The importance of nurse caring behaviors as perceived by patients receiving care at an emergency department

Critical analysis of the scientific production on Jean Watson's Theory of Human Care

OBJECTIVES

to analyze current scientific production on the use of the theoretical-methodological precepts of Jean Watson's Theory of Human Care/Clinical Caritas Process.

METHODS

quantitative, exploratory, descriptive study using data from 1979 to 2023 in the Scopus database. Analysis was carried out using VOSviewer software.

RESULTS

the 73 studies included establish a network of collaboration among 221 authors from 155 institutions in 18 countries, who discuss the development of ethical behavior in nursing staff, through technical improvement, implementation, and validation of instrumental strategies capable of measuring and evaluating the quality of holistic and empathetic care. The Theory of Human Caring contributes to nursing training and care, and Process Clinical Caritas-Veritas is useful for the different possibilities of practice and education.

CONCLUSIONS

it is important to strengthen with more empirical data a nursing work model centered on individual human care, supporting the evolution of scientific nursing knowledge.

Perceptions of Caring Behaviors among Patients and Nurses

The concept of caring is fundamental to nursing practice. The aim of this study was to investigate patients' and nurses' caring behaviors and the possible differences between the two groups. In this descriptive and comparative study, 310 patients and 329 nurses from six general hospitals from Greece completed the Caring Behaviors Inventory-16. The mean score of Caring Behaviors Inventory-16 for patients was 78.94 (±17.85) and for nurses 80.27 (±9.36). The items "Demonstrating professional knowledge and skills" (Mean: 5.45 ± 3.62) and "Treating my information confidentially" (Mean: 5.34 ± 1.06) were the most important caring behaviors while the items "Including me in planning care" (Mean: 4.36 ± 1.56), and "Treating me as an individual" (Mean: 4.55 ± 1.46) were the least important caring behaviors for patients. For nurses, the most important caring behavior was "Treating patients" information confidentially" (Mean: 5.43 ± 0.94) and the least important was "Returning to the patient voluntarily" (Mean: 4.57 ± 3.68). Significant differences were observed in items: "Attentively listening to me/the patient" (t = -2.05, p = 0.04), "Treating me/the patient as an individual" (t = -7.82, p = 0.00), "Being empathetic or identifying with me/the patient" (t = -2.80, p = 0.00), and "Responding quickly when I/the patient call (t = -2.01, p = 0.04). Respect, privacy, and dignity were the most important caring behaviors for nurses while for patients they were knowledge, skills, and safety.

Translation, adaptation, and validation of the Filipino version of the Caring Behaviors Inventory

Background

The way patients perceive nurses' caring behaviors can potentially impact patient outcomes and satisfaction. Studies have revealed incongruence between nurses' and patients' perceptions with regard to which behaviors are considered caring.

Objective

This study aimed to conduct a cross-cultural validation and evaluation of the psychometric properties of the Caring Behaviors Inventory (CBI-16), a self-report questionnaire, from English to Filipino.

Methods

A descriptive cross-sectional design involving forward and back-translation with bilingual translators, expert validation, and a survey in a sample of patients and nurses was used. The psychometric evaluation used a sample of 142 staff nurses and 180 hospitalized patients. Exploratory factor analysis, internal consistency reliability, and inferential statistics were used for data analysis.

Results

The Filipino version of the CBI-16 (CBI-16-FIL) had excellent internal consistency (Cronbach's alpha of 0.95) and a unidimensional factor structure (accounted for 85% of total variance). The CBI-16-FIL was found to be a valid, reliable, and unidimensional tool to measure the perceptions of nurse caring behaviors in the Philippines.

Conclusion

The CBI-16-FIL can be used to measure perceptions of nurse caring behaviors. There is a need for further studies involving other cultures, dyadic samples of nurses and patients, and larger sample sizes.

Psychometric Properties of the Caring Behaviors Inventory-16 in Ethiopia

Background: The Caring Behaviors Inventory-16 (CBI-16) is a comprehensive instrument measuring caring behaviors as experienced by patients. The study aimed to translate, culturally adapt and evaluate the psychometric properties of the CBI-16 among adult patients who speak the Amharic language. Methods: The measure was completed by 304 hospitalized patients. Construct validity was evaluated via exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and contrasted groups’ validity. Total CBI-16 scores were compared between groups that differed in self-rated satisfaction with care (Patient Satisfaction Instrument) to examine the contrasted groups’ validity. Reliability was assessed using internal consistency (Cronbach’s alpha). Results: The EFA suggested a four-factor model accounting for 66.1% of the total variance. The items loaded onto the subscales were similar to the CBI-24. The CFA supported the four-factor model with acceptable fit indices: normed Chi-square value 2.65 (X2 = 259.60, df = 98), SRMR = 0.06, and RMSEA = 0.07, CFI = 0.88 and TLI = 0.86. The contrasted groups’ validity was supported by significantly higher CBI-16 scores reported by patients more satisfied with their care (t = 3.66, p < 0.001). The reliability of the instrument was satisfactory (Cronbach’s alpha = 0.83). Conclusions: The Amharic version of the CBI-16 displayed a four-factor solution and was shown to be a valid and reliable instrument for the assessment of the perceptions of caring behaviors in Ethiopia.

The Effect of Caring Training on the Implementation of Caring Behavior and Work Culture of Nurses in Providing Services to COVID-19 Patients in an Indonesia’s National Referral Hospital

BACKGROUND: Nursing services are one of the criteria for hospital health care. Nurses are the health care workers who have the most contact with patients. Nurses had relatively limited interaction with patients during the epidemic. As a result, it is necessary to increase caring behavior in service delivery. AIM: This study aims to determine the effect of caring training on the implementation of caring behavior and work culture of nurses in providing services to COVID-19 patients in an Indonesia’s National Referral Hospital. METHODS: This study used a quasi-experimental design, with one-group pretest-posttest approach. The study was carried out in Indonesia’s National Referral Hospital. The research was conducted between August and December 2021. The caring training lasted around 4 h. Purposive sampling was used to select the sample, which included as many as 92 persons. The Caring Behaviors Inventory-42 and value culture tools were used to collect data. Questionnaires and observation sheets were utilized to retrieve direct measurement data. The collected data were analyzed using a univariate test and a Wilcoxon test for bivariate analysis. RESULTS: The average age of nurses was 34 years old, with an average working time of 9 years. There was no significant difference in knowledge between before and after care training (p > 0.05). However, there was a significant difference in attitude, work culture, and caring behavior between before and after caring training (p < 0.05). CONCLUSIONS: When nurses provided care to COVID-19 patients in an Indonesian national referral hospital, the caring training had an impact on their behavior and work culture. The hospital should continue a compassionate training program, reinforce it with regulations, monitor assessments, and apply rewords and consequences.

Developing and psychometric properties of the caring behaviors assessment tool-patient version-short form

PURPOSE

To develop and examine the psychometric properties of the caring behaviors assessment tool-patient version-short form (CBAP-SF) based on Human Caring Theory to evaluate caring behaviors by patients.

METHODS

This methodological study was conducted with 400 patients. The data were analyzed with SPSS 23.0 and LISREL 8.80.

FINDINGS

It was found that the scale with 27 items had good fit indices. The Cronbach's α was 0.96 for the scale and 0.77-0.94 for the subdimensions. Also, the item-total score correlation of the scale was 0.531-0.847.

PRACTICE IMPLICATIONS

The CBAP-SF was a valid and reliable tool to evaluate caring behaviors by patients.

Sonographers' experiences of being a caring professional within private practice in the province of Gauteng

Background

Medical imaging has been driven by technological advancements. However, the concept of caring has now become a significant element in the healthcare profession. Within a South African context, there are principles that emphasise the importance of people and service delivery: the Batho Pele Principles and Ubuntu. Now more than ever, there is a greater need for a patient-centred caring environment. Therefore, there is an expectation for sonographers to be adaptive to this new environment.

Aim

The purpose of this study was to explore and describe the sonographers’ experiences of being caring professionals.

Setting

Sonographers who work within private practices in Gauteng were part of this study.

Methods

A qualitative, exploratory, descriptive, contextual, phenomenological research design was used. Focus group interviews were conducted with qualified sonographers registered with the HPCSA. Thematic analysis was used to code data into themes and categories.

Results

Four themes emerged: the effects of a caring relationship between a sonographer and a patient; circumstances limiting a sonographer in being a caring professional; sonographers’ approach to caring; educational readiness of sonographers to be caring professionals.

Conclusion

The participants in this study explained and shared their understanding of being caring professionals. They shared many stories regarding trusting relationships with patients. However, as a caring professional, many challenges were encountered, both physically and emotionally. Recommendations such as reflective journals and the practices of Jean Watson’s theory of transpersonal caring are cited to focus on the practice and education that may improve caring among sonographers.

Patient experience studies in the circumpolar region: a scoping review

OBJECTIVES

Patient experiences with health systems constitute a crucial pillar of quality care. Across the Arctic, patients' interactions with the healthcare system are influenced by challenges of access, historical inequities and social determinants. This scoping review sought to describe the range and nature of peer-reviewed literature on patient experience studies conducted within the circumpolar region.

DESIGN

In a partnership between Danish/Greenlandic, Canadian and American research teams, a scoping review of published research exploring patient experiences in circumpolar regions was undertaken.

DATA SOURCES

Seven electronic databases were queried: MEDLINE, Embase, Scopus, 'Global Health 1910 to 2019 Week 11', CINAHL, PsycINFO and SveMed+.

ELIGIBILITY CRITERIA

Articles were eligible for inclusion if they (a) took place in the circumpolar region, (b) reported patients' perspective and (c) were focussed primarily on patient experiences with care, rather than satisfaction with treatment outcome.

DATA EXTRACTION AND SYNTHESIS

Title and abstract screening, full-text review and data extraction was conducted by four researchers. Bibliometric information such as publication date and country of origin was extracted, as was information regarding study design and whether or not the article contained results relevant to the themes of Indigenous values, rural and remote context, telehealth and climate change. Two researchers then synthesised and characterised results relevant to these themes.

RESULTS

Of the 2824 articles initially found through systematic searches in seven databases, 96 articles were included for data extraction. Findings from the review included unique features related to Indigenous values, rural and remote health, telehealth and climate change.

CONCLUSIONS

The review findings provide an overview of patient experiences measures used in circumpolar nations. These findings can be used to inform health system improvement based on patient needs in the circumpolar context, as well as in other regions that share common features. This work can be further contextualized through Indigenous methodologies such as sharing circles and community based participatory methods.

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.

An exploration of factors influencing inpatient nurses’ care behaviour in an acute hospital setting

Objective

To examine factors influencing caring behaviour of nurses in Singapore.

Design

Descriptive correlational study using Care Behaviour Inventory (CBI-24) questionnaire to assess nurses’ perceptions of their caring behaviours.

Setting

Acute tertiary hospital in Singapore.

Participants

A convenience sample of 167 full time registered nurses working in subsidized wards, with more than 1 year of experience in current practising ward were recruited.

Main outcome measure(s)

Nurses’ perception of their caring behaviours.

Results

Data analysis yielded a mean CBI score of 123.11 out of 144, indicating that nurses had a positive perception of their caring behaviours. Among the 4 CBI subscales, Respectfulness and Connectedness components of CBI were ranked the lowest with a mean score of 4.2 and 4.9, respectively. This indicated that although nurses generally performed adequate caring during patient care, they appeared to be lacking in the expressive aspect of caring. Significant differences (P < 0.05) were found among subgroups of nationality, ethnicity, religion and education level. Nurses’ perception of their caring behaviours was positively correlated to their age and total working experience. Linear regression showed that age, religion, education level positively influenced nurses’ perception of their caring behaviours.

Conclusion

Findings from this study raise awareness to the caring behaviours that nurses were lacking in and also offer valuable insights to the potential factors influencing nurses’ caring behaviours. This information serves as a foundational knowledge to guide the development of interventions aimed to promote patient-centred care and improve quality of future nursing care.

Emergency patients' and family members' experiences of encountering care providers and receiving care in nonconveyance situations

BACKGROUND

Not much research has been conducted on emergency patients' and family members' experiences of encountering care providers and receiving care in nonconveyance situations. This knowledge is required to develop the quality and safety of emergency care.

AIM

The aim of the study was to describe patients' and family members' experiences concerning encounters with emergency care providers and the patient's care in nonconveyance situations.

METHODS

The study is a descriptive, cross-sectional survey carried out using quantitative methods. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open question were analysed using inductive content analysis.

RESULTS

Patients and family members found that emergency care providers had acted in a professional and friendly manner. They would have expected more psychological support. Family members were less satisfied with the emergency care than patients, especially as regards psychological support and the amount of time given to the patient.

CONCLUSIONS

Emergency care providers should take the whole family's situation into consideration and seek to promote the family's coping by providing comprehensible counselling and support.

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.

Who cares? A critical discussion of the value of caring from a patient and healthcare professional perspective

BACKGROUND

This study was undertaken in order to discover and illuminate the essential caring behaviours valued by both patients and staff in an orthopaedic setting within a district general hospital in the United Kingdom.

OBJECTIVES

This descriptive study was undertaken in order to acquire a greater understanding of perceptions of caring from both patient and orthopaedic healthcare professional perspectives.

METHODS

A sample of 30 patients and 53 healthcare professionals consisting of doctors, nurses, physiotherapists and occupational therapists were asked to complete the Caring Behaviours Inventory (CBI) questionnaire (Wolf et al., 1994). Data were analysed using descriptive and inferential statistics.

RESULTS

The findings revealed both similarities and differences relating to the importance of positive caring behaviours exhibited during caring interactions. Healthcare professionals working in the orthopaedic setting acknowledged the value of similar positive caring behaviours to those of the patient group but ranked the importance of these differently.

DISCUSSION

Several important insights into perceptions of caring have been gained. These relate to an overall understanding of the caring behaviours that are considered of importance to patients and healthcare professionals; the differences that exist between the caring perceptions of both groups and the factors which influence these perceptions.

Impact of Instructors' Caring on Students' Perceptions of Their Own Caring Behaviors

PURPOSE

The aim of this study was to identify the correlation between instructors' and students' caring behaviors and to explore the impact of instructors' caring on students' perceptions of their own caring behaviors.

DESIGN

A descriptive, nonexperimental design was used in this study.

METHODS

A total of 586 student nurses from four countries (Greece, the Philippines, India, and Nigeria) were recruited to participate in this study during the months of September 2013 to January 2014. Data collection was based on interviews using two standardized questionnaires: the Nursing Students' Perception of Instructor Caring (NSPIC) and the Caring Behavior Inventory (CBI). Inferential statistics such as the Pearson r correlation and regression analysis were used to determine correlations between relevant variables.

FINDINGS

Student nurses perceived "instills confidence through caring" (mean = 4.275, SD = 0.755) as the most frequently demonstrated subscale, while "control vs. flexibility" (mean = 3.469, SD = 0.701) was the least demonstrated subscale. The highest self-reported subscale in the CBI was "assurance" (mean = 4.796, SD = 0.949), while "connectedness" (mean = 4.541, SD = 0.985) was the lowest self-rated subscale. The NSPIC correlated significantly with the CBI (r = .587, p < .001). Four of the five subscales in the NSPIC correlated significantly with the CBI when considered individually; the exception was the "Supportive learning climate" subscale (r = .009, p < .40). Among the NSPIC subscales, "instills confidence through caring" explained 32% in the CBI and "appreciation of life's meaning" explained 3% in the CBI.

CONCLUSIONS

Instructors' caring behaviors influenced nursing students' caring behaviors positively. Through positive faculty modeling and role modeling, nursing students can be professionally trained to develop the competence of caring.

CLINICAL RELEVANCE

The knowledge generated from this study provides direction in developing useful and effective caring strategies and curricular programs for nursing students. Understanding this concept in a cross-cultural context is necessary in order to develop an international perspective about caring, which is necessary in developing and formulating effective teaching and clinical strategies.

Patients' strategies to deal with their situation at an emergency department

INTRODUCTION

The care in the emergency department (ED) is often characterised by high standards of efficiency and rapid treatment and the encounter between patient and staff can be described as both short and fragmented. Research within this field has mostly been performed with quantitative measurements and patients are both satisfied and vulnerable in their care at an ED. There is a lack of qualitative studies about patient's strategies to deal with their situation.

AIM

The aim was to describe patient's strategies for dealing with their situation at an ED.

METHODS

Secondary analysis has been made of 13 qualitative interviews grounded in a lifeworld perspective. The interviews were analysed by qualitative content analysis.

RESULTS

The results showed that patients' strategies to deal with the situation at the ED are passive or active. The passive strategy is being patient and the active strategies varied in terms of having hidden tactics, using visible tactics and using families as support.

CONCLUSION

These findings increase the importance of gaining knowledge about these strategies so that the staff at the ED can support the patients so they do not have to use them.

Perceptions of patients and nurses towards nurse caring behaviors in coronary care units in Jordan

AIMS AND OBJECTIVES

To (1) identify the perceptions of Jordanian patients who suffer from coronary artery diseases towards nurse caring behaviours in critical care units; (2) identify the perceptions of Jordanian nurses who work in critical care units towards nurse caring behaviours; and (3) compare the perceptions of both patients and nurses towards nurse caring behaviours in critical care units.

BACKGROUND

Caring is an important concept in nursing, when nursing behaviours were perceived by patients as caring behaviours, and thus, their satisfaction with the quality of care can be improved. Therefore, it is important for nurses to be knowledgeable about the caring behaviours as perceived by patients who complained from coronary artery diseases themselves.

DESIGN

A descriptive comparative design was used.

METHODS

A convenience sample of 150 patients who complained from coronary artery diseases and 60 critical care unit nurses completed the demographic form and the Caring Behavior Assessment scale.

RESULTS

Patients in critical care units perceived physical and technical behaviours as most important caring behaviours, whereas nurses in critical care units perceived teaching behaviours as most important caring behaviours.

CONCLUSION

There were significant differences between patient participants' and nurse participants' perceptions towards four subscales of Caring Behavior Assessment scale that should be considered when caring for patients with coronary artery diseases.

RELEVANCE TO CLINICAL PRACTICE

Patients with coronary artery diseases need well-trained and clinically competent nurses to meet their needs. 'Spiritual needs' was an important nurse caring behaviour that should be emphasised in nursing practice.

Competencies in Swedish emergency departments - The practitioners' and managers' perspective

The task of emergency departments (EDs) is to provide safe emergency healthcare while adopting a caring, cost-effective approach. Patients attending EDs have different medical and caring needs and it is assumed that practitioners have the requisite competencies to meet those needs. The aim of the present study is to explore what kind of competencies practitioners and managers describe as necessary for the practitioners to perform their everyday work in EDs.

METHODS

This study used a qualitative, exploratory design. Interviews were conducted in two EDs. Data were analysed using inductive content analysis.

RESULTS

The competence focus in everyday work in EDs is on emergency and life-saving actions. There is a polarisation between medical and caring competencies. There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the ability to develop competencies in everyday work. Medical competencies are valued more and caring competencies are subsequently downgraded. A medical approach to competencies consolidates the view of necessary competencies in everyday work in EDs.

CONCLUSIONS

The study shows that the competencies that are valued consolidate the prevailing medical paradigm. There is a traditional, one-sided approach to competencies, a hierarchical distinction between professional groups and unclear occupational functions.

Trust in nurse–patient relationships

The aim of this study was to report the results of a literature review of empirical studies on trust within the nurse–patient relationship. A search of electronic databases yielded 34 articles published between 1980 and 2011. Twenty-two studies used a qualitative design, and 12 studies used quantitative research methods. The context of most quantitative studies was nurse caring behaviours, whereas most qualitative studies focused on trust in the nurse–patient relationship. Most of the quantitative studies used a descriptive design, while qualitative methods included the phenomenological approach, grounded theory, ethnography and interpretive interactionism. Data collection was mainly by questionnaires or interviews. Evidence from this review suggests that the development of trust is a relational phenomenon, and a process, during which trust could be broken and re-established. Nurses’ professional competencies and interpersonal caring attributes were important in developing trust; however, various factors may hinder the trusting relationship.

The Relationship Between Surgical Patients and Nurses Characteristics With Their Perceptions of Caring Behaviors

The purpose of this European survey was to examine the relationship of surgical patients’ and nurses’ personal characteristics with their perceptions of caring behaviors. Caring Behaviors Inventory (CBI) was completed by convenience samples of 1,659 patients and 1,195 nurses from six countries of Europe. The results showed that the older the patients, the more positive were their evaluations of CBI. Those with planned admission and good/very good health conditions gave higher ratings compared to those with an emergency and poor health conditions. Type of admission, age, and health conditions explained 5.2% of CBI variance. Nurses with more work experience and experience in the unit gave significantly higher ratings compared to nurses with less experience. Nurses’ total experience and gender explained 2.3% of the variance of perceived care. Therefore, in a multinational surgical environment, caring behaviors may be influenced by other variables, better captured by using different research methods.

Caring in pediatric emergency nursing

An environment committed to providing family-centered care to children must be aware of the nurse caring behaviors important to parents of children. This descriptive study assessed the psychometrics of a revised version of the Caring Behaviors Assessment (CBA) and examined nurse caring behaviors identified as important to the parents of pediatric patients in a pediatric emergency department. Jean Watson's theory of human caring provided the study's theoretical underpinnings. The instrument psychometrics was determined through an index of content validity (CVI) and internal consistency reliability. The instrument was determined to be valid (CVI = 3.75) and reliable (Cronbach's alpha = .971). The revised instrument was completed by a stratified, systematic random sample of 300 parents of pediatric emergency patients. Participants rated the importance of each item for making the child feel cared for by nurses. Individual survey item means were computed. Items with the highest means represented the most important nurse caring behaviors. Leading nurse caring behaviors centered on carative factors of "human needs assistance" and "sensitivity to self and others." Nearly all nurse caring behaviors were important to the parents of pediatric patients, although some behaviors were not priority. It is important for nurses to provide family-centered care in a way that demonstrates nurse caring.

Nurse competence: a concept analysis

PURPOSE

  The purpose of this analysis was to explore the concept of nurse competence.

DATA SOURCES

  Data sources include EBSCOhost, Gale PowerSearch, ProQuest, PubMed Medline, Google Scholar, and Online Journal of Issues in Nursing.

DATA SYNTHESIS

  This paper utilizes Rodgers' evolutionary method to analyze the concept of nurse competence.

CONCLUSION

  Antecedents to nurse competence include personal and external motivations. Attributes include integrating knowledge into practice, experience, critical thinking, proficient skills, caring, communication, environment, motivation, and professionalism. Consequences include confidence, safe practice, and holistic care. Implications for nursing responsibility regarding defining nurse competence and ensuring nurse competence need to be identified. More research is needed to determine the best evaluation methods for the different facets of nurse competence.

During and beyond the triage encounter: chronically ill elderly patients' experiences throughout their emergency department attendances

BACKGROUND

Chronically ill elderly patients are frequent users of care in emergency departments (EDs). Due to their presenting symptoms, these patients are often assessed on a low urgency level of priority by the triage nurse.

AIM

The aim of the study was to explore and describe the experiences of a group of chronically ill elderly patients' during their triage encounter and subsequent ED stay.

METHOD

The data consisted of 14 open-ended interviews with chronically ill patients aged between 71 and 90years. A lifeworld approach was used in order to describe the essence of patient experiences. The study was carried out with a descriptive phenomenological research perspective.

CONCLUSION

The visit to the ED was experienced as contradictory. The triage encounter fostered confidence and set promising expectations, but during the rest of the visit, the patient felt abandoned and considered the staff to be uncommitted and reluctant. These ambiguous experiences of their ED visits indicate a need for exploring possible ways of improving the situation for the chronically ill older person in ED.

On a hidden game board: the patient's first encounter with emergency care at the emergency department

AIMS AND OBJECTIVES

Describe and understand the patient's first encounter in emergency care at the emergency department, as experienced by the patient, next of kin and first providers from different professions.

BACKGROUND

The emergency department is most often described as having high levels of satisfaction with the quality of care delivered. Although the patients appreciate clinical competence, quick assessment and technical skills, a close connection between patient satisfaction and vulnerability has been shown.

DESIGN

A lifeworld research perspective was used in four different situations at the emergency department.

METHODS

The data consisted of 14 open-ended interviews with patients, next of kin and first providers.

RESULTS

The analysis showed that narratives of the past, present and future characterises the encounter where mutual narratives form a foundation for those involved in the encounter. Five constituents further described the variations; vague rules and conflicting expectations in the encounter, an encounter with the biological body, 'courtesy encounters', isolated in a timeless encounter, striving for meaning in the encounter.

DISCUSSION

Instead of expecting the patients to know the unwritten rules of the emergency department, the first providers could give clear information about expected waiting times and what to expect in the encounter. The challenge is to make a meaningful comprehensible context for all involved which can be generated in the interpersonal encounter.

RELEVANCE TO CLINICAL PRACTICE

The findings highlight the importance of disclosing the rules of the game by means of giving clear information which would give possibilities for the patient to maintain control, for strengthening the nurse's role as the patients' advocate and for strengthening the effort for an emergency department to become more of a learning organisation.

Evaluation of a caring education program for Taiwanese nursing students: a quasi-experiment with before and after comparison

BACKGROUND

Caring is an essential component in nursing curricula. However, how caring can be accomplished effectively has rarely been taught to nursing students.

OBJECTIVES

To examine acceptability and preliminary efficacy of a caring education program for nursing students in Taiwan.

METHODS

Students were recruited to participate in a pre-post-test quasi-experimental study. Students self-selected into a control group (n=33) or an experimental group (n=35). The experimental group registered for a 13-week caring education program based on Watson's 10 creative factors through multiple teaching strategies. The Caring Behaviors Assessment (CBA) was used to collect data at weeks 1 and 13. Content analysis was used to reach the main descriptions of caring education from an experimental group of nursing students.

RESULTS

The experimental group reported a significantly higher score of caring behaviors after participating in the education program (t=3.4, p=.00). The score of each CBA subscale in the experimental group was significantly enhanced from week 1 to week 13, except in the existential/phenomenological/spiritual dimension. Qualitative results supported that a caring education could help nursing students by building caring behaviors which could be adapted to clinical situations.

CONCLUSIONS

The findings support the credibility of caring-focused teaching strategies and such focused caring programs are acceptable and show efficacy for nursing students.

Therapeutic relationships in critical care nursing: a reflection on practice

AIMS

The aim of this paper is to gain a greater understanding of the emotional intelligence required to form therapeutic nurse-patient relationships in the context of critical care nursing.

CONTEXT

There is currently a demand for patient-centred nursing in all aspects of health care to improve both quality of care and consumer satisfaction. Central to patient-centred care is the presence of a therapeutic nurse-patient relationships, but the development of these relationships present a challenge in the acute and technological world of critical care nursing.

THEORETICAL FRAMEWORK

Using Titchen's Skilled Companionship Model as a guide as well as empirical and theoretical knowledge on nurse-patient relationships, this paper presents a reflection on a relationship that the author developed with a patient and his family encountered in her practice as a critical care nurse. REFLECTIVE CONCLUSIONS: Engaging in therapeutic nurse-patient relationships can expose nurses to emotional pain in the context of critical care nursing. The process of reflection can facilitate critical care nurses in the development of the emotional intelligence required to develop and maintain these relationships and this enhances the care of critically ill patients and their families.

The importance of critical care nurses' caring behaviours as perceived by nurses and relatives

AIM OF PAPER

This paper will report a research study conducted to compare the perceptions of nurses and relatives of critically ill patients on the importance of the caring behaviours of critical care nurses.

BACKGROUND

The concept of caring is central to the nature of nursing with many approaches to defining and describing it in the nursing literature. Caring in critical care nursing involves affective, cognitive and action processes. It is the action processes or caring behaviours that are most evident to nurses, patients and relatives.

METHOD

This descriptive, comparative, quantitative study was conducted in an Irish critical care setting. Convenience sampling was used to recruit n=40 nurses and n=30 relatives of critically ill patients. Data were collected over a 3-week period in 2006 using an adapted version of the Caring Behaviours Assessment Tool. Descriptive statistics were used to analyse the data.

FINDINGS

There was congruence between nurses and relatives on the most and least important caring behaviours of critical care nurses. Both groups placed a higher value on caring behaviours which demonstrate technical competence, the altruistic and emotional aspects of caring.

CONCLUSION

The results of this study have demonstrated that there are more similarities than differences between the perceptions of nurses and relatives on the importance of the caring behaviours of critical care nurses. The results of this study will give critical care nurses a greater understanding of how their caring behaviours are perceived by others. Incorporating the views of relatives into the delivery of care in the context of critical care will allow nurses to create a patient-centered service.

Perceptions of nurses' caring behaviors by trauma patients

A descriptive study of moderately to severely injured patients' perceptions of nurses' caring behaviors was conducted at a level I trauma center. Seventy patients older than 18 years admitted through the trauma resuscitation unit were included. The participants were interviewed in their rooms/cubicles by the research team to complete the Caring Behaviors Inventory. The average rating for the sample was 4.8. Patients receiving care through trauma services expressed an overall positive perception of caring from the nursing staff while there was room for improvement in some areas.

Injured road users’ experience of care in the emergency department

AIM

To describe the patients' perceptions of quality of care (QoC) in an emergency department (ED) and to analyse associations between patients' background characteristics and estimated QoC.

BACKGROUND

Each year 1.4 out of every 100 inhabitants are injured in the traffic environment and receive care at the ED. No study has yet analysed different injured road users' perceived QoC, or how important they rate different caring dimensions.

DESIGN

Cross-sectional study at the ED, in the University Hospital in Umeå, Sweden.

METHOD

A stratified consecutive sample of 166 car occupants, 200 cyclists and 199 pedestrians, aged 18-70 years, all injured in the traffic environment. Data were collected from medical records and from a mail survey using a short form of the Quality from the Patient's Perspective questionnaire, modified for ED use. The statistical methods used included Mann-Whitney's U-test, the Kruskal-Wallis test and multiple logistic regression.

RESULTS

The perceived QoC and the subjective importance of the corresponding QoC dimensions were rated at the 'better' half of the rating scale, with no differences between the different road user categories. The most prominent factors associated with a positive perceived QoC rating were a short waiting time, moderate or serious injuries and high age as well as high educational level of the injury victim. For the subjective importance, a short waiting time was rated as the most important but slight differences were seen, related to education and sex.

CONCLUSION

The association patterns between the areas of perceived reality and subjective importance indicated that expectations were higher than perceived QoC, suggesting that patients expected somewhat higher QoC than they received.

RELEVANCE TO CLINICAL PRACTICE

Information on factors causing long waiting times, adapted to patients' age, sex and educational level, may reduce dissatisfaction among long waiting patients, especially among those with minor injuries.

Creating a profile of a nurse effective in caring

BACKGROUND

Watson's Theory of Caring and Caritas proposes that caring and love potentiate healing. Creating a profile of the characteristics of a "Caritas nurse" has implications for integrating caring and love into patient care, and measuring the impact of caring on patient and operational outcomes.

METHODS

This psychometric study examined the profile of nurses effective in caring. The Caring Factor Survey and the Healthcare Environment Survey were selected to measure caring and work environment conditions as reported by the patient and by the nurse, respectively.

RESULTS

The results of this study revealed that nurses of all ages who received high scores in caring were most frustrated with the work environment, were most experienced, worked only the hours scheduled, were most affected by the relationship with the patient, derived the most enjoyment from the relationship with their coworkers, and provided continuity of care most consistently.

DISCUSSION AND IMPLICATIONS

Findings from this study indicate that further inquiry into the profile of nurses effective in caring and evaluation of the presence of caring and love on patient outcomes is warranted.

Trauma patients’ encounters with the team in the emergency department—A qualitative study

BACKGROUND

Encounters in emergency departments have been described from different perspective and with different research approaches. On reviewing the literature, along with medical skills, interpersonal skills such as the ability to create a relationship with the patient was considered significant. Patients exposed to high-energy violence arrive at the emergency department in a vulnerable condition. Apart from their physical condition, they might be in shock and frightened by the experiences of the injury. The team at the emergency department is responsible for a complex situation and has to quickly establish rapport, gather information, assess the physical condition, and design a treatment plan.

AIM

The aim of this study was to explore trauma patients' conceptions of the encounter with the trauma team.

DESIGN AND METHOD

A qualitative inductive design was used and data were collected by semi-structured interviews. The interviews were transcribed verbatim and analysed according to contextual analysis.

PARTICIPANTS

Twenty-three trauma patients with minor injuries, 17 from a university hospital and six from a county hospital with minor injuries, were included in the study.

FINDINGS

The main findings were three main categories, labelled modes of being with the patients: the instrumental, the attentive and the uncommitted mode. All encounters contained the instrumental mode and mostly there were a combination of instrumental mode and attentive mode. The patients were satisfied with these modes, which created emotions of confidence, comfort and satisfaction. The uncommitted mode occurred in some encounters together and generated emotions of abandonment, dissatisfaction.

CONCLUSION

The main conclusion is that a high-quality encounter in trauma care is likely to be received from caregivers who can shift their mode of being with the patient between the instrumental and the attentive mode as the patient/situation demands. That is, flexibility between the physical and psycho-social care.

Development of the Perinatal Concerns Program: care of mothers after diagnosis of fatal infant anomalies

Care of the grieving mother in the labor and delivery setting is a complex phenomenon requiring collaboration of professionals and designing sensitive care based on theory and compassion. This article describes The Perinatal Concerns Program, which was developed to make available a complete range of care for women whose pregnancies are complicated by fetal abnormalities. Development of this program required collaboration of several services, coordination of protocols, and establishment of clear lines of communication. It was born after a particularly difficult case in labor and delivery that alerted a staff nurse to the fact that coordination of care for this patient could have resulted in enhanced ability of all the staff to meet this woman's physical and emotional needs. The development of this program demonstrates that a motivated staff nurse with effective leadership skills can make major changes in an institution which can make a difference in the care of grieving patients.

Patients' perceptions of quality of care at an emergency department and identification of areas for quality improvement

AIMS

This paper reports a study to identify patient's perceptions of quality of care at an emergency department and areas for quality improvement.

BACKGROUND

Patients are not always satisfied with the care received at emergency departments. More attention needs to be paid to the specific needs and expectations of the non-urgent group of patients, who make up the majority of attenders at many emergency departments. Nurses' and physicians' perceptions about good quality of care do not always agree with patients' perceptions. Instruments measuring patient satisfaction have often been focused on inpatient treatment.

METHOD

A prospective, descriptive survey design was adopted and the study took place in one emergency department at a Swedish university hospital in 2002. The participants were 99 women and 101 men, with an average age of 51 years. The emergency department version of the questionnaire Quality from the Patient's Perspective was used for data collection.

RESULTS

Patients estimated quality of care at the emergency department as fairly good, but there were areas in need of improvement. A high percent of inadequate quality was related to the environment in the emergency department. About 20% of patients reported that they did not receive effective pain relief. More than 20% estimated that nurses did not show an interest in their life situation and patients did not receive useful information on self-care and about which physician was responsible for their medical care.

CONCLUSIONS

The use of a research-based instrument gave valuable information for quality improvement in clinical practice. Many of the identified areas for quality improvement are related to nursing care. Therefore, the importance of nursing care in the emergency department should be highlighted to nurses and physicians and they also need to be more attentive to the need of the individual patient.

RELEVANCE TO CLINICAL PRACTICE

Identifying areas for quality improvements are important, to know where to take action. These findings may facilitate the work with changing attitudes and working routines, which are needed to deliver effective care and to improve patients' perceptions of quality of care at emergency departments.

The changing context of Western European healthcare systems: convergence versus divergence in nursing problematics

Many countries reorganizing their health services are drawn toward similar reform programs and tend to experience what seem to be similar problems relating to implementation outcomes. One such problem is the major crisis within the nursing profession relating to the labor market, working conditions and level of autonomy. This research examines the thesis that the profile of nursing problems is global (the 'convergence' thesis) by comparing the changing hospital contexts nursing has been confronting in 20 Western European countries between 1990 and 2001. The analysis indicates that in spite of growing convergence, the divergence in patient care processes, workforce composition and resources allocated for care is still rather remarkable and that similarity or divergence between countries changes over time. This contextual variability highlights why problems such as the crisis of the nursing profession must be analysed from a divergent rather than a convergent perspective.

The Acute Care Nurse Practitioner: challenging existing boundaries of emergency nurses in the United Kingdom

AIM

This study explored the opinions of nurses and doctors working in emergency departments towards the development of the Acute Care Nurse Practitioner service in the United Kingdom.

BACKGROUND

Studies carried out in the United States and Canada suggest that the Acute Care Nurse Practitioner can have a positive impact on the critically ill or injured patients' experiences in the emergency department. This role is well developed in the United States and Canada, but is still in its infancy in the United Kingdom.

DESIGN AND METHODS

A descriptive, exploratory design incorporating questionnaires (n = 98) and semi-structured interviews (n = 6) was employed. The sample included nurses and doctors from seven emergency departments and minor injury units.

RESULTS

Respondents felt it was important for the Acute Care Nurse Practitioner to have obtained a specialist nurse practitioner qualification and that the Acute Care Nurse Practitioner should retain a clinical remit. While participants seemed comfortable with nurses undertaking traditional advanced skills such as suturing, reluctance was displayed with other advanced skills such as needle thoracocentesis. Three main themes were identified from the interviews: inter-professional conflict, autonomy and the need for the Acute Care Nurse Practitioner.

DISCUSSIONS

Doctors were reluctant to allow nurses to practise certain additional advanced skills and difficulties appear to be centred on the autonomy and other associated inter-professional conflicts with the role of the Acute Care Nurse Practitioner.

CONCLUSION

Nurses and doctors identified a need for the Acute Care Nurse Practitioner, but the blurring of boundaries between doctors and nurses can result in inter-professional conflict unless this is addressed prior to the introduction of such advanced practitioners. Relevance to clinical practice. As the role of the emergency nurse diversifies and expands, this study re-affirms the importance of inter-professional collaboration when seeking approval for role expansions in nursing.

Patients with Acute Chest Pain - Experiences of Emergency Calls and Pre-Hospital Care

Acute chest pain is a common reason why people call an emergency medical dispatch (EMD) centre. We examined how patients with acute chest pain experience the emergency call and their pre-hospital care. A qualitative design was used with a phenomenological-hermeneutic approach. Thirteen patients were interviewed, three women and 10 men. The patients were grateful that their lives had been saved and in general were satisfied with their pre-hospital contact. Sometimes they felt that it took too long for the emergency operators to answer and to understand the urgency. They were in a life-threatening situation and their feeling of vulnerability and dependency was great. Time seemed to stand still while they were waiting for help during their traumatic experience. The situation was fraught with pain, fear and an experience of loneliness. A sense of individualized care is important to strengthen trust and confidence between the patient and the pre-hospital personnel. Patients were aware of what number to call to reach the EMD centre, but were uncertain about when to call. More lives can be saved if people do not hesitate to call for help.

Variables influencing intravenous catheter insertion difficulty and failure: An analysis of 339 intravenous catheter insertions

BACKGROUND

Inserting an intravenous catheter (IV) is one of the most frequently performed invasive procedures by nurses. Little research has been conducted on ways to reduce the difficulty and failure, and enhance the ease and success, of IV insertion. We conducted this study to determine variables associated with IV insertion difficulty, failure, and success, and to learn special techniques nurses use to facilitate IV insertion.

METHODS

Data were collected on 339 IV insertions in hospitalized patients by 34 registered nurses. The data included information about the nurse (eg, age, education, and self-rated IV insertion skill); the patient (eg, age and race); the IV (eg, site, gauge, and type); and the IV insertion, (eg, duration and difficulty). Data were analyzed to determine the effects of these variables on IV insertion outcome. In addition, nurses were asked to describe special techniques they used to facilitate IV insertion.

RESULTS

A total of 77% of the IV insertions were successful. Nurses who were older, had more years of experience, were certified in a specialty, and rated themselves higher in insertion skill had significantly more successful insertions than their younger and less-experienced and less-skilled counterparts (P < .001). Successful IV insertions were significantly faster (mean 32 seconds) than unsuccessful ones (mean 66 seconds) (P < .001), and were rated as significantly less difficult (P < .001). Failed IV insertions were associated with higher degrees of difficulty arising from vein variables, such as vein rolled or vein was resistant to puncture, and patient variables, such as tough or dark skin and patient movement. The nurses described a wide variety of techniques to facilitate insertion success. The most frequently mentioned were getting self and patient in a comfortable position, using mechanical stimulation such as tapping the vein, and stabilizing the vein.

CONCLUSION

Approximately one fourth of the 339 IV insertions in this study were unsuccessful. Repeated insertion attempts are painful and costly. This study identified nurse, patient, and IV variables associated with IV insertion success and failure. Future research is needed to confirm and expand these findings and to develop interventions to improve IV insertion skills and outcomes.

Cancer patients' descriptions of their nursing care

AIM

This paper reports a study of cancer patients' descriptions of nurses and nursing care.

BACKGROUND

Nurses lament their poor representation in the media, and campaigns to improve their portrayal have been initiated. Media portrayal of nurses might be more realistic if patients' descriptions of nursing care were incorporated.

METHOD

Qualitative data from an instrument development study were analysed. A total of 461 patients answered the question, 'In general, how do you feel about nurses?' The data were analysed by the constant comparative method and grounded theory coding techniques.

FINDINGS

A typology of four concepts reflecting cancer patients' descriptions of their nursing care emerged from the data. The concepts were: laudable, caring, professional and outcomes. The concept laudable refers to commendable qualities of the nurse and nursing care. Caring refers to the nurse showing compassion, concern and kindness. Professional refers to the nurse as meeting expected standards of knowledge, skill and demeanour. Outcomes refer to the affective, cognitive, or physical effects attributed to nursing care. Both positive and negative instances of the concepts were included in the analysis. Examples of each concept using patients' own words are given.

CONCLUSIONS

These cancer patients held nurses in relatively high esteem. These findings could be disseminated to the public press as an example of what patients' value about nurses and nursing care. They also could be used in media efforts to recruit and retain nurses.