Perceptions of nurses' caring behaviors by trauma patients

Translation and validation of caring behaviors inventory among nurses in Iran

BACKGROUND AND OBJECTIVES

Nurses' caring behaviors, professional activities, and behaviors for the benefit of patients, influence patients' perception of care and satisfaction with the quality of care provided. Caring behaviors of nurses are contextual and various factors such as patients' social structure, lifestyle, culture, and interests, as well as their biographical, social, and physiological characteristics, can influence perceptions of caring behaviors of nurses, as caring behaviors are an interactive and mental process between patients and nurses. This study was conducted to provide a transcultural translation and psychometric analysis of Caring Behaviors Inventory (CBI) among nurses in Iran.

METHODOLOGY

Transcultural translation of the 16-item CBI was performed. Then, face validity (qualitative), content validity (quantitative and qualitative), and construct validity were examined in a cross-sectional study of 509 patients. A demographic questionnaire and the 16-item CBI were sent to enrolled patients via online questionnaires. The reliability of the instrument was assessed by internal consistency using Cronbach's alpha. Then, construct validity of the single factor CBI was assessed using Confirmatory Factor Analysis (CFA). Since one factor CBI was not confirmed, construct validity was examined using Exploratory Factor Analysis (EFA). The final number of factors was confirmed using CFA.

RESULTS

The internal consistency of the instrument was good with Cronbach's alpha 0.89. Based on EFA, the CBI were loaded on two factors, eigenvalues >1, no item was removed. The emergent factors were named "Communicating respectfully" and "Professional knowledge and skill". These two factors explained 50.197% of the total variance. Then, CFA showed an acceptable fit for the two factors CBI.

CONCLUSION

The results showed that the Persian version of the 16-item CBI had adequate validity and reliability. Accordingly, this instrument can be used to study nurses' caring behaviors.

Predictors and priority of caring behaviours in intensive care units

BACKGROUND

There is an increasing number of studies addressing nurses' perception of caring behaviours; however, on the issue of quality of care, it is important to understand why nurses focus more on certain elements of caring than others, and this needs to investigate influencing factors on, priorities, and predictors of caring behaviours.

AIMS

The main goal of this study was to determine the predictors and priorities of nurses' caring behaviours in intensive care units to improve the quality of care and patient outcomes.

METHODS

This is a cross-sectional survey of nurses working in adult and pediatric ICUs in Iran. The participants were 470 ICU nurses from eight hospitals in Iran. Data were collected over 6 months in 2018 using the Persian version of "Caring Assessment Report Evaluation Q-Care"; "Determinants of Nurse Caring Behaviors"; and a demographic data form.

RESULTS

By broad descriptive and analytical analysis, thirteen items were recognized as predictors of caring behaviours. The most important individual predictors reported as "interest in the nursing profession," "moral obligation," and "job experience," respectively. The most important perceived nursing behaviours were, respectively, subscales of "accessible," "monitors/follow-through" and "explains/facilitates."

CONCLUSION

The results provide insight into new and context-specific predictors of nurses' caring behaviours. These findings suggest that nursing managers, besides selecting skilful staff for ICUs, may consider employing those of higher "interest in the nursing profession"; "moral obligation"; and "job experience." They, also, need to be aware that organizational culture, climate, and values have a great impact on the caring behaviours of nurses. This could help them to handle the complex issue of improving the quality of care more efficiently.

Trauma Patients' Family Members' Perceptions of Nurses' Caring Behaviors

A mixed methods study was conducted to identify trauma patients' family members' perceptions of nurses' caring behaviors on a trauma step-down unit at a level I trauma center. Family members completed Caring Behaviors Inventory-Short Form 24 and a qualitative section. Quantitative data were analyzed using descriptive statistics. On a scale of 1 to 6, the mean score for individual items was 5.2 (median = 5.3). Participants considered the nurses' behaviors to be indicative of caring in each of the 4 areas measured-assurance, knowledge/skills, respectfulness, and connectedness. Four themes were identified-technical, nonverbal, personal connections, and addressing comfort.

Perceptions of caring in China: patient and nurse questionnaire survey

BACKGROUND

The concept of caring is important to both patients and nurses. If patients and nurses perceive caring behaviours differently, patients may not have their needs met or will be dissatisfied with the nursing.

AIM

This study conducted in mainland China compared the perceptions of nurses and patients concerning nurses' caring behaviours.

METHODS

From November 2011 to June 2012, 680 patients and 540 of their nurses in five hospitals in southern, central and eastern China were invited to complete a descriptive comparative survey with four subcategories, the Caring Behaviors Inventory-24. Respondents scored each of the 24 items on the survey from 1 (low) to 6 (high). Of those invited, 595 patients (87.50%) and 445 (82.41%) nurses completed the survey.

RESULTS

The mean item score on the Caring Behaviors Inventory-24 was 4.32 and 4.96 for patients and nurses, respectively. The subcategory with the highest mean score for both groups was knowledge and skills (4.73, 5.25), and the lowest for both groups was positive connectedness (3.98, 4.51). Nurses' scores were significantly higher than those of patients for all four subcategories (P < 0.001).

CONCLUSIONS

The gap between the two groups indicates that nurses need to improve their understanding and response to patients' actual and perceived needs and expectations. In China, patients require more support from nurses of their psychological needs.

STUDY LIMITATIONS

Participants came from a limited number of hospitals in three cities. A larger sample from different hospitals in mainland China could have increased the power of the study.

The experience of being a trauma nurse: a phenomenological study

The lived experience of being a trauma nurse was explored using a phenomenological qualitative research approach. Seven registered nurses employed in a trauma unit from one large metropolitan Canadian teaching hospital participated in in-depth conversational interviews. Data analysis revealed four sub theme clusters embedded within the overarching theme of Seeing Through Cloudy Situations: being on guard all the time, being caught up short, facing the challenge and sharing the journey. Even though trauma nurses are able to find meaning and satisfaction in their work, the findings of this research reveal the need for support and the assurance of safe work environments as trauma nurses can live with violence and aggression in their daily nursing practice.

Describing compassionate care: the burn survivor's perspective

Compassion is vital in burn care. Its delivery could be considered a professional duty and a characteristic of care that affects patient satisfaction. However, the description of compassionate care is underexplored in the burn care literature. This study investigates the concept of compassionate care and how it is described from the perspective of the burn survivor. A qualitative design with two focus groups at the Phoenix Society for Burn Survivors' World Burn Congress was used to examine views of compassionate care directly through 31 burn survivors' accounts to better understand the concept and its delivery within the context of burn care. Discussions were recorded and transcripts were analyzed for prominent themes and descriptive components. Participants were primarily Caucasian (77%), female (60%), with an average age of 47.6 years and an average TBSA burn of approximately 49% sustained approximately 12 years ago. Qualitative data analysis yielded primary themes of: 1) respect the person (subthemes were: establishing an empathic connection, restoring control through choice, providing individualized care, and going above and beyond), 2) communication (subthemes: interpersonal and informational), and 3) provision of competent care. The three primary themes were components of compassionate care; it was not defined by a single characteristic, behavior, or skill but might be best understood as the convergence of the three themes. Implications of findings and barriers to the provision of compassionate care are also discussed.

Memories from intensive care unit persist for several years--a longitudinal prospective multi-centre study

INTRODUCTION

In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients' delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective.

AIM

The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL).

METHODS

In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU.

RESULTS

The patients' memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury.

CONCLUSIONS

Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term.

Trauma resuscitations and patient perceptions of care and comfort

Patients subjected to common trauma resuscitation practices can have varied emotional responses to certain aspects of their initial evaluation and care. Thirty-four patients admitted to the hospital after blunt traumatic injury were randomly selected to complete a self-reported questionnaire regarding their comfort levels with certain aspects of their initial trauma care and resuscitation. Most patients reported higher levels of comfort with procedures generally expected by the lay public and lower levels of comfort with those procedures less well known or for which they were not prepared. Analysis of survey data showed a larger percentage of discomfort with the digital rectal examination than with other aspects of trauma care. Notably, data analysis also showed a significant percentage of patients who were reluctant to disclose receiving a digital rectal examination. Additional investigation into the validity and reproducibility of these trends is warranted; however, there is legitimate evidence that there is room to improve a patient's perception of comfort during a trauma resuscitation and initial workup through improved communication and procedure disclosure.

Do they really care? How trauma patients perceive nurses' caring behaviors

Applying the theory of Nursing as Caring can help the nurse provide care that is perceived as caring by moderately to severely injured trauma patients. The Caring Behaviors Inventory was administered in a 1-to-1 interview format to hospitalized trauma patients in a level 2 trauma center. Nurses were positively perceived in their caring behaviors with some variation based on gender and ethnicity. The modified Caring Behaviors Inventory is quick to use and is reliable and valid.

Cross-cultural validation and psychometric properties of the Greek version of the Caring Behaviors Inventory: a methodological study

RATIONALE

Translation, adaptation and cross-cultural validation of instruments or scale to measure concepts of interest among different populations can facilitate sharing of knowledge and advance cross-cultural research globally, especially in countries with diverse populations.

AIMS AND OBJECTIVES

This is a two-phase study aiming to: (1) translate, adapt and cross-validate the 24-item English version of Caring Behaviors Inventory into Greek; and (2) evaluate the psychometric properties of the Greek version (CBI-GR).

METHODS

A descriptive correlational design was used to conduct the study. The procedure involved professional translators, committee approach, and a sample of nurses and patients. The psychometric evaluation of the CBI-GR used a sample of 245 Greek and Cypriot medical-surgical nurses. Data analyses comprised internal consistency reliability (Cronbach's alpha coefficient), stability (test-retest) reliability, item analysis and confirmatory factor analysis.

RESULTS

The Cronbach's alpha for the overall CBI-GR was 0.92 and ranged from 0.76 to 0.87 for the subscales. Correlation coefficients between test and retest for the overall CBI-GR was r = 0.83 and ranged from r = 0.69 to 0.78 for its subscales. Confirmatory factor analysis of the scale supports its four-factor structure and the model indexes were adequate: X(2) (239) = 515.54, P < 0.001; comparative fit index = 0.91; incremental fit index = 0.91; and Tucker Lewis index = 0.90; parsimony normed fit index = 0.73; parsimony comparative fit index = 0.79; and root mean square of approximation = 0.07.

CONCLUSIONS

The CBI-GR is comparable with the original 24-item English version of the CBI and it is suitable to measure nurse caring among Greek-speaking nurses. Further psychometric testing of the instrument among nurses and patients is warranted.

A holistic framework for nursing time: implications for theory, practice, and research

TOPIC

Nursing time has relevance for those who produce it, those who receive it, and those who must pay for it. Although the term nursing time may be commonly used, a common understanding of the concept within the fields of nursing and healthcare administration is lacking.

PURPOSE

The purposes of this paper are to explore the concept of nursing time and to identify implications for theory development, clinical and administrative practice, and research.

DISCUSSION

Both physical and psychological forms of time are viewed as fundamental to our experience of time as social beings. Nursing time has significant intrinsic and instrumental value in nursing and health care. A holistic approach incorporating the physical, psychological, and sociological aspects and dimensions of nursing time is advocated.

CONCLUSIONS

Multiple strategies to enhance the patient experience of nursing time are warranted and should address how much time nurses spend with patients as well as how they spend that time. Patterns of overlapping and competing time structures for nurses should be identified and evaluated for their effect on physical time available for patient care and the psychological experiences of time by nurses and patients.

Who is the emergency room patient? An evolutionary concept analysis

There is an absence of concept analysis discussing: "Who is the emergency room patient?" in the literature. This study aims to clarify and conceptually develop these concepts as they are contextually mediated. Using the evolutionary method of Rodgers (Concept Development in Nursing: Foundations, Techniques, and Applications. 2000:77-127), the findings clearly identified the references, contextual basis, attributes, antecedents, and consequences of the concepts. Clarity of the concepts is important as they could greatly influence future developments in practice, theory, and research.