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Patient satisfaction is an established indicator of quality care measuring the perception and
expectation of nurse caring in human-to-human interpersonal interactions. Nursing theory and
empirical research substantiates the value of caring behaviors in nursing practice. Caring
interactions between nurses, patients, and families are highly correlated with value-based
performance incentive payments specific to nurse communication. The patient experience is
associated with how well nurses provide information and attend to the needs of patient and
families in every encounter, every day. The education modules focus on the nurse’s role in
value-based innovations to improve patient satisfaction.
Intervention
Four new education modules provided participants an opportunity to review aspects
of caring from the patients’ perspective. The modules included: (1) Concepts of Caring and
Application of Caring Theory; (2) Caring Behaviors and Models of Nursing Practice; (3) Caring
Environments and Workforce Engagements; and, (4) Outcomes of Caring, Consumerism, and
Satisfaction. A Caring Dimensions Inventory (CDI) of 25 core statements has a Cronbach’s
alpha reliability from 0.91 to 0.92 was used to measure the perceptions of caring by nurses in a
pre and posttest for changes in perception. Perceptions of caring increased (t (8) = 4.04, p =
0.004 overall. Affective aspects of nursing increased (t (8) = 5.20, p = 0.001. Perceptions of
technical caring approached statistical significance (t (8) = 2.16, p =0.06. The difference in the
mean score average of affective questions of 4.67 and technical questions of 2.98 appear to be in
response to education. On their first shift after the education experience, nurse participants
completed a Personal Observation and Reflective Observation Summary of patient and nurse
dialogue identifying ways of being (affective) and ways of doing (technical) care provided.
These observations were used to help determine their responsiveness to patients and families
care delivery experiences and application of the education modules.
Implementation
The nursing theories of Watson (1996), Leininger (1994), Swanson (1991), Boykin &
Schoenhofer (2001) and Roach (2002) were used to identify the potential affective nature of
nurse caring behaviors. Caring indicators for improving the perceptions of nurse caring were
identified by participants. Enhanced education modules included examples of affective
and technical nurse caring behaviors, as measured by the CDI, to support the interpersonal nurse-
patient caring relationship in practice. Rogers’ Innovation Decision Process model was used as a
guiding framework for the education intervention.
Results
The participants identified differences between their intended and demonstrated caring behaviors in
affective and technical aspects of care. Posttest perceptions of affective caring increased with statistical
significance after the nurses received the education instruction . Technical aspects of caring also increased,
to a smaller degree, at a rate that approached statistical significance. Participants who had been in their
position in health care greater than three years, there was a greater change in mean scores than those
for less than three years. The trend in the mean scores suggests there is a pattern than requires further
analysis. Translating existing research into nursing practice promoting affective and technical aspects of caring
makes good economic sense.
Conclusions
Caring behaviors displayed through nurse interventions can influence the patients’ perceptions of
satisfaction with nursing care. These behaviors can be translated into practice with focused
caring educational experiences and the adaptation of caring behaviors to accommodate the
patient-family-nurse relationship in value-based patient-centered care in today’s health care
environment. There is a predictive relationship between patient-family-nurse perceptions of
caring and satisfaction with care delivered. The phenomenon of caring is influenced by multiple
perspectives of nursing practice and patient experience expectations. The economics of nurse
caring and compassion in health care reform requires nurses to provide knowledge and insights
into nursing practice efficiencies, costs and outcomes.