Quality Caring in Nursing

Table of Content

8 Caring Factors of Nursing Nurses are one of the largest groups of healthcare professionals. They can contribute to the positive and negative ways to a health care quality problem. The nurse has an intimate knowledge of the patient’s needs and they are continuously interacting with patients and their families. The patient and their family’s experiences and outcomes while in the hospital is highly influenced by the nursing care they received. In 2001, a report published by Dr. Claire Fagin of the University of Pennsylvania, states that some nurses and patients were concerned about their safety while staying in the hospital.

Nurses were spending less time with the patients. The reduction in the amount of time professional nurses spend in direct patient care was the cause. There has been a growing use in unlicensed assistive staff in the mid 90’s. This helped contribute to the cause of the perception. Having a shortage of nurses also contributed to this problem. Nurses were unable to spend as much time with the patients and their families at the bedside listening to the patient’s and their family’s concerns.

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Nursing was a part of this as well as getting to know their families, educating them about their illnesses, and attending to their needs of comfort, support, and security. Due to the shortage of nurses they were focusing more in completing their tasks that are assigned to them and placing a lot of time in front of the computer charting what they have done. This became difficult for the patient and their families to get their needs met while in the hospital. In the U. S. , a study of the quality of nursing care found significant variations of nursing.

The rural or smaller community hospitals found to have poor ratings. Why did this occur? Shortage of nursing staff was for one. The large teaching hospitals with residents want to do more for the patient. They wanted to do some nursing tasks such as dressing changes, and treatments. This gave the nurse more of an opportunity to spend nurse more time at the bedside to meet the needs of the patient. Indicators, or measures, that specifically reflect nursing care are used to evaluate and demonstrate to the public how nursing contributes to the quality of healthcare recipients that are hospitalized. In the 1970s, Dr.

Norma Lang developed a quality assessment tool to better assist with enhancing the knowledge of evidence based nursing. The American Nurses Association developed a study of nursing sensitive indicators for acute care. They developed a database using ten nursing quality indicators. Some of these indicators were a challenge, nursing still fell short. They were not able to “be with” the patient. This was the patient’s point of view. There is evidence that registered nurses spend less than half their work time in direct patient care . Although staffing may be a big factor in this report, there are other issues.

Nurses may not be motivated, educationally prepared. Perhaps culture may contribute to nursing quality. Nurses are focusing on task completion, technical competence and documentation. This has curbed the process of being with the patient and listening to them in meeting their needs. Many would ask, “Why did he or she go into nursing if they need to be taught on how to be caring? ” The truth is, they do care. And, they want to be with the patient and their families more. Nurses were so worried about getting their tasks completed before the end of their shift; otherwise, they will be questioned as to why it was not completed.

Relationships and healthcare do go hand in hand. It is through a relationship that an individual can learn, live, work and grow. This begins in the earliest stages of life. The Quality Caring Model places relationships at the heart of the healthcare process. In 2007, a group of hospital and nursing administrators adopted a caring professional practice model. This model emphasized nursing and will help to facilitate relationship building and the true work of nursing. The outcomes of the patients and their families as well as the nurses will improve.

The Eight Care Factors developed for nursing are as follows: 1. Mutual Problem Solving 2. Attentive Reassurance 3. Human Respect 4. Encouraging Manner 5. Appreciation of Unique Meanings 6. Healing environment 7. Affiliation Needs 8. Basic Human Needs I was first introduced to this topic, I thought to myself. I know this already. I have felt like this my entire life. That is why I became a nurse. To me, this is the type of personality a nurse has, otherwise we would not be in this profession. It’s certainly not the money. Some nurse’s need to be reminded of these things. Yes, it is a fast paced business.

Especially when there are so many tasks and procedures that need to be completed as well as the increased documentation requirements that needs to be made for reimbursements for insurance companies. With the pressures, the nurses are strayed away from the patient’s bedside. Humans are complex beings that have physical, emotional, spiritual, social and cultural characteristics. During an illness, these characteristics can be affected when an illness occurs. Illness can represent a basic threat to one’s basic sense of wholeness. Physiological changes can create feelings of discomfort, vulnerability and dependence upon others.

This can affect a person psychologically. Patients feel helpless and under the authority of physicians and nurses. Hospitalization unintentionally contributes to these threats. Patients are being labeled as “the GI Bleeder in room 2”, or the psych patient I room 18 has a court hold”. These patients are not only being labeled, but have to follow the rules. The term caring is an intentional process that requires special knowledge, skills, self awareness and choice. Intention is described being conscience. Being aware of the needs that need to be met is intentional caring.

Several healthcare providers have documented certain factors necessary for a therapeutic relationship between the nurse, patients and their families. Watson identified 10 factors in human caring in the nurse patient relationship. Joanne Duffy, identified his first three as a foundation that nurses have: altruism, faith, and sensitivity to others. She founded eight factors that independently explain caring. Mutual Problem Solving is one of the largest factors. This involves the behavior of the nurse to help the patients as well as their families to understand about their illness.

This gives the nurse an opportunity to help them to learn about their illness and to know what to ask. Exploring different alternatives to deal with their illness can be solved by brainstorming. Working as a team with the patient and family. The nurse can listen how the patient cares for themselves at home and assist them to adapt while being hospitalized. Attentive Reassurance refers to the availability of the nurse. It assures patients and families that they can rely on the nurse, and a sense of security develops. Despite the patient’s illness, they want the nurse to be available to encourage them orward in the healing process. When I mention reassurance, I do not mean, “Oh don’t worry the surgery will turn out all right”. Although the patient may have a poor prognosis, the nurse will be there for them to answer any questions that they may have or just be available if they are needed. Using a gentle touch or clarifying any misperceptions is a behavior that nurses use. This is what builds the patient’s confidence in their nurse. This caring factor has two components actually. They are reassurance and attention. Both are necessary for caring relationships.

Human Respect is a third identified factor. It refers to honoring the worth of humans by displaying behaviors such as kind handling of the human body or unconditional acceptance, no matter what type of patient you are caring for. Be respectful to patients by calling them Mr. or Mrs. Instead of using their first name. Celebrating or talking about a person’s life when he or she is not ill. Encouraging Manner refers to the attitude of the nurse. This includes verbal and nonverbal messages. An example of nonverbal messages is made by use of body language or facial expression.

An encouraging approach would suggest use of enthusiasm, support, positive comments for the person’s efforts. Even during a bad experience, an encouraging nurse can point out some positive remarks no matter how small. Appreciation of Unique Meanings is knowing what is important to a patient including sociocultural connections associated with their experiences. This factor is more of an approach than a behavior. It values the person as a whole including the patient and their illness. A nurse that can relate to patients and their families in this manner can often help them to feel understood.

Jehovah Witness would be an example. They prefer not to receive blood transfusions. Facilitating a Healing Environment has always been considered in the nursing profession. This refers to the setting where caring is taking place. The nurse views the person as being holistic, the surroundings, stressors; structures for privacy, safety, and control are aspect of this factor. A healing environment not only involves the nurse, but it includes the staff and management, the workflow of patient care as well as meeting spiritual needs. The healing environment plays a big part of the healing process. Basic

Human Needs is well known to nurses and include the physical needs such as air, food, and fluids, sleep, rest and elimination. Safety and security, socio and relational needs, self esteem needs, and self actualization. These needs were first introduced by Maslow. Often, physical needs come first due to the fact that they are a symptom of the illness. The higher order of patient needs such as social and self esteem needs are often forgotten. Meeting the basic human needs is a progression of an illness or the return to health. Affiliation Needs refers to a person’s need for belonging. This factor includes the family as well as their families.

It allows them to engage in the health care situation, including the decision making. The importance of families to the health and well being of patients is well recognized by rehab centers, oncology nurses, psychiatric facilities, pediatric units and obstetric units. These family members are often assisting with meeting the needs of the patient. This is a fine example of how nurses can appreciate and involve families as they care for the ill patient. These factors are not usually used all at once. Many are used together. Such intentions only contribute to a better outcome not only for the patient, but for the nurse as well.

The eight caring factors that were validated through research have been listed with examples. The use of these factors can only trigger positive feelings in the recipient that informs future relations and advancement toward health. It is important for nurses to balance the doing with the being. By doing this it creates a higher quality of nursing care that can be delivered to the patient. Duffy, Joanne R. Quality Caring In Nursing. New York: Springer Publishing Company, 2009. “Nursing Theory Page. ” July 2, 2009. “Watson Caring Science Institute. ” July 2, 2009.

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Quality Caring in Nursing. (2018, Apr 26). Retrieved from


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