Of the 120 first-year nursing students, 77 (64.17%) completed all three parts of the questionnaire. Respondents’ mean age was 21.53 (SD = 4.02). The sample comprised 37.7% males (n = 29; M = 23, SD = 3.36) and 62.3% females (n = 48; M = 20.48, SD = 4.80).
Motivation for nursing studies
The thematic analysis of students’ answers to the open question concerning their choice of nursing degree course identified seven distinct themes:
- Willingness to care for people (HEL)
- Human contact (HUM)
- Healthcare-related personal experiences (EXP)
- Personal interest in scientific topics (TOP)
- Job opportunities (JOB)
- Family tradition (FAM)
On average, two categories were selected for each subject (M = 1.86, SD = 0.94). Table 1 summarises the identified themes and subthemes of the thematic analysis, with a brief description of each. The category ‘Other’ was not included in the following analyses due to their scarcity and heterogeneity.
As shown in Table 2, the highest reported motivation was the willingness to care for and help others (HEL). The second most frequently stated motivation concerned job opportunities (JOB). The category related to social influences (FAM) rarely appeared in students’ reported answers.
Hierarchical cluster analysis, conducted using the R function ‘heatmap’, where the heat scale corresponding to the correlation matrix values, and confirmed with SPSS software, suggested associations among different categories (see Figure 1). The desire to help others (HEL) in association with the family’s influence (FAM) formed the first cluster of motivation. The second cluster was the association between healthcare-related experiences (EXP), such as voluntary work in healthcare settings or a family member’s hospitalisation, with the desire to enter into contact with other people (HUM). These two clusters were separated by the cluster formed by job opportunities (JOB) and personal interest in scientific topics (TOP).
This preliminary result seems to suggest a more complex motivational structure with respect to a dichotomous separation between internal and external motivational factors . The internal motivational factors (EXP, HUM, HEL and FAM) can be subdivided into two clusters. The first cluster groups motivations oriented towards the individual (EXP and HUM), while the second groups the other two categories, which are more related to a prosocial attitude (HEL and FAM). The external dimension appears to be represented by the JOB and TOP categories.
An exploratory factorial analysis (EFA) was conducted to better understand these clusters of motivations. The properties of the correlation matrix, related to the limited sample size and the relative sporadic occurrence of the various categories, only partially support the possibility to conduct the EFA with three components with eigenvalues larger than 1, explaining 63% of the total variance (KMO test < .50, Bartlett test: c 2 = 23.67, df = 15; p < 0.1). The very good compatibility between the outcomes of the PCA, with three factors and varimax rotation, and the previous hierarchical structure (Table 3) supports the validity of these findings.
The loads in Table 3 confirm the motivational structure in Figure 1. In particular, the second rotated component, denominated RC2 in Table 3, appears connected to an external dimension, with job opportunities as the strongest motivational theme. The third component, denominated RC3, seems to correspond to internal motivations oriented to individual interests, with major loadings on the categories EXP and HUM related to personal experience and human personal contact, respectively. Finally, the first RC1 component reflects the internal motivations with a prosocial orientation, and the categories HEL and FAM prevail; that is, categories oriented towards the needs of other people, with a negative correlation with TOP. Motivation and empathy scores are separately analysed in the subsequent part of this paper, after which correlations between motivation and the scores in the JSE questionnaire are examined.
Observing the frequencies of the different categories with respect to gender and age, some differences can be highlighted (see Table 2). In females’ motivations, the categories that refer to the willingness to help and care, as well as healthcare related experiences, are recurrent (HEL, HUM, and EXP). In males, the highest reported motivations, other than the HEL category, are more oriented towards job security (JOB) and interest in scientific topics (TOP). This gender difference is statistically significant (c2 = 34.22, df = 5; p < 0.01).
For the younger students (‘Young’ and ‘Mid’ classes in Table 2, age £ 21), the frequencies of the motivation categories are not different with respect to the total sample. Older students (‘Old’ class in Table 2, age > 21) were shown to give more relevance to motivations related to job opportunities (JOB). These differences have a weaker statistical significance (p < 0.04).
Descriptive statistics are reported in Table 4 regarding the JSE-HPS administered to the first-year students in the nursing degree course. The mean and standard deviation of the JSE-HPS empathy total scores and the statistical analysis are summarised. Considering the JSE scores reported in the literature [28, 48], the statistics that were obtained agree with the expected values and confirm a good external validity of the data collected in this sample.
Taking gender into account (Table 5), the mean of empathy scores was higher for female students (M = 114.90, SD = 10.20) than for males (M = 106.90, SD = 12.97). The non-parametric Kruskal-Wallis test confirmed a significant difference (c2 = 6.73, df = 1; p < 0.01) between the empathy total scores, and this difference was more significant if the subscale ‘Compassionate Care’ is considered (c2 = 11.16)
Regarding age, there was no significant correlation between the JSE scores and students’ age when tested with an ordinary linear regression model. The separate analysis of each of the three age classes (‘Young’, with age £ 19; ‘Mid’, with ages between 20 and 21; ‘Old’, with age > 21) confirms differences among the groups. The study of the interaction between age and gender shows a significant effect for the differences in the total JSE scores only in the case of younger students, with young females’ total scores being higher than those of young males (p < 0.05). For the other two age classes, these differences were not statistically significant.
Associations between the motivation for choosing nursing studies and JSE-HPS empathy scores
The data in Table 5 show that higher empathy scores are associated with internal motivation, particularly with the internal motivations with a prosocial orientation (HEL and FAM). The external motivational factors (JOB and TOP) are associated at mean scores below the average, but this difference is only significant for the TOP category.
The results of the PCA were used to obtain a more statistically significant analysis of the associations between motivation and empathy scores.
Starting from the components illustrated in Table 3, it is possible to obtain a personal score vector for each student in the sample, which summarises their position in the three-dimensional space defined by the three rotated components: RC1, RC2, and RC3. Consequently, all components can be regressed on the JSE-HPS scores. When the JSE scores are used, we obtain two interesting correlations: a positive correlation between the prosocial scores (RC1) and the JSE total scores, and a negative correlation between the external dimension scores (RC2) and the scores in the JSE-HPS subscale ‘Compassionate Care’ (see Table 6). No other analysis shows statistically significant results.