Attitudes and skills in caring for family caregivers among undergraduate nursing students and influencing factors: A psychometric validation and cross-sectional European study

Background: Family caregivers provide most of the long-term care and can benefit from support by nurses, yet undergraduate nurses feel unprepared. The aim of this study was to investigate students' attitudes and skills in caring for family caregivers and influencing factors. To reach this aim, the specific objectives were a) psychometrically validate the "Attitudes and skills of undergraduate nursing students in caring for family caregivers" instrument; b) describe the attitude and skill levels; c) evaluate educational exposure effect on attitudes and skills. Methods: Validation study and cross-sectional study conducted in four European undergraduate nursing programmes (Denmark, Italy, Spain, and Sweden). Psychometric validation was performed using EFA and CFA. Associations between educational exposures and attitudes and skills were examined using univariate and multivariable linear regression models. Results: Nursing students (n = 1307 out of 2230) across the three years of the undergraduate programme participated. The attitudes subscale was unidimensional with high internal consistency. For skills, EFA identified a three-factor structure, and CFA showed acceptable fit across other countries. Mean attitude scores increased across academic years (Year 1: 48.09 ± 6.81; Year 3: 50.24 ± 6.82; p < .001), as did total skills scores (Year 1: 69.04 ± 14.80; Year 3: 81.62 ± 13.19; p < .001). In multivariable models, attendance at a dedicated teaching module was associated with better attitudes and skills. Internship training objectives were associated with higher skills but not attitudes. Direct experience with family caregivers was associated with higher attitudes and skills, with the highest scores observed when exposure occurred in all clinical placements (attitudes: B = 3.47, 95% CI 2.20-4.73; total skills: B = 10.12, 95% CI 7.65-12.59). Supervisor openness was associated with attitudes only when present in all experiences (B = 1.87, 95% CI 0.31-3.42), whereas supervisor facilitation was associated only with skills (all experiences on total score: B = 7.69, 95% CI 4.91-10.47). Clinical context openness to family involvement showed no association after adjustment. Conclusions: Nursing education should ensure curricular content on family caregiving, explicit internship objectives, repeated direct contact with family caregivers during training, and supervisors' training to actively facilitate learning, to prepare future nurses to engage families not only as partners in care but also as a central unit of care.