Four Es of caring in contemporary nursing: Exploring novice to experienced nurses

Caring seems to be undervalued in the technologically‐advanced and fast‐paced clinical environment. To improve nursing practice, it is important to understand the meanings of caring to nurses. The aim of the present study was to explore nurses' perspectives of caring in the contemporary clinical environment. A focus group exploration was employed. Multiple perspectives were elicited from 80 nurses with different backgrounds: nursing students, nurse educators, registered nurses, advanced clinical nurses, and nurse executives. The qualitative data were analyzed using thematic analysis. Nurses' understanding of caring could be described using four Es: engaging in reciprocal relationships, embracing the essence of caring, engendering instances of caring, and embodying caring in practice. Participants described nurses as having the dual roles of caregiver and care recipient. The centrality of caring in nursing and the necessity of caring for caregivers were emphasized. The nurses also described various caring behaviors in daily practice. The present study revealed that nurses need empowerment to sustain their compassion. The findings provide new insights, which indicate that the revitalization of nurses' passion for caring in the contemporary clinical environment should begin with caring for caregivers.     

A framework for caring in the human resource management process of nurses

The aim of this paper is to describe the provision of a human value system in nursing management that would lead to an environment conducive to quality of care to nurses. Caring is a complex phenomenon with caring concepts which emphasized the human element in human resource management in the health services. Watson (1985) focused on the philosophical and spiritual basis of caring. The ten carative factors as described by Watson (1985) were used as a framework for the application of caring to the human resource management process in nursing. This framework enables a basis for the development of a caring environment for the nurse manager, in which the nurse could experience caring. It served as a point of departure for a research study undertaken during 2000 on caring to the caregivers in health services.     

What caring means to geriatric nurses

Caring is the major concept in nursing. The purpose of this study was to describe the meaning of caring for nurses caring for elderly patients. Parse' s phenomenology was addressed in the research design, which included four steps: participant selection, dialogical engagement, extraction-synthesis, and heuristic interpretation. By stratified sampling, 30 nurses who worked in medical-surgical wards in a general teaching hospital were selected as participants. Dialogical engagement was completed through in-depth, tape-recorded interviews on the open question, " What is the meaning of caring for you as a provider of care to the elderly? ". Data were interpreted by process of Parse' s phenomenology, which included extracting the essence, synthesizing the essence, formulating a proposition, extracting concepts, and structuring the meaning. The meaning of caring for nurses engaged in caring for the elderly was: " Through the initiative deliberation from sincerity, the nurse is to dedication by the empathy and tolerance". The core concepts of caring were: deliberation, initiative, sincerity, tolerance, empathy, and dedication. It should develop and apply the caring concept and theory actively to geriatric nursing care.     

Creating a profile of a nurse effective in caring

BACKGROUND: Watson's Theory of Caring and Caritas proposes that caring and love potentiate healing. Creating a profile of the characteristics of a "Caritas nurse" has implications for integrating caring and love into patient care, and measuring the impact of caring on patient and operational outcomes. METHODS: This psychometric study examined the profile of nurses effective in caring. The Caring Factor Survey and the Healthcare Environment Survey were selected to measure caring and work environment conditions as reported by the patient and by the nurse, respectively. RESULTS: The results of this study revealed that nurses of all ages who received high scores in caring were most frustrated with the work environment, were most experienced, worked only the hours scheduled, were most affected by the relationship with the patient, derived the most enjoyment from the relationship with their coworkers, and provided continuity of care most consistently. DISCUSSION AND IMPLICATIONS: Findings from this study indicate that further inquiry into the profile of nurses effective in caring and evaluation of the presence of caring and love on patient outcomes is warranted.     

Oncology patients' and professional nurses' perceptions of important nurse caring behaviors

Background  

Caring is the essence of nursing. Caring to be meaningful needs to be based on mutual agreement between nurses and patients as to what constitutes nurse caring behaviors. As a result, healthcare professional can enhance patients' satisfaction of care by providing appropriate caring behavior. However, previous research that combined multiple types of patients, nurses and institutions demonstrated disagreement in prioritizing important behaviors. This paper reports a study that aimed at determining the caring behaviors which oncology patients and oncology nurses perceive to be the most important.     

A longitudinal study into the perceptions of caring and nursing among student nurses

A longitudinal study of a cohort of student nurses was undertaken in order to investigate whether changes in perceptions of nursing and caring take place and how perceptions of nursing and caring are related. The Caring Dimensions Inventory (CDI) and the Nursing Dimensions Inventory (NDI) were employed for data collection at entry to nurse education and after 12 months. There were significant changes in the scores of a range of items in both inventories which suggested that student nurses lose some of their idealism about nursing and caring after 12 months in nurse education. While the overall ranking of items in the inventories was very similar, it was possible to distinguish between the inventories at entry to training and to observe a change, particularly in the CDI, over time by means of Mokken scaling. Nursing and caring would appear to become more synonymous to the student nurses after 12 months in nurse education. Factors scores, for factors identified in the CDI in a previous study, were used to investigate whether these scores changed at 12 months into nurse education compared with entry. No significant changes were detected.     

The caring behaviors of the home health nurse and influence on medication adherence

The purpose of this study was to determine if the caring behaviors of the home health nurse toward the patient influence the patient's medication adherence. The study focused on what effects the verbal and nonverbal caring behaviors of the nurse toward the patient have on the patient's medication adherence. How is the patient's perception of caring by the nurse related to his or her medication adherence? The study was conducted in a Midwestern home health agency over a 4-week period. Findings indicated an improvement in the use of verbal and nonverbal caring behaviors by the nurses with their patients. The patients perceived an increased use of these caring behaviors by the nurses with them. The patients' medication adherence and barriers to adherence improved. Other significant findings indicated that the verbal and nonverbal caring behaviors of the nurses and the patients' perception of the caring behaviors influenced and improved the patients' medication adherence by week 4.     

肿瘤科护士关怀照护行为现状调查

目的调查肿瘤科护士关怀照护行为现状。方法采用关怀行为量表,对115名肿瘤科护士进行问卷调查。结粜肿瘤科护士关怀照护行为得分为（59．64±11．82）分。3个维度的得分从高到低为：协助患者度过疾病不平顺的过程（2．00±O．43）分、了解患者需求（I．99±0．47）分、患者权益的维护（I．97±0．44）分。不同学历和工作性质的护士整体关怀照护行为差异具有统计学意义（P〈0．05）;不同职称、工作年限以及工作性质的护士“协助患者度过疾病不平顺的过程”维度得分差异具有统计学意义（P〈O．Ol或P〈O．05）。结论肿瘤科护士协助患者度过疾病不平顺关怀照护行为较好,维护患者权益的关怀照护行为较差。低学历、低职称以及合同制护士的关怀行为亟待提高。     

Senior nursing students' and professional nurses' perceptions of effective caring behaviors: a comparative study.

Care forms the basic core of nursing actions. Traditionally nurses have described the acts of administering to patients as care behaviors. Many nurses find it difficult to define these caring behaviors. It is important that nurses have insight into the specific behaviors that patients perceive to be most important. Several studies have examined and compared nurses' and patients' perceptions of effective care behaviors. The literature supports an incongruence of what nurses perceive and what patients perceive as effective. This study identifies and compares student nurses' and professional nurses' perceptions of effective caring behaviors. The Caring Assessment Report Evaluation Q-sort (CARE-Q) was used to obtain the data. The participants included senior baccalaureate nursing students (n = 30) at Thomas Jefferson University, College of Allied Health Sciences, and professional nurses (n = 30) with 1 or more years experience. The significance of the difference between the groups was tested using the Mann Whitney U test. Results indicate agreement between the students and the nurses in all categories except trusting relationship (p = .06). The ages within the groups varied from 21 to 47 years. The difference in ages between the nurses and the students is significant (p = .0002). Findings provide a better understanding of student nurse perceptions of caring behaviors and provide implications for further research for nurse educators.     

北京市养老院护士关爱能力及影响因素调查

目的调查北京市养老院护士的关爱能力现状,并分析其影响因素。方法采用关爱能力问卷,对北京市2所公立养老院的154名注册护士进行调查。结果养老院护士关爱能力总分为（180．36±16．58）分,各维度得分均低于国外常模（P〈0．01）,87．66％的护士关爱能力总体处于低等水平。多元回归分析显示,职务、学历、有无子女是关爱能力的影响因素（P〈0．01）。结论养老院护士总体关爱能力水平较低,尤其是职务为普通护士、学历为本科、无子女的护士。应在教育和培训中强化护士关爱能力的培养,并呼吁家庭和社会营造关爱氛围。     

South African student nurses' experiences of professional nurses' role-modelling of caring

BackgroundStudent nurses are expected to implement a caring practice in order to become professional nurses. Caring has remained the art and science of nursing, which student nurses learn from professional nurses during clinical practice. The South African Nursing Council mandates professional nurses to teach and supervise student nurses to master the art of caring during clinical practice. Caring is taught through role-modelling of daily nursing activities.Research purposeThis study was performed to gain an understanding of South African student nurses' experiences of professional nurses' role-modelling of caring.MethodsPhenomenological, qualitative research. Purposive sampling of fourth-year student nurses. Data collection: focus groups, observations and field notes. The data were analysed using Giorgi's modified Husserlian five-step method. Ethical principles were respected.ResultsThree themes were identified. Theme 1: inconsistency in the clinical environment; Theme 2: effective and ineffective role-modelling of caring and Theme 3: carelessness cascading.ConclusionsThe study facilitated an understanding of student nurses' experiences of professional nurses' role-modelling of caring. Recommendations to facilitate professional nurses' role-modelling of caring in a public hospital were formulated: Mentorship training, recognition system for professional nurses, clinical support for student nurses, open channels of communication, random nurse leader rounds, employee wellness program, workshops and positive learning environment promotion.     

Differences and similarities in the perception of caring between Spanish and UK nurses

The aim of the present paper was to compare and contrast perceptions of caring in nursing between Spanish and UK nurses. There are no previous studies comparing directly the perceptions of caring across cultures in nursing. A survey method was used employing the 25-item Caring Dimensions Inventory. Data were Mokken scaled for comparison with data from a previous study and scores for common items on the 25-item Caring Dimension Inventory for Spanish and UK nurses were correlated. There were similarities and differences between Spanish and UK nurses' perceptions of caring: many similar items were incorporated into Mokken scales but the endorsement of items did not correlate. The present work demonstrates that it is possible to measure differences and similarities in perceptions of caring. The study design could be improved and such work could be valuable in cross-cultural work with nurses.     

Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China

Aims. The aims of the study were to develop an understanding of caring in nursing from the perspective of cancer patients and attempt to identify the concept of caring in the Chinese cultural context. Background. Caring as a concept remains elusive, the acceptable definitions of the term care have not been reached. The expressions, processes and patterns of caring vary among cultures, but there is a lack of Chinese culture‐based study about caring in nursing. Methods. A qualitative research design was used and 20 cancer patients were interviewed using a semi‐structured interview guide. A qualitative content analysis was used to identify themes in the data. Results. Three themes emerged from the data, which suggested that caring is delivering care in an holistic way: nurses’ caring attitudes and their professional responsibility for providing emotional support, nurses’ professional knowledge and their professional responsibility for providing informational support and nurses’ professional skills and their professional responsibility for providing practical support. The caring behaviour of nurses as perceived by cancer patients involved the provision of emotional, informational, and practical support and help based on patients’ needs. A model of caring in nursing was formulated. Conclusions. Caring in nursing as perceived by cancer patients involves nurses having qualified professional knowledge, attitudes and skills in oncology and providing the informational, emotional and practical supports and help required by cancer patients. Relevance to clinical practice. Caring is manifested in nursing actions through nurse–patient communication process. Patients have their inner expectation for nurses’ caring behaviour and attitudes and nurses’ performance of caring or uncaring behaviour has a direct influence on the feelings of patients. It is necessary for all nurses to continue improving their oncology professional knowledge, attitudes and skills as well as their abilities of offering informational, emotional and practical support and help for their cancer patients.     

A longitudinal study into the perceptions of caring among student nurses using multivariate analysis of the Caring Dimensions Inventory

A longitudinal study involving student nurses' responses to the Caring Dimensions Inventory (CDI) was carried out to investigate the development of perceptions of caring. This study continues previously reported work in which the development of the CDI was described. The current study was designed to see if the CDI could detect changes in perceptions of caring among student nurses as they progressed through their training. Data were collected on the same subjects at three points, each a year apart, throughout the study. A cohort of 168 student nurses entering training was recruited into the present study and data from the CDI was analysed using exploratory factor analysis. A four factor structure for perceptions of caring throughout the study was supported, with some evidence for a five factor structure at 24 months into the programme of nurse education. A professional and technical factor increased in congruence with a similar factor, identified in a previous study, throughout the present study and was used to provide factor scores for individual students. There was a statistically significant and moderately sized correlation between the score on this factor and the age of the student nurses. The five factor solution yielded a factor of accountability. Professional and educational consequences of the study are discussed along with the problem of attrition in longitudinal studies.     

The effect of the training of presence in care (TPinCare) on the care-oriented patient-nurse interaction and the caring behaviors of nurses working with oncology patients: A randomized controlled trial

AimThe aim of this study is to investigate the effects of “The Training of Presence in Care-TPinCare” of nurses working with oncology patients on care-oriented patient-nurse interaction and caring behaviors.BackgroundHelping the individual to realize, protect and maintain his/her existence can be considered as the basis of "good nursing care". Presence is a way of care for the nurse and patient that fosters human-to-human bonding and deep contact experience and healing.DesignThis is a randomized controlled study.MethodData were collected between January 2019 and May 2019. The sample selection consisted of 52 nurses working with oncology patients, 26 interventions and 26 controls in accordance with the criteria of inclusion, exclusion and exemption by randominization and blinding. The data were collected by using the "Nurses Introductory Features Form", "Caring Behaviors Scale − 24 " and "Caring Nurse-Patient Interaction Scale". The training was applied to nurses in the intervention group. In data analysis used SAS 9,4 program; statistically Mean score, t test, Repeated Measures ANOVA. In the context of these effect sizes, the power of the study was calculated to be 0.99 for each scale. This study was conducted in line with the principles of the Declaration of Helsinki.ResultsAccording to the control group of nurses in the intervention group, there were no statistically significant differences in the mean scores of caring behaviors at different measurement times. A statistically significant difference was found in favor of the intervention group for caring nursing patient interaction general, sub-dimensions of "importance”, “competence” and “practicality", in nursing interventions (p < 0.05). Although the pretest mean scores of the nurses in the intervention group were lower compared with the control group, it was found that the posttest mean scores increased and the level of follow-up was maintained by a little increasing or decreasing. It was determined that there was no significant change in the posttest and follow-up scores of the nurses in the control group according to the pre-test mean scores.ConclusionsThis study showed that TPinCare has a positive effect on nurses working with oncology patients with respect to care quality perception and viewing “importance”, “competence” and “practicality", of attitude and behaviours related to care-focused patient nurse interactions. In this context, it can be suggested to continue the trainings which will contribute to caring behaviors and patient-nurse interactions of nurses and to support them with institutional contribution.     

Family-nurse co-construction of meaning: a central phenomenon of family caring

The purpose of the study was to understand and interpret caring in the family health experience by exploring the interactional phenomenon of family-nurse co-construction of meaning in the paediatric intensive care unit (PICU). A hermeneutic phenomenological method within a framework of existentialism and symbolic interactionism was used in the investigation. The convenience sample for this study was four family-nurse dyads, that is four families of critically ill children (all with positive outcomes) and the four nurses assigned to their care who were participating in a larger study. Data were derived from semi-structured interviews regarding significant interactions throughout the child's illness and subsequent significant interactions of families with other nurses and nurses with other families. Trustworthiness of the study was addressed through the criteria of credibility, dependability, transferability and confirmability. Co-construction of meaning in the family health experience was found to have two dimensions: interdependent and independent. Both families and nurses described being like family as an essential component of the interdependent experience. Independent dimensions for families were journeying through troubled waters of learning the meaning of the illness event and sensing family comfort through the nurse's care. Independent dimensions described by nurses were journeying through troubled waters of learning to care for families and living with another's fear. The family-nurse interaction, the relational connection and the evolution of meanings that families and nurses construct, was affirmed as the major vehicle in the co-construction experience. Family caring is influenced by the existential meaning constructing, process-oriented, interactional nature of the family health experience. Caring in the family health experience is enhanced through actions the nurse performs on behalf of, and with, the family while understanding the family's unique situation. Caring enacted by nurses in participation with families holds abundant potential for enhancing the family health experience and honor the ethic of caring as central to nursing.     

Exploring a culture of caring

AIM: The delivery of patient-centered care is basic to a large midwestern healthcare institution's mission and highly valued by the department of nursing. Even so, nurses on one medical unit questioned whether caring behaviors were devalued in a technology-oriented environment of providing care. The nursing leadership on the unit responded to the inquiry by conducting a research study. This study explored the state of patient-centered nursing care on a medical unit as perceived by the nursing staff and patients, using Watson's Theory of Human Caring as a framework. SUBJECTS AND METHODS: The study utilized surveys for both nursing staff (n = 31) and patients (n = 62), and included a focus group of nursing staff (n = 8) to explore ideas for innovation. RESULTS AND CONCLUSIONS: Both nurses and patients perceived a high level of caring on the unit. The overall theme from the focus group was that "caring begets caring," with 2 subthemes: "relationships of care" and "the context of caring." Caring for each other was identified as essential to keep staff energized and able to work lovingly with patients. Nursing leadership brought the research findings to all staff on the unit for discussion and implementation of structural support for the unit culture of caring.