Self-Caring Practices Among Nurses: Findings From an Online Survey.

Faith community nurses receive additional education in holistic health and intentional spiritual care, including self-caring. This study used an online survey to explore self-caring practices of faith community nurses and clinical nurses. Despite sample limitations, faith community nurses reported significantly higher levels of self-caring practices than clinical nurses.

The Relationship Between Staff Nurses' Perceptions of Nurse Manager Caring Behaviors and Patient Experience: A Correlational Study.

OBJECTIVE: The objective of this study was to explore the relationship between staff nurses' perceptions of nurse manager caring behaviors and patient experience. BACKGROUND: Despite numerous interventions aimed at changing the provision of patient care to improve care quality, patient experience scores have remained moderate. Little research has been conducted exploring how caring relationships in the professional practice environment might play a role in the patient experience of care. METHODS: A cross-sectional, correlational design was used to examine the relationship between staff nurses' perceptions of nurse manager caring behaviors as measured by the Caring Assessment Tool-Administration (CAT-Adm) and acute-care patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. RESULTS: There was a positive relationship between the staff nurses' perceptions of nurse manager caring behaviors and patients' HCAHPS overall hospital rating. There also was a positive relationship between the CAT-Adm scores and nurse manager visibility. CONCLUSION: Departments had higher HCAHPS overall hospital rating when the staff nurses perceived their unit manager as caring. In addition, the more staff nurses actually visualized their nurse manager during a shift, the more they perceived their nurse manager as caring.

Do caring behaviors in the quality caring model promote the human emotion of feeling cared for in hospitalized stroke patients and their families?

The aim of this study was to explore the discrete behaviors that comprise the human emotion of feeling cared for as described by hospitalized stroke patients and their families. Joanne Duffy's Quality Caring Model© (QCM) describes 8 caring behaviors supporting the experience of caring relationships exhibited during health care encounters. A secondary analysis of data from a guided interview was analyzed by 3 persons independently using general thematic content analysis and predetermined categories from the QCM, with final validation by the theorist. Percent agreement was 74.3% at first analysis, and 100% after secondary analysis. 82 of 100 phrases fit into at least one caring behavior, 17 phrases overlapped, and 18 phrases did not fit. Overlap between the caring behaviors is consistent with published quantitative reports. Patient experiences generating the emotion of "feeling cared for" may be formed from multiple caring behaviors enacted simultaneously by clinicians. Characteristics of clinicians, such as knowledge, may be as important as caring behaviors.

Description and Factors Associated With Missed Nursing Care in an Acute Care Community Hospital.

OBJECTIVE: The aims of this study are to describe and evaluate the factors associated with missed nursing care in an acute care community hospital. BACKGROUND: Despite RNs' accountability for high-quality patient care in hospitals, missed nursing care is widespread, jeopardizing patient safety and health system costs. Better understanding of the factors associated with missed nursing care may provide nurse leaders with opportunities for improvement. METHODS: Using a cross-sectional correlational study design, 138 RNs were randomly sampled during May-June 2017. RESULTS: The extent of missed nursing care is consistent with other studies, was greater on medical-surgical and telemetry units compared with specialty units, and was negatively associated with staffing/resources, satisfaction with current position, and collegial nurse-physician relationships. CONCLUSION: Findings suggest urgent nurse leader action and future research.

Nurses' Research Capacity, Use of Evidence, and Research Productivity in Acute Care: Year 1 Findings From a Partnership Study.

OBJECTIVE: The aim of this study was to compare baseline and year 1 findings from a research-focused academic-service partnership (ASP) designed to increase research capacity, evidence-based practice (EBP) use, and research productivity. BACKGROUND: Few combined individual and organizational best practices could be found that successfully sustain EBP. An ASP model, using structural and enabling processes, was evaluated. METHODS: Using a nonexperimental pretest-posttest design, 67 acute care nurses who participated at baseline were resurveyed, and year 1 focus groups were conducted. RESULTS: Knowledge increased from baseline to year 1, and nurses who participated on a committee with an embedded scientist were more knowledgeable at year 1 than those who did not. While EBP confidence and self-reported EBP use did not improve, research productivity increased 33%. Year 1 focus groups identified facilitators and barriers. CONCLUSION: Findings support some EBP benefits related to a research-focused ASP including research productivity; however, implementation barriers and contextual factors may have limited potential outcomes.

Nurses' research capacity and use of evidence in acute care: baseline findings from a partnership study.

OBJECTIVE: The aim of this study is to report baseline findings from a research-focused academic-service partnership. BACKGROUND: Despite widespread efforts, the research-practice gap remains considerable. A research-focused academic-service partnership may offer a strategy for decreasing this gap. METHODS: With the use of a shared model and a descriptive correlational design, 75 acute care nurses were sampled from July to October 2013. RESULTS: Attitudes toward evidence-based practice (EBP) were favorable, but knowledge of common research language was low and EBP confidence was reported as moderate. Evidence-based practice confidence had the strongest relationship to EBP use and was greatest in those who held professional certification and were more educated. CONCLUSION: Findings continue to demonstrate the need for new approaches to reduce the research-practice gap.

Evaluating patient-centered care: feasibility of electronic data collection in hospitalized older adults.

Evaluating patient-centered care (PCC) is crucial to its improvement. This pilot study tested the feasibility of an electronic format to assess PCC during hospitalization. Using a validated indicator of PCC embedded on a mobile device, 86 older adults evaluated its delivery by registered nurses. Patients older than 85 years rated PCC poorer than those who were younger (r = -0.22; P = .04). The electronic format was appraised as feasible; it performed well and took on average 30 minutes to complete.

Feasibility of a multi-institution collaborative to improve patient-nurse relationship quality.

OBJECTIVE: The objective of the study was to assess the feasibility of a multi-institution quality improvement collaborative to improve patient-nurse relationship quality. BACKGROUND: Patient-nurse relationships provide the foundation for nursing services and are linked to patient outcomes. Measuring the quality of these relationships is important for ongoing practice changes. METHODS: A prospective evaluation approach was used. Patients from 12 hospitals in 4 distinct areas of the United States comprised the sample. RESULTS: All 12 hospitals submitted patient data on a quarterly basis, yielding a reliable database for performance improvement. The Caring Assessment Tool (CAT) performed well, and individual hospitals used the results to improve their performance. Inconsistencies in labeling, differing sample sizes, and administrative burden limited the results. CONCLUSIONS: Adult patients were willing to provide feedback about their care during hospitalization and multiple institutions successfully participated in the project. An electronic version of the CAT with real-time analysis would decrease burden and provide more timely and accurate results for actionable practice changes.

Evidence-based nursing leadership: Evaluation of a Joint Academic-Service Journal Club.

This article describes the importance of evidence-based nursing leadership in the development and evaluation of a joint academic-service nursing leadership journal club. The use of scientific evidence and the embracing of an environment of continuous learning are essential to quality practice; however, nursing leadership has been slow to apply evidence-based practice to their own work. A noontime monthly meeting schedule, incentivized by lunch, was organized as a nursing leadership journal club. Articles were selected and reviewed monthly, and the process was formally evaluated using a written evaluation at the end of year 1. Eighteen articles were appraised by the group with 6 topics identified. Positive results included increased knowledge, competence of the leader, and attainment of goals. Recommendations include revision of goals, plans to share leadership of the group, development of a rigorous evaluation of outcomes, and dissemination of findings. The journal club was valuable in increasing awareness of nursing leadership research, promoting leadership development, and improving competence in the performance of research appraisals. Process improvement and further study are needed to increase understanding regarding the benefits of leadership journal clubs.

Advancing nursing education science: an analysis of the NLN's Grants Program 2008-2010.

The National League for Nursing has responded to the increasing need for nursing education research through its grant program. Significant growth in proposals has intensified competition for funds and challenged the Nursing Education Research Advisory Council's review process. The purpose of this article is to explore the NLN's nursing education research proposals from 2008 to 2010 in order to improve performance and provide guidance to future nursing education researchers. Beginning with the 2008 grant cycle, a database was developed to assist in performance improvement. A total of 113 proposals were submitted; of those, 24 were funded for a success rate of greater than 21 percent. Various designs and samples were employed and all geographic regions of the United States were represented. Inter-rater reliability among reviewers remained high and the scientific rigor of proposals steadily increased. Increased funding from other sources is urgently needed to build the science of nursing education.

Improving outcomes for older adults with heart failure: a randomized trial using a theory-guided nursing intervention.

Newly discharged older adults with heart failure continue to experience frequent hospital readmissions, lower quality of life, and decreased satisfaction with health services. A theory-guided intervention delivered by home health nurses via the telephone was studied using a randomized controlled trial to assess its feasibility and inform further studies. Findings generated a profile of older adults with heart failure, utilization by patients and nurses, operational issues, and preliminary data on intended outcomes. Implications for further study are presented.

Longitudinal Comparison of Hospital Nurses' Values, Knowledge, and Implementation of Evidence-Based Practice.

BACKGROUND: Hospital-based educators use resource-intensive residency and continuing education programs to assist RNs in delivering evidence-based practice (EBP). Yet, little is known about whether such programs improve or sustain nurses' EBP values, knowledge, and implementation. METHOD: A two-group longitudinal posttest-only study was conducted using a convenience sample of 115 RNs; 51 participants received a comprehensive EBP continuing education intervention, and 64 participants received no intervention. RESULTS: Participation rates were 85% at 6 months and 65% at 12 months. Knowledge scores between the two groups were significantly different at 6 months and sustained at 12 months, although the intervention group comprised more master's-prepared nurses. EBP values and implementation scores did not differ between the two groups, and EBP values were not associated with EBP use. The only nurse characteristic demonstrating a statistically significant relationship with the outcomes was highest degree earned. CONCLUSION: Further research is needed with more robust study designs to determine how best to facilitate the use of EBP among hospital RNs. Support for RN advanced education and evidence-based continuing education strategies are recommended. [J Contin Educ Nurs. 2020;51(5):209-214.].

Research challenges and lessons learned from a heart failure telehomecare study.

Examining the benefits of nursing interventions through research significantly contributes to both professional nursing and quality healthcare, yet few benefits of home healthcare have been rigorously studied. Research challenges and lessons learned during a clinical trial of heart failure patients receiving home health nursing services are presented with recommendations.

Psychometric testing of the caring assessment tool: Administration (CAT-Adm©).

OBJECTIVES: The overall purpose of this study was to evaluate the validity and reliability of the Caring Assessment Tool-Administration survey. Three specific aims were to (1) evaluate construct validity of the Caring Assessment Tool-Administration survey by testing the hypothesized eight-factor structure of staff nurses' perceptions of nurse manager caring behaviors, (2) estimate the internal consistency, and (3) conduct item reduction analysis. METHODS: A 94-item Caring Assessment Tool-Administration designed to assess nurse manager caring behaviors appeared in the literature but lacked robust psychometric testing. Using a foundational theory and a cross-sectional descriptive design, the Caring Assessment Tool-Administration was evaluated for reliability and construct validity. Using convenience sampling, 1143 registered nurses were recruited from acute care hospitals in three states located in the Midwestern, Mid-Atlantic, and Southern Regions of the United States. RESULTS: Psychometric testing of the Caring Assessment Tool-Administration was conducted using confirmatory analysis to determine the dimensionality of the construct, nurse manager caring behavior. The null hypothesis was an eight-factor solution fitting the theoretical model being tested. The null hypothesis was rejected because none of the measures examined for goodness of fit indicated the model fit the data. Confirmatory factor analysis did not support the hypothesized structure; however, exploratory factor analysis supported a one-factor solution that was conceptually labeled caring behaviors. To decrease subject burden, the 94-item survey was reduced to 25 items using item reduction analysis including assessing minimum factor loadings of ≥0.60 and evaluating survey item-total correlation and alpha. The Cronbach's alpha of the new 25-item survey was 0.98. CONCLUSION: The new 25-item Caring Assessment Tool-Administration survey provides hospital administrators, nurse managers, and researchers with a sound, less burdensome instrument to collect valuable information about nurse manager caring behaviors.

Teaching/learning health promoting behaviors through telehealth.

Associate degree nursing students in a community setting apply self-efficacy theory while helping clients with chronic health problems take personal responsibility for health-related behaviors. Students meet weekly with clients in an apartment complex for seniors and use the telephone to work toward achieving desired short-term health outcomes. Between weekly meetings, they use the telephone to coach clients while establishing a trusting relationship. The role of the faculty member in supervising students is explored.

Improvement in the outcome indicator of readmission of patients with heart failure: a case analysis.

This article describes the process used by one performance improvement committee to analyze comprehensive assessment data, including OASIS data, and relate it to nursing activities described in the clinical nursing notes. The end goal was to improve, or decrease, the hospital readmission rate of their patients with heart failure. The fit between patient characteristics and the plan of care described and delivered in two groups was evaluated. Differences in patient characteristics and nursing documentation of outcomes provided the data for remediation and for testing of a new intervention.

The Quality-Caring Model: blending dual paradigms.

Evidence supports associations between professional nursing and quality health outcomes. Yet, what specifically accounts for those linkages remains buried in the daily practice of nursing. The Quality-Caring Model exposes and demonstrates the value of nursing within the evidence-based practice milieu of modern health care. It favors a process, or way of being, that challenges modernist conventions and highlights the power of relationships. By reaffirming the nature of nursing's work as relationship-centered, the blended model describes the 2 dominant relationships that comprise professional encounters. Relationships characterized by caring are theorized to influence positive outcomes for patients/families, health care providers, and health care systems. Model components are clarified, assumptions described, and propositions stated. Conceptual-theoretical linkages in the model are identified and ties to empirical indicators provide the logical consistency necessary for validation. Clinical practice and research applications of the model are offered. The Quality-Caring Model helps to translate the hidden work of nursing into objective terms that can be tested. Scientifically demonstrating its worth will advance professional nursing while simultaneously improving the quality of health care.

The clinical leadership role of the CNS in the identification of nursing-sensitive and multidisciplinary quality indicator sets.

Within a team-oriented approach to healthcare, the demonstration of quality is challenging. Multidisciplinary quality indicators ideally represent all pertinent stakeholders and are preferred when evaluating the quality of care for specific patient populations. Recently, however, nursing-sensitive indicators have been developed that reflect the unique contribution of nursing to patient outcomes. Because nursing-sensitive quality indicators reflect nursings' accountability for patient care, they must also be considered when identifying indicators sets. Controversy exists concerning the appropriate definition, number, and approach to indicator identification. Many organizations are attempting to measure everything to ensure that all appropriate indicators are represented. To incorporate both nursing-sensitive and multidisciplinary quality indicators, a phased organization-wide approach is advocated. Through clinical leadership skills combined with the advanced practice roles of consultant, educator, and researcher, the clinical nurse specialist can facilitate the inclusion of relevant indicators, preserve both multidisciplinary and nursing-sensitive approaches, and maintain efficiency during the process. The clinical nurse specialist, with clinical expertise and advanced education has a unique leadership role in the identification of the resultant critical indicator matrix.

Revision and psychometric properties of the caring assessment tool.

Evaluation of the Caring Assessment Tool (CAT) is essential for its use in the monitoring and ongoing improvement of patient-nurse relationships. This descriptive, prospective study evaluated the dimensionality and internal reliability of the instrument in a sample of hospitalized adults. In addition, reduction of items was achieved, lessening clinical and administrative burden. Data were collected from 1,111 patients in 12 U.S. hospitals in 4 geographically distinct regions. A single factor explained 73% of the variance in the construct and the number of items was reduced to 27. Internal consistency remained high (a = .97). Patient-nurse relationship data were collected safely and efficiently from hospitalized patients using a paper-and-pencil approach. The CAT holds promise for providing acute care registered nurses with the information they need to deliver reliable patient-centered care.

Dimensions of caring: psychometric evaluation of the caring assessment tool.

The increase in relationship-centered professional practice models has expanded the interest in the measurement of caring. Using a cross-sectional descriptive study of 557 adults from 5 acute care institutions, a factor analysis and reliability statistics were used to revise the Caring Assessment Tool. Eight independent factors (mutual problem solving, attentive reassurance, human respect, encouraging manner, appreciation of unique meanings, healing environment, affiliation needs, and basic human needs) explained 62.6% of the variance in caring. The findings provide insight into patients' assessment of caring in nursing and offer a baseline evaluation of the psychometric properties of the Caring Assessment Tool.