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Background: Few studies have evaluated the effectiveness of family functional care interventions among stroke caregiver dyads. This study aimed to examine the effect of a nurse‐led therapeutic conversation intervention on resilience, family function, self‐efficacy in managing the disease, and quality of life (QoL) in stroke family caregiver dyads. Aims: This study aimed to examine the effect of a nurse‐led therapeutic conversation intervention on resilience, family function, self‐efficacy in managing the disease, and QoL in stroke–family caregiver dyads. Design: This study was a single‐blind (evaluator) randomized controlled trial. The planned execution time was from August 2021 to December 2022, in the rehabilitation ward of a medical university hospital. Methods: A total of 82 dyads were included in this analysis. Dyads randomized to the intervention group received nurse‐led therapeutic conversations intervention one at four weeks after the patient's hospitalization for a stroke. The family caregiver dyads of stroke survivors in the control group received routine care. An effectiveness analysis that included patients' resilience, self‐efficacy, and patient–family caregiver dyads' family function and QoL was conducted at one month. We used the CONSORT Checklist for reporting parallel group randomized trials in this study. Results: The patients in the intervention group showed improvement in resilience and self‐efficacy after one month. Furthermore, the effects on resilience (Cohen's d = 0.49) and self‐efficacy (Cohen's d = 0.46) were significantly higher than in the control group. Family functioning was significantly higher in patient–family caregiver dyads in the intervention group than in the control group (Cohen's d = 0.55; Cohen's d = 0.50). However, no significant difference in QoL was found between patients and caregivers in either group. Conclusions: The intervention was effective in promoting family functioning and can also promote patient resilience and self‐efficacy in disease management. However, the intervention did not have a significant effect on the QoL of patient–family caregiver dyads. Summary statement: What is already known about this topic? Many interventional care treatments ignore the important psychological factors involved in caring for patients with stroke.Family nursing actions through conversations between nurses and patients/families are helpful for families dealing with the challenges and complex experiences of a patient's illness. What this paper adds? The present study demonstrated that a nurse‐led therapeutic conversation intervention could promote family functioning among patients and family caregivers.Nurse‐led therapeutic interventions can also promote patients' resilience and self‐efficacy in managing the disease.However, the therapeutic conversation intervention did not have a significant effect on the quality of life of the patient–family caregiver dyads. Implications of this study It is recommended to corroborate a nurse‐led therapeutic conversation intervention as a strength‐oriented family intervention in stroke rehabilitation practice.Nurses can identify the care requirements of patients and their family caregivers through therapeutic conversations and offer personalized care solutions.Nurse‐led therapeutic conversation interventions can be implemented in patient empowerment strategies, emphasizing its effectiveness in boosting patient resilience and self‐efficacy in disease management. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to investigate factors associated with facial pressure injury (FPI) in patients receiving non‐invasive positive pressure ventilation (NIPPV) during hospitalisation in the intensive care unit (ICU) and to identify predictors of FPI. Background: Non‐invasive positive pressure ventilation is a method of treating patients with acute and chronic respiratory failure. However, FPI may occur due to unsuitable nasal‐oral NIPPV masks and discomfort in contact with the skin surface. Design: A retrospective case–control study. Methods: From January 2018 to October 2020, a total of 397 patients admitted to a national hospital in Taiwan were enrolled. Patients received NIPPV and routinely used under‐mask prophylactic dressings during hospitalisation. Patients were divided into the non‐FPI group (n = 357) and the FPI group (n = 40). Demographic, clinical characteristics, acute physiology and chronic health evaluation II scores, and Braden Scale scores were collected from medical records. Logistic regression analysis was performed to examine the contribution of each factor to the FPI, and odds ratios were reported. The STROBE checklist was used in this retrospective case–control study. Results: There were significant differences between the groups in age, serum albumin, C‐reactive protein, body mass index (BMI), disease severity, Braden Scale score, length of stay, duration of mechanical ventilation and use of corticosteroids. Logistic regression analysis revealed that the risk factor for FPI was the Braden Scale score [OR = 1.630 (1.176–2.260)], BMI [OR = 0.396 (0.210–1.784)] and corticosteroids [OR = 0.394 (0.159–1.811)], which were predictors of FPI in patients with NIPPV. Conclusions: Facial pressure injury may still occur in patients who routinely use prophylactic dressings under NIPPV masks. This study provides information on continuing education training for FPI to more accurately identify high‐risk and timely preventive measures to reduce FPI. Relevance to Clinical Practice: Addressing FPI‐related factors to prevent facial skin damage and reduce comorbidities in patients using NIPPV masks. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to examine the efficacy of cryotherapy with frozen gloves for the prevention of the chemotherapy‐induced peripheral neuropathy of the hand. Background: Most breast cancer patients receive chemotherapy; consequently, patients frequently experience adverse effects of chemotherapy‐induced peripheral neuropathy. Methods: A quasi‐experimental and prospective self‐controlled study was conducted. Breast cancer patients wore frozen glove on the dominant hand for 90 min during their weekly treatment with paclitaxel (80 mg/m2). Treatment of the dominant hand, the intervention group, was continued for 12 weeks. The non‐dominant hand was considered the control group. Results: A total of 22 patients participated in this study, and only one patient did not reach the cumulative dose (960 mg/m2). Findings show that the incidences of sensory and motor symptoms of chemotherapy‐induced peripheral neuropathies at the following times (Time 1 to Time 4) were significantly lower in the intervention group than in the control group. However, although the incidences of motor symptoms were lower in the experimental group than in the control group, a significant difference was shown only at Time 4. Additionally, both groups of patients reported that their incidence of sensory symptoms were higher than those of motor symptoms. Conclusion: Cryotherapy with frozen gloves is useful in reducing both the sensory and motor symptoms of the chemotherapy‐induced peripheral neuropathy of the hands. Summary statement: What is already known about this topic? Most breast cancer patients receive chemotherapy; consequently, patients frequently experience adverse effects of the chemotherapy‐induced peripheral neuropathy.Previous studies have indicated that cryotherapy (frozen gloves or shocks) may effectively reduce chemotherapy‐induced peripheral neuropathy associated with the use of paclitaxel. However, there is limited evidence for the effective treatment of chemotherapy‐induced peripheral neuropathy. What this paper adds? Paclitaxel‐induced peripheral neuropathy is frequently observed in patients with breast cancer and cryotherapy may effectively reduce this.The study results show that cryotherapy with frozen gloves can effectively alleviate the sensory and motor symptoms of the hands in breast cancer patients during chemotherapy.Moreover, we also found that breast cancer patients reporting sensory symptoms had higher motor symptoms during treatment with paclitaxel. The implication of this paper: Cryotherapy is a simple, safe, and effective strategy to prevent chemotherapy‐induced peripheral neuropathy in patients with breast cancer who receive paclitaxel treatment.Moreover, a reduction in group effects may increase the willingness of patients to receive chemotherapy. [ABSTRACT FROM AUTHOR]

The aims of the present study were to investigate changes in QOL in post-stroke patients during the first 3 months of rehabilitation treatment. We estimate minimal detectable changes (MDCs) and minimal clinically important differences (MCIDs) of the eight dimensions of QOL and assess the proportion of patients' change scores that exceed MDCs and MCIDs in stroke survivors who receive rehabilitation in a hospital ward. This prospective cohort study enrolled 40 stroke survivors (57.5% male; M age = 58.3 years) who received in-hospital rehabilitation for a total of 3 months. The Stroke Impact Scale 3.0, which has eight subscales—strength, activities of daily living (ADLs)/instrumental ADLs (IADLs), mobility, hand function, communication, memory and thinking, emotion, and social participation—was used for assessment on the third day of rehabilitation (Time 1), 1 month later (Time 2), and 3 months later (Time 3). Our findings indicated that the MDC95 and MCID proportions varied from 7.5% to 30% and 7.5% to 65%, respectively, of individuals who exhibited change based on individual change scores. The findings show compliance with MDC and MCID values in physical function, with the lowest proportion in hand function. [ABSTRACT FROM AUTHOR]

This study aimed to examine the factors affecting the relationship between stress and anxiety in critically ill patients. A cross-sectional research paradigm was employed to enroll patients admitted to the medical intensive care unit (ICU) of a medical university hospital. Partial least squares structural equation modeling (PLS-SEM) was used to examine the data. A total of 90 ICU patients were included in this study; 56 were men and 34 were women. The patients' mean age was 65.3 years. Only the emotional responses dimension of illness was significantly positively correlated with stress. However, the emotional responses dimension of illness representation, acute physiology and chronic health evaluation system (APACHE) score, age, and education level were significantly positively correlated with anxiety. Nevertheless, treatment control was significantly negatively correlated with anxiety. Overall, illness representations (emotional responses and treatment control), APACHE score, age, and education were important predictors of anxiety, with an explanatory power of 37.9%. We recommend that for clinically relevant practice, besides focusing on ICU patients' illness representation, attention should also be paid to their individual characteristics, such as differences in age and education levels. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine whether interventions that use the Specific Thematic Nursing Care Action Modules (STNC‐AM) platform improve patients' psychological health over a two‐month period. Background: Stroke survivors often are left with a disability after a stroke, which can have an impact on their physical and mental health. Therefore, it is necessary for stroke patients to have tailored programmes in the face of post‐stroke mental health concerns and the need for care information. Design: A non‐randomised controlled pilot study was conducted. Methods: Participants included 44 post‐stroke patients at a medical university hospital, between 1 August 2019–28 February 2021, of whom 24 were assigned to the control group and 20 were assigned to the intervention (STNC‐AM). Data were analysed on an intention‐to‐treat basis. We used the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist (case–control studies) for this study. Results: There were no statistical differences between the two groups at baseline. At the end of two months, however, the scores for resilience, depression and positive factors illness representation were statistically different between the two groups (p <.05). The results of the generalised estimating equation model analysis indicated that resilience and anxiety remained more significant in decreasing depression in the intervention group than in the control group. Conclusion: This preliminary trial suggests that, although action modules may be associated with a decrease in depression post‐stroke, part of this effect was likely associated with an increase in resilience and a decrease in anxiety of the patients. Relevance to clinical practice: The STNC‐AM platform provides a coaching platform that helps patients and caregivers to be effective and accessible. [ABSTRACT FROM AUTHOR]

The purpose of this study is twofold: to examine the relationship between illness representation and self-efficacy and to test the determinants and the effect of self-efficacy, resilience, and stroke impact on fatigue in middle-aged stroke survivors. This study used a cross-sectional and quantitative approach. The instruments included the Chronic Disease Self-Efficacy Scale, Stroke Impact Scale, Resilience Scale, and Fatigue Impact Scale. Structural equation modeling (SEM) was performed to analyze the data. A total of 63 patients with stroke (39 male and 24 female) were recruited form a medical university hospital. The results showed that patients' illness representation had a significantly effect on self-efficacy for managing disease. In addition, SEM analysis demonstrated that self-efficacy, resilience and stroke impact influenced fatigue, explaining 20.6% of the variance in fatigue. It was concluded that to improve patient fatigue, we believe it is imperative to design interventions that improve patients' self-efficacy, promote patients' resilience, and better function. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the relationship between the metabolic syndrome severity Z -score and kidney function by gender. We also examined the estimated glomerular filtration rate in relation to other known risk factors. The study used was a population-based prospective longitudinal research design. A total of 4,838 participants (2,683 females and 2,155 males) included individuals aged >30 years who were undergoing a health examination from 2006 to 2014 in Pingzhen City, Taiwan. In the initial generalized estimated equation model analysis, which included the covariates of age of first visit, period between the first and current visit, and metabolic syndrome severity Z -score, the results indicated that the interaction between age and metabolic syndrome severity Z -score is significantly related to the estimated glomerular filtration rate for males (p =.040). For females, the interaction between age and metabolic syndrome severity Z -score was not significant, but a higher metabolic syndrome severity Z -score was significantly associated with lower estimated glomerular filtration rate (p =.001). After controlling for the confounders, unhealthy behaviors, and comorbidities, the metabolic syndrome severity Z -score was still a negative predictor of estimated glomerular filtration rate in both the male (p =.005) and female (p =.023) models. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine the relationships among nursing students' perceived nursing image, caring behaviours and gender‐friendliness barriers to determine whether gender‐friendliness barriers affect nursing image and caring behaviour among male nursing students. Background: Because caring is typically seen as a feminine trait, male nurses face gender‐role strains in the current nursing environment. Gender‐friendliness barriers may have an impact on the vital relationship between professional nursing image and caring behaviour. Design: This study used a quantitative and cross‐sectional research design. Methods: Participants were 141 male students who had obtained at least 1 month of clinical practice experience. We collected data using three instruments: The Caring Assessment Report Evaluation Q‐sort (CARE‐Q), Gender‐Friendliness Barriers in Nursing Programs (GFB‐NP), and Nursing Image—as a Profession Questionnaire (NIPQ). Data were collected from August 2016–July 2017. Partial least squares structural equation modelling (PLS‐SEM) with bootstrapping was used to test the hypothesis model. Results: The full model results indicated a direct positive and significant path from professional nursing image to caring behaviour (β = 0.47, 95% CI = 0.32 to 0.61, t = 6.19, p < 0.001). Gender‐friendliness barriers had a direct and significant negative relationship between professional nursing image (β = −0.31, 95% CI = −0.49 to −0.12, t = 3.17, p < 0.01) and caring behaviour (β = −0.18, 95% CI = −0.35 to −0.02, t = 2.18, p < 0.05). In addition, the variable of student‐perceived barriers to gender‐friendliness was indirectly and significantly negatively related to caring behaviour (β = −0.15, 95% CI = −0.27 to −0.05, t = 2.57, p < 0.05) through professional nursing image. Conclusion: Male nursing students with a higher nursing image engage in greater caring behaviour. Gender‐friendliness barriers, however, decrease students' nursing image and caring behaviour. Relevance to clinical practice: As applied to nursing education, the goal should be to improve male nursing students' caring behaviours and professional nursing image and decrease gender‐friendliness barriers. [ABSTRACT FROM AUTHOR]

Background: Ensuring the delivery of quality care and patient safety requires that nurses improve their self-reflection and insight as well as their critical thinking. To understand the factors that influence self-reflection, insight, and critical thinking, more evidence-based research is needed. Purpose: The purpose of this study was to examine whether professional qualifications (i.e. age, years of job experience, and position on the clinical ladder) would affect self-reflection and critical thinking in the experienced registered nurses (RNs) group. Methods: This quantitative and correlational study included 597 RNs (297 novice nurses and 300 experienced nurses), recruited from one medical center hospital in central Taiwan, as participants. Data were collected on self-reflection and critical thinking, using the Chinese-version of the Self-Reflection and Insight Scale and the Taiwan Critical Thinking Disposition Inventory. A structural equation modeling approach was used to examine the relationships among variables. Findings: The results showed a non-significant mean difference in self-reflection with insight scores between the two groups. Experienced RNs had a significantly higher mean score for critical thinking. Further analysis of the data of experienced nurses revealed that self-reflection with insight significantly affected critical thinking (β = 0.24, t = 4.141, p <.001). Qualifications also affected self-reflection with insight (β = 0.11, t = 1.808, p >.05) and critical thinking (β = 0.18, t = 3.143, p <.001). The correlation between qualifications and self-reflection with insight, however, was non-significant. Discussion: Nurses who perceived that they had greater self-reflection and insight reported more critical thinking in clinical care practice. Nurses' qualifications had more of an effect on critical thinking than on self-reflection and insight. [ABSTRACT FROM AUTHOR]

Aims and objectives This study identified the factors that affect health-related quality of life at one and six months post-stroke in women who have undergone a mild stroke and that affect their informal caregivers' psychological health status. Background Middle-aged women perform the main care roles in a family. When they suffer a stroke, it upsets the equilibrium of their family life. Design This is a longitudinal design. Methods This prospective follow-up study recruited 41 middle-aged women stroke survivors (mean age = 54·95, SD = 9·63) and their informal caregivers (mean age = 41·56, SD = 15·93). The Short-Form Health Survey (SF-36) was used to assess stroke survivor's health-related quality of life, and the Chinese Health Questionnaire was used to measure the level of depression of the stroke survivor's informal caregiver. Data were analysed through descriptive statistics, Wilcoxon signed-rank tests and the generalised estimating equation approach for modelling repeatedly measures. Results All stroke survivors showed significant improvement in the physical component summary of the health-related quality of life at one and six months after stroke, but there was no significant difference in the mental component summary. In addition, there was no significant difference in the health of the informal caregivers of the women over time. Generalised estimating equation analysis showed that the most important determinant of mental component summary of health-related quality of life among women stroke survivors was cognitive appraisal. The informal caregivers' most important determinants of health status, as measured by level of depression, were their sense of coherence, burden and patients' mental component summary of the health-related quality of life. Conclusion This study highlights the impact of cognitive appraisal in determining health-related quality of life of women stroke survivors and how it affects their caregivers' mental health. Relevance to clinical practice The findings of this study may contribute to home care nurses' understanding the importance of the psychosocial impact of the stroke for the survivor and their ability to help the surviving women to promote the confidence needed for self-care, which will contribute to their quality of life and affect their caregivers' health. [ABSTRACT FROM AUTHOR]

Knowledge of sexual health is an important indicator of the development of healthy adolescent sexuality. An evaluation instrument in nursing school practice, whose results can lead to improved sexual health in adolescents, is needed. We conducted this study to undertake rigorous testing of the Sexual Health Knowledge Scale (SHKS) as a means to ensure a reliable and valid quantitative measure of sexual health knowledge among young adolescent females. A panel of experts assessed the content validity of the 40-item measure. Initial testing involved 481 female adolescents (12–14 years old), using principal component factor analysis with varimax rotation and the determination of Cronbach's alpha coefficients. Confirmatory factor analysis (CFA) was conducted using data from an additional sample of 234 female adolescents (12–14 years old). Principal component factor analysis yielded a four-factor solution with eigenvalues greater than 1 that explained 43.40% of the variance. As a result of the analysis of the scale, 22 items were deleted, resulting in an 18-item scale. The CFA identified a second-order factor termed “sexual health knowledge.” Goodness-of-fit indices showed an acceptable fit overall with the full model (χ2/df(131) = 1.69, RMSEA = 0.054, RMR = 0.013, CFI = 0.92, and GFI = 0.99). We determined that the SHKS is a reliable and valid measure, with good composite reliabilities and goodness-of-fit indices. [ABSTRACT FROM PUBLISHER]

Aims and objectives. The purpose of this study was to test a process model that assesses the relationship of sexual health knowledge and normative beliefs to sexual health behavioural intention, with sexual self-concept as a mediating variable. The model is intended to assist in the prediction of which adolescents would exhibit a lower intention to engage in protective sexual health behaviour. Background. Previous research has shown that sexual-related behaviours are associated with sexual self-concept, sexual health knowledge and perceived parental/peer approval of sexual behaviour. Design. This study is a cross-sectional research. Methods. This study was conducted with 545 adolescent girls, aged 12-15 years, from eight junior high schools in Taiwan. Participants were assessed using the Sexual Self-Concept Inventory, the Sexual Health Behavior Intention Scale, the Parental Approval of Sexual Behavior Scale (PASB), the Friends' Approval of Sexual Behavior Scale and the Sexual Health Knowledge Scale. Data were analysed using structural equation modelling, with the maximum likelihood estimate determined by the LISREL 8.52 program. Results. The model exhibited adequate fit (goodness-of-fit index = 0·96, adjusted goodness-of-fit index = 0·94, normed fit index = 0·96, comparative fit index = 0·98, standardised root mean square residual = 0·049 and root mean square error of approximation = 0·048) and the findings indicate that sexual self-concept was a significant influence on the relationship of sexual health knowledge and normative beliefs to sexual health behavioural intention. Conclusions. The results of this study revealed the importance of sexual self-concept for adolescent girls' sexual health behaviour. Relevance to clinical practice. Evidence-based strategies that reinforce and clarify sexual self-concept as a mediating factor may aid in adolescent females' intention to engage in protective sexual health behaviour. [ABSTRACT FROM AUTHOR]

This study presents a workshop on the Situation Model Nursing Education Action program, examines how to promote gender awareness and decrease barriers related to differences in gender friendliness through the implementation of this program and tracks the trends of the relevant variables. Pre- and post-observations and a cohort study were conducted. A total of 58 nursing students (42 females and 16 males) were included. Nursing students were offered a gender-care intervention as two 90-minute workshops and surveys that measure gender awareness and gender friendliness were administered. The results concerned gender-bias awareness and gender-friendliness barriers scores across the four weeks of the program intervention, with the generalized estimated difference score compared with the Week 1 baseline. Mean student scores showed that gender-bias awareness was significantly decreased at Week 2 (p <.001) and Week 4 (p <.001) and that mean gender-friendliness barrier scores significantly declined at Week 4 (p <.001). The findings indicate that a faculty professional learning community workshop that facilitates intentional behavioral change can help faculty to become aware of gender bias, which can improve students' gender awareness through clinical case discussion and lead to a decline in barriers to students' gender friendliness. • Nursing education should attempt to improve students' gender awareness. • A faculty community workshop that helps faculty to become aware of gender bias. • The Situation Model Nursing Education Action Program was developed by the faculty community team. • A Situation Model Nursing Education Action Program was shown to improve students' gender-bias awareness. [ABSTRACT FROM AUTHOR]

Professional skill development and socialization require appropriate guidance and learning. We aimed to examine the effect of self-appraisal of the clinical simulation care task (CSCT-SA) action program on the self-learning effectiveness, self-reflection and insight, caring behavior, nursing competence, and professional socialization of novice nursing students. This study has a single-group longitudinal research design. Five measurement variables, including students' self-learning effectiveness, self-reflection and insight, caring behavior, nursing competence, and professional socialization, were assessed at the baseline, middle, and termination points of the study. The generalized estimating equation and a latent growth curve model were used to examine research hypotheses. A total of 92 students (22 male and 70 female students) completed three point surveys. Students' learning effectiveness, self-reflection and insight, caring behavior, nursing competence, and professional socialization presented a positive growth trajectory throughout the CSCT-SA action program series. In addition, latent growth curve analyses indicated that the levels of nursing competence and professional socialization, as well as the changes in these variables, were positively associated with each other. Findings support the key role played by nursing competence in enhancing students' professional socialization, which suggests that such competence should be improved to promote professional socialization. • Nursing students require guidance to develop professional and socialization skills. • The CSCT-SA action program can effectively improve the learning ability of nursing students. • Nursing competence is an important covariate of professional socialization trajectories. [ABSTRACT FROM AUTHOR]

Abstract Aim We explored the impact of gender role orientation (masculinity and femininity) on student nurses' caring behaviour and critical thinking. Background Caring and critical thinking are at the core of professional nursing education. Previous studies revealed inconsistent findings regarding the impact of gender roles on caring behaviour and critical thinking. Design and Methods We employed a quantitative correlational study. Nursing students (N = 449; female = 310, male = 139) who had at least had one month of clinical practice experience were recruited from four universities in Taiwan. Students' ages ranged from 19 to 29 years (Mean age = 21.24 years, SD = 1.28). Data were collected from August 2016 to July 2017, using three questionnaires: Taiwan Critical Thinking Disposition Inventory (CTDI), Caring Assessment Report Evaluation Q-sort Scale (CARE-Q), and Bem Sex Role Inventory (BSRI). Partial least squares structural equation modelling and generalized linear models were conducted to test the research model and hypotheses. Results Findings indicated that students who reported higher caring and masculinity presented greater critical thinking (ß =.37 and ß = 0.24, respectively; p s <.001). Students' gender, age, femininity, or clinical practice experience, however, were not significantly associated with critical thinking (ß = -0.01, ß = 0.09, ß =.10, and ß = 0.01, respectively; p s >.05). In addition, students who reported higher masculinity and femininity presented greater caring behaviour (ß =.22 and ß = 0.38, respectively; p s <.001). Students' gender, age or clinical practice experience were not significantly associated with caring behaviour (ß =.04, ß =.03, and ß = -0.05, respectively; ps > 0.05). The findings confirmed a direct influence of caring and masculinity on critical thinking. Masculinity indirectly affected critical thinking via caring behaviour. Caring and masculinity accounted for 34.4% of the variance in critical thinking, and masculinity and femininity accounted for 29.1% of the variance in caring behaviour. Conclusion Our study confirms the effect of age, gender role, and caring behaviour on critical thinking. We recommend that the cultivation of nursing care behaviour focus on students' gender role orientation. In addition, clinical nurse educators, when working with male students on patient caring, should consider their gender role orientation and support male nursing students' ways of presenting caring behaviours. [ABSTRACT FROM AUTHOR]