The relationship of patients' perceptions of holistic nurse caring to satisfaction with nursing care

The relationship between Iranian patients' perception of holistic care and satisfaction with nursing care

Background

Holistic care is comprehensive care that emphasizes the interaction of human existential dimensions and has a significant role in accelerating the recovery process. Since nurses interact and communicate with patients more than other health care providers, the current study aimed to determine the Iranian patients’ perceptions of holistic care and overall satisfaction with nursing care.

Methods

It is a descriptive-correlational study done on patients admitted to the oncology wards of hospitals in southeastern Iran. The holistic caring inventory and patient satisfaction instrument were used to measure the patients’ perceptions of holistic care and their satisfaction, respectively. SPSS 19 was used to analyze the data.

Results

The results showed that there is a significant positive correlation between patients’ perception of holistic care and overall satisfaction with nursing care (P < 0.01, r = 032), which means that the higher the patients’ perception of holistic care, the greater their overall satisfaction. Based on the regression model, type of hospital, Patient’s perception of holistic care, education, previous experience of hospitalization, age and marriage are respectively predictors of overall satisfaction with nursing care (P < 0.05).

Conclusion

The present study showed that patients’ overall satisfaction with nursing care depends on holistic nursing care, meaning that nurses should pay attention to patients’ physical, mental, emotional aspects and increase the quality of care.

Development of a Quantitative Measure of Holistic Nursing Care

Holistic care has long been a defining attribute of nursing practice. From the earliest years of its formal history, nursing has favored a holistic approach in the care of patients, and such an approach has become more important over time. The expansion of nursing's responsibility in delivering comprehensive primary care, the recognition of the importance of relationship-centered care, and the need for evidence-based legitimation of holistic nursing care and practices to insurance companies, policy-makers, health care providers, and patients highlight the need to examine the holistic properties of nursing care. The Holistic Caring Inventory is a theoretically sound, valid, and reliable tool; however, it does not comprehensively address attributes that have come to define holistic nursing care, necessitating the development of a more current instrument to measure the elements of a holistic perspective in nursing care. The development of a current and more comprehensive measure of holistic nursing care may be critical in demonstrating the importance of a holistic approach to patient care that reflects the principles of relationship-based care, shared decision-making, authentic presence, and pattern recognition.

Cancer patient and staff ratings of caring behaviors: relationship to level of pain intensity

This study explored differences in the perceived importance of nursing caring behaviors between patients with cancer pain and oncology nurses and to explore the relationship between level of pain intensity and the importance of various nursing caring behaviors. The study included 50 matched cancer patient-staff pairs from oncology inpatient units of 3 hospitals in northern Taiwan. The Brief Pain Inventory-Chinese version (BPI-C) and the Caring Assessment Report Evaluation Q-sort (CARE-Q) were used for data collection. Results revealed that cancer pain patients ranked "being accessible," "monitors and follows through," and "anticipates" as being the most important nursing caring behaviors; the nursing staff ranked "being accessible," "explains and facilitates," and "monitors and follows through" as being the most important behaviors. No correlations were found between cancer pain patients and staff rankings of the perceived importance of various caring behaviors. The self-reported level of pain intensity by patients was significantly positively correlated with the patient rating of the "anticipates" behavior. Patient self-reported level of pain interference was significantly positively correlated with the "monitors and follows through" behavior and significantly negatively correlated with the "explains and facilitates" behavior. Staff perception of both a patient's level of pain intensity and pain interference was significantly positively correlated with staff rating of the "being accessible" behavior. Results demonstrated that greater patient-staff communication is needed for staff to more accurately provide caring interventions to make patients with cancer pain feel cared for.

Nurses’ assessments and patients’ perceptions: development of the night nursing care instrument (NNCI), measuring nursing care at night

BACKGROUND

Nursing care provided at night has a different purpose and objective to that provided during the day. A review of the literature does not reveal any scientifically tested research instruments for evaluating and comparing the nurse's assessment of nursing care with the patient's perception at night.

AIMS AND OBJECTIVES

The aim of this study was to develop and test an instrument for evaluating nursing care and to compare nurses' assessments with patients' perceptions of nursing care provided at night.

DESIGN

The study was carried out in two phases; the first had an explorative design and the second an evaluative and comparative design. The Night Nursing Care Instrument (NNCI) included two questionnaires; one for nurses and one for patients. These questionnaires were developed from a nursing framework and covered the following three areas: 'nursing interventions', 'medical interventions' and 'evaluation'.

METHODS

Nurses (n = 40) on night duty on a medical ward at a central hospital in southern Sweden were consecutively selected, to participate in the study. The patients (n = 80) were selected by means of convenience sampling. In order to achieve construct validity, factor analysis of each individual area was carried out. Reliability in terms of internal consistency was tested by Cronbach's alpha.

RESULTS

The overall NNCI had acceptable reliability and validity. There was no statistically significant difference between nurses' assessments and patients' perceptions in any of the three areas of 'nursing interventions', 'medical interventions' or 'evaluation'. The patients rated night nursing care as satisfactory for the majority of the items.

RELEVANCE TO CLINICAL PRACTICE

These findings demonstrate that it is possible to create a short instrument with acceptable reliability and validity, which is easy to use in clinical practice. The results also show that night nurses need to improve their ability to assess patients' needs during the night to increase the quality of night nursing care.

Inpatient heart failure treatment from the patient's perspective

OBJECTIVE

The objective of this study was 2-fold: (1) to identify particular opportunities for improvement in patient-centered care of heart failure patients and (2) to suggest strategies for service quality improvement focusing on those areas.

SAMPLE

A national cross-sectional sample of survey data from diagnostic-related group 127 patients was collected between December 1, 2001, and November 30, 2003. Data were split into two 12-month samples to compare results over time. The 2002 sample included 5224 patients treated at 220 hospitals; the 2003 sample included 6531 patients treated at 269 hospitals.

METHOD

A standardized mail-out/mail-back methodology was used to collect data from random samples of patients within 5 days of discharge.

RESULTS

For both samples, the ranking of service issues was highly similar, with the same 4 areas emerging as the foremost priorities: patient involvement in decision making, staff response to concerns voiced during the hospital stay, staff sensitivity to the inconvenience of heart failure and hospitalization, and emotional/spiritual support. Improvement in these 4 service areas should be associated with the greatest increases in patient satisfaction and quality of care for heart failure patients.

CONCLUSIONS

Adequately addressing these patient needs should increase patient satisfaction and quality of care for heart failure patients.

Healing Ourselves, Healing Others

Although not used in most nursing texts and journals, the term "nurse healer" is common in holistic nursing literature. Nurses who identify themselves as healers have tapped into a source of strength and confidence that adds creativity and vitality to their nursing work. In this qualitative study, the researcher asks 11 relatively "holistically naïve" medical-surgical nurses if they would label themselves as healers. Their responses reveal an inherent understanding of the multidimensionality of the healing process and the importance of relationships and therapeutic presence to the healing role.

Addressing patients' emotional and spiritual needs

BACKGROUND

A comprehensive, systematic literature review and original research were conducted to ascertain whether patients' emotional and spiritual needs are important, whether hospitals are effective in addressing these needs, and what strategies should guide improvement.

METHODS

The literature review was conducted in August 2002. Patient satisfaction data were derived from the Press Ganey Associates' 2001 National Inpatient Database; survey data were collected from 1,732,562 patients between January 2001 and December 2001.

RESULTS

Data analysis revealed a strong relationship between the "degree to which staff addressed emotional/spiritual needs" and overall patient satisfaction. Three measures most highly correlated with this measure of emotional/spiritual care were (1) staff response to concerns/complaints, (2) staff effort to include patients in decisions about treatment, and (3) staff sensitivity to the inconvenience that health problems and hospitalization can cause.

DISCUSSION

The emotional and spiritual experience of hospitalization remains a prime opportunity for QI. Suggestions for improvement include the immediate availability of resources, appropriate referrals to chaplains or leaders in the religious community, a team dedicated to evaluating and improving the emotional and spiritual care experience, and standardized elicitation and meeting of emotional and spiritual needs. Survey data suggested a focus on response to concerns/complaints, treatment decision making, and staff sensitivity.

Caring Behaviors Among Nurses

Caring behaviors have been shown to financially benefit business in general and the health care industry in particular. Nursing presence is a concept representative of caring behaviors within the nursing profession. This article suggests a means through which nursing presence might be identified and taught. Patients may, as a result. increasingly view their assigned nurses as caring in attitude and behavior.

Predictors of patient satisfaction with inpatient hospital nursing care

The purpose of this predictive nonexperimental study was to investigate the influence of registered nurse (RN) job satisfaction, context of care, structure of care, patient-perceived nurse caring, and patient characteristics on patient satisfaction with inpatient hospital nursing care in an academic medical center in north-central West Virginia. Convenience samples of patients (N = 362) and RNs (N = 90) were recruited from two medical units, two surgical units, and three intensive care step-down units. Causal modeling identified patient-perceived nurse caring as the major predictor of patient satisfaction, with nurse/physician (RN/MD) collaboration as the only other direct predictor. Age had an indirect influence on patient satisfaction. Strategies to achieve and maintain patient satisfaction should address the enhancement of patient-perceived nurse caring and RN/MD collaboration.

Patients' and nurses' perceptions of quality nursing activities

Nurses and patients come from varying backgrounds and have different life experiences. Their perceptions regarding what comprises quality nursing care may differ. The objective of this article was to determine whether there is a difference in the perceived importance of nursing activities from the point of view of patients and nurses. If differing perceptions were found, the goal would then be to increase nursing awareness of these differences. A convenience sample of 30 nurses and 30 patients on a medical-surgical unit were surveyed about nursing care using a 41-item questionnaire. Data obtained were divided into four classes of nursing activities: psychosocial, physical, safety, and indirect. There was a significant difference in the perceived importance of nursing activities by nurses and patients in the psychosocial and safety categories. Nursing activities that may not be recognized as such by patients, or which are not seen as important to quality care, should be clarified for patients. Clarification may also be useful in helping patients to understand the professional nursing role. In addition, this insight may heighten patient satisfaction with caregiving.

Nursing presence, patient satisfaction, and the bottom line

Hospital planners rely on a number of motivational models to increase patient satisfaction. Missing is the user friendly model oriented to nursing presence. Absent is the approach which taps into that contribution particular nurses might make to increase patient satisfaction and enhance the bottom line. This paper remedies this circumstance by the introduction of the Nursing Presence Grid model. The model is based upon a review of the literature conducted in the manner of Polit and Hungler (1995) and appearing since 1983. Nursing presence is defined. The Nursing Presence Grid matches the various dimensions of nursing presence with various courses of action thought to attain nursing presence. An explanation of how the model might be applied is presented.

Patient satisfaction with nursing care in the context of health care: a literature study

To evaluate and improve the quality of care provided, it is of vital importance to investigate the quality of care in the context of health care. Patient satisfaction is a significant indicator of the quality of care. Consequently, quality work includes investigations that map out patient satisfaction with nursing care. To improve the quality of nursing care, the nurse needs to know what factors influence patient satisfaction. The aim of this literature study was to describe the influences on patient satisfaction with regard to nursing care in the context of health care. In the description of nursing care, we have used Henderson's nursing care model. The results describe eight domains that have an influence on patient satisfaction with nursing care: the socio-demographic background of the patients, patients' expectations regarding nursing care, the physical environment, communication and information, participation and involvement, interpersonal relations between nurse and patient, nurses' medical-technical competence, and the influence of the health care organization on both patients and nurses. The bulk of the literature included in the study came from the UK, Sweden and the USA. This means that the results should be applicable to health care in the western world. An important implication for future research is to continue to elucidate the factors that influence satisfaction with nursing care, as seen from the patient's perspective.

Recovering From Cardiac Surgery: What Patients Want You To Know

• Background Care of cardiac surgery patients has changed substantially in the past decade, with an emphasis on streamlined procedures and shortened hospital stays. The few qualitative reports of patients’ perspectives of this experience focus primarily on physical complications and discomforts during the immediate postoperative period.

• Objective To examine patients’ perceptions of the quality of the nursing and medical care they received during their hospital stay after cardiac surgery.

• Methods Data were collected from a consecutive sample of 89 cardiac surgical patients who consented to participate in 2 telephone interviews at 1 week and 6 weeks after hospitalization. Patients responded to a single open-ended question: “What do you want your nurses and doctors to know to help them do a better job?” Thematic extraction analysis of patients’ responses was conducted by using commercially available statistical software. Extracted themes were applied to the structure-process-outcome framework of quality of care.

• Results Four major themes (and 12 subthemes) were identified: (1) being satisfied (having a positive experience, getting information), (2) not being cared for (feeling depersonalized, having expectations that did not match recovery experiences, not being listened to, experiencing unprofessional behavior by care providers, experiencing continued care needs after going home), (3) physical needs unmet (sleep, pain, complications, physical environment), and (4) informational needs unmet (needing more or different information).

• Conclusions Patients want nurses and doctors to provide a smooth transition to home, recognize the patients as individuals, prepare them honestly for their experiences with specific information, and manage pain and sleep.

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

BACKGROUND

Increased workload at the emergency department (ED) and the shortage of nurses may leave some patients without proper care. The importance of patients' perceptions of caring is vital when organizing nursing practice under such circumstances.

PURPOSE

The purpose of the study was to identify which nurse caring behaviors are perceived by patients in an ED as important indicators of caring. The nurse caring behaviors were categorized in terms of relative importance with respect to demographic variables and perceived illness. Watson's theory of caring was used as a theoretic framework for this quantitative and descriptive study.

METHOD

A 61-item questionnaire designed on the basis of Cronin and Harrison's Caring Behaviors Assessment tool, which reflected the 10 carative factors of Watson's theory, was mailed to 300 ED patients. The response rate was 60.7%.

RESULTS

Results showed that subjects scored the items "Know what they are doing", "Know when it is necessary to call the doctor", "Know how to give shots, IVs, etc.", and "Know how to handle equipment" as the most important nurse caring behaviors. The subscale "human needs assistance" was ranked highest.

CONCLUSION

In line with several previous studies, subjects considered clinical competence to be the most important nurse caring behavior, which further emphasizes the notion of caring as a moral stance integral to all interactions with patients.

Accomplishing the impossible: talking about body and soul and mind during a medical visit

This study examines the practical side of communicating about patients' thoughts, feelings, and physical health. A study of 53 medical visits suggests that biopsychosocial communication need not be as difficult or as time consuming as many practitioners believe. Biopsychosocial medical visits can be conducted in roughly the same amount of time as biomedical visits with many important advantages. This report describes 6 communication techniques used by 1 doctor to encourage talk about lifeworld issues. The techniques include self-disclosing, expressing empathy, involving patients in decision-making, talking openly about patients' fears, asking open-ended questions, and listening attentively. The doctor studied was able to use these techniques without exceeding the average length of a biomedical visit.

Oncology patients' and oncology nurses' perceptions of nurse caring behaviours

Previous research on patients' and nurses' perceptions of nurse caring behaviours has documented significant differences in the ranking of important behaviours. However, these samples have included a variety of medical-surgical patients and nurses and different types of institutional settings, all of which may have affected the results. The present study sought to determine if patients and nurses from one subspecialty area and one institution would have more concordant perceptions of caring. Forty-four oncology patients and 49 oncology nurses completed the Respondents Perceptions of Caring Behaviour Scale (RPCBS). Results showed that overall mean patient rankings were highly correlated with mean nurse rankings (Spearman's correlations coefficient 0.94, P<0.0001). The Wilcoxon two-sample rank sum test was used to test the difference in rank of the 20 items between the patients and nurses. There was a significant difference in rank in only six of the 20 items. These data suggest that oncology patients and nurses have more concordant perceptions of caring than previously investigated groups. Implications for practice and further research are discussed.

Implementing a caring model to improve patient satisfaction

OBJECTIVE

To evaluate the effect of implementing a Caring Model on patient satisfaction.

BACKGROUND

Patient satisfaction has become an important indicator of quality care and financial success of healthcare institutions. Acknowledging the importance of nurse caring behaviors and the impact on patient satisfaction has been relatively recent. Based on a synthesis of the literature, five caring behaviors have been formulated into a model; no single study identified the five selected behaviors included in this study.

METHODS

In an acute care setting, eight patient satisfaction attributes were incorporated into a Caring Model. Implementation of the model among nursing staff members included an educational in-service, printing of the behaviors on the name badge, reminders in monthly staff meetings and nursing rounds, and inclusion of the caring behaviors in patient care documentation, job descriptions, and performance appraisals. The impact upon patient satisfaction was compared 6 months' preintervention to 6 months' postintervention.

RESULTS

Postintervention, the patient satisfaction attributes of Nurses Anticipating Needs and Responds to Requests significantly increased. Attributes that began preintervention as immediate priorities for improvement became major strengths postintervention.

CONCLUSIONS/IMPLICATIONS

Results of this study provide evidence that nurse caring behaviors can influence patient satisfaction. For a Caring Model to be effective, it must become an integral part of strategic planning and be implemented throughout the entire organization. To sustain the effects of the model, there must be frequent reminders among staff members. Nurse caring is an important predictor of patient satisfaction. The authors discuss the effect of implementing a caring model on patient satisfaction. In an acute care setting, eight patient satisfaction attributes incorporated into five nurse caring behaviors were evaluated pre- and postintervention. Results of the study indicated the patient satisfaction attributes of Nurses Anticipating Needs and Responds to Requests significantly increased. Attributes that began as immediate priorities for improvement before intervention became major strengths after intervention.

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.

The cardiac surgical patient's expectations and experiences of nursing care in the intensive care unit

There is an abundance of research investigating patient satisfaction. However, few studies have addressed patient satisfaction by comparing patients' expectations of nursing care with the care they actually received. This qualitative study explores both cardiac surgical patients' preconceptions and expectations of nursing care in the intensive care unit (ICU) and their actual experience of nursing care while in the unit. Data were collected using a semistructured interview technique. Interviews took place prior to admission and following discharge from ICU, and were taped and transcribed. Using thematic analysis, major and minor themes emerged from the data. The preoperative interviews revealed that participants had clear expectations of the nurse's role in ICU. They expected the nurse who cared for them to be capable, intelligent, experienced and technically adept. Further, they wanted a nurse who would be vigilant and provide them with personalised care. Participants understood they would be vulnerable and looked to the nurse to help them through this period. Post-operative interviews revealed that when participants perceived vigilance or experienced personalised care from the nurses they felt reassured and secure. However, patients also described feelings of anxiety, apprehension, fear and other unexpected experiences, notably confusion and hallucinations. Recommendations suggest that modification to pre-operative patient education programs could lead to a reduction in anxiety in the post-operative period. They also highlight the importance, to the patients, of nurse caring activities. In addition, the findings suggest a need for staff education that addresses patient anxiety and post-operative psychological disturbances.

Perceptions of caring. Comparison of antepartum and postpartum patients

An exploratory, comparative survey design was used to describe and compare similarities and differences in perception of caring behaviors between hospitalized antepartum and short-stay postpartum patients. Forty-two patients completed the 63-item Caring Behavior Assessment instrument (CBA). The scale, based on Watson's theory of caring, contains seven categories. There were no statistically significant differences in age, education, gravida, or para between the two groups. Significantly more women in the postpartum group were married. There were no statistically significant differences or correlations in the total CBA scores and the demographic variables. No statistically significant differences in total CBA scores were found between antepartum participants and postpartum participants. These findings corroborate the results of "caring" studies in other patient populations, that satisfying basic needs--that is, evidence of technical knowledge and skills--is more important to patients than meeting higher order needs.