A PILOT STUDY ON THE ART AND SCIENCE OF CARING: A STUDY ON CARING
BEHAVIOUR AMONG NURSES AT A PUBLIC HOSPITAL
Nur Liyana Che Husin ¹ ², Nur Syakirah Beng Selamat ¹ ³, Rosuzeita Fauzi ¹
¹ Centre for Nursing Studies, Faculty of Health Sciences, UiTM Puncak Alam Campus, 41200,
Puncak Alam, Selangor
² Hospital Shah Alam, Persiaran Kayangan, Seksyen 7, 40000 Shah Alam, Selangor
³ Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, 83000 Batu Pahat, Johor
ABSTRACT
The principles of art and science form the basis of nursing practice, shaping the way nurses engage
with patients and provide holistic healthcare. This study aims to explore the caring behaviour level as
well as the relationship between sociodemographic factors and caring behaviour among nurses at
Hospital Shah Alam. A cross sectional design in this pilot study used proportional stratified sampling
to select 70 respondents from different departments and simple random sampling was used to select
participants, each assigned a unique identification number to protect confidentiality. The inclusion
criteria specified registered nurses with over one year of working experience, while nurses on
extended leave and managerial roles were excluded. The questionnaire was validated and consists of
two sections. Section A focuses on demographic factors: age, marital status, number of children,
educational level, year of services, time spent on clinical and shift work while Section B, The CBI-24
measures caring behaviour among nurses. The data was analysed used SPSS version 26. The average
caring behaviour score of μ=3.17 (SD=0.53) suggests a generally high level of caring behaviour
among respondents. The Kruskal-Wallis test (statistic = 355.13, p ≈ 9.83×10 ⁻⁷³) and ANOVA (with a
very low p-value) confirm significant differences in caring behaviour levels among the groups based
on sociodemographic variables. The unexpected cluster analysis highlights the middle-aged, married
individuals with moderate education and service years, exhibiting high caring behaviour as well as
who are in older, married individuals with higher education and service years.
Keywords: Art, Caring Behaviour, Nurses, Science
1. INTRODUCTION
The principles of art and science form the basis of nursing practice, shaping the way nurses
engage with patients and provide holistic healthcare. The caring aspect of nursing
encompasses support and ethical considerations that play a crucial role in building strong
connections, with patients and improving their overall well-being. Caring is widely
acknowledged as crucial to health outcomes globally. Current research highlights the
significance of comprehending the elements influencing actions, in nurses—especially within
varied sociodemographic settings. A study by Wei and Watson (2019) highlights that caring
not just a quality but also a skill that can be shaped by one’s education and life experiences.
This aligns with findings from a systematic review by Natan et al. (2021), which indicates
that nurses with higher educational attainment tend to exhibit more compassionate and
effective caring behaviors. Furthermore, the review suggests that sociodemographic factors,
such as age, marital status, and years of service, significantly impact how nurses perceive and
enact caring in their practice. Statistically, a recent survey of nursing professionals revealed
that 78% of respondents rated their caring behaviour as high, with significant correlations
between years of service and levels of compassion satisfaction (Permana et al., 2023). This
underscores the need for targeted educational interventions to enhance the caring
competencies of nurses, particularly those with less experience or lower educational
qualifications. Durant et al. (2015) highlight those hospitals that use Caring Science
principles like collaboration and comprehensive patient care have superior patient-centric
outcomes. Moreover, hospitals with higher Caring Science scores showed better patient
satisfaction and safety outcomes, indicating that effectively implementing the art of caring
can improve global health outcomes. Research shows that displaying caring behaviours
positively impacts patient satisfaction and treatment adherence (Watson, 2020). However, the
Malaysian healthcare system lacks comprehensive studies and relies on anecdotal evidence
without structured methodologies to assess outcomes on caring behaviour. There is a need for
more structured research and data collection to quantify the impact of caring behaviour
practice on health outcomes in the Malaysian context (Jawahir et al., 2021). In light of these
findings, this study aims to explore the caring behaviour level as well as the relationship
between sociodemographic factors and caring behaviour among nurses at Hospital Shah
Alam.
2. METHODOLOGY
2.1 Research design
The study design for this study is cross-sectional to determine the caring behaviour levels
among nurses. This allows a single point-in-time data approach for data collection, enabling
researchers to gather information without incurring significant costs or requiring long term
commitment.
2.2 Sampling method
In this pilot study, 70 respondents were selected using a proportional stratified sampling
method to ensure the sample reflected the distribution of nursing staff across different
hospital departments. This technique maintained the ratio of respondents from each
department based on their actual size, enhancing the sample's representativeness and
providing a better understanding of caring behavior in various clinical settings. The second
stage of sampling, simple random sampling was used. Nurses who met the inclusion criteria
were included in the study. To protect confidentiality, each respondent was assigned a
unique identification number. A random number generator was then used to select
participants, who were invited to take part in the research. The departments and respondents
involved in this pilot study will not be included in the actual data collection. Sample size
within the department:
1) Paediatric department (n=20)
2) Intensive Care Unit (n=39)
3) Central Sterile Supply department (n=11)
2.2.2 Justification for Sample Size
The sample size of 70 respondents was deemed sufficient for a pilot study, as it allows for
preliminary assessments of the research instruments and the feasibility of the study design.
While pilot studies typically involve smaller sample sizes, this number provides enough data
to identify potential issues and make necessary adjustments before conducting a larger-scale
study. By utilizing this sampling strategy, the study aims to gather relevant data that will
inform future research and contribute to the understanding of factors influencing caring
behavior among nurses in different departments.
2.3 Research Setting
This preliminary study was carried out among nurses at Hospital Shah Alam (HSAS)
because has the greatest number of workers working in the multidisciplinary department.
This setting allows for the direct engagement of the target population, providing a relevant
and accessible group for determining caring behaviour level among nurses.
2.4 Inclusion and Exclusion Criteria
Participants are registered nurses who had at least one year of professional experience.
Besides, the inclusion criteria also include the nurses who work under contract. For
exclusion criteria, nurses who were on extended leave, including those on long medical
certificates, absent from work, or study leave will be excluded from this study.
2.5 Research Instrument
The questionnaire was validated and consists of two sections. Section A focuses on socio
demographic factors: age, marital status, number of children, educational level, year of
services, time spent on clinical activities and shift work. For Section B, The Caring
Behaviour Instrument (CBI-24) measures caring behaviour among nurses adapted from Wu
et al. (2006) are scored from 1 to 4 (4 Likert Scale) consists of 24 questions. The data was
analysed used SPSS version 26.
3. RESULTS AND DISCUSSION
The results of this preliminary study provide significant insights into the caring behaviour of
nurses, as well as the sociodemographic characteristics of the participants. The high
Cronbach’s Alpha value of 0.907 indicates strong internal consistency for the caring
behaviour scale, suggesting that the measurement tool is reliable.
Sociodemographic Insights
Characteristic Percentage (%)
Age (31-40 years) 58.57
Marital Status (Married) 84.29
Number of Children (1-3) 50.00
Highest Level of Education (Diploma) 97.14
Years of Service (Over 10 years) 47.14
Time Spent on Clinical Activities (More than 50%) 92.86
Shift Work 88.57
Table 1 Sociodemographic Characteristics of Respondents
The sociodemographic data reveal that the majority of respondents are young to middle-aged
adults, predominantly aged between 31 and 40 years (58.57%). A significant portion of the
respondent is married (84.29%) and has 1-3 children (50%). The educational background
shows that a vast majority (97.14%) have attained a diploma as their highest level of
education, which emphasizes the necessity for targeted educational interventions to bridge
potential knowledge gaps. Additionally, the data indicate that a large proportion of the
respondents have over ten years of service (47.14%), which may correlate with their caring
behaviours. The high percentage of respondents (92.86%) spending more than 50% of their
time on clinical activities and the prevalence of shift work (88.57%) further contextualize the
working environment of these nurses.
Caring Behaviour Analysis
Characteristic Percentage (%)
Percentage Distribution of Caring Behaviour Categories
Low 5.71
Medium 70.47
High 23.80
Caring Behaviour Dimensions
Assurance 78.26
Knowledge and Skill 84.40
Respect 76.71
Connectedness 77.93
Table 2 Caring Behaviour Scores and Distribution
The average caring behaviour score of μ=3.17 (SD=0.53) suggests a generally high level of
caring behaviour among respondents, with most scores clustering towards the higher end of
the scale. The distribution of caring behaviour categories indicates that while 5.71% rated
their caring behaviour as low, a substantial 70.47% rated it as medium, and 23.80% rated it as
high. This indicates a predominantly positive perception of caring behaviour, particularly in
areas such as assurance (78.26%), knowledge and skill (84.40%), respect (76.71%), and
connectedness (77.93%).
Statistical Analysis
The results from the Kruskal-Wallis test (statistic = 355.13, p ≈ 9.83×10 ⁻⁷³) and ANOVA
(with a very low p-value) confirm significant differences in caring behaviour levels among
the groups based on sociodemographic variables such as age, marital status, number of
children, educational level, years of service, time spent on clinical activities, and shift work.
These findings suggest that these sociodemographic factors play a crucial role in influencing
the caring behaviour of nurses.
Cluster Analysis
Cluster 1 Cluster 2 Cluster 3
Age 2.5 1.68 3
Marital status 1.82 1.85 2
Number of children 2.32 1.55 3
Educational level 2 2 3
Years of service 3 1.6 3
Time spent in clinical 1 1.07 2
Shift work 1.21 1 2
Total caring behaviour 76.86 75.4 84
Table 3 Summary of Cluster Analysis Each Group
The cluster analysis further illustrates the diversity within the sample. Cluster 1 consists of
middle-aged, married individuals with moderate education and service years, exhibiting high
caring behaviour. Cluster 2 includes younger, married respondents with fewer children and
service years, showing moderate caring behavior. Finally, Cluster 3 comprises older, married
individuals with higher education and service years, reflecting high caring behaviour levels.
The findings of this preliminary study relate closely to the art and science of caring in
nursing. The "art" aspect emphasizes the emotional and relational components of caring,
which are influenced by sociodemographic factors such as age, marital status, and education.
Understanding these influences can help nurses develop more empathetic and tailored care
strategies. Conversely, the "science" aspect involves the systematic assessment and
measurement of caring behaviours, as highlighted by the need for reliable measurement tools.
By integrating both the art and science of caring, nurses can enhance their practice, ensuring
that care is not only compassionate but also informed by evidence-based strategies. This
holistic approach is essential for fostering an environment where both nurses and patients
thrive.
4. CONCLUSION
In summary, this preliminary study contributes to the understanding of the relationship
between sociodemographic factors and caring behaviour among nurses. The findings
highlight sociodemographic factors play a crucial role in shaping nurses' caring behaviour.
Understanding these clusters can inform strategies to support nurses, ultimately improving
patient care outcomes. Future research should continue reassess the measurement tools for
caring to ensure they adequately capture these constructs in the context of healthcare work
and additional variables such as burn out level to explore the complex relationship in caring
behaviour.
ACKNOWLEDGMENT
Firstly, we wish to thank God for allowing us to embark on the journey of crafting research
a significant endeavor that often requires the support, guidance, and encouragement of many
individuals. This acknowledgment serves as a heartfelt expression of my gratitude to all
those who contributed to the development and refinement of this research. We would like to
extend our deepest thanks to our academic advisor, Miss Rosuzieta Binti Fauzi who help and
guide us a lot in our journey.
We would like to express our sincere thanks and appreciation to the organizers of the
Nursing Colloquium 2024. They provided us with the opportunity to showcase our research
findings and gain valuable experience in an academic setting. This event has been a fantastic
platform for us to present the results of our pilot study, which will greatly benefit us as
students. We also want to acknowledge the unwavering support of our esteemed university,
UiTM, in guiding us on our journey as students.
On a personal note, we extend our deepest gratitude to our family for their unwavering
support and encouragement throughout this process. Their belief in our capabilities and their
patience during the long hours of research and writing has been a source of immense
strength and motivation.
The Clinical Research Centre of the Hospital Shah Alam deserves our gratitude for their
provision of facilities and assistance during the sampling process. We would like to express
our gratitude to our colleagues and friends for their invaluable assistance in contributing to
this project.
Finally, we wish to express our appreciation to the broader academic community and the
participants who may eventually contribute to this research. Their future engagement and
willingness to share their experiences. Lastly, we hope this finding can make a meaningful
contribution to the healthcare setting, particularly for nurses who play a crucial and often
overlooked role as "unsung heroes" in the healthcare system.
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