Confronting the caring crisis in clinical practice

A study of the correlation between residents' humanistic care skills and their level of emotional intelligence-A cross-sectional survey

BACKGROUND

There is variability in the structure of junior doctors' knowledge of humanistic medicine. The level of residents' emotional intelligence affects their professional development and the doctor-patient relationship. Currently, there is a paucity of research examining the humanistic competence and emotional intelligence of medical residents, both domestically and internationally.The primary objective of this study was to scrutinize the prevailing status of residents' humanistic competence and emotional intelligence levels, aiming to assess the correlation between humanistic competence and emotional intelligence.

METHODS

A cross-sectional survey using the Demographic Characteristics Questionnaire, the Humanistic Care Competence Scale, and the Emotional Intelligence Scale was conducted in September 2022 among residents of a tertiary general hospital in Sichuan Province. The relationship between humanistic care competence scores and emotional intelligence scores among residents was analyzed using Pearson correlation analysis and multiple linear regression analysis.

RESULTS

The mean score of residents' humanistic care competence was 188.82 ± 20.80, and the mean score of emotional intelligence was 87.08 ± 13.49.The Pearson correlation results demonstrated a significant correlation (r = 0.400, p = 0.000) between the level of emotional intelligence and humanistic care competence. The results of multiple linear regression analysis indicated that self-emotional appraisal, emotional appraisal of others, emotional control, emotional use, and school community work experience independently predicted humanistic care competence.

CONCLUSION

The scores for residents' humanistic care competence were notably low, influenced by a multitude of factors that also exhibited varying levels of impact on emotional intelligence development. Emotional intelligence was positively associated with humanistic care competence. Emotional intelligence is an important consideration in the development, implementation, and evaluation of humanistic care interventions. Residency programs should provide education and training in humanistic competencies to improve residents' levels of emotional intelligence and promote the overall health of society.

Humanistic care ability and its influencing factors among Chinese surgical nurses

AIM

This paper aims to investigate the humanistic care ability among surgical nurses in China and identify its statistically significant influencing factors.

DESIGN

A cross-sectional, descriptive and correlational design was used.

METHODS

A total of 210 surgical nurses were recruited from a tertiary public hospital in Wuhu, Anhui Province. Four with incomplete responses were excluded, leaving 206 participants for data analysis. Variables were measured using the general questionnaire, caring ability inventory (CAI), and General Self-Efficacy Scale (GSES). Multivariate linear regression analyses were performed to identify the statistically significant influencing factors of participants' humanistic caring ability.

RESULTS

The overall average score of the CAI was 190.14 (SD = 19.24), and the average scores for the three dimensions of cognitive, courage, and patience were 70.46 (SD = 7.77), 62.12 (SD = 8.47) and 57.56 (SD = 6.02), respectively. The overall average score of the GSES was 26.05 (SD = 5.77). Professional attitude, perceived care from the department head nurse, perceived care from colleagues and self-efficacy were the statistically significant factors influencing the humanistic care ability of surgical nurses (R2 = 0.45, adjusted R2 = 0.44, F = 40.64, p < 0.001).

Defining Caring Efficacy for Nursing Students in South Korea: A Mixed-Method Analysis

Introduction

Caring efficacy is a core nursing concept, but its application in nursing practice remains unclear.

Objective

This study analyzed the meaning and attributes of caring efficacy among nursing students, defined caring efficacy in this context, and identified the substantive constituents of the concept.

Methods

This hybrid study analyzed and compared data from a literature review and in-depth interviews with students in the clinical practice stage of a nursing program, according to the model suggested by Schwartz-Barcott and Kim.

Results

The results revealed five attributes of nursing caring efficacy and 17 indicators across two dimensions. Considering the attributes identified in theoretical work and fieldwork, this study defined nursing students' care efficiency based on their "qualifications and personality for caring" as "self-confidence in caring capabilities," rooted in their "growth through caring experience" and the conditions of their "educational environment for learning caring and social support."

Conclusion

The findings could guide the development of nursing caring efficacy scales. Future studies should explore caring efficacy among professional and student nurses in various clinical fields.

The Daily Rhythmic Changes of Undergraduate Students' Emotions: An Analysis Based on Tencent Tweets

Emotional stability is of great importance for undergraduates and has significant predictive power for mental health. Emotions are associated with individuals' daily lives and routines. Undergraduates commonly post their opinions and feelings on social networks, providing a huge amount of data for studying their emotional states and rhythms. Based on the construction of the emotion dictionary of undergraduates' Tencent tweets (TTs)-a social network for users to share their life situations and express emotions and feelings to friends-we used big data text analysis technology to analyze the emotion words in 45,996 Tencent tweets published by 894 undergraduates. Then, we used hierarchical linear modeling to further analyze the daily rhythms of undergraduate students' emotions and how demographic variables are associated with the daily rhythmic changes. The results were as follows: (1) Undergraduates tweeted about more positive emotions than negative emotions (love was most common and fear was the least common); (2) The emotions in undergraduates' tweets changed considerably from 1 a.m. to 6 a.m., but were fairly stable during the day; (3) There was a rising trend in the frequency of using emotion words in Tencent tweets during the day as each hour progressed, and there was a higher increase in positive emotion than negative emotion; and (4) The word frequencies and daily rhythms of emotions varied depending on demographic variables. Gender was correlated with the frequencies of gratitude and the daily rhythms of anger. As the grade increased, the frequency of emotion words in most subcategories in TTs decreased and the fluctuation in daily rhythms became smaller. There was no significant difference in the frequency and daily rhythm of emotion words used in TTs based on having had a left-behind experience. The results of the present study provided emotion expression in social networks in Chinese collectivist culture. This study added new evidence to support the notion that positive and negative emotions are independent dimensions.

Learning Outcomes Attributed to Prelicensure Clinical Education in Nursing: A Systematic Review of Qualitative Research

BACKGROUND

Educators agree that clinical experiences are vital to the development of a graduate nurse; however, there is little research on student learning outcomes related to these experiences.

PURPOSE

The purpose of this systematic review was to examine qualitative studies of student learning in traditional clinical models.

METHODS

A systematic review was conducted following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Nine electronic databases were searched using 43 search terms. Full-text review was completed on 109 articles, with 26 undergoing critical appraisal.

RESULTS

Only 6 qualitative studies reported learning outcomes attributed to clinical education models, focusing on experiences in foreign clinical placements, nurse-run clinics, the night shift, transition to professional identity, practicing as a clinical dyad, and development of caring skills.

CONCLUSIONS

The results of the systematic review of qualitative research that studied outcomes of prelicensure clinical education were insufficient to provide recommendations for traditional clinical education that are supported by evidence.

Design and Initial Validation of a Humanistic Care Evaluation Tool

Objective

This study aimed at developing and validating a humanistic care tool in Anhui province that could be used across Chinese public hospitals, and to reflect the humanistic care from patients’ perspective.

Participants

A cross-sectional survey was conducted in three public hospitals of Anhui Province, China by adopting simple random sampling, which included 312 outpatients and 323 inpatients.

Methods

The dimensions of the tool were set according to “Further Improve Medical Service Action Plan” in China and Patient-Doctor Relationship Questionnaire. Cronbach’s alpha values were calculated and used to evaluate the reliability of this tool. Construct validity was tested by the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The associations between characteristics and humanistic care were analyzed by binary logistic regression.

Results

These initial findings showed that about two-thirds of the respondents experienced humanistic care. Both the reliability and construct validity of the humanistic care evaluation tool were suitable Social aspects (location and yearly income), treatment style and having a regular doctor were significantly associated with better humanistic care (all P<0.05).

Conclusion

The humanistic care tool can directly reflect the humanistic care from patients’ perspective, and can be popularized and applied across Chinese public hospitals. These findings have important implications to further improve medical service in Chinese public hospitals.

Caring in process: A 3-year qualitative longitudinal study of nursing students

AIM

This paper aims to describe caring perceptions and behaviors among student nurses in Italy as they progress through their nursing education.

BACKGROUND

As nursing students are potential nurses of the future, there is an expectation that in addition to appropriate academic qualifications, they will develop appropriate caring behaviors/attitudes. However, there has been some evidence that the educational process does not always modify their caring perceptions/behaviors or that the direction of the change is not always positive.

DESIGN

A qualitative longitudinal design with three data collection points, was performed from October 2013 to October 2016 at the University of Verona, Trento Campus.

METHODS

Semi-structured interviews were conducted at the time of entry into a 3-year bachelor's degree program in nursing and at the end of the second and third years. Observation of the students during their clinical practice was carried out at the end of each of the three years of education. Thirty students commenced the study and 24 finished. Data were analyzed using a phenomenological approach.

RESULTS

The iterative process of analyzing interviews and observations resulted in nine themes collectively from all three stages: establishing a trusting relationship with the patient, satisfying the patient's needs, paying attention, being respectful, being competent, giving time, being concerned with the emotional dimension, acting within context to facilitate caring actions and giving information.

CONCLUSIONS

At the end of the third year the students' concept of caring was enhanced; their initial generic or lay view of caring turned into an intentional, competent, conscious, accountable and realistic caring approach.

Predictors of caring ability and its dimensions among nurses in China: A cross-sectional study

BACKGROUND

Caring is an essential component of professional nursing practice, which directly affects the quality of patient care. Nurses' caring ability may not meet patients' demands for high-quality care. There are challenges in designing and implementing interventions to improve nurses' caring ability, especially in China. Understanding Chinese nurses' caring ability and related influential factors serves as the basis for effective interventions to improve their ability to care for patients.

AIM

To describe the caring ability of nurses and its potential predictors in China.

METHODS

From January to February 2018, a cross-sectional survey was conducted among 2304 Registered Nurses working at different levels of hospitals across 29 provinces in China. The structured online survey included socio-demographic information, Caring Ability Inventory, Caring Efficacy Scale and Professional Quality of Life. Descriptive statistics, univariate analyses and multivariate analyses were conducted.

RESULTS

Overall caring ability and its three dimensions of the participants were all significantly lower than the Nkongho' norm, an international scoring standard of nurse's caring ability. Age, employment type, workplace, caring efficacy, compassion satisfaction, burnout and secondary traumatic stress were predictors of knowing, explaining 41.8% of the variance. Predictors of courage were educational level, bereavement experience, caring efficacy, compassion satisfaction and burnout (31.7% of the variance). Educational level, workplace, exposure to critically ill patients, caring efficacy, compassion satisfaction, burnout and secondary traumatic stress were influencing factors of patience, accounting for 19.5% of the variance.

CONCLUSIONS

Chinese nurses' caring ability, with patience, knowing, and courage in descending order. Particular attention needs to be paid to the courage dimension of the nurses' caring ability. Further, the predictors of overall caring ability and each dimension were diverse. These results indicate that nurse educators and administrators need to identify training priorities and design targeted interventions based on the influencing factors.

Facilitating and hindering experiences to the development of humanistic caring in the academic and clinical settings: an interpretive phenomenological study with nursing students and nurses

Objectives This paper reports on nursing students' and nurses' lived experiences mediating their development of humanistic caring. Methods Using interpretive phenomenology, 26 participants were individually interviewed. A five-stage phenomenological analysis based on Benner's (Benner, P. (1994). Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: SAGE) method occurred simultaneously. Results The analysis highlighted that the development of humanistic caring is affected by role models and counterexamples, environments in which humanistic caring is exalted or trivialized, communication-related courses, patient storytelling, and work overload. Conclusions It might be valuable to raise the awareness of nurse educators about their opportunity in shaping the development of students' humanistic caring.

Nurses' knowledge, attitudes, and behaviours related to pressure injury prevention: A large-scale cross-sectional survey in mainland China

AIMS AND OBJECTIVES

To determine the level of and factors in nurses' knowledge, attitudes and behaviours towards pressure injury (PI) prevention.

BACKGROUND

Although there has been a declining trend in global PI prevalence and hospital-acquired rates in recent years, this has not been the case in China. Evidence in the literature indicates the importance of nurses' knowledge, attitudes and behaviours for promoting PI prevention.

DESIGN

Cross-sectional study.

METHODS

A total of 1,806 nurses from 10 tertiary general hospitals in Hunan Province, China, participated in this study. Nurses' knowledge and attitudes were assessed using Pieper's Pressure Ulcer Knowledge Test and Attitude towards Pressure Ulcer Prevention Instrument, respectively, and behaviours were measured using a researcher self-designed questionnaire. Multiple logistic regression analysis determined factors affecting the nurses' PI-prevention knowledge, attitudes and behaviours. A STROBE checklist was used to report findings.

RESULTS

Among all nurses involved in this study, 41.7% had insufficient PI-prevention knowledge, 46.6% had negative PI-prevention attitudes, and 21.8% had poor PI-prevention behaviour. Nurses with a bachelor's degree or above were more likely to have adequate PI-prevention knowledge. Increased PI-prevention training frequency increased the nurses' positive attitude scores for PI prevention; longer years of service and a higher number of PI-prevention trainings attended predicted better PI-prevention behaviours.

CONCLUSION

Chinese nurses' PI-prevention knowledge and attitudes in this study were unsatisfactory, while their PI-prevention behaviour was acceptable. Increasing PI-prevention training frequency can help improve Chinese nurses' PI-prevention attitudes and further behaviour. Having a minimum of a bachelor degree may be beneficial to Chinese nurses' PI-prevention knowledge, but more evidence is needed.

RELEVANCE TO CLINICAL PRACTICE

Chinese nurses have insufficient knowledge about PI-repositioning, inadequate practices in PI nutrition assessment, and low confidence in their personal competence regarding PI-prevention. The key solution for the above issues is to promote ongoing education and training based on strong clinical leadership.

Caring in community nursing practice: Inductive content analysis reveals an inter-dynamic system between patients and nurses

AIMS AND OBJECTIVES

To examine the understanding of caring in the practice of community nursing from the perspectives of patients and nurses.

BACKGROUND

An increasing population of patients with chronic disease has produced a need for humanistic caring in communities. As a result, caring has become a core value of community nursing professionals. However, community nurses meet many difficulties in trying to practice person-centred care with their clients. Furthermore, most community nurses-especially in China-lack systematic education and training about caring because the practical meaning of caring in community practice is unknown.

DESIGN

The qualitative study described herein employed inductive content analysis.

METHODS

Eleven community patients with chronic disease and fifteen community nurses who were nominated as a caring nurse from different community clinics in Beijing, China, participated in thirty-one interviews during January to August in 2018. Nine documents from the interviewed nurses were collected. Both interview data and documents were analysed using strategies of inductive content analysis. The COREQ checklist was used.

RESULTS

Patients and their corresponding nurses described a wide range of caring experiences that were generalised into 28 concepts. Caring emerged as an inter-dynamic system that comprised the foundation and quality of a caring relationship, the caring philosophy and behaviours of interactions, and positive feedback from caring interactions. A relationship-based framework of caring in community nursing practice was constructed.

CONCLUSIONS

Identifying this systematic concept of caring provides insights that are applicable to the creation of targeted management, education and practice interventions to ultimately enhance the quality of community health care-in China or elsewhere.

RELEVANCE TO CLINICAL PRACTICE

The systematic understanding of caring in community nursing practice will inform nurses in community health clinics, their educators and their managers on how to provide care to community patients and how to develop caring competence for community nurses.

Faculty Ability to Care and Caring Characteristics in School of Nursing Climate: A National Survey

AIM

This study surveyed faculty ability to care and perception of caring characteristics within school of nursing climate.

BACKGROUND

Caring within schools of nursing is not well understood.

METHOD

A stratified, random, multistage cluster national sample of 2,043 faculty were surveyed using the Caring Ability Inventory and the Caring Characteristics Within the School of Nursing Climate instruments.

RESULTS

No significant differences on the Caring Ability Inventory were identified by school type. Significant differences were noted in faculty perceptions of a caring climate by school type. State universities and community colleges scored lower on the Trust/Teamwork, Support, and Respect subscales and total Caring Characteristics Within the School of Nursing Climate. Community college scores were lower than private, not-for-profit, and state university scores (p < .05) on the Valued subscale.

CONCLUSION

Further research is needed to describe and evaluate the caring climate within schools of nursing and the effectiveness of specific strategies to facilitate caring in the school of nursing climate.

Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016)

BACKGROUND

Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.

AIM

To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.

METHODS

A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I² statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.

RESULTS

Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.

CONCLUSION

The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.

Caring characters and professional identity among graduate nursing students in China-A cross sectional study

BACKGROUND

Caring is recognized as the essence of nursing and the core of nursing practice while a positive professional identity can lead to personal, social and professional fulfillment. Analyzing caring characters and professional identity yields important indications for the improvement of teaching methods. This study aims to explore the graduate nursing students' professional identity and caring characters in China, and analyze their correlation.

METHOD

A descriptive cross-sectional study was used to collect data from 216 graduate nursing students between January and February 2017 in China.

RESULTS

Graduate nursing students perceived they possessed positive caring characters while their professional identity was at a low level. A significant positive correlation was found between the Nursing Caring Characters Assessment Tool and Professional Identity Scale for Nursing Students.

CONCLUSION

Graduate nursing students' professional identity was not satisfactory and one strategy to improve this is to internalize caring into the education process. Nursing educators should focus more on the formation of the students' professional identity and caring as a contributing factor to it.

Nursing and midwifery students' encounters with poor clinical practice: A systematic review

The aim of this paper was to systematically review evidence about nursing and midwifery students' encounters with poor clinical care. We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students' encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis. N = 14 papers met inclusion criteria; study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction; ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice; iii) a range of influencing factors impact the likelihood of reporting; iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students. Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so.

The caring concept, its behaviours and obstacles: perceptions from a qualitative study of undergraduate nursing students

Developing caring competences is considered to be one of the most important aims of undergraduate nursing education and the role of clinical placement is recognised as special in this regard. Students' reflection on caring, their experience and obstacles in being caring is recommended as a key strategy in the process of teaching and studying the nursing discipline. Therefore, the aim of this study was to describe the concept of caring, its manifestations and possible obstacles while caring, as perceived by first-year nursing students before and after their first clinical placement. Qualitative content analysis of 15 Polish students' narratives written before and after their clinical experience in the form of text-diaries was undertaken. The findings revealed that students entered their nursing education with a deep humanistic vision of caring both on theoretical and practical levels and the first clinical placement has enriched this vision. Expressive caring was more appreciated by students than the instrumental one and their concept of caring was coherent with the caring behaviours as described in their narratives. Several internal and external obstacles for caring have been reported by students, indicating a specific tension between their ideal of caring and their practical experience of caring in the clinical reality.

One University Making a Difference in Graduate Education

As online education gains momentum, strategies to promote student engagement, develop social presence, and create a virtual community are essential for students’ successful learning. A university with a philosophy grounded in caring developed two strategies for the graduate online education setting. These two strategies intentionally promote caring for self and others as a means to foster engagement, social presence, and a vibrant online community. One strategy was online Caring Groups, that is, small groups of four to five nursing students created each semester in one of the students’ required courses in the online setting. The second strategy was the creation of two Caring Connections online sites, one for master of science in nursing students and one for doctorate in education nursing students. The sites were developed external to required courses to provide support for the online students throughout the graduate programs. Each site provides an ongoing space for students and faculty to post and discuss inspirational quotes, self-care tips, music, and photographs. The online Caring Groups and Caring Connections sites will be described, including how they were created, how they are used by students, how faculty support students, lessons learned, and how Caring Groups are integrated into the curriculum

Baccalaureate nursing students' perspectives on learning about caring in China: a qualitative descriptive study

BACKGROUND

The need to provide humanistic care in the contemporary healthcare system is more imperative now and the importance of cultivating caring in nursing education is urgent. Caring as the primary work of nursing has been discussed extensively, such as the meaning of caring, and teaching and learning strategies to improve nursing students' caring ability. Yet attempts to understand students' perspectives on learning about caring and to know their learning needs are seldom presented. The aim of this qualitative descriptive study was to explore the baccalaureate nursing students' perspectives on learning about caring in China.

METHODS

A qualitative descriptive study using focus group interviews were undertaken in two colleges in Yunnan Province, China from February 2010 to April 2010. Purposeful sampling of 20 baccalaureate nursing students were recruited. Content analysis of the transcribed data was adopted to identify the themes.

RESULTS

Four categories with some sub-categories related to students' perspectives on learning about caring were identified from the data: 1) Learning caring by role model; 2) conducive learning environment as the incentive to the learning about caring; 3) lack of directive substantive way of learning as the hindrance to the learning about caring; 4) lack of cultural competency as the barrier to the learning about caring.

CONCLUSIONS

Both caring and uncaring experiences can promote the learning about caring in a way of reflective practice. The formal, informal and hidden curricula play an important role in the learning about caring. Cultural awareness, sensitivity and humility are important in the process of learning to care in a multicultural area.