Why are nurse caring behaviors so important?

When nurses show empathy, they foster a collaborative relationship with patients, which can help in rooting out causes, symptoms or explanations that result in a proper diagnosis and appropriate treatments. Open communication and mutual respect between nurses and their patients can result in these positive patient outcomes:
  • shorter hospital stays
  • alleviation of pain
  • decreased anxiety
  • optimistic outlook about recovery
Patients who are more satisfied with their care
  • are more likely to follow medically prescribed regimens

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  • have reduced risk of malpractice lawsuits
  • hospitals have an increased profitability
  • have increased involvement in their treatment
  • have improved health conditions and outcomes13
  • will choose that institution’s services again
  • have a reduction in psychological symptoms (depression/anxiety)
  • have increased patient confidence and self-efficacy
  • have a reduction in symptoms
  • have increased survival rates14

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A good nurse-patient relationship
  • reduces the days of hospital stay and
  • improves the quality and satisfaction for both patients and nurses15

Varibles

  • Both patients and nurses have expectations about the nature and importance of the caring relationship
  • Both the nurses' and patients’ perceptions of nurse caring behaviors may be affected by several variables
  • Caring relationships between the patient and nurse may be described around 6 areas: expectations, values, knowledge and skills, communication, context and the impact of the relationship

What affects nurse caring behaviors?

According to several nurse researchers, nurse caring behaviors may be impacted by several factors. Here are a few of the most cited factors (in no particular order of importance):

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Individual Factors
  • age
  • gender
  • culture
  • marital status
  • education level
  • years of service
  • patient's diagnosis
  • employment status
  • religious beliefs, spirituality
Psychological factors
  • attitudes
  • motivation
  • job satisfaction
  • sense of responsibility
  • empathy, compassion, conscientiousness
  • personality traits (agreeable, willing to make sacrifices, warm, compassionate, generous, unselfishness)

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Organizational factors
  • communication
  • adequate staffing
  • type of institution
  • salary, rewards, recognition
  • management, decision making
  • organizational support, conducive work environment

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Perceptions of caring behaviors

Perceptions of nurse caring behaviors are a way of regarding, understanding, or interpreting what is important. It is how patients and nurses understand and interpret caring behaviors in nursing.

Watson’s (2008) 10 carative factors/carative processes: (based on love, heart, centered caring, compassion; it is assumed that people have a knowledge base and clinical competence).

1. humanistic-altruistic system of values/embrace

Practices of loving, kindness, compassion and mental calmness with self and other.

2. enabling faith-hope/inspire

Is being authentically present; enabling a belief system within a subjective world of self and other.

3. cultivation of sensitivity to self and others/trust

Cultivating your own spiritual practices and going beyond ego-self to an authentic transpersonal presence.

4. helping-trusting, human care relationship/nurture

Sustaining a loving, trusting, and caring relationship. Being sensitive to self and others by cultivating your own spiritual practices and going beyond ego-self to transpersonal presence.

5. expressing positive and negative feelings/forgive

Allowing for expression of feelings; authentically listening and holding another person’s story for them.

6. creative problem-solving caring process/deepen

Creating solution and seeking through caring process; full use of self; all ways of knowing, doing, and being; to engage in artistry of  human caring-healing practices and modalities.

7. transpersonal teaching-learning/balance

Is authentic or genuine teaching-learning experience within the context of a caring relationship; staying within the other’s frame of reference; and a shift towards a health-healing-wellness coaching model.

8. supportive, protective, and/or corrective mental, physical, societal  and spiritual environment/co-create

Creating a healing environment at all levels; creating a subtle environment that is conducive for authentic caring presence.

9. human needs assistance/minister

Reverently and respectfully assisting with basic needs as sacred acts; having an intentional, caring consciousness; includes touching that embodies mind, body, and spirit of another; working with life force/life energy/life mystery of another; and sustaining human dignity.

10. existential-phenomenological-spiritual forces/open

Opening and attending to spiritual, mysterious, unknown, and existential dimensions of all uncertainties of life, death, suffering, pain, joy, and transitions life change; it includes allowing for a miracle.43

Top 10 caring behaviors

According to Taber’s (1993), the top ten caring behaviors are:

1. attentive listening

It conveys the nurse’s full attention and interest. This means fully concentrating on what is being said rather than just passively 'hearing' the message of the speaker. Active listening involves listening with all your senses. It’s important to truly listen to what is important to the patient. Listening is not only taking in what the patient says it means interpreting and understanding what the patient really means. helps to encourage patients to share their perspective and engage in collaborative care.44

2. comforting

Means to calm emotions and relieve stress. Comfort is a transient and dynamic state characterized by ease from pain, emotional and physical distress and an emerging sense of positivity, safety, strength and acceptance of one's situation that is underpinned and sustained by feeling valued, cared for, confident and accepting treatment by choice.45

3. honesty

Nurses are dedicated to being truthful. Patients need to know that the nurse is being honest and truthful. Patients are then able to trust the nurse and a therapeutic relationship is built. The nurse answers patients questions honestly and gives them accurate information. This relationship helps the patient to move forward to optimal wellness.46

4. patience

Patience is a virtue. It is the capacity to be tolerant and even- tempered; an ability or willingness to suppress restlessness or annoyance when confronted with troubles. It means quiet, steady perseverance; even tempered care; diligence.47

5. responsibility

Is being accountable; it is the condition of being required to account for one’s actions; trustworthiness.48

6. providing information

Allows the patient to make informed decisions.

7. touch

Touch is providing comfort and communication through purposeful tactile contact. Touch is interpersonal and social. Caring touch leads to a connection between the nurse and patient physically and emotionally. Caring touch is a form of nonverbal communication. It is expressed in the way one hold a patient’s hand, give a back massage, gently position a patient, or participate in a conversation.49

8. sensitivity

To be sensitive is to be able to responsive; capable of or perceiving differences or changes in the environment. It is being acutely perceptive of interpersonal situations. Being aware of or careful about the attitudes, feelings, or circumstances of others.50

9. respect

Respect is the treatment of others with dignity during interactions. It is the intentional act of showing consideration for another person’s interests and well-being. It includes weighing values, views, opinions and preferences. It is showing consideration for and treating courteously and kindly; treating with care and compassion; valuing and appreciating others.51

10. calling the patient by name

Helps to create trust and an understanding between patients and nurses. It is a sign of courtesy and a way of recognizing them. Using a person’s name personalizes the care experience and can help put the patient at ease. A person’s name is the greatest connection to his or her own identity and individuality. It is the most important word in the world to that person.52

Studies that compared patient and nurses perceptions of caring behaviors have suggested that there are differences and similarities in their perceptions.22

Nurse’s perceptions of caring behaviors

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Nurses consider expressive (psychosocial needs) caring behaviors, which are based on the interpersonal relationship between the nurse and patient as most important . It requires a caring attitudes that show respect, kindness, sensitivity, and patience.53

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The top 5 five caring behaviors from high to low are:
1. listening to the patient
2. putting the patient first no matter what else happens
3. touches the patient when comfort is needed
4. talks to the patient
5. speaks to the patient in understandable terms54,55,56,22

Patients’ perceptions of caring behaviors

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Patients consider instrumental (activities) behaviors, which aim to meet the physical health needs as most important. It is what nurses do using evidence based interventions and being efficient.53

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The top 5 five caring behaviors from high to low are:
1. knows when to call the doctor
2. has knowledge and skills
3. being honest with them
4. putting them first no matter what else happens
5. speaking to them in understandable terms54,56,22

How to cultivate nurse caring behaviors

Caring includes relationships that are patient-centered and the nurse and patient are in a 1:1 relationship. 
As nurses, how do we overcome barriers and bridge the gap(s) so that everyone can understand?

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When nurses develop a clearer understanding of which nursing behaviors convey caring to patients, they will be able to systematically design caring interventions that enhance patients' coping abilities and help patients deal with the stress more effectively.9

Rice (2018) identified that nurse-led education sessions for adults with heart failure contributed to a reduction in the following:
  • cost benefits
  • higher functioning
  • hospital readmissions
  • improved quality of life
  • reduction in hospitalization

Some suggestions for cultivating a caring relationship and environment are (not exhaustive and in no particular order):

  • set expectations
  • clean environment
  • determine learning styles
  • be punctual, timely manner
  • complete pre-learning surveys
  • consider the most recent research
  • utilize a compassionate approach11
  • consider limitations and strengths
  • make it personal, attentive listening
  • consider family and caregiver education
  • patient self-management and self-efficacy
  • form respectful and courteous relationships
  • nurse empowerment, opportunities, resources
  • stimulate interest and encourage empowerment
  • awareness of spiritual knowledge and sensitivity
  • consider cultural knowledge, sensitivity and competence
  • use effective teaching strategies based on learning theories
  • recognize stressors self and patient (adequate staffing, salary)
  • develop a rapport through effective communication and teamwork
  • identify patient expectations, needs improvement, and motivating factors
  • nurse-led education sessions for nurses, patients, families, and other healthcare professionals57

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