Students’ Caring Ability at Nursing Faculty of Padjadjaran University

Caring is the core of nursing values. Caring for nursing students is an important element to learn and practice. There was limited research on the development of the caring ability of nursing students. Students came from different familial, social, cultural, ethnic, and economic backgrounds. The development of students caring ability needs to be considered by educational institutions. This research aimed to describe nursing students’ caring ability at the Faculty of Nursing, Padjadjaran University. This quantitative descriptive study used a proportional stratified sampling method. In total240 students were selected as samples. Data were collected using an Indonesia version of the Caring Ability Inventory and analyzed using descriptive statistics. The results showed that half of the students had low caring ability (50%), less than half of students were in a moderate category (42.5%), and a small percentage of students were in high category (7.5%). In conclusion, nursing student's caring ability mostly were in the low and moderate category. Faculty of Nursing, Padjadjaran University, needs to improve attention to the development of students’ caring ability.


INTRODUCTION
Nkongho (2009) defined caring as a procedure of helping others to grow and selfactualize. As stated by McFarlane (1976;in Burnard & Morrison, 2009), caring is the essence of nursing, the core of nursing moral values based on human values and prioritizing the well-being of others, particularly the patient and his family. Caring could affect a person's life in a meaningful way and trigger a more fulfilling existence. Caring is one of the most important abilities possessed by nursing students (Mayehoff 1972;in Burnard & Morrison, 2009).
Factors affecting the caring ability of nursing students, as stated by Cheng, Liu, Ke, & Wang (2017), are the factors of education level and student's gender. Nadelson (2010) found there was a significant relationship between age and student caring behavior. The implications, Nadelson also found some younger students but had high caring behaviors. It revealed that the demographic characteristics of students, such as age, gender, and education level, affect the caring ability of nursing students.
The research of Yulianti, Agustina, & Komariah (2012) revealed that the caring behavior of students of the Nursing Faculty of Padjadjaran University was deeply influenced by experience factor and level of student's education. While surroundings factors, mass media, and emotion have no significant effect on student caring behavior. Conforming to the above data, the researcher concludes that the influenced factors on student caring were demography characteristics, mother's parenting, role model, the climate of surroundings education, and student's experience.
The research result of Utami (2013) about the caring perception of student class of 2009 as the last stage student at Faculty of Nursing, Padjadjaran University (n = 138), revealed that the proportion of students who had the positive per-98 mahasiswa. ception (52.2%) and negative (47.8%). This research showed that the positive perception of students still needs to be improved.
Research by Dewi (2016) about caring student's ability of nurse profession at Faculty of Nursing, Padjadjaran University (n = 126). This quantitative descriptive study used the Caring Ability Inventory (CAI) instrument. The results of this study indicated that the caring ability of professional students class XXX and XXXI generally were in the moderate category. For the knowing aspect, almost half of the students were in high category (49,2%), the courage aspect was mostly categorized as low (76,2%), and patience aspect almost half of them were categorized as moderate (47,6% ). It showed that the caring skills of students still need more improvement.
Padjadjaran University, as a producer of professional nurse candidates, has to improve the quality of graduates of Nursing Faculty, caring ability of students who were taking nursing education needs to be considered its development. Restelli (2004) stated that the development of students caring ability needs to be considered because they were coming from different familial, social, cultural, ethnic, and economic backgrounds. Therefore, this research to describe nursing students' caring ability at the Faculty of Nursing, Padjadjaran University.

METHODS
This research conducted through descriptive quantitative approach. Researchers described the caring ability of students of the Nursing Faculty of Padjadjaran University. The research's sampling technique was proportionate stratified sampling. The population of this study was the students of Nursing Faculty, Padjadjaran University, which amounted to 596 students. It consisted of a sub-population of 148 students of the class of 2013, 170 students of the class of 2014, 130 students of the class of 2015, and 148 students from the class of 2016. The formula of proportional allocation determined the number of samples per class. Based on the calculation, the number of samples in this study was 240 samples, with the distribution of the sample of each class which was the class of 2013 (stratum 4) of 60 students, the class of 2014 (stratum 3) as many as 68 students, the class of 2015 (stratum 2) as many as 52 students and the class of 2016 (stratum 1) as many as 60 students. The determination of the sample unit had been done randomly by sorting each stratum. The sorting was done by using a computer program. If among the selected students were not able to or not willing to involve in, then the researchers sorted again to determine the new sample.
Data collection was done by using Google docs form. During data compilation, researchers assisted by colleagues who have explained the data retrieval in this research. The implementation of the data compilation was acknowledged and transcribed authorized by the first vice dean and the head of the study program of a bachelor's degree in Nursing Faculty of Padjadjaran University. The approval of this data compilation was attached to the thesis draft and thesis attachment, including the informed consent as consideration by the Nursing Faculty of Padjadjaran University. Within the Google docs' link, the researcher provided informed consent to the subject by included an explanation of the purpose, benefits, impact of the research, and the guarantee of confidentiality. Subjects had the privilege to accept or refuse to participate in the research. Researchers did not force subjects to be respondents in the research if they refuse to be involved -the research conducted from July 21 to 28, 2017, at the Nursing Faculty of Padjadjaran University.
Linguistically, the term of caring is defined as an act of caring. According to Nkongho (2009), caring was seen as a way of helping others to grow and actualize themselves. The knowing was the knowledge of the steps to understand yourself and others. Courage was the ability to deal with new things. Also, the aspect of patience was your tolerance and perseverance.
The research instrument was a Caring Ability Inventory (CAI) questionnaire developed by Nkongho (2009). The questionnaire consisted of 37 statements that described the caring ability. The questionnaire consisted of 14 items to measure the aspects of knowledge in the form of positive statements, 13 items to measure courage aspects in the form of negative statements and ten items to measure the patience aspect in the form of positive statements. This questionnaire used the Likert scale, and respondents chose the option 1-7 with one as strongly disagree up to 7 to strongly agree. On a negative statement, the reverse was applied.
CAI translated into Indonesian has been used several times, such as Utami (2013) and last used by Dewi (2016). The validity of the CAI translation of Dewi (2016) has been evaluated through the content validity stage, backtranslated method, face validity, and validity test with validity value range 0,239 -0,590. The reliability value of the CAI translation was calculated by Dewi (2016) using the alpha Cronbach formula, with the alpha value reached 0.839. It indicated that the translation of the CAI instrument into Indonesian is valid and reliable to be used in this particular research.
The data analysis of this research used descriptive statistical methods based on Sugiyono's criteria (2008). The caring abilities were categorized into high, moderate, and low.

RESULT
The presentation of students' caring ability at the Nursing Faculty of Padjadjaran University description identified through table 2. Characteristics of student's demographics encompassed a class of, gender, and age. Then, based on aspects of caring ability consisted of aspects of knowing, aspects of courage, aspects of patience, and frequency statement of the caring ability. CAI scoring for students can be seen in table 1. Table 2 showed that caring ability in the knowledge aspects for female students can be categorized as low if the CAI score was below 68.8, categorized as moderate if the CAI score was 68.8-79.5 and categorized as high if the CAI score was above 79.5. Meanwhile, caring skills in the knowledge aspects for male students can be categorized as low if the CAI score was below 64.6, categorized as moderate if the CAI score was 64.6-75.11, and categorized as high if the CAI score was above 75.11.
The caring ability in the courage aspect for female students could be categorized as low if the CAI score was below 62.14, categorized as moderate if the CAI score was 62.14-73.6 and categorized as high if the CAI score was above 73.6. While caring ability in courage aspect for male students was categorized as low if CAI scores below 54.41, categorized as a medium if the CAI score was 54.41-66.56 and categorized as high if CAI scores above 66.56.
As presented in table 2, the result found the caring ability of a class of 2013 with the highest proportion was in low category (46,6%). Students' caring ability in a class of 2014 with the highest proportion wherein low category (55,9%). The students' caring ability in a class of 2015 with the highest proportion wherein moderate category (51.2%). Student's caring ability of a class of 2016 with the highest proportion in the low category (60,0%). By gender, male students' caring ability with the highest proportion in the moderate category (65.0%). The caring ability of female students with the highest proportion in the low category (54.0%). Whereas, based on age, students' caring ability did not have significant differences.  Table 3 resulted that students' caring ability in the knowing aspect was in a low category (15,8%), mostly in the moderate category (44,6%) and high (39,6%). Courage aspect mostly in the low category (88,8%), and the rest was in the moderate category (11,3%). Patienceaspect was almost half of it in the moderate category (47,5%) and a small part of it in the low category (24,6%) and high (27,9%).
As presented in Table 4, resulted in the frequency distributions of each aspect from strongly disagree to agree strongly. Knowing aspect had the most highly agree percentage (33.2%), courage aspect had the highest percentage of quite agree (20.8%), and patience aspect had the highest percentage of strongly agree (39,2%).

DISCUSSION
The data revealed that the caring ability of students of the Nursing Faculty of Padjadjaran University for each class was mostly in a low and moderate category. Class of 2016 reached the highest percentage of the low category (60,0%). As Restelli (2004) stated, the reason was that the new students are still in the adaptation stage with the educational surroundings at the university. Whereas students of the class of 2015 (34,7%), 2014 (55,9%), and 2013 (46,6%) as former students who were considered through passed the process of adaptation with their education surroundings had a lower percentage of low caring ability category. Besides, due to the influenced factors of caring, this difference was also caused by the difference of program and the composition of student learning class of 2013 until the class of 2016 even though both used student-based curriculum (student-centered learning). The result of Al-Khouri's (2011) research revealed that the learning program affected the knowledge escalation about caring and increased self-perception.
The result of the research based on the gender, the caring ability of more than half of male students, were in the moderate category (65.0%), Kurnia, I., Sriati, A., and Widianti, E.| Student's Caring Ability at Nursing Faculty of Padjadjaran University 1. Knowing the aspect of caring ability were 14items (Positive Statements).
2. Courage aspect of caring ability were 13 items (Negative Statements).
3. The patience aspect of caring ability was ten items (Positive Statements).
high category (30.0%) and small part categorized as low (5.0%). The caring ability of more than half of female students was in low category (54,0%), some categorized as moderate (40,5%), and the rest categorized as high (5,5%). The result was in line with previous research that was conducted by Dewi (2016) to professional nurse students, which showed that the caring ability of male students was higher than female students. The disproportionate number of male and female students is a challenge in comparing caring student ability by gender. The number of male students in this research reached 20 students, while female students were 220 students. The results of research by Khademian & Vizeshfar (2008) about students' perceptions of caring revealed that there was no significant difference between male and female students' perceptions of caring. It is in line with the results of Labrague, Mcenroe-Petitte, Papathanasiou, Edet, & Arulappan (2015) studies showed no significant difference in caring perceptions of male and female students. The distinction of caring in male or female's perception was just through the caring expression. Male's caring expression was more likely to be psychosocial (Zhang & Liu, 2016).
The students' caring ability of 18 to 23 years old had an almost similar caring ability. The number of students who reached 18 years old was only ten students and 23 years old were three students. Restelli's research result (2004) revealed that there was a difference was noted between younger (less than or equal to 26) and older(greater than or equal to 27) age student groups with the younger group reporting higher caring ability.
The result of the students' caring ability in the knowing aspect of the students was mostly in the moderate category (44,6%) and high (39,6%). It implied that the knowledge aspects (knowing) of the students were good enough. The results of research by Al-Khouri (2011), who examined the effect of learning programs on caring attitudes and self-perception of nursing students in intensive clinical training in Jordan, showed that the learning program influences students' professionalism and selfperception improvement. Khouri argued that the frequency of student communication with the instructor could improve student professionalism. It implied that the role model was also important in developing the self-perception and professionalism of nursing students.
The result of the student's caring ability in the courage aspect was mostly in the low category (88,8%). Based on the average of the lowest statement where the item of the questionnaire number 32 stated "I do not like to be asked for help," item number 11 "Nothing I can do to make my life better" and item number 13 "I do not like to use my way to help others. " it implied that the aspect of courage of students was not good enough. According to Bickhoff, Sinclair, & Levett-Jones (2017), most nursing students did not dare to participate or speak when they faced a bad situation. The research results of Kuo, Turton, Cheng, & Lee-Hsieh (2011) on the experiences of students and instructors in the use of Clinical Caring Journaling (CCJ) showed that CCJ was able to guide caring behavior toward patients, enables students to express caring skills, build student's confidence, enhance interaction between students and instructors, improve student development and overcome student difficulties in writing skills. Therefore CCJ can be used as an effort to improve the aspect of student's courage.
The result of the student's caring ability on the patience aspect based on student characteristics was mostly in the moderate category (47,5%). It implied that the patience aspect of students was good enough. The results of the research of Mulyaningsih (2013) revealed that critical thinking and training ability could improve the caring skills of nurses to face complex situations, situations that required accuracy, appropriate decision making, and continuous learning. Based on this research can be concluded that the patience aspect of students can be improved by improving critical thinking ability and training about caring as another solution.
Limitations in this study are only considered the caring ability based on demographic characteristics of student's class, age, and gender. The next study is needed for an analysis of factors related to students' caring ability. Including other factors such as personality, psychology, economic background, ethnicity, marital status, experience, parenting pattern, school climate, motivation, and role model were not included.

CONCLUSION
The caring ability of the students of the Nursing Faculty of Padjadjaran University was half of the students who have caring skills in the low category (50%), less than half the students in the moderate category (42.5%) and only small students in the high category (7.5%).
The ability of caring based on the knowledge aspect (knowing) was almost half categorized as moderate (44,6%), courage aspect was mostly categorized as low (88,8%), and patience aspect almost half of it was categorized moderate (47,6%).