Nurse Caring Enhancements of The Caring Model® (TCM): Education Modules Improve Nurse Communication and Patient Satisfaction

Monday, 9 November 2015

Sharon Kay Dingman, DNP, MS, BSN, RN
The Caring Model® LLC, Plain City, UT, USA


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.


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. 


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.


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. 


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.