Caring theory and practice--entering a simultaneous concept analysis

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.

A concept analysis of Watson's nursing Caritas process

AIM

The main objective of this analysis is to give an understanding of Watson's nursing Caritas as a concept.

DESIGN

Watson's nursing Caritas is an abstract concept, and difficult to define and operationalize because of its philosophical nature. Watson's nursing Caritas develops a clear relationship between care, caring factors, and the processes of human life.

METHODS

We used Walker and Avant's method. PubMed, Scopus, Ovid, EBSCO, Science Direct, Web of Science, Google Scholar, and ProQuest were searched. "Caritas process" and "Watson's caring theory" were searched. In the primary search, 883 articles were found, but eventually, 25 articles were included in the study.

RESULTS

We define Watson's nursing Caritas as the process based on caring consciousness, engaging in reliable human caring relationships for healing support, integrity, and development of humanity that alters the concept of caring into a higher ethical commitment inspired by responsibility for others, and different meanings, including kindness, compassion, joyfulness, and peacefulness and leads to the establishment of caring behavior in clinical Watson's nursing Caritas, thus leading to improving performance.

CONCLUSION

Clinical nursing Caritas enables nurses to develop an effective human being relationship between nurse-client-family, and ultimately achieve a common experience and perception of caring.

Appropriation and application of caring science theory: Experiences of master education alumni in three Nordic countries

BACKGROUND

A theoretical foundation in caring science is invaluable for nursing care because it enriches practice by providing explanations, clarity and direction. However, after graduation, students experience the frustration of not being able to sufficiently intertwine caring science theories in practice. Consequently, the integration of caring science theories in nursing education and practice is considered an essential focus area to reduce this theory-practice gap.

AIM

This study aims to elucidate master alumni's experiences of appropriation and application of caring science after completing a master's education.

METHODS

The data were collected by semi-structured interviews with 21 alumni from Finland, Sweden and Norway who had recently completed a master's degree with caring science as the major subject. A thematic analysis was used.

FINDINGS

The analysis resulted in two main themes, both with three subthemes. Educator's bearing and a learning community are important for students' appropriation of caring science theories. Learning through reflection and the response of others evoke new paths of thought, and practice-related teaching promotes the intertwining and application of caring science theory in practice. The appropriated theory has significance to alumni by providing a guiding basis that strengthens alumni's professional bearing and way of being. The caring science theory guides alumni in providing nursing care with an increased ethical awareness and questioning approach that enables good patient care. Their professional identity and confidence in caring are also strengthened.

CONCLUSION

Educators' bearing is of outermost importance for appropriation and application of caring science theory. It has a key function in facilitating students' understanding and intertwining of caring science theory and practice. Appropriated caring science theory provides authority and courage to practice nursing care. The appropriated theory promotes alumni's ethical awareness, confidence and a sense of pride in the profession.

The development and psychometric testing of three instruments that measure person-centred caring as three concepts - Personalization, participation and responsiveness

AIM

To develop and test the psychometric properties of three instruments that measure Person-centred Caring: as Personalization, Participation and Responsiveness.

DESIGN

A three-phase mixed methods design used two frameworks: content validity determination and quantification; consensus-based standards for selection of health measurement instruments.

METHODS

A narrative literature review identified the domain definition. A systematic review of instruments provided the basis for item pools, which were refined by focus groups (N = 4) of multidisciplinary staff and service users (N = 25) and cognitive interviews (N = 11) with service users. Scale content validity indexes were calculated. Three cross-sectional surveys were conducted between April 2015 and June 2016. The instruments' psychometric properties tested included factor structure, internal consistency and construct validity. Convergent validity was tested, hypothesizing that: Personalization related to relational empathy; Participation related to empowerment; and Responsiveness related to trust.

RESULTS

Scale content validity indexes were ≥0.96 in all instruments. Response rates were 24% (N = 191), 15% (N = 108) and 19% (N = 124). Two factors were revealed for the Personalization and Responsiveness instruments and one factor for the Participation instrument. All had acceptable: reliability (Cronbach's Alpha >0.7); construct validity (>50%); and convergent validity (Spearman's correlation coefficient >0.25, p < 0.05).

CONCLUSION

This study composed definitions and instruments that reflect the multidisciplinary teams' caring behaviours, which have acceptable reliability and validity in the community population. Further psychometric testing of Participation and Responsiveness instruments should be undertaken with a larger sample.

IMPACT

The instruments can be used to monitor the variability of multidisciplinary teams' caring behaviours; research effective interventions to improve caring behaviours; and increase understanding of the impact of caring on health outcomes.

A model to facilitate the teaching of caring to diagnostic radiography students: Original research

BACKGROUND

Healthcare has moved towards a patient-centred caring environment. Radiography students have described feeling unprepared for daily patient interactions therefore, it is essential for educators to facilitate the development of caring attributes in students.

OBJECTIVE

The objective of this article is to describe the process that was followed in order to develop a model to facilitate the teaching of caring to diagnostic radiography students.

METHOD

A qualitative, theory-generating, exploratory and descriptive research design was used. Phase one was a descriptive, exploratory study that utilized focus group interviews to explore and describe the concept of caring from the perspective of first year diagnostic radiography students. Phase two, the focus of this article, was the theory generation phase of the study which began with identifying a central concept from the focus group interview results. The central concepts were then defined according to dictionary and literature sources and relationships between the identified concepts were created. Thereafter, the model was developed.

RESULTS

The central concept was identified as the "facilitation of a culture of caring". This concept was then defined, classified and described.

CONCLUSION

This model as a framework of reference could assist diagnostic radiography educators in facilitating the teaching of caring among student radiographers.

Caring efficacy: nurses' perceptions and relationships with work-related factors

BACKGROUND AND AIM OF THE WORK

Caring nursing practice is central aspect of quality of services. It is important to assess nurses' caring experience in terms of perceived caring efficacy to make them aware of their outcomes and improve their strategies. The aims of the study was to analyze: (1) the caring efficacy level, (2) differences between the caring efficacy levels concerning  positive and negative work attitudes, (3) individual and organizational predictors of perceived caring efficacy.

METHODS

200 nurses were recruited from a University Hospital in Southern Italy. A self-reported questionnaire was administered. T-test was performed to analyze differences between caring efficacy levels concerning outcomes variables. Regression analysis was carried out to examine how some work factors were related to perceived caring efficacy.

RESULTS

Participants referred high confidence to care (CC) for 55%, and low doubts and concerns (DC) for 72.9%. Nurses who had low DC had lower emotional exhaustion than nurses with moderate DC. Nurses with low DC had higher job satisfaction than nurses with high DC. Regarding CC levels, there were no differences between mean values for both attitudes at work. The emotional dissonance significantly predicted DC and CC. The supervisor support had a negative link with emotional dissonance, which in turn was negatively related to CC.

CONCLUSIONS

Education and training should be addressed to reduce doubts and concerns to care and improve the ability to manage emotions. A work environment that value caring and give support in managing emotions can reduce emotional dissonance and improve caring self-efficacy.

Effectiveness of standard of care protocol on patient satisfaction and perceived staff caring

BACKGROUND

Nurse caring has been linked to many clinical outcomes, including patient satisfaction, well-being, and healing. In addition, it is valued by nursing staff and viewed as being essential to clinical practice.

OBJECTIVES

The purpose of this program evaluation study was to determine the difference in patient satisfaction with overall nursing care and perceived nurse caring when a nursing staff standard of care protocol, which included caring activities, was implemented within a nursing department at a National Cancer Institute-designated comprehensive cancer center.

METHODS

A pre-experimental pre-/post-test design with comparison group and a post-test-only design were used to test the effect of the caring protocol on patient satisfaction with nursing care and perceived nurse caring. The study was conducted on seven inpatient units.

FINDINGS

Patient satisfaction with nursing care increased for some items, and perceived nurse caring was ranked highly immediately before discharge. Additional program evaluation studies involving a modified caring protocol may improve satisfaction with nursing care in other settings.

Development and Psychometric Testing of the Humanistic Nurse-Patient Scale

Quality of life and well-being of older patients in chronic care facilities is often determined by their relationships with nurses. The authors developed and tested a scale to assess patients' views of what matters most when relating to nurses. Based on the humanistic nursing theory by Paterson and Zderad (1988), 69 items were created and tested with a sample of 40 patients, resulting in refinement of a scale with 24 items. This scale was factor analysed on responses from 249 patients residing in five facilities in Ontario, Canada. The Humanistic Relationship Importance Scale demonstrated strong internal consistency, stability, and reliability with a five-factor solution (α = .87). Construct validity was supported through factual identification. This scale is a valid measure of patients' perspectives of a nurse-patient relationship in chronic care and can be used to measure health professionals' relationships with their older patients and evaluate interventions to enhance relational care.

Patients' experiences with cholecystitis and a cholecystectomy

Nurses commonly care for patients with cholecystitis, a major health problem with a growing prevalence. Although considerable research has been done to compare patient outcomes among surgical approaches for cholecystitis, few studies have examined the experiences of patients with cholecystitis and the subsequent cholecystectomy surgery. A qualitative study with a phenomenological approach was initiated to better understand the experience of hospitalized patients with cholecystitis through their cholecystectomy surgery. Face-to-face semistructured interviews were conducted with patients diagnosed with cholecystitis and scheduled for a cholecystectomy at a rural, Midwestern hospital in the United States. Postoperative interviews were then conducted with the patients who experienced an uneventful cholecystectomy. Giorgi's technique was used to analyze postoperative narratives of the patients' cholecystectomy experiences to determine the themes. Following analysis of interview transcripts from the patients, 5 themes emerged: (a) consumed by discomfort and pain, (b) restless discomfort interrupting sleep, (c) living in uncertainty, (d) impatience to return to normalcy, and (e) feelings of vulnerability. Informants with acute cholecystitis described distressing pain before and after surgery that interfered with sleep and family responsibilities. Increased awareness is needed to prevent the disruption to daily life that can result from the cholecystitis and resulting cholecystectomy surgery. Also, nurses can help ease the unpredictability of the experience by providing relevant patient education, prompt pain relief, and an attentive approach to the nursing care.