Gender similarities and differences in the perception of caring among nurses during the COVID-19 pandemic: a mixed-methods study

BACKGROUND

Caring is the essence and core of nursing. Current studies on the effect of gender on nurses' perception of caring have been inconsistent. Most of these studies were quantitative and conducted before the COVID-19 pandemic. The study aimed to explore the gender similarities and differences in nurses' perception of caring during the COVID-19 pandemic.

METHODS

In 2020, a cross-sectional mixed-method study was conducted in 11 cities in China using structured online questionnaire (n = 8030) and face-to-face individual interview (n = 42). Data collection tools included the Caring Dimensions Inventory and semi-structured interview.

RESULTS

In stepwise multivariable linear regression analysis, female nurses scored 1.93 points higher on caring than male nurses, after completely controlling for the other factors. The interview results showed that both male and female nurses agreed that caring was to deal with three kinds of relationships, namely nurses and people, nurses and themselves, nurses and society. There were gender differences in the connotation of caring between nurses and themselves, but not in the connotations of caring between other relationships. The ranking of the importance of caring connotations among these relationships showed no gender difference except between nurses and themselves.

CONCLUSION

The quantitative findings suggest that gender influences nurses' perception of caring. The qualitative findings demonstrate that nurses regard themselves as both recipients and implementers of caring. The qualitative results indicate nurses of different genders have similarities and differences in their perception of caring, and the biggest difference lies in the relationship between nurses and themselves.

The State of the Science of Nurses' Implicit Bias: A Call to Go Beyond the Face of the Other and Revisit the Ethics of Belonging and Power

This article summarizes the current state of nurses' implicit bias and discusses the phenomenon from Levinas' face of the Other and ethics of belonging, Watson's human caring and unitary caring science, and Chinn's peace and power theory. Nurses' implicit bias is a global issue; the primary sources of nurses' implicit bias include race/ethnicity, sexuality, health conditions, age, mental health status, and substance use disorders. The current research stays at the descriptive level and addresses implicit bias at the individual level. This article invites nurses to go beyond "the face of the Other" and revisit the ethics of belonging and power.

Mediating effect of workplace violence on the relationship between empathy and professional identity among nursing students

Background

Studies have reported that empathy had a positive effect on professional identity (PI) in nursing students. However, little was known about the mechanism underlying this relationship between empathy and professional identity in nursing students.

Objective

The purpose of this study was to analyze in depth the mediating effect of workplace violence (WVP) between empathy and professional identity in nursing students.

Methods

A total of 405 nursing students participated and were investigated using the Chinese version of the Jefferson Scale of Empathy-Health Professional (JSE-HP), the scale of professional identity about nursing students, and the workplace violence Incident Survey in this study. Hierarchical regression was used to analyze the mediating effect of workplace violence on the relationship between empathy and professional identity among nursing students.

Results

The score of nursing students' professional identity was 103.69 ± 17.79. Workplace violence had a significant negative correlation with empathy (r = -0.449, P < 0.001) and professional identity (r = -0.330, P < 0.001). Workplace violence accounted for 14.59% of the total mediating effect on the relationship between empathy and professional identity for nursing students.

Conclusions

In this study, the level of professional identity of nursing students was low. Workplace violence had a partially significantly mediating effect on the relationship between empathy and professional identity. Maybe, it was suggested that nursing students' professional identity might be improved and driven by a decrease in workplace violence. Targeted interventions at reducing nursing students' workplace violence should be developed and implemented. In addition, nursing managers and educators should be aware of the importance of empathy and improve professional identity in nursing students.

A Preliminary Assessment of Compassion Fatigue in Chimpanzee Caregivers

Compassion fatigue is defined as "traumatization of helpers through their efforts at helping others". It has negative effects on clinicians including reduced satisfaction with work, fatigue, irritability, dread of going to work, and lack of joy in life. It is correlated with patients' decreased satisfaction with care. Compassion fatigue occurs in a variety of helping professions including educators, social workers, mental health clinicians, and it also appears in nonhuman animal care workers. This study surveyed caregivers of chimpanzees using the ProQOL-V to assess the prevalence of compassion fatigue among this group. Compassion satisfaction is higher than many other types of animal care workers. Conversely, this group shows moderate levels of burnout and secondary traumatic stress; higher levels than other types of animal care workers and many medical professions. While compassion fatigue has an effect on the caregiver's experience, it has potential to affect animal welfare. Caregivers are an integral part of the chimpanzee social network. Compassion fatigue affects the caregiver's attitude, this could in turn affect the relationship and degrade the experience of care for captive chimpanzees. Compassion fatigue can be mitigated with professional development, mindfulness training, interrelationships among staff, and specialized training. This preliminary assessment indicates the work ahead is educating caregivers about compassion fatigue and implementing procedures in sanctuaries to mitigate burnout and secondary traumatic stress.

The development of an evidence-informed Convergent Care Theory: Working together to achieve optimal health outcomes

BACKGROUND

Healthcare is a complex and divergent system with uncertainty, unpredictability, and multi-layered stakeholders. The relationships among the stakeholders are multifaceted and dynamic, requiring continual interpersonal connections, networks, and co-evolution. It is pivotal to have an evidence-informed theory to explain the phenomenon, uniting the multifaceted stakeholders' efforts.

PURPOSE

To describe the development of an evidence-informed theory, the Convergent Care Theory, assembling healthcare stakeholders to work together and achieve optimal health outcomes.

METHODS

The Convergent Care Theory was developed using a theory synthesis approach based on empirical research and literature reviews published by the theory-proposing author. The empirical evidence was categorized into: patients and families, healthcare providers, healthcare organizations, and patients' and healthcare providers' self-care.

RESULTS

The Convergent Care Theory includes four concepts: all-inclusive organizational care , healthcare professional collaborative care, person-centered precision care, and patients ' and healthcare providers' self-care. Achieving convergent care is a process requiring all stakeholders to work together. Six major facilitators emerged from the research evidence: competence, compassion, accountability, trusting, sharing, and engaging.

CONCLUSION

This article introduced the development process of the evidence-informed Convergent Care Theory. Healthcare systems are complex, with multiple stakeholders' needs to meet. The Convergent Care Theory strives to unite healthcare stakeholders, bond resources, and join forces to achieve optimal healthcare outcomes. The underpinning of the theory is a caring culture, which is an underlying code for organizational and team behaviors and the foundation of optimal health outcomes.

Nursing Students' Perceptions of Faculty Caring as a Predictor of Students' Caring Behaviors

This cross-sectional, descriptive survey study aimed to examine the relationships among nursing students' perceptions of faculty caring, students' caring behaviors, and their confidence, satisfaction, and empathy in an undergraduate nursing program. The instruments included the Caring Behaviors Inventory-16 Student Version, Nursing Students' Perceptions of Instructor Caring, and students' confidence, satisfaction, and empathy. There were significant pair-wise relationships among students' perceptions of faculty caring, students' caring behaviors, satisfaction, confidence, and empathy. Students' perceptions of faculty caring were a significant predictor for students' caring behaviors. These findings are significant in future designing and implementing interventions to enhance students' learning experiences.

Promoting Breastfeeding and Lactation Among Mothers of Premature Newborns in a Hospital in China

OBJECTIVE

To promote breastfeeding and lactation in mothers separated from their premature infants admitted to the NICU in a hospital in China.

DESIGN

For this evidence-based practice project we used a mixed method of survey measures and interviews and were guided by the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice framework.

SETTING/LOCAL PROBLEM

Obstetric unit of a Women and Children's Hospital in China from September 2017 to August 2018. Before the project, the partial breastfeeding rate in the hospital was 17.9%, and the exclusive breastfeeding rate of premature infants was 1.8%; these rates were much lower than the national breastfeeding rate in the country.

PARTICIPANTS

Seventeen nurses and 70 mothers of premature infants.

INTERVENTION/MEASUREMENTS

The project included three phases: (a) finding the best evidence to promote breastfeeding in the literature and identifying the gaps between best practice and current practice, (b) implementing best practice strategies, and (c) comparing pre- and postintervention outcomes. Based on the evidence in the literature and the barriers, strategies were implemented in practice to promote breastfeeding and lactation among women separated from their preterm newborns. Chi-square and t tests were performed to compare the pre-/postintervention differences.

RESULTS

Partial breastfeeding rates increased from 17.9% to 52.7%, and exclusive breastfeeding rates increased from 1.8% to 4.1%. Compliance with breastfeeding guidelines and measures of maternal lactation volume both improved significantly.

CONCLUSION

Promoting breastfeeding and lactation among mothers of premature infants requires not only scientific knowledge but also a caring environment and family-centered practice.

Self-care Strategies to Combat Burnout Among Pediatric Critical Care Nurses and Physicians

BACKGROUND

Professional burnout is a widespread phenomenon in health care. The health of patients and organizations begins with the well-being of health care professionals. Identifying and understanding self-care strategies that professionals perceive to be helpful is crucial to combat burnout.

OBJECTIVE

To determine perceptions of self-care strategies to combat professional burnout among nurses and physicians in pediatric critical care settings.

METHODS

This was a qualitative descriptive study with a phenomenological overtone. The study was conducted in a 20-bed pediatric intensive care unit and an 8-bed intermediate care unit of a children's hospital in the United States. Information flyers and emails were used to introduce the study. A combination of convenience and purposive sampling methods was used to recruit participants who were full-time nurses and physicians in the 2 units. Information saturation was used to regulate sample sizes, resulting in 20 participants. Data were collected through a onetime face-to-face interview with each participant. A qualitative descriptive approach was used to analyze the data. The first author was the primary coder and discussed the codes with the coauthors throughout the coding process.

RESULTS

Six major self-care strategies were identified: finding meaning in work, connecting with an energy source, nurturing interpersonal connections, developing an attitude of positivity, performing emotional hygiene, and recognizing one's uniqueness and contributions at work.

CONCLUSIONS

Developing effective self-care strategies helps promote health care professionals' physical and psychological well-being and reduce burnout. It is vital for health care professionals to care for themselves so that they can best care for others.

A unitary caring science resilience-building model: Unifying the human caring theory and research-informed psychology and neuroscience evidence

Resilience is the psychological capability to recover from difficulties quickly. Healthcare professionals are especially vulnerable to job-related stress and burnout. Unitary Caring Science is the framework for Watson's Human Caring Theory, providing a philosophy of practice in healthcare. With the high rates of clinician burnout and psychological issues, it will be significant to unify the human caring theory with research-informed psychological and neuroscience evidence to develop clinicians' resilience-building strategies. The purpose of this article is to introduce a Unitary Caring Science Resilience Model and explain the science behind the core strategies based on Unitary Caring Science philosophy and the psychological and neuroscience research. This model includes six strategies: Embracing loving-kindness for self and others; Nurturing interpersonal and intersubjective connections/relations; Deepening a creative use of self and sense of belonging; Balancing self-learning, self-awareness, and an evolved self-consciousness; Valuing forgiveness and releasing negativity; Inspiring and maintaining faith-hope. The caring-theory guided resilience-building strategies are proven to alleviate the depletion of clinicians' energy and emotions. Healthcare practices are challenging but rewarding. Clinicians can be emotionally, psychologically, and physically exhausted if they always consider themselves 'giving' and 'doing' institutional tasks without a sense of purpose or fulfillment. The practice can be rewarding if it becomes more aligned with clinicians' value to serve humanity. Through the unitary caring science resilience strategies, clinicians can build resilience as an antidote to clinician burnout and depletion.

Mothers' experiences of parenting a child with chromosomal structural abnormalities: The journey to acceptance

PURPOSE

This study aimed to investigate the process mothers go through in coming to terms with raising a child with chromosomal structural abnormalities.

METHODS

Sixteen mothers living in Japan were interviewed and a modified grounded theory approach was used for the analysis.

RESULTS

A total of 35 concepts, nine subcategories, and six categories were extracted. The six categories were: (a) Concern about abnormalities; (b) A healthy child is considered as a standard; (c) Deepening attachment to the child; (d) Acceptance of the child as s/he is; (e) Changing attitude toward disabilities; (f) Creating a frontier for other mothers. The parenting journey meant that parents did not move in a straightforward way from the beginning of the process to the endpoint but instead moved between "Deepening attachment to the child" and "Acceptance of the child as s/he is" before they moved ahead.

CONCLUSION

Having support and meeting peers of mothers with similar issues is essential for mothers to review their perspectives that healthy children are the standard against which to measure their child and to motivate them to raise their children, but it was extremely difficult to have such opportunities due to rarity of the disorder. It is crucial to accumulate more practical information so that mothers can access and use it. Mothers also need support to enhance their self-worth while giving due consideration to the possibility that they may be conscious of being stigmatized. Nurses need to advocate for these children and families to get the appropriate help, understanding and support.

Connecting Patients' Perceptions of Nurses' Daily Care Actions, Organizational Human Caring Culture, and Overall Hospital Rating in Hospital Consumer Assessment of Healthcare Providers and Systems Surveys

OBJECTIVE

The aim of this study was to connect patients' perceptions of nurses' daily care actions with patients' overall ratings of their hospital experience and hospitals' human caring culture.

BACKGROUND

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized survey measuring patients' hospital experience. Current literature lacks the connections between patients' perceptions of nurses' daily care actions and their overall hospital experience measured by the HCAHPS survey.

METHODS

This is a correlational study based on the HCAHPS surveys from patients discharged from a hospital in the United States. Correlations were conducted between patients' perceptions of nurses' daily care actions and overall hospital experience.

RESULTS

A total of 3,258 (16.6%) patients returned the HCAHPS survey between January and May 2019. Significant relationships were found among patients' perceptions of nurses' daily care actions, hospitals' caring culture, and overall experience.

CONCLUSION

Nurses' daily care actions significantly contribute to favorable patients' overall hospital ratings on HCAHPS.

Parents' and healthcare professionals' perceptions of the quality of care: A PITSTOP model of caring

BACKGROUND

Quality of care is measured by various indicators. Besides objective quantifications, it is necessary to understand the meaning of quality of care from the perspectives of patients, families, and healthcare professionals.

OBJECTIVES

This study aimed to understand parents' and healthcare professionals' perceptions of the quality of care.

METHODS

This was a secondary data analysis of two qualitative studies examining parents' and healthcare professionals' perceptions of caring in 2014 and 2018, respectively. Both studies took place in a children's hospital in the United States. There were 40 participants, 13 parents of children undergoing heart surgery and 27 healthcare professionals. The current study focused on parents' and healthcare professionals' viewpoints about the quality of care.

RESULTS

Seven themes emerged: patient-centered care, interprofessional collaboration, team communication, safety and security, trusting relationships, optimal outcomes, and positive patient experiences. The acronym PITSTOP was developed to enable healthcare professionals to recall the elements deemed as important to the quality of care by parents and professionals.

CONCLUSIONS

This study brought up a novice opinion that healthcare should be like a "pitstop," not just a "repair shop." Healthcare encounters may be brief but invaluable in helping patients and families succeed in their health promotion.

Analyzing Patients' Complaints: Awakening of the Ethic of Belonging

Nursing ethics are fundamental principles to nursing practice. The purpose of this study is to analyze patients' complaints filed against nurses from a nursing ethics perspective. This is a qualitative study. The data source is the patients' complaints filed in a university-affiliated hospital in China. The complaints are categorized into 4 themes: uncompassionate attitudes, unprofessional communication, disrespect of patient rights, and unsatisfactory quality of nursing care. The ethic of belonging reflects nurse-patient relations. Patients expect to be treated with dignity. This study sends out a call for nurse leaders and educators to reevaluate the practice and education of the nursing professional identity.

The Current Intervention Studies Based on Watson's Theory of Human Caring: A Systematic Review

This article reviewed 19 intervention studies based on Watson's Human Caring Theory between January 2005 and February 2018. The studies reviewed targeted on promoting patients', nurses', and nursing students' psychological health and patient care experiences. Most (15/19; 78.95%) of the studies in this review indicated that Watson's caring science-based interventions could decrease patients' emotional strains, increase patients' self-management confidence and emotional well-being, increase nurses' job satisfaction and engagement, and improve nursing students' confidence in the clinical performance and the awareness of caring behaviors. Nursing is a discipline that requires both scientific knowledge and the art of human caring.

Nurse leaders' strategies to foster nurse resilience

AIM

To identify nurse leaders' strategies to cultivate nurse resilience.

BACKGROUND

High nursing turnover rates and nursing shortages are prominent phenomena in health care. Finding ways to promote nurse resilience and reduce nurse burnout is imperative for nursing leaders.

METHODS

This is a qualitative descriptive study that occurred from November 2017 to June 2018. This study explored strategies to foster nurse resilience from nurse leaders who in this study were defined as charge nurses, nurse managers and nurse executives of a tertiary hospital in the United States. A purposive sampling method was used to have recruited 20 nurse leaders.

RESULTS

Seven strategies are identified to cultivate nurse resilience: facilitating social connections, promoting positivity, capitalizing on nurses' strengths, nurturing nurses' growth, encouraging nurses' self-care, fostering mindfulness practice and conveying altruism.

CONCLUSIONS

Fostering nurse resilience is an ongoing effort. Nurse leaders are instrumental in building a resilient nursing workforce. The strategies identified to foster nurse resilience will not only impact the nursing staff but also improve patient outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

The strategies presented are simple and can be easily implemented in any settings. Nurse leaders have an obligation to model and enable evidence-based strategies to promote nurses' resilience.

Healthcare interprofessional team members' perspectives on human caring: A directed content analysis study

OBJECTIVES

As Watson's Human Caring Theory continues to evolve and guide the discipline of nursing, the challenge is to find ways to integrate it into practice. The purpose of this study is to describe interprofessional team members' perspectives on human caring based on the Ten Caritas Processes®/Caritas-Veritas Literacy of Watson's Human Caring Theory within the Unitary Caring Science.

METHODS

This is a qualitative directed content analysis study, taking place in a Children's Hospital in the United States between November 2017 and April 2018. Information redundancy was utilized to guide the recruitment. Data were collected via a one-time face-to-face individual interview. A qualitative directed content analysis was conducted using Watson's Ten Caritas Processes®/Caritas-Veritas Literacy as a coding framework.

RESULTS

Twenty-seven healthcare professionals participated in the study. Interprofessional human caring, based on the Ten Caritas Processes®/Caritas-Veritas Literacy, was referred to as performing loving-kindness to patients, each other, and self; maintaining faith-hope in teamwork; valuing inter-subjective interactions and building trust among team members; cultivating heart-centered-caring relations; acknowledging and processing positive and negative feelings non-judgmentally; applying all ways of knowing in caring; encouraging reciprocal teaching-learning; developing caring-healing environments collaboratively; respecting human dignity of patients and each other; and being open-minded to the unknowns and believing in miracles.

CONCLUSIONS

Watson's Human Caring Theory can be an underlying guide to enrich human-to-human relations and create a caring-healing environment. When human caring is applied in interprofessional teams, healthcare professionals find a caring consciousness to care for oneself and each other and promote patient care.

A mixed method analysis of patients' complaints: Underpinnings of theory-guided strategies to improve quality of care

PURPOSE

Patients' complaints can be predictors of patient care quality and safety. Understanding patients' complaints could help healthcare organizations target the areas for improvements. The purpose of this study is to use a mixed method analysis to a) examine the characteristics and categories of patients' complaints, b) explore the relationships of patients' complaints with professions and units, and c) propose theory-based strategies to improve care quality.

METHODS

This is a descriptive mixed method study. Data examined are patients' complaints filed at a university-affiliated hospital in China from January 2016 to December 2017. A qualitative content analysis was conducted to categorize complaints. A TwoStep cluster analysis was performed to provide an overall profile of patients' complaints. Chi-Square tests were conducted to investigate the relationships among complaints, professions, and units.

RESULTS

838 complaints were filed, with 821 valid cases for analysis. Six categories surfaced from the qualitative analysis: uncaring attitudes, unsatisfactory quality of treatment or competence, communication problems, the process of care, fees and billing issues, and other miscellaneous causes. Physicians received most of the complaints (56.6%). The unit receiving the most complaints were outpatient clinics and medical support units (52.7%). The cluster analysis indicated four distinct clusters. Significant relationships existed between complaints and professions (χ 2 (20) = 178.82, P < 0.01), and between complaints and units (χ 2 (15) = 42.72, P < 0.01).

CONCLUSIONS

Patients' complaints are valuable sources for quality improvements. Healthcare providers should be not only scientifically knowledgeable, but also humanistic caring. Caring-based theories may provide guidance in clinical practice.