Instrument development and preliminary validation of a scale assessing pre-nursing students’ perceived instructor care in anatomy and physiology

Background: While numerous studies have shown a correlation between student-instructor rapport and student academic performance, few studies have investigated the relationship between students’ perception of instructor care and academic performance, particularly in gateway STEM courses. Anatomy and Physiology, a gateway course to nursing programs, is generally associated with high rates of unsuccessful outcomes.

Method: A psychometric instrument was developed to identify the attributes that pre-nursing students perceive as indicators of instructor care. The instrument also measures the extent to which students attribute instructors’ care to their academic performance in Anatomy and Physiology. A preliminary validation of the instrument was completed to assess its reliability and validity.

Results: This paper describes a pilot study to assess the reliability and preliminary validation of the instrument.

Conclusion: This tool contributes to existing scholarly work on student–instructor relationships and supports institutional decisions aimed at improving student academic performance. However, full empirical and structural validation of the instrument is reserved for future large-sample studies to further establish its factor structure, stability, and generalizability.

1 Introduction

One area receiving attention from researchers as a best-practice predictor of student success in higher education is the student-instructor rapport (Berková and Krejèová, 2016; Tormey, 2021). Additionally, research has shown a strong correlation between student-instructor rapport and academic performance in gateway STEM (science, technology, engineering, and mathematics) courses and successful degree completion (Bani and Haji, 2017; Caruth, 2018; Koch and Pistilli, 2015; Lewis and Terry, 2016). In the context of pre-nursing education, it is essential to understand factors that promote the successful completion of STEM gateway courses for entry into nursing programs. Anatomy and Physiology (A&P) is a gateway course that serves as a prerequisite for nursing programs and is often associated with low rates of successful completion. Despite the importance of understanding student-instructor rapport, few studies have examined students’ perceptions of A&P instructors’ care.

Instructor care refers to the behaviors, attitudes, and interactions through which instructors demonstrate concern for students’ academic, emotional, and motivational wellbeing. Noddings (1984) conceptualizes care as an ethic grounded in attentiveness, responsiveness, and the creation of supportive learning relationships, which help students feel valued and understood. Empirical research further shows that instructor behaviors such as clear communication, empathy, availability, and encouragement strengthen student–instructor rapport and positively influence engagement and academic performance, particularly in challenging gateway courses (Deep et al., 2024; Li, 2022; Zhou, 2021). Thus, instructor care encompasses both affective and instructional practices that contribute meaningfully to student success.

There are no instruments that allow researchers to identify attributes that pre-nursing students perceive as indicators of instructor care and to measure the extent to which students contribute to instructors’ care to academic performance in A&P. The purpose of this study is to develop and validate an instrument to identify attributes that pre-nursing students perceive as indicators of instructor care and to measure the extent to which students contribute to instructors’ care to academic performance in A&P. The findings add to existing scholarship on the student-instructor relationship and provide a framework for researchers to gain a deeper understanding of student success in higher education, ultimately promoting degree completion and workforce employability.

Numerous studies demonstrate the impact of instructor rapport on student academic performance (Lammers et al., 2017; Schriver and Harr Kulynych, 2021; Wade and Kasper, 2006). Using the Student–Instructor Rapport Scale-9 (SIRS-9) instrument, Lammers et al. (2017) found that students who perceived higher rapport with their instructor scored better on exams and that student-instructor rapport was predictive of final grades. Schriver and Harr Kulynych (2021) also highlight the importance of student-instructor rapport in higher education by utilizing the Professor–Student Rapport Scale (PSRS), the General Mattering Index, and the Interpersonal Mattering Scale. However, their study concludes that student-instructor rapport was predictive of students’ instructor rating rather than associated with final grades. Wade and Kasper (2006) developed a survey instrument, the Nursing Students’ Perceptions of Instructor Caring (NSPIC), that uses a 6-point Likert scale for student responses. However, this instrument has been used only with students in nursing programs and does not measure the extent to which students contribute to instructors’ care in academic performance. While these studies have used various survey instruments to examine the role of the student-instructor relationship in student academic performance in gateway courses, no instrument identifies the instructor attributes that pre-nursing students perceive as indicators of instructor care and relationship to academic performance in undergraduate Anatomy and Physiology courses.

Two theories, Tinto’s institutional departure model and Noddings’ ethics of care model, guide this study (Noddings, 1984; Tinto, 1975). First, Tinto’s institutional departure model describes three main components that influence the process by which students leave an institution before graduation: academic and social integration, goal commitment, and institutional commitment (Tinto, 1975). Tinto argues that “interaction with faculty not only increases social integration and therefore institutional commitment but also increases the individual’s academic integration” (p. 109). This model suggests that a more substantial commitment to the institution arises when the student experiences greater social and academic integration. Second is Noddings’ ethics of care model, which argues that “caring” is an integral component of the educational system and should be at its heart (Noddings, 1984). This philosophy is grounded in the belief that caring relationships between students and instructors are paramount to successful learning outcomes and that care involves demonstrating concern for students’ wellbeing beyond the classroom. Given the significance of the student-institution integration in Tinto’s institutional departure and the centrality of the caring relationship in the ethics of care, these two models serve as a valuable theoretical framework for developing an instrument to identify attributes that pre-nursing students perceive as indicators of instructor care and to measure the extent to which students attribute instructors’ care to their academic performance in Anatomy and Physiology. This study applies these frameworks to guide instrument construction and provides a preliminary validation. This study aimed to answer the following research questions:

1. How to identify attributes that pre-nursing students perceive as Anatomy and Physiology instructor care?

2. How to measure the extent to which pre-nursing students contribute their academic performance in Anatomy and Physiology to instructor care?

2 Materials and methods

This study followed the four recommended phases for instrument development outlined by Creswell and Guetterman (2024): planning, construction, quantitative evaluation, and validation. Tinto’s (1975, 2017) institutional departure model, Noddings (1984) ethics of care, and the Nursing Students’ Perception of Instructor Caring instrument (NSPIC) (Wade and Kasper, 2006) served as the guiding frameworks throughout the development process. During the planning phase, the researchers clarified the purpose of creating a psychometric questionnaire and identified the target population—pre-nursing students enrolled in undergraduate Anatomy and Physiology (A&P). The overarching aim was to design an instrument capable of identifying the instructor attributes perceived as indicators of care and measuring the extent to which these attributes contributed to students’ academic performance in A&P.

2.1 Instrument design

During the construction phase, the researchers determined the instrument’s structure and developed items aligned with the established literature on instructor–student relationships, caring behaviors, and academic integration. The instrument was constructed by a research design, assessment, and evaluation professor in collaboration with a content expert in anatomy and physiology. Item generation was grounded in Tinto (1975) model and Noddings (1984) ethics of care, as well as prior measures of instructor rapport, to ensure strong theoretical alignment. These theoretical frameworks served primarily as guides for item and domain construction rather than for empirical structural validation. Consistent with the preliminary nature of this study, full empirical validation of the instrument’s factor structure is intentionally reserved for future large-sample research. Items were created to capture the dimensions most relevant to pre-nursing students navigating a gateway STEM course.

In addition to theory-driven development, the researchers incorporated elements from validated instruments, including the NSPIC, the Professor–Student Rapport Scale (PSRS; Wilson and Ryan, 2013), and the Student–Instructor Rapport Scale–9 (SIRS-9; Lammers et al., 2017). Items addressing empathy, instructor attentiveness, responsiveness, communication clarity, and emotional support were conceptually adapted and rewritten to reflect the academic, cognitive, and affective demands of A&P. This adaptation process ensured conceptual continuity with existing constructs while tailoring item language to the context of pre-nursing education.

The final questionnaire included four sections (Table 1). Section I comprised 15 demographic items addressing age, gender, ethnicity, language, academic status, year in school, housing, major, support systems, and study habits. Section II included ranking and Likert-scale items measuring students’ perceptions of instructor care across three personality-linked domains of the Big Five framework (conscientiousness, agreeableness, neuroticism) and three pedagogical domains central to instructor care: communication, motivation, and emotional wellbeing. All Likert-type items were treated as interval-level data, consistent with common psychometric practice in preliminary scale development, enabling parametric analysis and item comparison. Section III included Likert-scale items measuring the degree to which students attributed their A&P academic performance to perceived instructor care, including communication, motivational support, and emotional support. Section IV invited students to describe, in an open-ended format, specific experiences illustrating how their instructor created either a positive or negative climate of care.

TABLE 1

Table 1. The structure of the questionnaire design.

To establish content and face validity, the full item set underwent review by a panel of four experts selected for their disciplinary expertise, teaching experience, and knowledge of assessment or survey design. Experts independently evaluated each item for clarity, relevance, and alignment with theoretical constructs. Their evaluations yielded 97% agreement, and qualitative feedback informed item refinement, including wording adjustments, redundancy removal, and improved conceptual coherence. These revisions resulted in the finalized pilot version of the instrument.

2.2 Data collection

Sixty-four participants completed the pilot study, all students in Anatomy and Physiology enrolled at a regional university in Southwest Florida. Qualtrics, a web-based survey platform, was used for online administration. Participants were invited to complete the survey along with the purpose of the study. All participants were assured of the confidentiality of their responses. The pilot study was essential to ensuring the validity and reliability of the final version of the instruments (Fink, 2008). Descriptive and correlational statistics were used to describe sample characteristics and analyze respondents’ responses.

3 Pilot study and results

The questionnaire was distributed online to 90 students between April and June 2024. Sixty-four completed surveys were submitted for a response rate of 71.1%. A sample of 64 participants meets established methodological recommendations for pilot instrument validation, as researchers suggest that samples of 30–100 are sufficient for preliminary reliability testing and item refinement (DeVellis, 2012; Johanson and Brooks, 2010).

The full 51 questionnaire items demonstrated excellent reliability, with a Cronbach’s α = 0.93, indicating excellent internal consistency of the instrument measuring the underlying construct (DeVellis, 2012). Most of the respondents were female (73%), White/Caucasian (40%), 18–20 years old (58%), and in their second year (41%). Table 2 outlines the respondents’ demographic data from section I of the survey.

TABLE 2

Table 2. Demographic data of the respondent.

In Section II, the respondents were asked to rank instructor attributes in order of perceived importance as indicators of care within the three personality traits (5 = most important, 1 = least important). These Likert-type responses were treated as interval data for statistical analysis, consistent with standard practice in educational and psychometric research when Likert scales demonstrate strong reliability and approximate equal intervals between response options. This approach allowed for the use of parametric analyses; however, in accordance with the preliminary nature of this pilot study, all inferential statistical findings (including regressions and ANOVA) are presented explicitly as exploratory rather than confirmatory. This framing aligns with the study’s purpose of generating initial insights to inform future large-scale validation work.

Figure 1 shows the frequency of respondents’ rankings of instructor attributes indicating care, in order of importance. The attribute “confident” within the “conscientiousness” personality trait had the highest overall frequency of most important ranking (Figure 2). The top four attributes ranked as indications of care were: “empathetic” (M = 3.30, SD = 1.10), “punctual” (M = 3.24, SD = 1.57), “sensitive (M = 3.22, SD = 1.68), and “competent” (M = 3.17, SD = 1.50) (Table 3). The descriptive analysis of the pilot study summarized respondents’ perceptions of the attributes of the A&P instructor across the three personality traits (Table 4).

FIGURE 1

Figure 1. Frequency of respondents’ ranking of instructor attributes indicating care in order of importance.

FIGURE 2

Figure 2. Mean of respondents’ perception of instructor attributes across the three personality traits.

TABLE 3

Table 3. Mean and standard deviation of respondents’ ranking of instructor attributes indicating care in order of importance.

TABLE 4

Table 4. Mean and standard deviation of respondents’ perception of instructor attributes under three of the big five personality traits.

The respondents perceived the instructors’ personality trait of “conscientiousness” slightly higher (M = 4.83, SD = 0.45) as compared to “agreeableness” (M = 4.80, SD = 0.56) and “neuroticism” (M = 4.78, SD = 0.57) (Table 4). A one way ANOVA revealed that there was no statistically significant difference in the mean score between the “conscientiousness” and “agreeableness” [F(1, 124) = (0.016), p = 0.90] with a small observed effect size f (0.011) and η² = 0.0001 (Table 5). Additionally, 73.02% of the respondents strongly agreed they would say “A&P lecture instructor cares about me.” Multiple linear regression was used to examine the extent to which the three instructor personality traits, conscientiousness, agreeableness, and neuroticism, predict respondents’ perception of instructor care (Table 6). The overall regression was statistically significant, F(3, 59) = 8.85, p < 0.001, with the model accounting for roughly 31% of the variance in respondents’ perception of instructor care (R² = 0.31, R²_adj = 0.27). Conscientiousness was a significant positive predictor (β = 0.40, p < 0.001), suggesting that instructors perceived as more conscientious were more likely to be viewed as caring.

TABLE 5

Table 5. ANOVA Comparison of conscientiousness and agreeableness personality traits.

TABLE 6

Table 6. Multiple linear regression examining the extent to which the three instructor personality traits, conscientiousness, agreeableness, and neuroticism, predict respondents’ perception of instructor care.

The respondents were subsequently asked to rate their level of agreement with statements about their A&P instructor in relation to three domains of care: motivation, communication, and emotional wellbeing using a Likert scale (1-strongly disagree and 5-strongly agree). Table 7 outlines the mean and standard deviation of the responses to each of the questions within each domain. Although the domain “communication” was perceived as the highest domain of care (M = 4.88, SD = 0.43), a multiple linear regression examining the extent to which the three domains of care predict respondents’ perception of care showed “communication” was not a predictor (β = –0.01, p = 0.956) (Table 8), while “motivation” was a significant positive predictor (β = 0.55, p = 0.001). The culmination of results of in Section II of the instrument answer our research question one.

TABLE 7

Table 7. Mean and standard deviation of respondents’ rating of statements about the A&P instructor and the three domains of care.

TABLE 8

Table 8. Multiple linear regression examining the extent to which the three domains of care, motivation, communication, and emotional wellbeing, predict respondents’ perception of instructor care.

Section III aims to answer our second research question. The respondents were asked to rank their level of agreement regarding academic performance as it relates to instructor communication, concern for the level of motivation, and emotional wellbeing. 95.24% of respondents strongly agreed that instructor communication positively impacts academic performance. Similarly, 93.65 and 95.24% strongly agreed with instructor motivation and emotional wellbeing, respectively, positively impacting academic performance. Section III concludes with respondents selecting the percentage of their academic performance that they attribute to the A&P lecture instructors’ care. Respondents selected the following: Less than 25% (4.76%), 26–50% (19.05%), 51–75% (31.75%), 76–100% (44.44%).

Finally, three open-ended questions asked respondents to describe how their A&P instructor created a favorable climate of care, a negative climate of care, and how the instructor’s care influenced their academic performance. Forty-five respondents provided written feedback. These responses were analyzed using qualitative content analysis to identify recurring patterns and themes (Creswell and Poth, 2018). Two coders independently conducted open coding to identify meaningful units of text related to students’ perceptions of caring and non-caring instructional behaviors. After initial coding, the coders compared and refined their individual code lists, resolving discrepancies through discussion. Axial coding was then used to group related codes into broader categories, which were subsequently synthesized into overarching themes capturing students’ experiences with instructor communication, motivational support, and emotional wellbeing in the A&P classroom. To ensure the rigor and dependability of the analysis, intercoder reliability was assessed using percent agreement, which exceeded 90% following codebook refinement. Remaining disagreements were resolved through consensus, strengthening the credibility and trustworthiness of the qualitative findings.

Three overarching themes were identified: instructional support and clarity, emotional reassurance and encouragement, and personalized attention and flexibility. The first theme, instructional support and clarity, reflected students’ perceptions that instructors who consistently monitored understanding, answered questions thoroughly, and adjusted pacing contributed to a climate of care. Representative quotes included: “They thoroughly went through what the class needed to know and would continue to answer questions until everyone understood them,” and “He ensured we understood the material and was extremely helpful.” Students also emphasized that instructors who frequently checked comprehension, such as “Making sure we are all ready to move on,” helped reduce anxiety and improve learning.

The second theme, emotional reassurance and encouragement, highlighted students’ value for instructors who motivated them, validated their efforts, and responded compassionately to stress. Many students described feeling supported when instructors reassured them about academic challenges: “Always encourages us to try our best and reassures overthinking/stressed students” and “Assured us that there was no right or wrong answer.” Small gestures of care were also meaningful: “Our instructor brought us bagels one morning because she was worried that we weren’t eating before class,” and “She noticed some of us do not eat breakfast…so she went out of her way to bring us snacks.”

A third theme, personalized attention and flexibility, captured how instructors adjusted their approach to individual needs. Examples included academic flexibility (“He accommodated when there was an issue with schedules”), technological support (“There was understanding when I had computer issues and helped me resolve them”), and respect for diverse backgrounds (“As an international student…I mispronounce terms; she corrects me respectfully”). Students also appreciated when instructors provided multiple avenues for engagement and help, such as “He walked around and checked up on students” and “Implemented a buddy system so we could support each other.”

The qualitative findings reinforced and enriched the quantitative results. Quantitatively, students strongly agreed that communication, motivation, and emotional wellbeing positively impacted academic performance (over 93% agreement). The themes identified in the qualitative analysis aligned directly with these domains. For example, the theme of instructional support and clarity aligns with high student ratings in the instructor communication domain. In contrast, the theme of emotional reassurance directly supports the motivation and emotional wellbeing domains. Additionally, several quotes described how caring behaviors improved confidence and comprehension, complementing quantitative patterns showing modest associations between instructor care attributes and academic performance.

These convergent findings support the quantitative findings in this study. Students consistently articulated the mechanisms through which perceived instructor care supported their engagement and performance. The qualitative data thus provide explanatory depth and highlight the interpersonal processes, such as reassurance, personalized support, and instructional clarity, that underlie the quantitative associations observed in the study.

To determine the instrument’s accuracy, readability, and suitability, three Anatomy and Physiology instructors and one associate professor of management were invited to serve as content experts and review the preliminary version of the questionnaire. These experts were selected based on (a) a minimum of 5 years of teaching experience in higher education, (b) demonstrated disciplinary expertise in A&P or assessment and measurement, and (c) familiarity with student–instructor relationship research or survey design. Each expert independently evaluated all items to establish both face validity (clarity, readability, and appropriateness of wording) and content validity (relevance, representativeness, and alignment with the intended constructs).

Experts were provided with a structured evaluation form in which they rated each item using a 4-point relevance scale and offered qualitative comments regarding clarity, potential redundancy, and alignment with the theoretical framework. Their ratings were compiled to calculate item-level and scale-level content validity indices. As shown in Table 9, the average expert agreement was 97%, exceeding commonly accepted thresholds for strong content validity (Wahono and Chang, 2019). Qualitative feedback from the experts was used to refine the instrument further, including revising ambiguous wording, improving the logical flow of items within each domain, eliminating repetitive items, and enhancing alignment between items and the constructs derived from Tinto’s (1975) institutional departure model and Noddings’s (1984) ethics of care. The iterative revisions resulting from this expert review contributed to the development of a clear, coherent, and theoretically grounded pilot instrument.

TABLE 9

Table 9. Content and face validity.

4 Discussion

The purpose of this study was to develop an instrument to identify attributes that pre-nursing students perceive as indicators of instructor care and to measure the extent to which students attribute instructors’ care to academic performance in A&P. The results showed that the instrument demonstrated strong reliability and provided preliminary evidence of validity in identifying how instructor care contributes to academic performance in A&P courses. Full construct validation, however, will require future studies with larger and more diverse samples. The development of this instrument fills a gap in existing scholarly work on the student-instructor relationship. It provides a framework for researchers to deepen their understanding of student success in higher education. Additionally, this instrument helps educators assess teaching philosophy and pedagogy to enhance student academic performance.

4.1 Instructor attributes as indicators of care

Findings from this study highlight key instructor attributes that pre-nursing students perceive as indicators of care within the A&P learning environment. Attributes such as empathy, punctuality, competence, and sensitivity were consistently ranked as the most meaningful indicators of instructor care. These results align with Noddings (1984) ethics of care framework, which emphasizes that caring relationships in educational contexts rely on attentiveness, responsiveness, and authentic regard for students’ wellbeing. When instructors demonstrate awareness of student needs, whether through timely communication, emotional support, or preparedness, students interpret these behaviors as clear signals of care.

The prominence of the conscientiousness personality trait in predicting whether students felt their instructor cared about them further supports existing literature. Behaviors such as organization, reliability, and consistency communicate to students that the instructor values their time and learning process. This finding complements previous research on student–instructor rapport, which has shown that relational qualities, including dependability, fairness, and emotional sensitivity, contribute significantly to positive student perceptions (Deep et al., 2024; Li, 2022; Zhou, 2021). The attributes identified in this study, therefore, reinforce the idea that care is communicated to students through both interpersonal warmth and professional competence.

Given the high-stakes nature of A&P as a gateway course, these findings offer important insight. Pre-nursing students may be especially attuned to instructors’ behaviors and attitudes because they perceive success in A&P as critical for admission to nursing programs. When instructors demonstrate care through their actions and communication patterns, students may feel more secure, more motivated, and more engaged, which are key factors in high-demand STEM courses (Koch and Pistilli, 2015; Lewis and Terry, 2016).

4.2 Instructor care and academic performance

This study provides further evidence that perceived instructor care is strongly associated with students’ academic performance. More than 93% of students reported that instructor communication, motivation, and emotional support positively contributed to their success in A&P. These findings align with those of Di Lisio et al. (2025), who found that instructor care is associated with academic engagement, which in turn leads to better academic performance. These results also align closely with Tinto (1975) institutional departure model, which emphasizes the importance of academic and social integration for students’ persistence. Instructor care, as communicated through motivational feedback, emotional support, and effective communication, serves as a critical mechanism for promoting both types of integration. When students perceive that instructors care about their progress, they are more likely to persist through challenging course content, maintain confidence in complex topics, and exhibit higher levels of grit and academic engagement. This may explain why a large proportion of students reported that instructor care accounted for 50–100% of their academic performance.

The findings also highlight the unique pressures faced by pre-nursing students. Because progression into nursing programs is competitive, students may attribute even greater weight to relational support and instructor behaviors that reduce stress and cognitive overload. This aligns with Wade and Kasper (2006) work with the NSPIC instrument, which demonstrated that caring instructor behaviors play a central role in students’ emotional comfort and perceived success. The current study builds on this by providing evidence that, in the context of A&P, these caring behaviors may also contribute directly to academic outcomes.

4.3 Accuracy, reliability, and suitability of the instrument

The instrument demonstrated excellent internal consistency (Cronbach’s α = 0.93), providing strong evidence of reliability in measuring attributes of instructor care and their perceived relationship to academic performance. These results offer preliminary validation of the instrument’s suitability for use with pre-nursing populations enrolled in A&P courses. The high content and face validity ratings from experts (97% agreement) further indicate that the items are aligned with the intended constructs and are appropriate for evaluating instructor care within a STEM context.

The four-phase development approach: planning, construction, quantitative evaluation, and validation, followed Creswell and Guetterman (2024) recommended procedures, enhancing the methodological rigor of the study. Additionally, aligning survey items with established instruments such as the NSPIC (Wade and Kasper, 2006) and rapport scales (Deep et al., 2024; Li, 2022; Zhou, 2021) strengthened the theoretical coherence of the developing measure. Unlike prior tools, however, this instrument expands beyond identifying caring behaviors to also assess students’ perceptions of how instructor care affects their academic performance, an important consideration in the context of A&P as a high-stakes gateway course.

Taken together, these findings indicate that the instrument is accurate, reliable, and promising as an initial measure of instructor care for pre-nursing students. However, full empirical validation, including factor analysis, test–retest reliability, and structural validation remains necessary in future large-sample studies to further establish its robustness and generalizability.

4.4 Limitations

Several limitations should be considered when interpreting the findings of this study. First, the small pilot sample was drawn from a single regional university, which may limit the generalizability of results to other institutional types, geographic regions, or student populations. Perceptions of instructor care and academic influences may differ in larger universities, community colleges, or programs with different demographic compositions.

Second, the study relied on self-reported data, which may be influenced by social desirability bias or students’ emotional responses to recent academic experiences. Students who performed better may have been more likely to attribute their success to the instructor’s care. In contrast, students who struggled may have attributed their performance to factors other than relational factors. Future work incorporating objective course performance data would strengthen this relationship.

Third, the instrument measures students’ perceptions of instructor care, not instructors’ actual behaviors. While perceptions are essential to understanding rapport (Zhou, 2021), observational or mixed-methods designs could provide more comprehensive insight.

Fourth, the study was conducted over a single semester. Instructor care may have cumulative, long-term effects that this pilot design does not capture. Repeated administration across multiple semesters and instructors would provide more substantial evidence of stability and predictive validity. Moreover, although the instrument demonstrates high reliability and strong content validity, further psychometric testing is required before broad implementation. Because the pilot sample consisted of 64 participants, the study did not conduct Exploratory Factor Analysis (EFA) or Confirmatory Factor Analysis (CFA), as factor-analytic procedures generally require substantially larger samples, typically 5–10 participants per item or a minimum of 150–300 participants to yield stable and interpretable factor structures (DeVellis, 2012; Worthington and Whittaker, 2006). Future large-scale validation studies with adequately powered samples will be necessary to conduct EFA, CFA, test–retest reliability, and external validity analyses to establish the instrument’s construct validity further.

4.5 Theoretical implications

The findings of this study offer Tinto (1975) assertion that meaningful interactions with faculty increase a student’s commitment to the course and institution. More specifically, the care-driven interactions identified in this study signal that instructor behavior directly influences students’ academic integration, particularly in challenging STEM courses where academic stress is high, and persistence is critical for program progression. The attributes identified by pre-nursing students in this study, empathy, sensitivity, competence, and punctuality, align directly with Noddings (1984) conceptualization of “caring encounters.”

Together, these findings suggest that instructor care serves as a vital bridge between the interpersonal and institutional dimensions of learning. Care-based behaviors promote emotional security and trust, supporting Noddings’ view of relational pedagogy, while simultaneously enhancing academic integration, as described by Tinto. This intersection points to a powerful theoretical synergy: caring instructor behaviors do not merely shape affective experiences; they directly contribute to academic persistence and performance in demanding academic contexts.

By preliminary validating a tool that captures these constructs, the present study extends both theories into the empirical domain of A&P and pre-nursing education. The instrument creates a future pathway for researchers to systematically investigate how relational care can be strengthened to improve outcomes in STEM gateway courses, offering new opportunities to integrate care-based pedagogies with student persistence models in higher education.

5 Conclusion

This study developed and provided preliminary validation of an instrument designed to identify instructor attributes that pre-nursing students perceive as indicators of care and to examine the extent to which these perceptions relate to academic performance in A&P, a critical gateway course for entry into nursing programs. Across both quantitative and qualitative findings, students consistently associated care with instructor attributes rooted in conscientiousness and agreeableness, such as empathy, punctuality, sensitivity, and competence. These attributes not only shaped their perceptions of classroom care but also influenced their confidence and engagement in A&P.

Notably, the majority of respondents reported that instructor care contributed substantially to their academic performance in the course, by more than 50% in many cases. Students described instructor communication, motivational support, and emotional responsiveness as integral to their learning, thereby reinforcing the well-established link between instructor–student rapport and academic success. The psychometric strength of the instrument, as demonstrated by high internal consistency and expert-validated content, further supports its suitability for assessing perceptions of instructor care in STEM gateway courses.

Overall, the results suggest that relational care is not peripheral but central to student success in rigorous prerequisite pathways such as pre-nursing. By identifying the specific caring behaviors valued by students, this instrument can guide faculty development, improve course design, and support institutional efforts to increase persistence and degree completion among aspiring healthcare professionals. Continued use and refinement of this instrument can deepen insights into student–instructor relationships and inform evidence-based teaching practices across higher education.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the author, without undue reservation.

Ethics statement

Ethical approval was not required for the study involving humans in accordance with the local legislation and institutional requirements. Written informed consent to participate in this study was not required from the participants or the participants’ legal guardians/next of kin in accordance with the national legislation and the institutional requirements.

Author contributions

NK: Conceptualization, Formal analysis, Investigation, Methodology, Writing – original draft. JZ: Writing – review & editing, Methodology. JC: Data curation, Writing – review & editing. VW: Data curation, Validation, Writing – review & editing. RS: Validation, Writing – review & editing.

Funding

The author(s) declared that financial support was not received for this work and/or its publication.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

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