Evaluating care from a care ethical perspective:: A pilot study.

BACKGROUND: Care ethical theories provide an excellent opening for evaluation of healthcare practices since searching for (moments of) good care from a moral perspective is central to care ethics. However, a fruitful way to translate care ethical insights into measurable criteria and how to measure these criteria has as yet been unexplored: this study describes one of the first attempts. OBJECTIVE: To investigate whether the emotional touchpoint method is suitable for evaluating care from a care ethical perspective. RESEARCH DESIGN: An adapted version of the emotional touchpoint interview method was used. Touchpoints represent the key moments to the experience of receiving care, where the patient recalls being touched emotionally or cognitively. Participants and research context: Interviews were conducted at three different care settings: a hospital, mental healthcare institution and care facility for older people. A total of 31 participants (29 patients and 2 relatives) took part in the study. Ethical considerations: The research was found not to be subject to the (Dutch) Medical Research Involving Human Subjects Act. FINDINGS: A three-step care ethical evaluation model was developed and described using two touchpoints as examples. A focus group meeting showed that the method was considered of great value for partaking institutions in comparison with existing methods. Reflection and discussion: Considering existing methods to evaluate quality of care, the touchpoint method belongs to the category of instruments which evaluate the patient experience. The touchpoint method distinguishes itself because no pre-defined categories are used but the values of patients are followed, which is an essential issue from a care ethical perspective. The method portrays the insider perspective of patients and thereby contributes to humanizing care. CONCLUSION: The touchpoint method is a valuable instrument for evaluating care; it generates evaluation data about the core care ethical principle of responsiveness.

Self-report questionnaire for measuring presence: development and initial validation.

BACKGROUND: The concept of 'presence' appears frequently in the literature and seems to be a highly relevant concept in discussing and evaluating quality of relations in healthcare practices. However, no existing self-report measure of presence for health professionals was found. PURPOSE: The purpose of this study was (i) to develop a self-report questionnaire for measuring presence and (ii) to conduct initial psychometric testing of the questionnaire. METHOD: The process followed two steps. Phase 1 consisted of the development of 64 items that were derived from the 'theory of presence' (ToP) as developed by Andries Baart in the Netherlands in 2001. Face and content validity were completed by a panel of experts in ToP. A pilot study to test understandability was done (N = 22). During Phase 2, 48 remaining items of the Presence Questionnaire for Caregivers (PQ-C) were tested among 723 healthcare professionals. Exploratory principal component analysis was conducted, and reliability coefficients and known-group validity were assessed. RESULTS: Principal component analysis showed three new components that were labelled 'dedicated attitude', 'openness in perception' and 'reciprocal humaneness'. Thirty-one items were retained which explain 25.4% of the variance. An initial psychometric assessment of the shortened scale showed a Cronbach's alpha of 0.82 and a Spearman-Brown coefficient (for equal length) of 0.63. There were significant differences in sum scores between groups based on age, years of experience and familiarity with ToP. CONCLUSION: It appeared possible to develop a self-report questionnaire for measuring presence and establish face and content validity. In initial exploratory factor analysis, the eight theoretical principles of ToP used to develop the questionnaire were not reflected, and three new components appeared. Further research is needed to examine the value of the three new dimensions, and investigation into the construct validity and reliability of the three new components is recommended.

Can quality from a care ethical perspective be assessed? A review.

BACKGROUND: Ethics-of-care theories contain important notions regarding the quality of care; however, until now, concrete translations of the insights into instruments are lacking. This may be a result of the completely different type of epistemology, theories and concepts used in the field of quality of care research. OBJECTIVES: Both the fields of 'ethics of care' and 'quality of care' aim for improvement of care; therefore; insights could possibly meet by focusing on the following question: How could ethics-of-care theories contribute to better quality in care at a measurement level? This study reviews existing instruments with the aim of bridging this gap and examines the evidence of their psychometric properties, feasibility and responsiveness. RESEARCH DESIGN: A systematic search of the literature was undertaken using multiple electronic databases covering January 1990 through May 2012. METHOD AND FINDINGS: Of the 3427 unique references identified, 55 studies describing 40 instruments were selected. Using a conceptual framework, an attempt was made to distinguish between related concepts and to group available instruments measuring different types of concepts. A total of 13 instruments that reflect essential aspects of ethics-of-care theory were studied in greater detail, and a quality assessment was conducted. CONCLUSION: Three promising qualitative instruments were found, which follow the logic of the patient and take their specific context into account.