Someone to Watch Over Me: Feeling Safe and Cared for in Clinical Settings

Friday, 28 July 2017

Madeline Marie O'Donnell, DNP1
Inge B. Corless, PhD1
Lisa Quinn, PhD1
Catherine Griffith, PhD2
Margie Sipe, DNP1
Patrice Kenneally Nicholas, DNSc, MPH3
(1)MGH Institute of Health Professions, Boston, MA, USA
(2)MGH Research Institute: Translational & Clinical Research Centers, Boston, MA, USA
(3)Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA


The purpose of this exploratory study is to identify what makes patients feel cared for and how caring behaviors and feeling safe contribute to feeling cared for in clinical settings.

 1: To determine whether there is a significant relationship between:

a. patients’ perceptions of caring behaviors and feeling safe.

b. patients’ perceptions of caring behaviors and feeling cared for.

c. patients’ perceptions of feeling safe and feeling cared for.

2: To investigate whether participants’ responses vary by demographic

factors, the length of the current hospital stay, whether the patient can identify a primary nurse caregiver, and the length of time the patient has been receiving care at the current facility other than the current hospitalization.

3: To identify themes in the open-ended questions regarding feeling safe and

feeling cared for.


After Institutional Review Board approval of the research, this mixed methods pilot study will be conducted on three medical and three surgical units in a tertiary care facility. Patients who have been hospitalized from 3 to 12 days, are English speaking and reading, and indicate a willingness to participate will be given an explanation of the study and their rights, an informed consent document for review of their rights, the questionnaire, and a return envelope addressed to the Principal Investigator. The questionnaire will be collected at a time convenient for the patient. It will be emphasized that current and future care at the tertiary care facility will not be affected by the decision regarding participation in the study. Completion of the questionnaire will imply consent. The questionnaire for this study is comprised of the CBI-24 (Wu, Larrabee & Putnam, 2006) that was reduced from the 42-item instrument (Wolf, 1986). The CBI-24 is preceded by a socio-demographic section containing questions on gender, age, ethnicity, education, length of hospital stay, identification of a primary nurse, and length of time receiving care at the tertiary care facility (other than the current stay). This is followed by questions on current physical and psychological status, perceptions of social support by family and friends, as well as perceptions of social support by nurses while hospitalized. The visual analog scales, measured on a 1-10 metric, assess self-perceived physical status, psychological status and social support and have been used multiple times in previous studies (Coleman, et al., 2006). Slight modifications to these scales query social support from nurses, feeling safe, presence of nurses in feeling safe, and presence of relatives in feeling safe. The next sections of the questionnaire contain the CBI-24 questionnaire and two variations of this instrument addressing feeling safe (CBI-24-FS) and feeling cared for (CBI-24-FCF) while hospitalized. The instrument also contains open-ended questions where participants can express their views about feeling safe and feeling cared for while in the hospital.


If the data demonstrate an overlap between caring and feeling safe, this in itself has implications for both nursing education and practice. First, this formulation resolves the discrepancy in the caring literature where nurses emphasize the psychosocial aspects of caring given that technical proficiency is assumed as a requisite for providing safe care. Nurses can take pride in caring for patients knowing that their technical, as well as their psychosocial, skills are essential for caring for the patient and should be acknowledged as contributing to the patient’s well-being. Further, identification of what makes patients feel cared for will be useful to nurses in practice as well as for nurse educators who strive to help their students achieve these skills.


The findings of this study will reinforce the importance of making explicit to patients what nurses take for granted, namely, their technical and monitoring activities. Nurses doing so as a part of providing care will help patients feel more secure in the clinical setting. With this as a foundation, much like Maslow’s hierarchy, nurses then can address the other needs of patients confronting a health issue; a health issue with ramifications for other aspects of a patient’s life and well-being. Finally, the findings of this study will contribute to the patient’s knowing “I have someone to watch over me” which we contend is essential to patients feeling safe and cared for in the clinical setting.