Trajectories and determinants of caring behaviours in nursing students: A longitudinal study over three academic years

Background: Caring is a key concept in nursing care, divided into Expressive and Instrumental Caring. Learning caring competencies during nursing education is influenced by numerous factors, but these are not clearly defined in literature. Moreover, the trend/trajectories of competencies are not described in the literature. Understanding these elements is essential for developing effective educational strategies to promote the strengthening of caring in nursing students and, therefore, nurses. The study aims to describe the caring trajectories of nursing students throughout their three-years program and to identify caring determinants. Methods: A three-year observational study was conducted, enrolling a cohort of nursing students in four teaching hospitals in Northern Italy. The Caring Behaviours Inventory measured caring, with a score ranging from 1 to 6 for the dimensions of Being with and Responding to individual needs (Expressive Caring), and Doing with competence and Providing effective care (Instrumental Caring). Mixed-effects models estimated caring trajectories and their determinants. Results: A total of 274 students (median age: 20 years; 84% female) were enrolled. Over the three-year period, Instrumental Caring increased significantly (Doing with competence: β = 0.66; 95% CI = 0.56; 0.76 and Providing effective care: β = 0.90; 95% CI = 0.73; 1.06), while Expressive caring, which had already shown high scores at baseline, remained stable. The following variables were identified as determinants of increased levels of caring: perceiving trust from the instructor in a positive learning environment (Providing effective care: β = 0.29; 95% CI = 0.11; 0.47), being female (β male = -0.19; 95% CI = -0.35; -0.03), and living with the family of origin (β = -0.11; 95% CI = -0.22; -0.01). Conclusion: Nursing education could provide a significant contribution to the increase in Instrumental Caring and maintains high levels of Expressive Caring. The trust instilled in students by the instructor and, consequently, a positive learning environment are essential in increasing students' levels of caring over time.