almost ular students are the nursing undergraduate students that
never, 3 = occasionally, 4 = usually, 5 = almost always, and graduated from high school, while the extension comprises
6 = always. of nursing diploma.
Both measuring instruments passed the validity and The results of data analysis on the variables of peer caring
reliability tests conducted before the data collection pro- behaviour showed that the mean PGCIS score of students
cess. The test results showed that the PGCIS gauge is was 66 (28, 83), and when converted into a percentage, the
reliable with a Cronbach’s alpha value of 0.87 after the value is 74.3%. Therefore, the students have good caring
removal of two invalid items, namely ‘‘Students on this behaviour with a percentage close to 100%. The difference
campus are too busy to help their classmates’’ and ‘‘There between the dimensions of modelling and mentoring showed
is a lot of competition among students on this cam- insignificant results, with a mean value of 32 (16, 42), which
pus.’’ Meanwhile, the validity and reliability test of the was higher than the median mentoring dimension of 34 (9,
CBI-24 measuring instrument was declared valid and reli- 42), as shown in Table 3.
able on all items with Cronbach’s alpha value of 0.93. The analysis of data showed that the CBI-24 had an aver-
Bivariate analysis data, which was conducted by using age score of 5.11 ± 0.55. Therefore nursing students showed

Table 1 Student characteristics based on age.

Age Mean Median SD Min---Max 95% CI
Students 25.28 23 4.6 21---39 24.33---26.22

Table 2 Characteristics of students based on gender and origin of the programme.

Sex (Gender) UG Regular UG Extension Total

n % n % n %
Male 6 6.4% 11 11.7% 17 18.1%
Female 56 59.6% 21 22.3% 77 81.9%
Programme Total 62 66% 32 34% 94 100%

Table 3 The total score and dimensions of the PGCIS measure caring behaviour towards peer students.
Variable Mean Median SD Min---Max 95% CI
PGCIS (14---84) 65.17 66 9.77 28---83 63.17---67.17
 Modelling (7---42) 31.44 32 5.05 16---42 30.40---32.47
 Providing assistance (7---42) 33.73 34 5.33 9---42 32.64---34.83

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 Enfermería Clínica 31 (2021) S105---S108

Table 4 CBI-24 total and dimension score measuring caring student nurse behaviour towards patients.
Variable Mean Median SD Min---Max 95% CI
CBI-24 (1---6) 5.11 5.13 0.55 4---6 5.00---5.23
 Respectful deference to the other 5.13 5.17 0.59 4---6 5.01---5.25
 Assurance of human presence 5.13 5.06 0.59 4---6 5.01---5.25
 Positive connectedness 4.89 4.90 0.81 3---6 4.75---5.04
 Professional knowledge and skill 5.29 5.20 0.59 4---6 5.17---5.41

Table 5 Relationship between peer caring behaviour and nursing student caring behaviour towards patients.
Correlation r r2 p
Peer caring behaviour --- caring behaviour 0.415 0.172 <0.001*
* Significant at ˛ = 0.05.

a high caring behaviour towards patients because the results the internship process.2 It consists of caritas processes which
were close to the highest value of the total CBI24 score of 6 is intended by nurses to improve the quality of care and
with a high average. The positive connectedness was a CBI’s involve patients in the process so that a teaching-learning
dimension with the lowest mean score 4.89 ± 0.81 and the relationship occurs, as well as mutual trust between nurse-
professional knowledge and skill was CBI’s dimension with patient.13 Clinical and caring decisions are influenced by the
the highest mean score of 5.29 ± 0.59 (Table 4). knowledge of science and technology with a commitment to
The results of the Pearson test showed a relation- the therapeutic relationship of nurses to patients, thereby,
ship between peers and nursing students’ caring behaviour making knowledge a core wheel in nursing care.12
towards patients (p < 0.001, ˛ = 0.05). The relationship was The dimension of positive connectedness is the lowest
moderate (r = 0.415) and in a positive direction. In addi- mean score in this research and previous studies.11 In the
tion, the results also found that peer’s caring behaviour positive connectedness dimension, it contains an optimistic
contributed to 17.2% of student caring behaviour towards understanding, relationship, and readiness of prospective
patients (r2 = 0.172), as shown in Table 5. nurses in providing assistance to others.14,15 The nurse-
patient relationship is one of the important things in the
nursing process created to ettend to patient’s welfare.16
Discussion Nursing students are still in the learning phase, for that rea-
son, their minimal experience tends to be the cause of the
The analysis revealed that the peer’s caring interaction low dimensions of positive connectedness. Therefore, this
among nursing students was in a good category. In addition, is enhanced by observing nurses interacting with patients
the dimension of providing assistants to nursing students and implementing caring behaviours towards peers. Stu-
was better than modelling, with no significant difference. dents can also improve this dimension by interacting directly
Provision of assistance provided by other students can with patients, in order to gain experience to deal directly
help reduce the academic burden of nursing internship with patients and gain patient confidence.3
students.8,9 Meanwhile, the modelling dimension is meant Based on the results of the bivariate analysis, there is a
to be willing to help and support other students, accompa- relationship between the peers and nurses’ caring behaviour
nied by sensitivity in feeling the assistance needed by their of patients. The positive correlation means that the bet-
friends.5 ter the caring behaviour of peers, the better the caring
The results of this study also got that the nursing students behaviour of the nursing students. Interaction between
showed good caring behaviour towards patients. Caring students on campus and clinical practice become part of
behaviour is the expected behaviour of every nursing stu- developing caring behaviour. Previous research stated that
dent because of the importance of caring in nursing. Caring peers are the first people that students interact when on
is essential and must be possessed by nurses to enable them campus. Therefore, they play an important contribution to
to make the right decisions and assist patients.10 A good car- cultivating the caring behaviour of nursing students.3 They
ing behaviour has the ability to increase patient satisfaction also ranked the second contributing person on the devel-
with their services.11,12 opment of nursing students’ caring behaviour for parents.
The best caring behavioural dimension in this study Over time, relationships between students get better and
was the professional knowledge and skill. This is similar students get to know and support each other. This support
to the finding of Papastavrou et al. studies, which stated involves providing assistance and feedback when needed,
that this dimension is the best owned by respondents.11 helps to solve problems, and also as an exercise to gain car-
This caused by nurses who have completed undergradu- ing experience from various dimensions.4 It can be trained
ate programmes. According to the latest nurses handbook, as long as students are in clinical practice.
graduates of nursing undergraduate programmes have an in- Clinical practice is part of the learning process before
depth understanding of the field, which are applied during students are allowed to work as nurses.17 Friends become

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an affiliation which encourage interaction amongst students 3. Kuntarti K, Yetti K, Novieastari E. The contributing indi-
and prevents them from harming patients.8 This is similar to viduals in developing caring behaviors of nursing students:
Watson’s theory, which emphasizes on transpersonal care in the focus group finding. Int J Hum Caring. 2018;22:169---78,
order to protect and maintain the honour and integrity of the http://dx.doi.org/10.20467/1091-5710.22.4.169.
patient.10 Caring behaviour is cultivated in peer groups by 4. Warshawski S, Itzhaki M, Barnoy S. The associations between
peer caring behaviors and social support to nurse stu-
getting to know one another, paying attention to sick friends,
dents’ caring perceptions. Nurse Educ Pract. 2018;31:88---94,
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Motivation has a contribution to the caring behaviour of stu- climate for caring. J Nurs Educ. 1993;32:78---83.
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Based on the explanation of the relationship between
http://dl6.globalstf.org/index.php/jnhc/article/view/1309
the two variables, peer caring behaviour has an impact
9. Sulisno M, Ulfa IH. Interaksi caring mahasiswa keperawatan
on developing student caring behaviour and peer caring tingkat I, II, dan III. Jurnal Manajemen Keperawatan.
behaviour can increase through caring group programmes. 2015;3:36---41. Bahasa Indonesia.
Previous research stated that students with caring group 10. Potter PA, Perry AG, Stockert PA, Hall AM. Fundamentals of
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and faculty members to develop caring. This programme is Merkouris A, et al. Cross-cultural validation and psychometric
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http://dx.doi.org/10.1111/j.1365-2753.2010.01445.x.
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12. AONE guiding principles for future patient care delivery
is consistent with recent research that found students with
[Internet]. Chicago: American Organization for Nursing Lead-
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http://dx.doi.org/10.1111/j.1547-5069.1994.tb00927.x.
15. Murphy F, Jones S, Edwards M, James J, Mayer A.
Nursing education institutions need to empower peers to The impact of nurse education on the caring behaviours
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caring behaviour in nursing students. tions of caring behaviours. Nurs Ethics. 2010;17:491---500,
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17. Lestari TRP. Pendidikan keperawatan: upaya menghasilkan
Conflict of interest tenaga perawat berkualitas. Aspirasi: Jurnal Masalah-Masalah
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nurses’ perceptions of stress in clinical learning: a phe-
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