Nursing students' perceived parental child-rearing attitudes and ego identity and their relationship with college adjustment: Research Article

doi:10.21203/rs.3.rs-3142103/v1

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Research Article

Nursing students' perceived parental child-rearing attitudes and ego identity and their relationship with college adjustment: Research Article

https://doi.org/10.21203/rs.3.rs-3142103/v1

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published 02 Jan, 2024

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Background: This exploratory investigation aimed to determine whether nursing students' perceived parental child-rearing attitude and ego identity were associated with college adjustment.

Methods:This study surveyed 224 nursing students enrolled in universities located in two regions within South Korea. Collected data were subjected to correlation analysis using SPSS version 26.0 for Windows.

Results:Among the parental child-rearing attitudes, paternal emotional warmth (r =.30, p <.001), maternal emotional warmth (r =.38, p <.001), and ego identity (r = 0.71, p <.001) were positively associated with nursing students' college adjustment, whereas maternal rejection was negatively correlated with ego identity (r = −.28, p <.001) and college adjustment (r = −.15, p =.025).

Conclusions:To improve nursing students' college adjustment, universities should establish programs that promote ego identity, provide education on parental child-rearing attitudes for underclassmen and parents, and improve parent–child relationship.

Adaptation

Ego identity

Parental Child-rearing Attitude

Parent–Child Relations

Students

Nursing

Nurses work in various settings, including hospitals, clinics, schools, and home health agencies. Moreover, they work closely with other health care professionals, including doctors, pharmacists, and social workers, to provide comprehensive health care services to patients [1], as well as education and emotional support to patients and their families. As such, nurses play a unique and essential role in health care[1, 2].

In South Korea, the number of nurses working in health care organizations increased from 2.4 to 4.4 per 1,000 people over the past decade (from 2011 to 2020) [3, 4]. The number of nursing school enrollments in South Korea has also increased over the past decade. In 2020, the number of students enrolled in nursing education institutions per 1,000 population was 0.4 and continues to increase [5].

While the number of students enrolled in nursing programs has increased, the number of those who drop out, either by taking a leave of absence or dropping out, has also escalated [6]. Nursing students, like other college students, may experience maladjustment during the transition from high school life to college life, which is centered on admissions. Common causes of maladjustment experienced by nursing students include academic stress, homesickness, financial difficulties, lack of social support, parental child-rearing attitude, and difficulty adapting to a new environment [7, 8]. In particular, nursing students experience anxiety and increased stress during their university life due to the heavy academic workload, more than 1,000 h of clinical practice, and preparation for the national nursing examination to acquire specialized knowledge in nursing

Maladjustment can affect their physical and mental health, academic achievement, and overall college life of nursing students and must be prevented and managed. Moreover, maladjustment in nursing students increases stress, anxiety, and depression [9], which can negatively impact their academic success and future careers [10]. Furthermore, maladjustment in nursing students can have broader implications for the health care industry as a whole [8] considering that nursing students who struggle to adjust to college are more likely to drop out or perform poorly [11], which can lead to a societal problem in the form of a future shortage of qualified health care workers [4]. Therefore, addressing the problem of maladjustment in nursing students is of considerable importance.

Research on the adjustment of college nursing students needs to examine various factors. In particular, internal and external factors need to be explored in such studies.

Parenting attitudes (an individual's extrinsic factors) refer to how an individual perceives parenting practices, such as discipline, communication, and warmth [12]. Another paper defines parenting attitudes as an individual's subjective perception of how their parents treated them and how their parenting style influenced their personality traits, beliefs, values, and behaviors [13]. Nursing students’ perceived parenting attitudes may influence their beliefs, values, and behaviors as health care professionals [3]. Ego identity (an individual's intrinsic factors) is the perception of oneself as a unique and distinctive being, reflecting on not only one's own views of one's own characteristics and values but also the views of others [14]. Ego identity begins to form and develop in childhood and is fulfilled during the psychosocial crises experienced during the college years as one transitions from adolescence to adulthood [15]. Nurse identity begins to form during the college years after entering nursing school and continues to develop throughout the nursing profession [16]. As such, parenting attitudes and ego identity are important intrinsic and extrinsic factors in understanding nursing students' adjustment to college [17, 18].

Therefore, this study aimed to examine the relationship between parental child-rearing attitudes (external factors) and ego identity (internal factors) and college adjustment among nursing students. Furthermore, based on the results of this study, we hope to provide a better understanding of nursing students' college adjustment and basic data for the development of programs to improve nursing students' college adjustment.

2.1. Study Design

This is an exploratory survey study to determine the relationship between nursing students’ perceived parental child-rearing attitudes, ego identity, and college adjustment.

2.2. Measurements

2.2.1. Parental Child-Rearing Attitude

Parental child-rearing attitude was measured using the s-EMBU instrument [19] developed by Arrindell and adapted into a Korean version by Jo [20]. This instrument consists of three subcategories (parental emotional warmth, parental rejection, and parental overprotection). This instrument consists of 23 items and is scored using a 4-point Likert scale. Each item is measured on a scale from 1, “No, never,” to 4, “Yes, most of the time,” with higher scores indicating higher characteristics of that subdomain. In the Arrinde study, the Cronbach's alpha of the instrument was 0.79 for paternal emotional warmth, 0.79 for maternal emotional warmth, 0.76 for paternal rejection, 0.77 for maternal rejection, 0.80 for paternal over protection, and 0.82 for maternal over protection [19]. In Jo's study, the Cronbach's alphas of the instruments were 0.88 for parental emotional warmth, 0.75 for parental rejection, and 0.72 for parental overprotection [20]. In the current study, the Cronbach's alpha of the parental child-rearing instrument was 0.82 for paternal emotional warmth, 0.80 for maternal emotional warmth, 0.81 for paternal rejection, 0.82 for maternal rejection, 0.078 for paternal over protection, and 0.79 for maternal over protection.

2.2.2. Ego identity

Self-identity was measured using the Korean version of the ego identity scale developed by Park [21] and revised by Park [22]. This instrument consists of six subcategories (initiativeness, self-receptiveness, confirmativeness for future, goal orientedness, subjectivity, and intimacy). The tool consists of 60 items and is scored on a 5-point Likert scale. Each item is measured on a scale from 1 (Not applicable at all) to 5 (It applies very much), with higher scores indicating higher ego identity. The Cronbach's alpha of the revised ego identity instrument was 0.94 [22]. In the current study, the Cronbach's alpha of the ego identity instrument was 0.96.

2.2.3. College Adjustment

College adjustment was measured using the college adjustment scale developed by Jeong and Park [23]. This instrument consists of five subcategories (interpersonal relations, academic activities, career preparation, personal psychology, and social participation). The instrument consists of 19 items and is scored on a 5-point Likert scale. Each item is measured from 1 (not at all) to 5 (very much so), with higher scores indicating higher adjustment to college. The Cronbach's alpha of the instrument was 0.86 in Jeong & Park's study[23] and 0.90 in this study.

2.3. Data Collection and Ethics

Before data collection, the survey was approved (IRB#: EU19–82) by the Institutional Review Board (IRB) of Eulji University to which the researcher belongs. Data were collected from 14 October to 31 November 2019. This study was conducted among nursing students enrolled in universities located in cities D and J, South Korea. The researcher visited each university to explain the study’s purpose, need, and data collection procedure; to obtain cooperation from university officials; and to survey those who agreed to participate in the study. The questionnaires were handed out in person, and the self-completed questionnaires were collected by the researcher in person. The sample size was calculated using G*Power version 3.1.9.2, a sample size calculation software. Considering an effect size of 0.4, significance level of 0.05, and power of 0.80 required for correlation analysis, a minimum of 204 subjects were needed [24]. Considering the 15% dropout rate, 235 people were surveyed with a return rate of 95%, and 224 copies were used for the final analysis.

2.5. Data Analysis

The collected data were analyzed using SPSS (IBM Corporation, New York, USA) for Windows. The reliability of the scales was verified using Cronbach’s α. General characteristics are presented using frequencies and percentages, whereas parental child-rearing attitude, ego identity, and college adjustment are presented using descriptive statistics (mean and standard deviation). College adjustment according to the general characteristics of nursing students was analyzed using the t-test and ANOVA, and a post-hoc analysis was conducted using Scheffé's test. Correlations between parental child-rearing attitude, ego identity, and college adjustment were analyzed by Pearson's correlation coefficient.

3.1. Participant Demographics and Characteristics

The general characteristics of the subjects included in this study are summarized in Table 1. There were 193 (86.2%) and 31 (13.8%) female and male students, respectively. According to grade level, 61 (27.2%), 56 (25.0%), 55 (24.6%), and 52 (23.2%) were juniors, sophomores, seniors, and freshmen. The most common religious affiliation was none at 138 (61.7%). The education levels of the students’ parents were as follows: college graduate, high school graduate or less, and graduate school or more (Table 1).

Table 1. Participants’ characteristics.

		(N = 224)
Variables	Categories	n (%)
Sex	Female	193(86.2)
	Male	31(13.8)
Grade	1st	52(23.2)
	2nd	56(25.0)
	3rd	61(27.2)
	4th	55(24.6)
Religion	Christian	46(20.5)
	Catholic	24(10.7)
	Buddhist	16(7.1)
	None	138(61.7)
Father′s education	≤High school	66(29.5)
Father′s education	College/University	130(58.0)
	＞College/University	28(12.5)
Father′s education	≤High school	86(38.4)
Father′s education	College/University	124(55.4)
	＞College/University	14(6.2)

3.2. Correlation among Research Variables

Correlations between parental child-rearing attitude (paternal emotional warmth, paternal rejection, paternal over protection, maternal emotional warmth, and maternal rejection, maternal over protection), ego identity, and college adjustment are shown in Table 2.

College adjustment was significantly positively correlated with paternal emotional warmth (r =.30, p <.001), maternal emotional warmth (r =.38, p <.001), and ego identity (r =.71, p <.001) but significantly negatively correlated with maternal rejection (r = -.15, p =.025; Table 2).

Table 2. Differences in college adjustment according to participant characteristics.

					(N=224)
Variables	Categories	Mean	SD	t or F	p
Sex	Female	66.02	12.17	−0.50	.647
	Male	67.06	9.31
Grade	1st^a	66.37	10.82	6.79	<.001
	2nd ^b	60.50	13.45		B < c,d ^*
	3rd^c	68.38	10.64
	4th^d	69.27	10.28
Religion	Christian	68.91	9.62	1.56	.187
	Catholic	66.00	13.17
	Buddhist	70.13	13.27
	None	64.79	11.98
Father′s education	≤High school	66.91	10.43	0.43	.730
Father′s education	College/University	65.51	12.50
	＞College/University	67.18	11.98
Father′s education	≤High school	66.10	11.05	0.51	.602
Father′s education	College/University	65.85	12.23
	＞College/University	69.21	12.77
^* p <.050 by Scheffé’s test

3.3. Differences in College Adjustment According to Participant Characteristics

The variable with a significant difference in college adjustment according to the general characteristics of the participants was grade (F = 6.79, p <.001; Table 3).

In this study, a significant difference in college adjustment was observed according to grade level (F = 6.79, p <.001). Post-hoc tests showed that third- and fourth-year students had significantly better college adjustment than did second-year students (Table 3).

Table 3. Correlations among the measured variables.

									(N=224)
Variables		Paternal child-rearing attitude			Maternal child-rearing attitude			Ego identity r(p)	College Adjustment r(p)
Variables		Emotional warmth r(p)	Rejection r(p)	Over protection r(p)	Emotional warmth r(p)	Rejection r(p)	Over protection r(p)	Ego identity r(p)	College Adjustment r(p)
F^*	Emotional warmth	1
	Rejection	−.29 (<.001)	1
	Over protection	.19 (.005)	.51 (<.001)	1
M^**	Emotional warmth	.66 (<.001)	−.27 (<.001)	−.02 (.770)	1
	Rejection	−.22 (.001)	.67 (<.001)	.39 (<.001)	−.47 (<.001)	1
	Over protection	.07 (.269)	.25 (.001)	.64 (<.001)	−.01 (.899)	.40 (<.001)	1
Ego identity		.46 (<.001)	−.24 (<.001)	−.09 (.178)	.56 (<.001)	−.28 (<.001)	−.08 (.246)	1
College adjustment		.30 (<.001)	−.09 (.172)	−.06 (.337)	.38 (<.001)	−.15 (.025)	−.07 (.281)	.71 (<.001)	1
^* Paternal child-rearing attitude ^** Maternal child-rearing attitude

This study focused on registered nurses as a promising profession for the future in line with global trends in population aging and an increasing demand for health care services [2, 25, 26]. In recent years, the number of registered nurses in Korea has increased due to the shortage of registered nurses [4]. Unfortunately, the number of students dropping out of the program, such as taking a leave of absence or dropping out, has also increased [6]. Therefore, the current study was conducted to provide basic data in hopes of enhancing nursing students' college adjustment. Specifically, our study examined the relationship between an individual's external (i.e., parental child-rearing attitude) and internal (i.e., ego identity) factors and college adjustment among nursing students.

After examining the relationship between nursing students' perceived parental child-rearing attitude, ego identity, and college adjustment, we found that paternal emotional warmth, maternal emotional warmth, and ego identity were significantly and positively associated with college adjustment (Table 3). The parental child-rearing attitude measurement tool used in this study consists of three subcategories, namely parental emotional warmth, parental rejection, and parental over protection [20]. More specifically, parental emotional warmth included “My parents praised me,” “I think that my parents tried to make my adolescence stimulating, interesting and instructive,” “If things went badly for me, I then felt that my parents tried to comfort and encourage me,” “My parents showed with words and gestures that they liked me,” “I felt that warmth and tenderness existed between me and my parents,” and “I felt that my parents were proud when I succeeded in something I had undertaken.” In other words, parental emotional warmth describes the overall positive parental child-rearing attitudes, such as fondness, pride, praise, comfort, and tenderness [20]. This study found that the external support system of these individuals, especially parental emotional warmth in the closest relationship, enhanced nursing students' ego identity and improved their adjustment to college. Parental support helps college students trust themselves and take responsibility for their actions, which is consistent with previous research showing that parental support and affection enhance ego identity[17, 27]. Affectionate parental child-rearing attitudes have a positive impact on college adjustment and help college students become more accepting, respectful, and confident in themselves [17]. They also help increase the psychological well-being of college students and improve their interpersonal problem-solving skills [28]. In particular, parental emotional warmth (as a subcategory of parental child-rearing attitudes) can provide support and stability for college students in coping with stress and emotional problems while also promoting their inner maturity and development [29]. Based on these previous findings and the results of the current study, we can surmise that parental support and affection have a positive effect on college students' self-identity.

On the other hand, the current study found that nursing students' perceived maternal rejection was negatively associated with self-identity and college adjustment (Table 3). This finding supports previous research showing that parental rejection leads to negative outcomes, such as social anxiety, psychological maladjustment, and smartphone addiction in college students [30–32]. Nursing students' perceived parental rejection leads to anxiety and maladjustment in nursing students and hinders the development of future health care workers [32]. Therefore, universities should establish an organized system to prevent this. For example, universities should engage mothers and provide programs, such as education, counseling, and faculty–parent–student meetings that could improve parenting attitudes. Such programs could provide opportunities for sustaining and enhancing positive parenting attitudes throughout the college years, an early period of self-identification. In addition, these programs can help nursing students adjust to college.

In the current study, nursing students’ ego identity was found to be positively associated with college adjustment. This is consistent with the findings of Kwon [33], who reported that college students' ego identity was positively associated with college adjustment and was a significant factor in explaining college adjustment. College students with a high ego identity tend to have an excellent perception of their own personality and worth, recognize their own competence, and have high self-confidence [33]. Moreover, such students are able to establish a realistic view of themselves and plan for the future based on this view [34]. This disposition has a positive impact on college adjustment [34]. In addition, college students with a high ego identity may have better social and relationship skills given that they are more active in their relationships with others and can resolve interpersonal problems amicably [35]. In short, college students' ego identity can have a positive impact on college adjustment. To this end, universities should provide various programs, such as college life support programs, stress management programs, and mentoring programs, through student counseling centers, learning support centers, and employment support centers to enhance nursing students' adaptation to university [36, 37]. Furthermore, the existing programs in South Korea need to be strengthened and systematically provided to enhance the internal and external factors of college students' ego identity and parental emotional warmth.

As adults, college students become independent of their parents and can psychologically separate their values and beliefs from their parents and make independent choices to live their own lives [38]. Although this process may lead to conflicts with parents, it also allows them to form and strengthen their ego identity [33]. During this time, parents need to respect and support their child's choices to help them develop independence and establish their ego identity, recognize their child's ability to be competent and independent, and provide appropriate support when needed rather than be overly interfering. Parents should have an appropriate child-rearing attitude to help their children establish their ego identity. An appropriate parenting attitude is one that is affectionate, supportive, and trusting of the child, not rejecting or overprotective [31]. Parental roles and appropriate parenting attitudes can be achieved through ongoing education. There have been studies on education and parenting attitudes from infancy to adolescence [39]. However, parenting education for college students who have reached adulthood is very rare in Korea. Therefore, to improve students' adaptation to university, universities should establish programs that not only help students establish their ego identity (an internal factor) but also strengthen their parenting attitude (an external factor) to help them establish their ego identity and adapt to university.

Among general characteristics analyzed herein, only grade level was significantly associated with college adjustment among nursing students. In the current study, third- and fourth-year nursing students had significantly better college adjustment than did second-year students (Table 2). This is consistent with previous research showing that college adjustment increases with grade level [17]. This suggests that as nursing students progress from lower to higher grades, the anxiety, stress, and burden they experienced as freshmen decrease [10], resulting in better college adjustment.

Nursing students who are well-adjusted to college have improved academic skills and academic achievement, as well as better job adjustment [17]. This is an important foundation for providing high-quality nursing care to clients after graduation. Therefore, universities should help nursing students successfully complete their college career academically and personally by preventing and resolving maladjustment issues early in order to generate professional nurses that would contribute to the future of the health care industry. Therefore, universities should be more proactive in helping nursing students adjust to university by developing and implementing ego identity enhancement programs for students and providing parenting seminars for parents.

The current study was conducted to determine the relationship between perceived parental child-rearing attitudes, ego identity, and college adjustment among nursing students. Among the perceived parental child-rearing attitudes of Korean nursing students, paternal emotional warmth, maternal emotional warmth, and ego identity were positively associated with college adjustment. In addition, among the perceived parental child-rearing attitudes of nursing students, maternal rejection was negatively associated with ego identity and college adjustment. The significance of this study lies in its further confirmation of the relationship between ego identity, an internal factor, and parental child-rearing attitude, an external factor, in exploring factors affecting college adjustment of nursing students. The results of this study may be helping develop programs to improve ego identity and appropriate parental child-rearing attitude education for successful college adjustment of nursing students.

This study was conducted with a sample of nursing students from universities located in two regions of Korea; hence, there may be limitations in the generalization of the results. Nevertheless, the subjects included herein were enrolled in a nursing college (Baccalaureate) accredited by the Korean Nursing Education Accreditation Commission. As such, these findings are reflective of nursing education in the province and appear congruent with global findings. We hope that the study will be replicated with nursing students in other countries and that further research will be conducted on various factors affecting nursing students' college adjustment. We also recommend that systematic programs be developed at the nursing college level to positively influence parental child-rearing attitudes.

This study was performed in accordance with relevant guidelines and regulations. Also this survey was approved by the Institutional Review Board(IRB) of Eulji University(IRB No.EU19-82).

Ethics approval and consent to participate
This survey was approved (IRB#: EU 19–82) by the Institutional Review Board (IRB) of Eulji University. Informed consent was obtained from all the subjects involved in the study.

Consent for publication
Not applicable

Availability of data and materials
The data that support the findings of this study are available from [Eulji IRB] but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of [Eulji IRB].

Competing interests

The authors declare that they have no competing interests.

Funding

This paper was supported by Woosuk University.

Authors' contributions

Hye Seon Choi wrote the main manuscript text, and Sona Lee prepared the tables and results. All authors reviewed the manuscript, with special contributions from Eunju Seo.

Acknowledgements
The authors would like to thank Enago (www.enago.jp) for the English language review.

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No competing interests reported.

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Nursing students' perceived parental child-rearing attitudes and ego identity and their relationship with college adjustment: Research Article

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Abstract

1. Background

2. Methods

2.1. Study Design

2.2. Measurements

2.2.1. Parental Child-Rearing Attitude

2.2.2. Ego identity

2.2.3. College Adjustment

2.3. Data Collection and Ethics

2.5. Data Analysis

3. Results

4. Discussion

5. Conclusions

Declarations

References

Additional Declarations

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