Nurses' and patients' perceptions of most important caring behaviors in a long-term care setting

Perinatal women's satisfaction with nurses caring behaviours in teaching hospitals in China

BACKGROUND

Adequate caring behaviours provided by nurses can increase patients' satisfaction of care. Yet few researchers have examined women's satisfaction in nurses' caring behaviours in China and then published the study in English.

AIM

The aim of this study was to identify the level of women's satisfaction with nurses' caring behaviours during the antenatal, childbirth and postnatal periods.

METHODS

A descriptive, cross-sectional study was performed using a sample of 422 postpartum women of two teaching hospitals in Wuhan, China. A structured questionnaire on socio-demographic information was completed, and a satisfaction scale of 60 items concerning nurses' caring behaviours was measured.

RESULTS

The findings showed that participants reported a good satisfaction score for nurses' caring behaviours during all three periods. Behaviours on the 'Monitor' subscale obtained the highest score (a mean score of 4.46 for the antenatal period, 4.64 for the childbirth period and 4.31 for the postnatal period). The subscale with the second highest score was 'Human respect' (4.53, 4.27 and 4.56, respectively), while the subscale with the lowest score was 'Trust' (3.78 and 3.98). The statistical significances of the demographics of the women were shown concerning their perceived satisfaction of five subscales of caring behaviours.

CONCLUSION

The study revealed no statistically significant differences in the perceived satisfaction in nurses' caring behaviours between the antenatal, childbirth and postnatal periods. However, nursing administration development projects that focus on caring are still needed. Additionally, more studies that reflect Watson's theory of human caring on the maternity population should be conducted with a larger sample size.

Review of Research Related to Watson's Theory of Caring

Forty retrievable studies are reviewed, covering the period of 1988 to 2003, that were based on Watson’s theory of caring. The author provides an overview of the studies, identifies measurement instruments developed, critiques the body of work, and offers suggestions for future research.

Consumer Satisfaction in Nursing Homes

Surveys of resident satisfaction are commonplace in most nursing homes, although surveys used in many facilities may be biased toward concerns of providers and regulators instead of residents. In this study, content for a nursing home satisfaction survey was synthesized from analysis of 11 published and 5 commercially available instruments, as well as qualitative data from interviews with a diverse group of 15 residents in three New Jersey nursing homes. Content analysis of the 16 instruments yielded six broad domains of resident satisfaction: activities, care and services, caregivers, environment, meals, and well-being. Data from residents yielded 87 discrete areas of content across the six domains. In all domains except meals, existing instruments failed to address at least one area of content considered important by residents. Findings from this study provided a framework to generate items for a standardized resident satisfaction survey to be used in New Jersey nursing homes.

Internal consistency and construct validity assessment of a revised Facts on Aging Quiz for Flemish nursing students: an exploratory study

BACKGROUND

Since more people are reaching older and older ages, healthcare systems are becoming in need of more and more knowledgeable nurses to meet the specific health care needs of older persons. Several instruments exist to measure and evaluate students' knowledge of older persons, ageing, and gerontological care; however, unequivocal evidence on their use and psychometric properties is scarce. The aim of the study was to validate a revised version of Palmore's Facts on Aging Quiz (FAQ).

METHODS

A cross-sectional, exploratory study was conducted. Palmore's FAQ version 1 and Facts on Aging Mental Health Quiz were used as bases for the development of a revised FAQ instrument. Three researchers translated these instruments into Dutch. A panel of nine experts in geriatric research and gerontological care evaluated the translation and the face and content validity of the instrument. We used a cross-sectional, exploratory design to assess its internal consistency and construct validity. Cronbach's alpha coefficients, exploratory factor analysis, and the known-groups technique were used for these analyses.

RESULTS

Based on the experts' consensus, a revised version of the FAQ, consisting of 36 items, was produced. Exploratory factor analysis did not reveal underlying constructs suggesting that the revised version encloses a more general concept of knowledge (e.g. about older persons, aging, gerontological care). Using the known-groups technique, we validated the instrument, showing that it discriminates between the knowledge of first- and third-year nursing students. The overall Cronbach's coefficient of 0.723 was acceptable and changed minimally (from 0.708 to 0.724) when items were removed.

CONCLUSION

We conclude that the revised version of the FAQ can be used to properly evaluate nursing students' knowledge about older persons and gerontological care, as reasonable reliability and validity were established for this revised version of the FAQ.

Nurses' and patients' perceptions of caring behaviours: quantitative systematic review of comparative studies

AIM

This paper is a report of a systematic review conducted to test the hypothesis that nurses and patients perceive the concept of caring in nursing differently.

BACKGROUND

Caring is viewed as the central focus of nursing. However, despite its fundamental place in clinical practice, researchers and scholars have failed in reaching a common definition. This failure has led to eliciting for nebulous interpretations of the concept often leading to perplexity and opposing views between patients and nurses.

DATA SOURCES

Extensive search was conducted using MEDLINE, CINAHL and EMBASE between March and May 2009 with no publishing time limit and the keywords 'care', 'caring', 'nurse', 'nursing', 'behavio(u)rs', 'patient', 'perception', 'quantitative' and 'comparative'.

REVIEW METHODS

This quantitative systematic review of comparative studies followed the guidance of the Centre for Reviews and Dissemination. A seven-item 'yes' or 'no' checklist was developed and used for appraising the quality status of the selected literature. Narrative summary technique was used to report outcomes.

RESULTS

Evidence of incongruence of perceptions between patients and nurses is mainly supported by the literature. Few studies, however, report aspects of congruence.

CONCLUSION

There is considerable evidence of the assertion that there is no congruence of perceptions between patients and nurses as regards to which behaviours are considered caring and intended caring is not always perceived as such by the patient. Further research is needed, however, to generate more knowledge on the relationship between caring behaviours, patient outcomes and health or nursing costs.

Oncology patients' and professional nurses' perceptions of important nurse caring behaviors

BACKGROUND

Caring is the essence of nursing. Caring to be meaningful needs to be based on mutual agreement between nurses and patients as to what constitutes nurse caring behaviors. As a result, healthcare professional can enhance patients' satisfaction of care by providing appropriate caring behavior. However, previous research that combined multiple types of patients, nurses and institutions demonstrated disagreement in prioritizing important behaviors. This paper reports a study that aimed at determining the caring behaviors which oncology patients and oncology nurses perceive to be the most important.

METHODS

This study is a comparative descriptive design that was conducted in an Iranian oncology centre. Convenience sampling was used to recruit 200 patients and 40 nurses to take part in the study. Data were collected over a period of 4 months in 2009 using the Caring Assessment Questionnaire, developed by Larson. Caring behaviors (n = 57) were ranked on a 5-point Likert-type scale and ordered in six subscales: "Being accessible", "Explains and facilitates", "Comforts", "Anticipates", "Trusting relationship", "Monitors and follows through". The data were analyzed using SPSS software version 13.0. The overall mean was calculated for each subscale to determine the rank distribution of the subscales. The nonparametric Mann-Whitney U test analysis of variables was used to compare patients' and nurses' scores on subscales.

RESULTS

The results demonstrate that both groups considered the same order of importance of caring, the high ranking of "Monitors and Follows through and "Being Accessible" and the low ranking of "Comforts" and "Trusting Relationships". Also, Patients only ranked "Being accessible" (p = 0.04) and "Explains and facilitates" (p = 0.03) higher than nurses.

CONCLUSIONS

The oncology patients and nurses perceived highly physical aspects of caring and the results provide for nurses to be aware of the need, during their interactions with patients, to validate the effect their intended caring has upon patients. By so doing and with further refinement of the concept of caring for nursing in studies such as this, the practical aim of making patients feel cared for can be achieved.

An instrument to measure job satisfaction of certified nurse assistants

We first presented the steps taken to develop the nursing home certified nurse assistant job satisfaction questionnaire (NH-CNA-JSQ) and, second, the psychometric properties of this instrument. Certified nurse assistants (CNAs) from 22 nursing homes in Pennsylvania were mailed the NH-CNA-JSQ. Of the 726 surveys mailed, 479 usable surveys were returned, giving a 66% response rate. The factor analyses show that the items were representative of the underlying factors, representing seven subscales. The percentage of CNAs not providing responses for each question was low (1.5%), and the floor and ceiling effects of the responses for each of the 19 questions were low (i.e., 9.4% and 5.2%, respectively). The item-scale internal consistency analyses determined that the correlation of items within indexes was higher than those of items with other indexes. Cronbach's alpha values for the domains ranged from .72 to .83 and were all higher than the usually recommended levels. Criterion validity was high (.77) as was the index of content validity (p > .05). We believe that we have produced a short psychometrically sound job satisfaction instrument for use in nursing homes.

The Language of Caring: Nurse's Aides' Use of Family Metaphors Conveys Affective Care

PURPOSE

Using a conceptual framework from the field of care work and the theory of boundary work, we explore the use of family metaphors by nurse's aides to describe their affective care for nursing home residents. We focus on how nurse's aides can express affective care in spite of experiencing racial abuse.

METHODS

Using the technique of domain analysis, we present a secondary analysis of semistructured interviews with 30 African American and immigrant aides working in three nursing homes about their experience of racism on the job.

RESULTS

Aides used metaphors associated with family, relationships, and attachment to describe their affective care of residents. They expressed the value of their caring by contrasting it with "uncaring" families. Immigrant aides expressed a form of caring culture shock about the uncared-for situation of American elders.

IMPLICATIONS

Through their use of metaphors of family and attachment, these aides define family care as their gold standard of affective care and communicate that they are attempting to provide good care. Aides distinguished caring tasks from affective care in that they applied affective care in an elective way, so that the caring task was the minimum, universal form of care and added affective care created an enriched form of care. They held out informal elder care in their cultures of origin as a model that is superior to the system of formal elder care in which they work. We use the theory of boundary work to explain how these aides provided affective care in the face of racial abuse.

Lamentation and loss: expressions of caring by contemporary surgical nurses

AIM

This paper is a report of a phenomenological study of caring from the perspective of nurses working on surgical wards.

BACKGROUND

While care and caring are complex foundational nursing concepts which have received considerable and ongoing attention from theorists, researchers and clinicians, there has been little research into caring on surgical units.

METHOD

A convenience sample of ten nurses working on surgical units in a public teaching hospital in Canada was interviewed using van Manen's phenomenological approach. Data were collected during 2001 using semi-structured interviews.

FINDINGS

The major theme of lamentation and loss was identified from the data. Participants revealed a dichotomous tension between what caring should be and what actually occurs. This tension was pervasive and generated lament - an expression of grief and mourning for the loss of caring. The essential structures supporting this theme included lack of time, lack of caring support, tasking, increased acuity, lack of continuity of care, emotional divestment and not caring for each other. Loss and sadness were articulated and participants lamented and grieved about the loss of care in contemporary practice.

CONCLUSION

The forces and influences described by participants undermined caring in the new practice milieu. If this is a glimpse of the future, then the values of the nursing profession may be under siege. Caring as the central core, the essence or unifying concept of nursing may be subject to marginalization in contemporary practice.

Quality of Care

A tool was developed, using the nominal group and Delphi techniques, to explore healthcare staff's perceptions of the quality of hospital care provided in the United Kingdom compared with a tool from the United States. Similarities were identified in many core areas; however, there were several differences between the UK and US tools. This article identifies the process and findings and discusses possible reasons for similarities and differences between the tools.

The care encounter: Pondering caring, honest communication and control

The proposition presented in this paper is that caring, underpinned by beneficence and non-maleficence, assumes that nurses will make determinations about another's best interests and act accordingly. With some emphasis on high-level (nursing home) aged care, it is the author's contention that nurses give priority to communication that controls the care encounter rather than acting in another's best interests. This view is supported in the literature, which suggests that nurses perceive honesty and information-sharing as less important in caring than do patients, and nurses' perception that telling another the truth is harmful and, therefore, contravenes the duties of beneficence and non-maleficence.

An exploration of the caring attributes and perceptions of work place change among gerontological nursing staff in England, Scotland and China (Hong Kong)

This study investigates caring attributes and perceptions of work place change among qualified and unqualified nursing staff working with older people in three countries. A Modified Caring Attributes Questionnaire and Perception of Workplace Change Schedule were administered to 737 staff. Caring attributes scores were highest for nurses working in long stay settings, and lowest in nurses aged 25-29 years. Nurses in Hong Kong appear better educated than UK counterparts. Staff development seemed more common in long stay settings. Results suggest workplace changes limiting care quality were more pronounced in Scotland. Reported job satisfaction and moral were lowest in the UK group.

Response formats and satisfaction surveys for elders

PURPOSE

A factor common to the results of many satisfaction surveys of elders is a lack of response variability. Increasing response variability may be useful if satisfaction surveys of elders are to be productively used in the future. In this paper, we first examine elders' preferences between five response formats and then examine the response variability of these five commonly used formats.

DESIGN AND METHODS

Satisfaction, demographic, and Short-Form 36 Health Survey data were self-reported by patients in four outpatient surgery centers during 1998 and 1999. We used six different survey instruments randomly given to 3,122 elders. Five instruments varied in response format (5-item Likert format, 5-item satisfaction format, 5-item valuation format, 4-item Chernoff faces, and 10-item visual analogue format). The sixth survey used all five different response sets, and then it asked for the respondents' preferences among the different response sets.

RESULTS

A total of 2,450 questionnaires were examined (response rate of 78.5%). The response format using four Chernoff faces was liked the least, with only 5% of the respondents preferring this format. The 10-item visual analogue format (10VAF) was liked the most, with 39% of the respondents preferring this format. In addition, 10% more elders thought this format was easier to use than the second-place choice (i.e., 32% vs. 22%). The coefficient of variation for the 10VAF was also higher than those in identical domains using the other response formats. This would seem to indicate that the 10VAF is less prone to a ceiling effect than the other response formats.

IMPLICATIONS

Our results show that elders have a preference for some response formats, and from the choices we gave them a 10VAF was preferred. The 10VAF also had more response variability then the other formats we tested.

Nurses' perceptions of care and caring

Care and caring have been identified as inherently difficult concepts to define, but many authors believe that care is the central and unifying core of nursing. It is vital that nurses understand what care is, with the current issues about measuring and justifying exactly what they do for patients in order to be clear about what good care is. If nurses are to constantly improve the care they give, they need to be clearer about how to care for patients. Nurses need to make sure that they are giving the patients what they want and not what the nurses want. This review of the literature explores nurses' perceptions of care and compares it with what patients want in terms of care. It also highlights some important and interesting differences between what patients and nurses perceive as good care.

Quantitative measurement of caring

Caring is a difficult, elusive concept not only to define but also to measure. Eleven different quantitative instruments designed to measure caring are reviewed. Out of these 11 caring instruments, seven are Likert scales, two are visual analogue scales, one is a checklist, and one is a Q-sort. For each of these instruments the following information is provided: description of the tool, such as number of items and length of time to administer; conceptual definition of caring upon which it is based; reported reliability and validity; and the instrument's use in research studies. Comparison of these instruments revealed that different aspects of caring are measured by these tools such as caring behaviours, satisfaction with caring behaviours, ability to care, and response to caring behaviours. Some caring instruments are designed to be completed by patients only, by nurses only, or by either patients or nurses. Multiple factors need to be taken into consideration by nurse researchers in deciding which instrument to use to measure caring.