Relationships Between Nurse-Expressed Empathy, Patient-Perceived Empathy and Patient Distress

It is increasingly important that nursing care be associated with measurable patient outcomes. A correlational study examined relationships between nurse-expressed empathy and two patient outcomes: patient perceived empathy and patient distress. Subjects (N = 140) were randomly selected from RNs and patients on medical and surgical units in two urban, acute care hospitals. Nurse-subjects (N = 70) completed two measures of nurse-expressed empathy: the Behavioral Test of Interpersonal Skills and the Staff-Patient Interaction Response Scale. Patient-subjects (N = 70) completed the Profile of Mood States, the Multiple Affect Adjective Checklist, and the Barrett-Lennard Relationship Inventory. Findings indicated a negative relationship (r =−.71, p<.001) between a set of empathy variables and a set of patient distress variables and a positive relationship between nurse-expressed and patient perceived empathy (r=37 −.47,p<.05). This study is one of the first to link behavioral measures of nurse empathy to patient outcomes     

Professional Commitment, Patient Safety, and Patient-Perceived Care Quality

Purpose: To examine how professional commitment influences patient safety and patient-perceived care quality.
Design: Investigators for this study used a cross-sectional design with questionnaires. A total of 348 pairs of nurses and inpatients were contacted at two medical centers in Taiwan during the period from August 2007 to January 2008, yielding 284 pairs of completed questionnaires.
Methods: Frequencies of six adverse patient events were used to measure patient safety; and the Service Quality Scale was used to measure patient-perceived care quality. Four items of the Professional Commitment Questionnaire were used to measure professional commitment. Regressions were used for the analyses.
Findings: Professional commitment positively influenced overall patient safety (ß=.19, p =.00) and overall patient-perceived care quality (ß=.13, p =.03). Furthermore, professional commitment positively influenced all patient safety indicators (ß≥.12, p ≤.04), except frequency of nosocomial infections, the coefficient of which reached borderline significance (ß=.11, p =.07). Professional commitment also positively influenced care quality in terms of responsiveness (ß=.16, p =.01) and empathy (ß=.14, p =.03).
Conclusions: Professional commitment may enhance patient safety and patient-perceived care quality.
Clinical Relevance: This study indicates that nurse professional commitment can enhance patient safety and patient-perceived care quality.     

Evaluation of empathy measurement tools in nursing: systematic review

Title.  Evaluation of empathy measurement tools in nursing: systematic review.
Aim.  This paper is a report of a systematic review conducted to analyse, evaluate and synthesize the rigour of measures used in nursing research to assess empathy, in order to identify a 'gold standard' for application in future studies.
Background.  Empathy is considered essential to the provision of quality care. We identified 20 different empathy measures used in nursing research. There are inconsistencies between tools, indicating both the inherent complexity of measuring empathy and the need to evaluate the rigour of the measures themselves.
Data sources.  An extensive search was conducted for the period 1987 and 2007 using the Medline, CINAHL and PsycINFO databases and the keywords 'empathy', 'tool', 'scale', 'measure', 'nurse' and 'nursing'. Twenty-nine studies were identified as relevant, in which 20 different empathy measurement tools were used. Twelve tools met the inclusion criteria for this review.
Method.  Twelve measures were critically reviewed and analysed. A 7-criterion framework was developed to appraise the rigour of the empathy measures, with a score range of 0–14 for each measure.
Results.  Quality scores obtained were low (2–8 of 14). Validity and reliability of data were commonly reported, but responsiveness to change was tested in only three measures. None of the measures were psychometrically robust or covered all the domains of empathy. User involvement was limited and only five were developed in nursing settings.
Conclusion.  Most measures have undergone rigorous development and psychometric testing, although none is both psychometrically and conceptually satisfactory. Empathy measures need to cover all relevant domains reflecting users' own perspectives and be tested with appropriate populations in relevant care settings.     

Orlando's deliberative nursing process theory: a practice application in an extended care facility

Ida J. Orlando was one of the first nursing theorists to write about the nursing process based on her own research. Her Deliberative Nursing Process Theory focuses on the interaction between the nurse and patient, perception validation, and the use of the nursing process to produce positive outcomes or patient improvement. Orlando's key focus was to define the function of nursing. This author's purpose is to acquaint nurses with Orlando's theory and to encourage the use of the deliberative process to bring about patient improvement. This article provides an analysis of Orlando's theory and a demonstration of its successful use in clinical practice in an extended care setting.     

The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement

OBJECTIVE: To test a theoretical model of professional nurse work environments linking conditions for professional nursing practice to burnout and, subsequently, patient safety outcomes. BACKGROUND: The 2004 Institute of Medicine report raised serious concerns about the impact of hospital restructuring on nursing work environments and patient safety outcomes. Few studies have used a theoretical framework to study the nature of the relationships between nursing work environments and patient safety outcomes. METHODS: Hospital-based nurses in Canada (N = 8,597) completed measures of worklife (Practice Environment Scale of the Nursing Work Index), burnout (Maslach Burnout Inventory-Human Service Scale), and their report of frequency of adverse patient events. RESULTS: Structural equation modeling analysis supported an extension of Leiter and Laschinger's Nursing Worklife Model. Nursing leadership played a fundamental role in the quality of worklife regarding policy involvement, staffing levels, support for a nursing model of care (vs medical), and nurse/physician relationships. Staffing adequacy directly affected emotional exhaustion, and use of a nursing model of care had a direct effect on nurses' personal accomplishment. Both directly affected patient safety outcomes. CONCLUSIONS: The results suggest that patient safety outcomes are related to the quality of the nursing practice work environment and nursing leadership's role in changing the work environment to decrease nurse burnout.     

PSYCHOLOGY AND BEHAVIORAL STUDIES

This study examined the relationship between catastrophizing and patient-perceived partner responses to pain behaviors. The Catastrophizing subscale of the Cognitive Coping Strategy Inventory and the West Haven-Yale Multidimensional Pain Inventory were completed by 62 adult chronic pain patients. Consistent with past research, catastrophizing, and patient-perceived solicitous partner behaviors were positively correlated with negative pain outcomes. The communal coping theory of catastrophizing suggests that catastrophizing might be undertaken to solicit support and empathy from others. However, catastrophizing was not related to perceived solicitous partner behavior in this study. Rather, catastrophizing was associated with perceived punishing partner responses. Implications are that catastrophizing and perceived solicitous partner behaviors are independently associated with pain and that catastrophizing may not be reinforced by empathy from significant others.
Comment: The psychologic issue, then, may be to recognize both sets of behaviors affecting outcomes in families of patients with chronic pain.—Stewart J. Tepper     

Nurse-perceived time pressure and patient-perceived care quality

teng c.-i., hsiao f.-j. & chou t.-a. (2010) Journal of Nursing Management 18, 275–284
Nurse-perceived time pressure and patient-perceived care quality Aims To examine how time pressure among nurses influences patient-perceived care quality. Background Although nurses worldwide face increased time pressure in the workplace, no studies have addressed how workplace time pressure influences patient-perceived care quality. Patient-perceived care quality predicts patient intent to revisit the hospital if care is required, warranting investigation as to whether nurse-perceived time pressure decreases patient-perceived care quality. Methods A cross-sectional design and survey method were adopted. The data analysis was based on 229 nurse-patient sets drawn from a medical centre in northern Taiwan. Each set comprised one nurse and three patients. Results The study results demonstrate that time pressure among nurses reduces patient-perceived reliability/accountability, responsiveness and assurance. The test results, however, did not indicate a significant negative association between time pressure and patient-perceived empathy and tangibles. Conclusion Time pressure among nurses may reduce patient perception of care quality in terms of reliability/accountability, responsiveness and assurance. Implications for nursing management To enhance patient perception of care quality, nursing managers need to devise means to reduce nurse-perceived time pressure.     

Predictors of Patient-Perceived Quality

Larrabee's model of quality proposes a relationship between quality and value. This study tested the relationship by identifying predictors of patient-perceived quality for nursing care. Data were obtained from interviews and records of 199 adult patients. Candidate predictors of patient-perceived quality included patient goal achievement, nurse-perceived quality, and nurse goal achievement. Candidate predictors also included seven demographic, seven financial, six illness, and six hospital variables. Predictors of both patient-perceived quality global and patient-perceived quality total were pain severity on exit interview, clinic referral, unit, and patient goal achievement. Medicare nonrecipient was a predictor of patient-perceived quality global. Worry score on admission was a predictor of patient-perceived quality total. The results support the relationship between quality and value and between quality and beneficence postulated by Larrabee's model of quality. Additional investigation of these relationships in other populations and using other operationalizations of the model concepts is needed to provide further support for the model. This model is potentially useful for investigating quality in diverse cultures because the operationalization of the model concepts can be designed to reflect local, regional, or national values.     

Hardiness,work support and psychological distress among nursing assistants and registered nurses in Quebec

BACKGROUND: Although nursing assistants (NAs) represent a large segment of Canadian health care providers, little is known about psychosocial factors related to their physical and psychological well-being and how these compare with their registered nurse (RN) counterparts. AIM: Guided by Maddi and Kobasa's theoretical framework of Factors Affecting Health-Illness Status, the purpose of the present study was to examine relationships among hardiness, psychological distress and work support in NAs, and to compare results with those from a sample of RNs. METHOD: A random sample of 171 NAs in Quebec completed self-report questionnaires. The study instruments included validated French-Canadian versions of Kobasa's Hardiness Scale, Ilfeld's Psychiatric Symptom Index, and Moos' Work Relationship Index. RESULTS: As theoretically predicted, statistically significant correlations were found between hardiness and psychological distress (r = -0.42; P < 0.001), hardiness and work support (r = 0.27; P < 0.001), and between work support and psychological distress (r = -0.21; P < 0.001). Using a mediational model and multiple regression analyses, hardiness among NAs was found to be a significant mediator between work support and psychological distress. Comparative analyses revealed that whereas NAs and RNs reported similar levels of psychological distress (P = 0.25) and work support (P = 0.13), NAs reported significantly less hardiness (t = -5.58; P < 0.01). In addition, NAs and RNs reported significantly more psychological distress than the general population of Quebec, Canada (t = 9.07 and 22.84, P < 0.01, respectively). CONCLUSION: Results add support to Maddi and Kobasa's theoretical propositions linking personal and contextual resources to health-related outcomes and offer insights into specific factors that may affect the health and well-being of both NAs and RNs as well as their work climate.     

Patient satisfaction with nursing care: a concept analysis within a nursing framework

Title.  Patient satisfaction with nursing care: a concept analysis within a nursing framework.
Background.  Patient satisfaction is an important indicator of quality of care, and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in the healthcare market. Nursing care has a prominent role in patient satisfaction. Using a nursing model to measure patient satisfaction with nursing care helps define and clarify this concept.
Data sources.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The literature search used the keywords patient satisfaction, nursing care and hospital. The sample included 44 papers published in English, between 1998 and 2007.
Results.  Cox's Interaction Model of Client Health Behavior was used to analyse the concept of patient satisfaction with nursing care. The attributes leading to the health outcome of patient satisfaction with nursing care were categorized as affective support, health information, decisional control and professional/technical competencies. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes.
Conclusion.  The meaning of patient satisfaction continues to evolve. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.     

Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals

Purpose: The aim of this study was to examine how nursing unit turnover affects key workgroup processes and how these processes mediate the impact of nursing turnover on patient outcomes.
Methods: A secondary data analysis was used to test the hypothesized model. This study used registered nurse and patient data from 268 nursing units at 141 hospitals collected as part of the Outcomes Research in Nursing Administration (ORNA II) project. Nursing units provided monthly nursing unit turnover rates for 6 consecutive months, and registered nurses completed questionnaires measuring workgroup processes (group cohesion, relational coordination, and workgroup learning). Patient outcome measures included unit-level average length of patient stay, patient falls, medication errors, and patient satisfaction scores.
Results: Nursing units with moderate levels of turnover were likely to have lower levels of workgroup learning compared to those with no turnover ( p <.01). Nursing units with low levels of turnover were likely to have fewer patient falls than nursing units with no turnover ( p <.05). Additionally, workgroup cohesion and relational coordination had a positive impact on patient satisfaction ( p <.01), and increased workgroup learning led to fewer occurrences of severe medication errors ( p <.05).
Conclusions: The findings of this study provide specific information on the operational impact of turnover so as to better design, fund, and implement appropriate intervention strategies to prevent registered nurse exit from nursing units. Further investigation is needed to assess the turnover-outcomes relationship as well as the mediating effect of workgroup processes on this relationship.
Clinical Relevance: Managing nursing unit turnover within appropriate levels at the nursing unit is critical to delivering high-quality patient care.     

Perceived job stress, job satisfaction, and psychological symptoms in critical care nursing

This study tested the relationships among perceived job stress, job satisfaction, and psychological symptoms of critical care nurses. A self-administered questionnaire was sent to a sample of 180 critical care nurses from eight hospitals. The results supported the hypotheses that higher levels of perceived job stress are related to lower levels of job satisfaction (r = -.24, p = .001) and to higher levels of psychological symptoms (r = .33, p = .000). These effects remained even when years of experience in nursing and shift were controlled. Item analysis, however, showed that four of the five top-ranking stressors were not related to the outcome measures. A distinction between positive and negative stressors is proposed to explain the pattern of results.     

Effects of a Relationship-Enhancing Program of Care on Outcomes

Purpose: To examine the effects of a relationship-enhancing program of care (REPC) on resident and care provider outcomes.
Design and Methods: A quasi-experimental, repeated measures design, with intervention and comparison groups. Questionnaires were distributed to 50 residents, and observations were conducted of 40 residents and 34 nursing staff at baseline and 3 months after the intervention, on two Canadian nursing home units. An investigator-designed educational program based on Winnicott's theory of relationships and the empirical literature, was provided to care providers and their supervisors on the intervention unit. Repeated measures analysis of variance (RM-ANOVA) was used to compare the intervention and comparison groups in regard to changes in the outcomes over time.
Findings: The REPC had statistically significant effects on (a) residents' perceptions of care providers' relational care, (b) care providers' relational behaviors, and (c) continuity of care.
Conclusions: Evidence showed that these care providers were taught how to enhance their relational skills with residents living in long-term care facilities without added staff. Recommendations for practice and research are discussed.     

Predictors of patient satisfaction with inpatient hospital nursing care

The purpose of this predictive nonexperimental study was to investigate the influence of registered nurse (RN) job satisfaction, context of care, structure of care, patient-perceived nurse caring, and patient characteristics on patient satisfaction with inpatient hospital nursing care in an academic medical center in north-central West Virginia. Convenience samples of patients (N = 362) and RNs (N = 90) were recruited from two medical units, two surgical units, and three intensive care step-down units. Causal modeling identified patient-perceived nurse caring as the major predictor of patient satisfaction, with nurse/physician (RN/MD) collaboration as the only other direct predictor. Age had an indirect influence on patient satisfaction. Strategies to achieve and maintain patient satisfaction should address the enhancement of patient-perceived nurse caring and RN/MD collaboration.     

Measuring satisfaction with nursing care among hospitalized patients: refinement of a Spanish version

This study was designed to improve the psychometrics of English and Spanish measures of hospitalized patients' satisfaction with nursing care. One hundred Spanish-speaking participants in the northeastern and southwestern United States completed a new 20-item Spanish version; 64 of the same participants also completed the English version. Correlations between item pairs (p < .001, r = .56-.96) and total scores of both versions (r = .92, p < .01), and similar factor structures support equivalence of the two versions. Evidence for construct validity is also presented. Results surpass standards for new instruments and support the utility of this much needed, bilingual measure of inpatient satisfaction with nursing care.     

Spirituality and Distress In Sheltered Battered Women

Purpose: To examine the relationship between spiritual beliefs and psychological distress in sheltered battered women.
Design: A convenience sample of 50 ethnically diverse women who had resided for at least 21 days in battered women's shelters participated. Data were obtained over a 7-month period in 1998 and 1999.
Methods: Participants completed the Spiritual Perspective Scale (SPS), Symptom Checklist- 90-Revised (SCL-90), Conflict Tactics Scale, and a demographic data sheet.
Results: These sheltered battered women placed high value on their spiritual beliefs and used a variety of spiritual practices to aid them. The relationship between the Global Severity Index as measured by the SCL-90 and SPS scores approached statistical significance (r = -.27, p = 0.06). However, a significant inverse relationship was found between the SPS score and the obsessive-compulsive score (r = -.34, p < 0.05), interpersonal sensitivity score (r = -.31, p <.05), and hostility dimensions score (r = -.37, p < 0.01) of the SCL-90.
Conclusions: The findings indicated that, among these sheltered battered women, spirituality may be associated with greater internal resources that buffer distressing feelings and calm the mind. This study shows support of spirituality as a means of reducing distress through greater connection to oneself and higher powers.     

Attitudes and Perceptions of Patients, Caregivers, and Health Care Providers toward Background Music in Patient Care Areas: An Exploratory Study

Abstract Background: Background music can be used to distract from ordinary sounds and improve wellbeing in patient care areas. Little is known about individuals' attitudes and beliefs about music versus ordinary sound in this setting. Objectives: To assess the preferences of patients, caregivers and healthcare providers regarding background music or ordinary sound in outpatient and inpatient care areas, and to explore their attitudes and perceptions towards music in general. Methods: All participants were exposed to background music in outpatient or inpatient clinical settings. 99 consecutive patients, 101 caregivers and 65 out of 70 eligible healthcare providers (93%) completed a survey about music attitudes and preferences. The primary outcome was a preference for background music over ordinary sound in patient care areas. Results: Preference for background music was high and similar across groups (70 patients (71%), 71 caregivers (71%) and 46 providers (71%), p=0.58). The three groups had very low disapproval for background music in patient care areas (10%, 9% and 12%, respectively; p=0.91). Black ethnicity independently predicted lower preference for background music (OR: 0.47, 95%CI: 0.23, 0.98). Patients, caregivers and providers reported recent use of music for themselves for the purpose of enjoyment (69%, 80% and 86% respectively p=0.02). Age, gender, religion and education level significantly predicted preferences for specific music styles. Conclusion: Background music in patient care areas was preferred to ordinary sound by patients, caregivers and providers. Demographics of the population are strong determinants of music style preferences.