Methodist Nurses Study Behaviors of Caring Nurses

At the Methodist Hospital, nurses are committed to providing superior care that exceeds the patient's expectations. Like most organizations, the hospital monitors patient satisfaction and traditionally has maintained high patient satisfaction scores. Yet, with the dramatic changes in the health care sector where shorter lengths of stay are a given, every patient encounter must be optimized.

The Methodist Hospital's nursing leaders convened the Nursing Quality Indicator Committee with the strategic vision to move nursing to the next level of excellence. Comprised of staff nurses, educators, managers and academia, the committee was asked to identify the nursing quality indicators that nursing would hold itself accountable for. Following a review of internal and external indicators and benchmarks, the committee identified patient satisfaction, specifically related to caring and respect, as one of the key indicators of nursing quality. A subgroup was formed to examine the defining characteristics of caring as a core concept in patient satisfaction, develop the nursing quality indicators, determine the measurement methodology, and design the educational plan.

The nursing literature clearly linked patient satisfaction with nurse caring, yet defining it operationally was difficult. This precipitated a review of 42 sources of nursing literature, which was synthesized and resulted in identifying 12 dominant and 13 supportive dimensions of caring perceived by patients. These findings crystallized the role that nurse caring plays in predicting patient satisfaction and as a measure of organizational effectiveness.

Promoting a strong culture of caring at Methodist required that a broader audience of nurses be engaged, leading the group to ask professional nurses throughout the institution to describe what they considered to be caring behaviors. In an open forum, 200 professional nurses were asked to respond to an open-ended question, "How do you as a nurse demonstrate caring for patients?" Fifty-one dimensions of caring were cited, including emotional support, respect and spiritual care.

These behaviors were grouped with the inventory of 12 dominant caring characteristics resulting in no new dominant characteristics emerging. Additional validation of the concepts that define caring was obtained through patient focus groups which were used to explore the core values and behaviors that patients perceived to convey nurse caring.

Input gathered from the literature, nurses and patient focus groups was used to develop the indicators for an instrument that has been psychometrically validated and determined to be reliable. An educational intervention to assist nurses in holistically integrating the dimensions of caring in partnership with the patient and family will soon be launched. We anticipate that as caring behaviors permeate each patient encounter, patient satisfaction will reach a new level.

-- Mary L. Shepherd, R.N., M.S.N., C.N.A.A. and Coreen Fazakerly, R.N., B.S.N.

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©2006 Texas Medical Center

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