The theory of Human Caring: retrospective and prospective

Beyond Competency: Developing Critical Digital Capabilities in Nursing Students Through Freirean Pedagogy

The digitalisation of healthcare is transforming nursing practice, presenting unique opportunities and challenges that demand more than technical competence from nursing professionals. Despite the growing integration of digital tools, nursing remains in the 'foothills of digital transformation', with significant gaps in the critical and theoretical frameworks required to navigate this shift effectively. This article explores how Paulo Freire's critical pedagogy may address these gaps by fostering critical digital skills in nursing students. Drawing on Freire's concepts of problem-posing education, conscientization, dialogue and praxis, the article proposes a pedagogical model that encourages students to critically examine the socio-political and ethical implications of digital tools within their practice. By aligning Freirean principles with contemporary nursing challenges, the article argues for a shift away from solely competency-based frameworks toward educational approaches that promote reflective, dialogical, and ethically informed engagement with technology. The limitations of Freirean pedagogy, including its difficulty in evidencing direct outcomes, are discussed alongside its potential to cultivate a philosophically engaged nursing workforce capable of navigating the complexities of a digital healthcare environment and its associated impact on the profession. This approach underscores the importance of preserving nursing's core ethical and relational values while embracing the transformative potential of digital technologies.

Applying the DASA-YV for aggression risk reduction in pediatric acute care

PURPOSE

Pediatric nurses frequently face aggression from children and adolescents, posing risks to both staff and patients. The Dynamic Appraisal of Situational Aggression Youth Version (DASA-YV) assesses aggression in youth but has only been studied in inpatient psychiatry and certain institutional settings, such as juvenile justice and residential care.

DESIGN AND METHODS

This study aimed to validate the DASA-YV in pediatric acute care settings, using an observational design across pediatric emergency, medical/surgical, and intensive care units at two academic medical centers in Southern California. The DASA-YV was administered to patients ages 6 to 17 years with a primary or secondary behavioral health diagnosis from 2022 to 2023.

RESULTS

The sample included 201 hospital encounters, of which 33 involved aggressive incidents (16.4 %). The most frequent DASA-YV indicators were outside stressors (39 %), anxiety (37 %), and irritability (29 %). Patients with a 'high' DASA-YV rating showed higher frequencies of overall aggression (P < .001), object aggression (P < .001), verbal aggression (P < .001), and aggression against people (P < .001). In adjusted models, older children and pediatric acute care encounters had a lower risk of aggression, while males had a higher risk. A medium DASA-YV risk rating was associated with an aggressive behavior incidence rate ratio (IRR) of 7.49, and a high rating had an IRR of 36.18. In ROC analysis, the AUC was 0.94, (95 % CI: 0.90-0.98) indicating strong model performance for classifying aggressive incidents.

CONCLUSIONS AND PRACTICE IMPLICATIONS

The DASA-YV is a valuable tool for assessing aggression risk in pediatric acute care, enhancing patient and staff safety.

Rural patients' satisfaction with humanistic nursing care in Chinese Public Tertiary Hospitals: a national cross-sectional study

Background

The provision of high-quality healthcare services and patient satisfaction are fundamental objectives in modern healthcare. Humanistic nursing care, which emphasizes empathy, respect for individuality, and cultural sensitivity, aims to build trust and improve the overall experience for patients. This approach is especially relevant for rural patients in China, who often face additional challenges in accessing care in large tertiary hospitals.

Methods

A multistage, stratified sampling method was employed to collect data from 8,263 patients aged 18 years or older in large public tertiary hospitals. Humanistic care satisfaction scores were measured using the Nurse Caring Instrument (NCI) questionnaire, a validated tool for assessing patient satisfaction with nursing care.

Results

Satisfaction with nursing humanistic care among rural Chinese patients attending large tertiary public hospitals was low with the overall mean satisfaction score 81.62 ± 16.85. Significant differences in satisfaction were found based on age, marital status, number of children, educational attainment, occupation, monthly household income, department visited, type of medical insurance, and first-time visitor. A multivariate analysis revealed positive correlations with satisfaction for factors such as having children, higher education, higher family monthly income, and first-time visitor, and negative correlations for factors such as older age, being widowed, department visited, and region.

Conclusion

Older adults, widowed individuals, and first-time patients expressed lower levels of satisfaction, highlighting the need for tailored interventions. The findings provide insights into the impact of humanistic nursing care for rural patients and emphasize the importance of culturally sensitive approaches to improve patient satisfaction in rural China. This study has several limitations. The cross-sectional design restricts the ability to establish causal relationships, and there is a potential for selection bias, as participants who completed the survey may have higher educational and economic levels, possibly leading to an overestimation of satisfaction. Lastly, as this study focused on rural patients in large public tertiary hospitals in China, the findings may not be generalizable to other settings or patient groups. Future studies should address these limitations for broader applicability and insight.

Visualizing Empathy in Patient-Practitioner Interactions Using Eye-Tracking Technology: Proof-of-Concept Study

Background

Communication between medical practitioners and patients in health care settings is essential for positive patient health outcomes. Nonetheless, researchers have paid scant attention to the significance of clinical empathy in these interactions as a practical skill.

Objective

This study aims to understand clinical empathy during practitioner-patient encounters by examining practitioners' and patients' verbal and nonverbal behaviors. Using eye-tracking techniques, we focused on the relationship between traditionally assessed clinical empathy and practitioners' actual gaze behavior.

Methods

We used mixed methods to understand clinical encounters by comparing 3 quantitative measures: eye-tracking data, scores from the Korean version of the Jefferson Scale of Empathy-Health Professional, and Consultation and Relational Empathy survey scores. We also conducted qualitative interviews with patients regarding their encounters.

Results

One practitioner and 6 patients were involved in the experiment. Perceived empathy on the part of the practitioner was notably higher when the practitioner focused on a patient's mouth area during the consultation, as indicated by gaze patterns that focused on a patient's face. Furthermore, an analysis of areas of interest revealed different patterns in interactions with new as opposed to returning patients. Postconsultation interviews suggested that task-oriented and socially oriented empathy are critical in aligning with patients' expectations of empathetic communication.

Conclusions

This proof-of-concept study advocates a multidimensional approach to clinical empathy, revealing that a combination of verbal and nonverbal behaviors significantly reinforces perceived empathy from health care workers. This evolved paradigm of empathy underscores the profound consequences for medical education and the quality of health care delivery.

Time to care: How a homecare model harnesses nurses' professional ethic and cultivates caring

BACKGROUND

A persistent devaluation of care-work, difficult working conditions, and low salaries have led to challenges with staff recruitment and retention in the homecare sector in France. A new homecare organization adopting an innovative organizational model recently experimented an hourly payment method yielding positive outcomes.

OBJECTIVES

Using Tronto's caring framework, this paper analyzes the strategies used by the founders as they developed their innovative model and the nursing activities performed during home visits.

DESIGN

A longitudinal qualitative study was conducted between 2017 and 2023. Homecare nursing teams were shadowed for 1-2 days per year yielding detailed field notes on caregiving activities, both before and after the new payment method. Secondary data included reports, videos, articles, and unpublished documents found online.

ETHICAL CONSIDERATIONS

While there is no requirement in France to obtain ethical approval in non-interventional research, verbal consent was obtained by all participants prior to their involvement in the study; confidentiality and anonymity were strictly maintained; and pseudonyms were assigned to protect identities.

FINDINGS

63 interviews and 185 h of shadowing and observations were conducted. Results revealed a virtuous cycle of caring facilitated and encouraged by new incentives that resonated with nurses' professional ethics. The favorable working environment and the hourly payment method enabled nurses to provide caregiving in accordance with their values.

CONCLUSIONS

As the new hourly payment experiment is scaled-up nationally, it is imperative that it is not isolated from the organizational model. Without the underpinning values and principles, the hourly payment method alone is unlikely to shift the value attributed to caring.

Impact of narrative nursing cognition, self-efficacy, and social support on the practices of registered nurses in China: a structural equation modeling analysis

BACKGROUND

Narrative nursing is a novel approach according with humanistic care, which has been shown to be effective in improving health outcomes for both patients and nurses. Nevertheless, few studies have investigated the status of narrative nursing practice among nurses, and a comprehensive understanding of factors influencing this practice remains elusive.

DESIGN

This was an observational, cross-sectional study using convenience sampling method.

METHODS

After obtaining the informed consent, a total of 931 registered nurses from three hospitals in China were investigated. Data were collected using the Social Support Rating Scale, the General Self-efficacy Scale, and the Knowledge-Attitude-Practice Survey of Clinical Nurses on Narrative Nursing. All the scales were validated in the Chinese population. The questionnaire results were verified by an independent investigator. Factors influencing narrative nursing practice were determined through a series of analyses, including independent sample t-tests, one-way ANOVA, and Pearson correlations. Subsequently, path analysis was performed and a structural equation model was established.

RESULTS

The score of narrative nursing practice in this study was 30.26 ± 5.32. The structural equation model showed a good fit, with a Root Mean Square Error of Approximation (RMSEA) of 0.007 (90%CI: 0.000, 0.047). Both social support and narrative nursing attitude could directly affect narrative nursing practice (βsocial support = 0.08, P < 0.001; βattitude = 0.54, P < 0.001) and indirectly influence it via self-efficacy (βsocial support = 0.04, P < 0.001; βattitude = 0.06, P < 0.001). In addition, narrative nursing knowledge (β = 0.08, P < 0.001) and the nurses' growth environment (β=-0.06, P < 0.001) also affected the practice of narrative nursing.

CONCLUSION

Narrative nursing in China is at a medium level and could be influenced by several personal and environmental factors. This study highlighted the critical role of nursing management in the advancement of narrative nursing practices. Nurse managers should prioritize specialized training and cultivate supportive environments for nurses to improve their narrative nursing practices.

Enhancing Transition to Nursing Practice: The Mental Health Immersion Experience

ABSTRACT

The number of people facing mental health issues continues to grow in the aftermath of COVID-19. Nurses are challenged with providing care for an increasing number of patients, including veterans, with complex mental health needs across healthcare settings. Of concern, many students transitioning into practice feel they lack the necessary confidence, education, and skills to competently care for patients with mental health illness. This article discusses an innovative mental health immersion experience strategically integrated within a new-nurse residency program.

[The concept of caring and its contemporary translation: the view of French doctoral candidates]

Jean Watson developed, in the United States, a conceptual model of nursing based on caring. A term sometimes translated as "to care" without properly reflecting what the concept entails. This theory has been adopted in many countries. Some authors report that it brings satisfaction to students, nurses, and managers of health facilities. Based on Watson's work, Chantal Cara built the humanist model of nursing at Montreal University. The aim of the project is to improve the well-being of patients and caregivers. It is likely to retain existing nurses and attract the next generation to the institutions which implement it.

Identifying Holistic Nursing Research Priorities for 2023-2026

The primary goal of holistic nursing research is to develop and expand the knowledge base of holism and healing for nursing praxis. This article provides an overview of the process used to identify the research priorities for holistic nursing research over the next 3 to 5 years. A mixed method design using Appreciative Inquiry and surveys revealed five research priorities and the holistic philosophical foundation for these priorities. Additionally, new challenges in the environment, person, health, and nursing will undoubtedly emerge, requiring nurses to discern the research needs beyond 2026. This work seeks to inspire holistic nurses to consider research related to the American Holistic Nurses Association's five key research priorities.

Emotional Engagement and Caring Relationships: The Assessment of Emotion Regulation Repertoires of Nurses

In spite of the importance of emotion regulation for nurses' well-being, little is known about which strategies nurses habitually use, how these strategies combine in order to regulate their emotional distress, and how these are related to their caregiving orientations. The current study aimed to explore the emotion regulation repertoires that characterize health-care providers and to investigate the association between these repertoires and caregiving orientations in a sample of nurses. Firstly, a confirmatory factor analyses was run to test the suitability of the Regulation of Emotion System Survey for the assessment of six emotion regulation strategies among health-care providers. Subsequently, the latent profiles analysis was employed to explore emotion regulation repertoires. Three repertoires emerged: The Average, the Suppression Propensity and the Engagement Propensity profiles. The participants of the last two groups relied on Expressive Suppression and Engagement, respectively, more often than others. Nurses were more likely to be placed within the Engagement Propensity group when compared to the first responders, and higher levels of hyperactivation of the Caregiving System were associated with this repertoire. A greater reliance on Expressive Engagement among nurses was discussed in terms of the fact that nurses usually have a longer and more care-oriented relationships with patients than first responders.

Interventions for Compassion Fatigue in Healthcare Providers-A Systematic Review of Randomised Controlled Trials

BACKGROUND

Compassion fatigue is a significant issue considering its consequences including negative feelings, impaired cognition, and increased risk of long-term morbidities. We aimed to assess current evidence on the effects of interventions for compassion fatigue in healthcare providers (HCP).

METHODS

We used the Cochrane methodology for Systematic Reviews and Meta-Analyses (PRISMA) for conducting and reporting this review.

RESULTS

Fifteen RCTs (n = 1740) were included. The sample size of individual studies was small ranging from 23 to 605. There was significant heterogeneity in participant, intervention, control, and outcome characteristics. The tools for assessing intervention effects on compassion fatigue included ProQOL, compassion fatigue scale, and nurses compassion fatigue inventory. Thirteen out of the fifteen included RCTs had overall high risk of bias (ROB). Meta-analysis could not be performed given the significant heterogeneity.

CONCLUSIONS

Current evidence on interventions for reducing compassion fatigue in HCPs is inadequate. Given the benefits reported in some of the included studies, well-designed and adequately powered RCTs are urgently needed.

African philosophy and nursing: A potential twain that shall meet?

Undoubtedly, the discipline of nursing has been influenced extensively by both Western and Eastern/Asian philosophies. What remains unknown or, perhaps, poorly articulated is the potential influence of African philosophy on the onto-epistemology of nursing. As a starting point, this article sought to examine the core claims of African philosophy and how they may offer new meanings to the metaparadigm domains of interest in the discipline of nursing. At the core of African philosophy is the notion of personhood (which is distinguished from what it means to be a human being), community, solidarity, and relationality. A major claim of African philosophy is the notion that 'a person is a person through persons' which may mean that nursing will be relevant from the African philosophical perspective if it is able to attain this. Health and illness from the African philosophical perspective are defined relationally which shifts attention from the biomedical framework to holism and relational care. The sick 'person' is also distinguished from the sick 'human being' which has the potential of leading to exclusion from the African philosophical viewpoint. Put together, the African philosophical stance potentially extends the meaning of the metaparadigm domains of interest to the discipline of nursing which warrants further exploration.

Transpersonal Caritas Relationship: A new concept from the unitary caring science framework of Jean Watson

Objective

To analyze deeply the concept of the transpersonal caring relationship as the core of the theory of Caring Science proposed by Jean Watson. To present a historical evolution and to introduce the Transpersonal Caritas Relationship construct.

Methods

Methodological Study to support the central concept measured by the Watson Caritas patient instrument. We designed a focus group with four nursing scholars to develop the "Transpersonal Caritas Relationship" construct. We recount the history of the concept of the transpersonal caring relationship, then analyze this concept in terms of Watson's theory. We reviewed the concept with Dr. Jean Watson, presented her with the construct, and discussed our considerations.

Results

This article introduces a transitional adaptation of the concept of transpersonal relationship to Caritas' transpersonal relationship. Transpersonal Caritas Relationship is the foundation of evolved Caritas nursing, recognizing that mutual caring affects the universal field we all belong to Caritas' consciousness and action affect the energy field when the nurse relates with the other, making it possible to awaken the compassionate heart, which is the foundation of Evolved Caritas Nursing Universal love and in this way evolve to the Caritas consciousness that allows recognizing the other with loving kindness in the practice of careful. This is the proposed central concept measured in the caring approach using the Watson Caritas Patient.

Conclusion

This article introduces a transitional adaptation of the concept of transpersonal relationship to the Caritas transpersonal relationship, which is the foundation of Caritas Evolved Nursing.

Use of Nursing Theory to Guide Doctoral Research: An Exploratory Study

It is unclear whether doctoral nursing students are using nursing theory to guide their research. This descriptive, exploratory study involved a review of 747 doctoral papers to determine whether nursing students are using nursing or non-nursing theory to guide their research. The findings revealed that although 86.9% of doctoral students used theory, just 31.7% used nursing-specific theory to guide their dissertation study or capstone project. The disproportionate relationship between the use of nursing and non-nursing theory at the doctoral level poses both challenges and opportunities.

Patient satisfaction with humanistic nursing in Chinese secondary and tertiary public hospitals: a cross-sectional survey

Background

Humanistic care pertains to the abilities, attitudes, and behaviors central to patient-centered care, contributing to patients' sense of safety and wellbeing. This study aimed to assess the satisfaction of patients with humanistic nursing care in Chinese secondary and tertiary public hospitals.

Methods

A national cross-sectional survey was conducted across 30 provinces and 83 hospitals in China. Patient satisfaction with humanistic care was assessed using the Methodist Health Care System Nurse Caring Instrument (NCI), which encompasses 20 items across 12 dimensions. Each item was rated on a 7-point Likert scale, yielding a total score of 140. Multiple linear regression analysis was employed to identify factors associated with patients' satisfaction.

Results

Moderate satisfaction (mean score 91.26 ± 13.14) with humanistic nursing care was observed among the 17,593 participants. Factors significantly associated with patient satisfaction included age, hospital type, presence of children, educational attainment, place of residence, family monthly income, and medical insurance type.

Conclusion

The study findings highlight the importance of tailored interventions, evidence-based practice guidelines, and patient-centered care in improving patients' satisfaction with humanistic nursing care. Continuous emphasis on nursing education and professional development is crucial for enhancing humanistic care and patient satisfaction.

Development and Psychometric Evaluation of the Patient's Perception of Nurse-Patient Relationship as Healing Transformations Scale (RELATE Scale)

A 3-phase study was conducted to develop and psychometrically evaluate the Patients' Perceptions of their Nurse-Patient Relations as Healing Transformations (RELATE) Scale. There is a lack of tools measuring nurse-patient relationship dynamics from a unitary-transformative paradigm to evaluate the patient's experience of what works to enhance their well-becoming. The 35-item scale was completed by 311 adults with chronic illness. The Cronbach α for the 35-item scale was 0.965 suggesting good internal consistency. Principal components analyses yielded a 17-item, 2-component solution explaining 60.17% of the total variance. This theoretically driven and psychometrically sound scale will contribute to quality-of-care data.

Climate Change, Environmental Health, and Challenges for Nursing Discipline

Current data and scientific predictions about the consequences of climate change are accurate in suggesting disaster. Since 2019, climate change has become a threat to human health, and major consequences on health and health systems are already observed. Climate change is a central concern for the nursing discipline, even though nursing theorists' understanding of the environment has led to problematic gaps that impact the current context. Today, nursing discipline is facing new challenges. Nurses are strategically placed to respond to the impacts of climate change through their practice, research, and training in developing, implementing, and sustaining innovation towards climate change mitigation and adaptation. It is urgent for them to adapt their practice to this reality to become agents of change.

Quality of palliative nursing care: Meaning, death anxiety, and the mediating role of well-being

BACKGROUND

There is increasing concern regarding the quality of palliative nursing care. However, despite the growing number of studies identifying related variables, there is still a paucity of studies analyzing models of how these variables interrelate.

OBJECTIVE

The study aimed to identify the role played in the quality of palliative care of nursing professionals by the variables meaning and death anxiety and to investigate the mediating role of psychological well-being and engagement.

METHOD

176 palliative nursing professionals participated, selected by non-probabilistic convenience sampling using the snowball method. A simple mediation analysis and a multiple mediator model were performed in parallel, and data were collected using a paper and online questionnaire between January and May 2018.

RESULTS

Well-being mediated the impact of meaning (indirect effect = 0.096, SE = 0.044, 95% confidence interval (CI): 0.028, 0.213) and death anxiety (indirect effect = -0.032, SE = 0.013, 95% CI: -0.064, -0.010) on the quality of care. Engagement, on the other hand, only mediated the impact of meaning (indirect effect = 0.185, SE = 0.085, 95% CI: 0.035, 0.372), while the indirect effect of death anxiety with the quality of care through engagement was not statistically significant (indirect effect = 0.008, SE = 0.009, 95% CI: -0.004, 0.032).

SIGNIFICANCE OF RESULTS

Death anxiety is not directly related to the quality of care, but rather has an effect through psychological well-being, a variable acting as a mediator between the two. The effect of meaning on the quality of care is explained by the mediation of both engagement and psychological well-being, and its impact on the quality of care is thereby mediated by more variables than death anxiety.

Patient Experience Coordinator: An Innovative Role to Improve Patients' Hospital Experience

OBJECTIVE

The aim of this study was to test the impact of an innovative nonclinical support role to improve patient experiences while supporting nurse work on inpatient units.

BACKGROUND

On the basis of the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey, patients' experience declined nationally during the COVID-19 pandemic. A nonclinical support role, titled an Experience Coordinator, was created as a test of change to collaborate with care teams and respond to patients' and families' nonclinical needs.

METHODS

This is a quality improvement (QI) project for a supportive role development and implementation. The health system's HCAHPS data were compared before and after the role was tested on 3 inpatient units.

RESULTS

The HCAHPS data indicated that 5 of the 10 domains' top box ratings increased during the QI project month compared with the previous month.

CONCLUSION

The study findings may support the implementation of new innovative nonclinical positions to alleviate nurses' workload and promote patients' hospital experience.

Patient satisfaction with nurses' care is positively related to the nurse-patient relationship in Chinese hospitals: A multicentre study

Background

The nurse-patient relationship and nursing care satisfaction are important factors that represent whether patients experience the care they expect from nurses. However, research is lacking on the relationship between nursing staff and patients, and the correlation between nursing care satisfaction and relationship care in China. Therefore, this study aimed to explore the correlation between the nurse-patient relationship and patients' satisfaction with nursing care, to form a basis for corresponding intervention measures.

Methods

A total of 29,108 patients from 107 hospitals in 30 provinces/municipalities in China completed a general information questionnaire, the Nursing Care Satisfaction Scale, and Relational Care Scale.

Results

The average nurse-patient relational care scale score was 4.38 ± 0.57, and the average patients' satisfaction with nursing care scale score was 5.40 ± 0.86. Nursing care satisfaction score was significantly related to differences among patients in different age, gender, marital status, education level, occupation, residence, family per capita monthly income, type of medical insurance, medical department, and regional patient characteristics. The correlation analysis showed that the total nurse-patient relational care score and its three dimensions of caring, trust, and professional ethics correlated positively with nursing care satisfaction scores. The multiple linear regression analysis showed that patients' age, marital status, region, department, income, type of medical insurance and the caring, trust, and professional ethics dimensions of relational care predicted nursing care satisfaction.

Conclusion

Enhancing nurse-patient relational care improves nursing care satisfaction, reduces nurse-patient disputes, promotes early rehabilitation of patients, and ensures patient safety.

Caring Ability and Professional Values of Polish Nursing Students-A Cross-Sectional Study

Caring ability and professional values developed and shaped during nursing university studies are often recognised as fundamental components of education and professional nursing attitudes. The aim of this study was to analyse the relationship between caring ability and professional values among nursing students and their correlation with selected sociodemographic variables. A cross-sectional study was conducted among a convenience sample of 379 nursing students. During the research, the Polish versions of the Caring Ability Inventory and the Professional Values Scale were used. The overall result in the Professional Values Scale was 108.78 (SD = 16.17)-which is considered average, and in the Caring Ability Inventory 189.55 (SD = 18.77)-which is considered low. Age correlated negatively with the professional values of students in total and in the subscale "care"; in contrast, "gender", "place of residence" and "financial situation" did not show any correlation with the level of students' professional values and caring ability. The professional values and caring abilities of nursing students depended on the year and mode of study and the type of university. The results of the study revealed that the caring ability and professional values of nursing students undergo changes during their education.

An Integrated Literature Review Revealing the Process of Awakening the Spiritual Self/Identity Among Adolescents With Cancer

This integrative review was conducted to determine the current state of science in understanding the process of awakening the spiritual self/identity among adolescents with cancer. Twenty-six studies were included in the data synthesis. Six major themes were identified: recounting rough spots of the cancer experience, the spiritual self/identity, nurturing the spiritual self/identity, affirming values and beliefs, abiding resilience and transcendence, and portraying the cancer experience. Findings offer increased understanding of the process of awakening the spiritual self/identity among adolescents with cancer that can guide spiritual nursing practice and inform future research including the development of spiritual care interventions.

Effective Holistic Approaches to Reducing Nurse Stress and Burnout During COVID-19

BACKGROUND

Prolonged exposure to work-related stress can lead to nurse burnout, potentiating clinical and medication errors and low-quality patient care. Holistic approaches (such as mindfulness training, "zen rooms," and massage chairs, among others) have been shown to reduce nurses' anxiety, stress, and burnout.

PURPOSE

To evaluate the use of "serenity lounges" (dedicated rooms where nurses can take workday breaks for the purposes of relaxation and rejuvenation) and massage chairs on nurses' anxiety, stress, and burnout.

METHODS

This quality improvement project analyzed 67 paired responses to surveys filled out by nurses before and after their use of serenity lounges at a medical center in Los Angeles between November 2020 and May 2021. Following successful implementation of a serenity lounge on a pilot unit, this project was expanded to a total of 10 units, including COVID-19 cohort units. As part of this expansion, massage chairs were added to 10 serenity lounges, along with items such as wipes, gloves, and shoe covers to enable nurses to adhere to infection control protocols.

RESULTS

Analysis of the 67 paired responses to pre- and post-lounge-use surveys revealed a significant reduction in feelings of emotional exhaustion, burnout, frustration, being worn out, stress, and anxiety after use of the serenity lounge. Improvements in feelings of emotional exhaustion, being worn out, and being anxious were also noted after using the massage chair for at least 10 to 20 minutes.

CONCLUSIONS

These results highlight the importance of providing a holistic approach, including a serene space, massage equipment, and other amenities, to help nurses reduce feelings of anxiety, stress, and burnout, particularly during challenging times such as the COVID-19 pandemic.

[Integrating spirituality into care]

Spiritual care or spirituality in care, spirituality of care or spiritual care. In recent years, it is impossible not to realize that this theme, which is expressed and understood in different ways, covers an increasingly vast field in the field of literature and challenges clinical settings as much as training.

Women Caring for Husbands Living with Parkinson’s Disease: A Phenomenological Study Protocol

Parkinson’s disease (PD) is an emerging pandemic caused by aging, longevity, and industrialization. Most people diagnosed with PD initially experience mild symptoms, but over time the symptoms become debilitating. Given their intensive care requirement, most married people living with PD receive care from their spouses; most are female caregivers. Because caregiving is hard work with long hours, caregivers experience stress, fatigue, and depression, often leading to exhaustion and burnout. The purpose of this descriptive phenomenological study is to understand the lived experience of women caregivers of husbands living with PD. As part of this study protocol, women caring at home for their husbands diagnosed with PD will be purposely recruited from the Colorado Parkinson Foundation. Semi-structured interviews will be conducted by Zoom© until data saturation is achieved. Colaizzi’s seven-step process will be used to analyze the data in Atlas.ti. Strategies have been incorporated into the study protocol to maximize trustworthiness and to insure methodological rigor. The study will be reported using recommendations from the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research. Findings from this study may guide intervention development to improve the caregiving experience and to inform clinical practice guidelines for health care professionals.

Spirituality as a core concept in the theoretical literature of nursing: A comparative overview between Watson & Lovering's perspectives

Nurse theorists have addressed the primacy of the phenomenon of caring, aiming at providing a framework that captures the complex nature of caring. Several theorists emphasized the mechanical facet of care while others emphasized the holistic aspect of care. Spirituality as a central concept in caring theories was targeted in this manuscript; as it a fundamental aspect of holistic care. Watson's Human Caring Science Theory and Lovering's Crescent of Care Nursing Model represent two distinctive approaches to caring in the dimension of spirituality. A compare/contrast approach is used to depict the similarities and differences between both works, focusing on spirituality as a common concept. The outcome of the comparison showed that spirituality is a multidimensional metaphysical concept that both theorists had identified as an indispensable core aspect of holistic nursing and is context-bound in terms of its dimensions, applications, and meaningfulness.

An integrative review of the use of the concept of reassurance in clinical practice

Aim

To synthesize evidence on the concept of reassurance in nursing practice.

Design

Integrative review.

Review Method

PubMed, OVID MEDLINE, CINAHL and PsycINFO were searched from their inception to the 30 May 2020. The search results were screened. We assessed the quality of primary studies using the Mixed Method Appraisal Tool. Included studies were analysed using narrative synthesis. The review protocol was pre‐registered (PROSPERO‐CRD42020186962).

Results

Thirty‐two papers out of the 2,771 search results met our inclusion criteria. The synthesis of evidence generated three intricate themes, namely “antecedents of reassurance,” “defining attributes of reassurance” and “outcomes of reassurance.” Emotional distress was the main antecedent of reassurance. The three sub‐themes identified under defining attributes of reassurance include self‐awareness, emotional connectedness and verbal and non‐verbal techniques. Ultimately, reposing the confidence of patients and their families in healthcare professionals and the care delivery process to enable them to overcome their challenges constitutes the outcomes of reassurance.

Humanized Care From the Nurse-Patient Perspective in a Hospital Setting: A Systematic Review of Experiences Disclosed in Spanish and Portuguese Scientific Articles

Nowadays, humanized care is an essential component in the field of health because the professional work of nursing seeks to provide quality services to patients who are suffering and fear illness or the dying process. Nurses recognize the need to incorporate humanized care into their daily work, as supported by Jean Watson, who states that caring entails establishing an adequate nurse–patient therapeutic relationship, where health education is a tool that promotes self-care in the patient, family, and community. The main objective of this work was to find scientific evidence on humanized care from the perspectives of nurses and hospitalized patients. To meet those research objectives, an exploratory systematic review of articles published in high-quality scientific journals from 2016 to 2020 using the PRISMA methodology in the Scopus and Scielo databases was conducted, yielding 26 studies that were analyzed. The findings show that nurses and patients perceive the need to remove the barriers that limit the advancement of humanized care in hospital institutions because they urgently demand that health professionals in all settings, especially critical ones, strengthen their humanizing role by sharing cordial, empathetic health experiences, and respecting their customs and beliefs during the hospitalization process. As a conclusion of the findings, the nurse–patient professionals agree that health personnel training is critical to providing humanized attention with quality in the hospital context, emphasizing that professional training should develop in practice soft skills, communication, safety environment, and human values.

Nursing Theory Makes a Practice Turn in the 21st Century

The author assumes that practice became prominent in nursing theory in the first two decades of the 21st century. The end of the last century saw a burgeoning of literature on what is known as grand theories, their implementation, and evaluation. The era of healthcare quality research began when the Institute of Medicine issued a report on building a safer health system. At this time, the 21st-century literature in nursing took a distinct turn toward practice, influencing nursing theory. The movement to individualize care acted to further this influence. The nurse and patient relationship is the source of data for knowledge development. Established research approaches such as grounded theory and new approaches such as story theory were being used to create nursing theory from practice. Grand theory work moved to the development of instruments to measure the effects of theory in practice, such as that of Watson and Roy. The middle-range theories were developed and seen as closer to and easier to use in practice. The evidence-based practice movement also contributed to the role of theory in practice. These knowledge developments led to nurses having expanded roles in nursing.

Towards a theory of communion-in-caring

BACKGROUND

When nursing practice assumes a fix-it view model, it limits the growing capacity of practice. The theory of communion-in-caring emerged as a hopeful response to the call to offer a new vista. This theory unifies caring and the endless potential of human care.

AIM

The aim of the paper is to describe the theory of communion-in-caring grounded in the human science philosophical perspective. Generated from a focused review of scholarly literature from classical caring theories in nursing to contemporary theoretical viewpoints in nursing published within the last decade guided by a creative theory-building process. This paper presents the theory of communion-in-caring with theoretical concepts and theoretical assumptions illuminating and supporting the contextual design and epistemological viewpoints of a caring-based theory of nursing.

FINDINGS

Communion-in-caring is defined as a deliberate and a momentary occurrence of a nursing-caring encounter in which the nurse and person nursed, together, design and express unique practice processes toward affirming and celebrating being human in a unitary-transformative world. The theory further illuminates the foundational acts (i.e. love, hope, faith and charity) emulated into the embodied processes of communion-in-caring (i.e., caring-nurturing encounter, caring-nurturing inquiry and caring-nurturing capacity). Such cyclical, rhythmical and moving processes yield a nurtured caring environment with ethical standpoints, resonate the meaning-essence of caring through participation-in-being and offer culturally congruent care.

CONCLUSION

This theory also realises that the discipline is overly influenced by technological advancements, digitalisation of care, the medicalisation of practice and a mechanistic lens of care. Thus, this theory calls for moral enrichment towards an identity that embodies participation-in-being, seeing self-in-others and communion-of-being.

Understanding to humanise: Teaching nurses' experience with caring for Mapuche patients

BACKGROUND

The Mapuche are a minority group living in small communities in southern Chile. Due to many variables, such as poverty and cultural factors, they are susceptible to inequalities in education and healthcare.

PURPOSE

To describe nurse educators' experiences of caring for Mapuche people in primary care centers in Chile.

METHODS

A descriptive qualitative study was performed with nine female nurse educators who supervised nursing students in clinical placement. Data were obtained through semi-structured interviews. Triangulation was achieved through consensus among the researchers.

RESULTS

The analysis yielded two themes: Cultural sensitivity and Humanisation of care. Nurse educators respect Mapuche beliefs and practices about health and treatment and adapt clinical interventions accordingly. Nurse educators are committed to integrate Mapuche spiritual and cultural needs into the biomedical model, aiming to build a genuine person-centered relationship with patients and to promote transcultural nursing models with students.

CONCLUSIONS

Culturally competent professionals are needed to train nurses about the demands of a globalized and culturally diverse world. Training is required in both humanized care competencies and cross-cultural nursing. Improving cultural competence among nurses and nurse educators would improve patients' health outcomes and would allow preventative intervention, therefore reducing treatment failures and further complications.

An evaluation of instruments measuring behavioural aspects of the nurse-patient relationship

The Fundamentals of Care Framework is an evidence-based, theory-informed framework that conceptualises high-quality fundamental care. The Framework places the nurse-patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse-patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of nurse-patient relationship instruments by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty-seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring 'focus', 'anticipate' and 'evaluate'. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse-patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework.

Being and becoming a nurse: Toward an ontological and reflexive turn in first-year nursing education

In this paper, we call for an ontological and reflexive turn in first-year nursing education. An ontological turn focuses on formation, the 'being' and 'becoming' of a nurse, and emphasizes the value of nursing knowledge. First-year nursing students often possess romanticized ideals about being a nurse that devalues the knowledge and expertise of nurses. We posit a thoughtful ontological orientation within nursing education that shifts the emphasis toward becoming skillful nurses, with expertise grounded in nursing perspectives. A focus on formation includes discussions regarding ideologies, dominant perspectives, and reflexive explorations of students' views of nursing juxtaposed with the realities of nursing practice. We propose ontologic reflexivity as an approach to consider what perspectives are prioritized (or not) within the nursing classroom. Within pedagogical dialogic spaces, ontologic reflexivity calls on educators to create opportunities for students to learn the value of nursing knowledge along with other forms of knowledge. We consider ways in which an ontological and reflexive turn within the first year of nursing education may contribute to the formation of nursing students who value nursing knowledge, are open-minded to various forms of knowledge, and possess an intentional reflexive way of being.

Clarifying the concept of the four-season symphony (I SEA) in nursing practice: A Wilson's approach to concept analysis

Acquired knowledge provides one with intuitive rationality as a means of achieving a goal. Spiritual, ethical and esthetic competencies are also required for acquiring intuitive rationality. Nurses pay less attention to intuitive rationality, think only with their brain rather than observe with their heart and therefore deprive themselves of proper, immediate and comprehensive cognition of their environment. An initiative to harmonize sensory receptors in charge of thinking, speaking, and acting in nurses is required for establishing a symphonic intellectual, spiritual, ethical, and aesthetic (I SEA) nursing practice. The present research was conducted to clarify the concept of four-season symphony of I SEA in nursing practice. The present study was conducted by employing Wilson's method of concept analysis and searching databases including Google Scholar, ScienceDirect, Scopus, PubMed, SID, and Magiran using symphony, rationality, intellectuality, spirituality, ethics, aesthetic, and nursing practice as keywords. According to the integrated concept of the four-season symphony in nursing care, nursing practice refers to performing the symphonic action of four seasons of I SEA in orderly and smart thinking, speaking and acting in looking, listening, speaking, heartfelt sympathy and using the hands for caregiving and steps for accompanying patients. This symphony provides an opportunity for the emergence of perfect nurses of four seasons and helps with individual and organizational symphonic improvements in nursing care and nurses. According to this perspective, nurses should always ask themselves whether their thought, speech, and action are intellectual, spiritual, ethical and aesthetic.

Implementing a Mentorship Program for New Nurses During a Pandemic

This article describes the implementation of an evidence-based mentoring program for new registered nurses (RNs) hired into medical-surgical units in a small community-based hospital during the unfolding of the SARS-Cov2 (COVID-19) pandemic. The hospital's nursing leadership supported the program implementation during the COVID-19 pandemic to provide a broader support system to new RNs to improve nurse retention. During a response to the pandemic, the medical-surgical units faced numerous process changes in a short time, which further reinforced the urgency of an additional support system for the newly hired RNs.

Assessment of the nurse-patient interaction competence in undergraduate nursing students

BACKGROUND

Nursing curricula must ensure the acquisition of nurse-patient interaction competence. This competence is assessed by several internationally validated tools, such as the Caring Nurse-Patient Interactions scale, based on Jean Watson's model.

PURPOSE

The aim of this study was to develop a predictive model of nurse-patient interaction composites in nursing students, based on the Caring Nurse-Patient Interactions scale.

METHOD

The original scale was translated into Spanish. A panel of experts then made readability- and culture-related adjustments. Construct validity and reliability were analysed. Content validity analysis was conducted by Jean Watson.

FINDINGS

A structural model of 5 composites with a good fit, based on Jean Watson's model, was obtained using partial least squares regression analysis.

DISCUSSION

The empirical evidence of the reliability and validity of the new scale makes it suitable for use as a tool for the evaluation of the caring nurse-patient interaction competence in undergraduate nursing students.

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.

Caring Behavior Coding Scheme based on Swanson's Theory of Caring - development and testing among undergraduate nursing students

Rationale

To maintain patients’ dignity and well‐being and alleviate suffering, it is essential that healthcare providers engage in caring behaviours. Yet, every year patient boards receive an increasing number of complaints from patients and significant others regarding healthcare providers’ non‐caring behaviours. Defining and measuring both verbal and nonverbal caring and non‐caring behaviour in healthcare delivery is vital to address such complaints. However, no studies were found that incorporated a comprehensive theory of caring to code encounters between healthcare providers and patients.

Aim

The aim was to develop and test a Caring Behavior Coding Scheme based on Swanson’s Theory of Caring.

Method

An instrument development process was used for behavioural coding including observational data from thirty‐eight video recordings collected in an undergraduate nursing course at a Swedish University. The observational data involved interactions between undergraduate nursing students and a standardised patient.

Result

The Caring Behavior Coding Scheme (the CBCS), contains seventeen verbal and eight nonverbal behavioural codes, categorised as caring and non‐caring in accordance with Swanson’s Theory of Caring. Content and face validity were assessed. Timed‐event sequential continuous coding was performed in INTERACT software. The coder achieved excellent agreement with the developed gold standard (k = 0.87) and excellent mean inter‐rater reliability (k = 0.82). All domains in Swanson’s Theory of Caring were observed and coded in the interaction.

Discussion/Conclusion

The CBCS is a theory‐based instrument that contributes to research on healthcare providers’ behavioural encounters. It uses verbal and nonverbal caring and non‐caring behavioural codes to assess the alignment of both the theory and practice of caring. The CBCS can contribute to both development and measurement of interventions focused on improving healthcare providers’ caring behaviour with the intended outcome of patient well‐being.

A new conceptualization of the nurse-patient relationship construct as caring interaction

The journey through the history of nursing, and its philosophical and political influences of the moment, contextualizes the interest that arose about the nurse-patient relationship after World War II. The concept has always been defined as a relationship but, from a phenomenological approach based on a historical, philosophical, psychological and sociological cosmology, it is possible to re-conceptualize it as 'caring interaction'. Under the vision of aesthetics and sociopoetics, the object of nursing care is the most delicate, vulnerable and unrepeatable raw material: the person, whose feelings and reciprocity, which must be considered. In addition, it involves the adoption of the socio-critical paradigm, as it considers the importance of actively involving the person, not just patient anymore, or their family in the nursing cares, optimizing the reciprocity inherent to this interactivity. In short, our philosophical and epistemological approach to the concept of nurse-patient relationship proposes a new conceptualization of it as a caring interaction.

A comprehensive review of compassion fatigue in pre-licensure health students: antecedents, attributes, and consequences

Compassion fatigue has been documented in the nursing and allied health literature as an emerging issue for health professionals. Little is known regarding the experience of compassion fatigue in undergraduate, pre-licensure students entering health care professions. This study used Walker and Avant's concept analysis methodology to explain antecedents, attributes, and consequences of compassion fatigue in undergraduate, pre-licensure students. Exploration of the published literature from January 1992-April 2020 occurred using systematic review criteria based on the Joanna Briggs Institute. Findings revealed three antecedents that included: Coping Ability; Self-Efficacy; and Clinical and Occupational Hazards. Three defining attributes of compassion fatigue included: Psychological Stress; Witnessing Negative Experiences of Others; and Depression. Consequences included: Decreased Well-Being; and Program Withdrawal and Intention-to-Leave. The results offer new perspectives and opportunities for research in pre-licensure health studies undergraduate students expected to uphold the values of their professional program prior to entry into the workforce.

Existential analysis of mothers in the care of their children with Sickle Cell Disease

OBJECTIVES

to unveil the experience of mothers of children who had a cerebrovascular accident due to sickle cell disease.

METHODS

qualitative, phenomenological research based on Martin Heidegger's philosophical framework. Ten mothers participated in the Association of People with Sickle Cell Disease of Minas Gerais. For the interpretative analysis of the reports, we performed the vague and medium understanding followed by hermeneutics.

RESULTS

the study revealed that, for the mother, the experience means remembering the diagnosis of the disease that had a significant impact. These women are in the center of care, and the consequences of stroke cause suffering. In this wandering, they seek to educate their children as close as possible to normal. Final Considerations: the study pointed out that we should look at these mothers seeking to see the multiple facets of their existence to the challenge of caring for the existential complexity of the human being.

Self-care as an ethical obligation for nurses

As members of the largest and most trusted healthcare profession, nurses are role models and critical partners in the ongoing quest for the health of their patients. Findings from the American Nurses Association Health Risk Appraisal suggested that nurses give the best patient care when they are operating at the peak of their own wellness. They also revealed that 68% of the surveyed nurses place their patients' health, safety, and wellness before their own. Globally, several nursing codes of ethics include the requirement of self-care. Often, these codes embed the responsibility to protect and promote one's own health within the clearly described obligation to provide safe patient care. The American Nurses Association Code of Ethics for Nurses is unique in that it states explicitly that nurses must adopt self-care as a duty to self in addition to their duty to provide care to patients. One of the basic assumptions of Watson's Philosophy and Science of Caring is that caring science is the essence of nursing and the foundational disciplinary core of the profession. Watson's theory of human caring provides support for the engagement in self-care. Two important value assumptions of Watson's Caritas are that "we have to learn how to offer caring, love, forgiveness, compassion, and mercy to ourselves before we can offer authentic caring and love to others" and we also must "treat ourselves with loving-kindness and equanimity, gentleness, and dignity before we can accept, respect, and care for others within a professional caring-healing model." Embedded within several caritas processes is an outline for a holistic approach to caring for self and others that can guide nurses to improve their mental, physical, emotional, and spiritual health.

Nursing's metaparadigm, climate change and planetary health

This paper offers a theoretical discussion on why the nursing profession has had a delayed response to the issue of climate change. We suggest this delay may have been influenced by the early days of nursing's professionalization. Specifically, we examine nursing's professional mandate, the generally accepted metaparadigm, and the grand theorists' conceptualizations of both the environment and the nurse-environment relationship. We conclude that these works may have encouraged nurses to conceptualize the environment, as well as their relationship with it, mainly in terms of the individual patient, and as such, nurses have not been encouraged to understand these concepts from a broader perspective. By not having the philosophical and theoretical foundations to understand the environment in relation to society, it is not surprising that nurses have had a delayed response to climate change and may not have viewed it as a professional concern. A planetary health perspective is suggested as a theoretical basis for nursing education, research and practice. Taking on a planetary health perspective could help nurses progress the profession and move healthcare systems towards supporting a climate-resilient future.

Staff Nurses' Perceptions of Nurse Manager Caring Behaviors: A Scoping Study

OBJECTIVE

The purpose of this scoping study is to review the published evidence regarding staff nurses' perceptions of nurse manager caring behaviors.

BACKGROUND

As healthcare administration becomes more complex and financial challenges continue, the ability of nurse managers to lead patient care environments that produce desirable outcomes becomes critical. Demonstrating caring behaviors that build relationships with individuals and groups is a necessary competency of nursing administrators to advance healthcare.

METHODS

This scoping study was guided by Arksey and O'Malley's methodology to review existing literature.

RESULTS

Published literature provided knowledge of staff nurses' perceptions of nurse manager caring behaviors. The final sample was 13 publications. The results were summarized in both numeric and thematic analysis.

CONCLUSIONS

Further research is needed to explore the relationship between nurse manager caring behaviors and patient outcomes.