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Caring Assessment Tool: A Key to Patient Satisfaction

Monday February 27, 2006
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A unique research tool that quantifies the caring behaviors of nurses is being used in various health care settings to gauge patient satisfaction and improve clinical care.
The 100-question survey, known as the Caring Assessment Tool, was created by Joanne R. Duffy, RN, CCRN, DNSc, associate professor, The Catholic University of America, Washington, D.C., as a way of correlating nurse-caring behaviors to patient outcomes.
"Nurse caring includes the values, attitudes, and behaviors that nurses perform with and for patients," Duffy explains. "Physical acts such as providing pain relief or just listening to patients are examples of caring. It's the core of what nurses do, as opposed to what Dr. Jean Watson, founder of the Center for Human Caring in Colorado, calls 'the trim,' which includes everything else."
Duffy created the Caring Assessment Tool based on Watson's Theory of Human Caring, which theorizes there are 10 factors that compose caring. "I took that overlying theory and created 130 elements which represented those 10 factors," Duffy says. "I then sent those statements to a team of nurse researchers, who had completed work in this area, including Dr. Watson, and asked them to rate the statements on how well they represented nurse caring.
The items were rated on a five-point Likert Scale ranging from one (never) to five (always). Under the carative factor of altruism, for example, items include "Accepts me as I am," "Treats me kindly," "Includes me in their discussions," "Respects me," and "Pays attention to me."
"My goal was to see if patients perceive they have a caring relationship with their nurses and the influence it would have on their health outcomes," Duffy notes. "In my first study, I found there was a positive relationship between nurse-caring behaviors and patient satisfaction with their hospital stay."
Early discharge
"As patients perceive more caring by nurses, they are more apt to comply with their medical regimens, meet their health care goals sooner, and be discharged sooner," Duffy continues. "Nurses who know their patients are also able to detect potential complications earlier."
According to Duffy, the Caring Assessment Tool is currently being used in academia and clinical practices, as well as in hospital administration.
"Educators want to produce caring nurses. But there has been no way to test whether, upon graduation, nurses have those attitudes and skills, so I adapted the Caring Assessment Tool for use in education," notes Duffy. "Educators are using the tool in the last semester of their students' senior year to get a sense of whether their students have the requisite knowledge and skills to perform in this way.
"The tool is also used to see whether students perceive their faculty as displaying caring attitudes and behaviors toward them. Caring is a phenomenon that is learned and socialized as well as acquired through book knowledge, so being educated in an environment where the faculty also display those same attitudes and behaviors can be helpful."
Career advancement
In addition, staff nurses use the tool to get a sense of how their patients perceive them.
"Many hospitals have clinical-ladder programs through which nurses apply for and receive promotions for high-quality nursing care," says Duffy. "Nurses can use the tool to survey several of their patients and then take the results to their administrators."
But by far, Duffy says, the tool is most often used by hospital administrators.
"One of the criteria for Magnet status is that the nursing organization base its practice on a theoretical model. Another is that they do research," Duffy explains.
"So the tool is used to demonstrate the facility is using a caring theoretical model and is used in specific research studies. Over the past year, at least 20 organizations throughout the U.S. have contacted me about using the tool for those purposes." Duffy has also received requests from health care organizations in Canada and England.
Caring staff nurses flourish in environments where the culture is also caring. The administrative version of the Caring Assessment Tool is an adaptation of the original instrument that staff nurses complete about their managers. This tool is being used in several organizations to assess whether staff nurses feel their managers display caring values, attitudes, and behaviors. Results can be used by nursing administration for leadership development programs.
Don Vaughan is a freelance writer. To comment on this story, e-mail pmeredith@nursingspectrum.com.