Discussion: Exploring Middle Range Theories and Framing Practice Issues

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Discussion: Exploring Middle Range Theories and Framing Practice Issues
You will begin this Discussion by identifying a practice issue that will be your frame of reference as you
analyze the theoretical basis of nursing practice. Be aware that your choice can potentially carry through
the course, as you will continue to address this issue in the context of other types of theories in Week 3.
This practice issue can also be one focus of your Module 3 exploration of evidence-based practice and
quality improvement, and your Module 4 investigation of a critical practice question. Consequently, as
you prepare for this Discussion, think carefully about your example for connecting middle range nursing
theories to patient care.
To prepare: Addressed each of the bullets below with a subtopic, all the references used must have
an in-text citation in each paragraph. All Articles MUST BE PEER REVIEWED ARTICLES THAT MUST BE
USED AND should come from USA and must be within last four years only that is from 2017 to 2021.
Please do not begin a paragraph with author name(s) (PLEASE USE parenthetical/in-text citations APA
format and 7 edition)
•
Analyze your nursing practice for issues of particular interest or concern to you. Identify one
issue as the focus of your application of theory to practice.( one of my practice issues in my
work place as a nurse practitioner I am interested in improving the Hispanic population age 35
and above with Type II Diabetes through Self-Management Education.) SUCH AS; 1.Maintain a
healthy weight. 2., Exercise regularly) MUST BE USED AS MY TOPIC OF INTEREST)
•
Identify specific middle range theories that may apply to your practice issue and explain why. Be
specific and provide examples. (1. JEAN WATSON ‘s theory OF HUMAN CARING, 2. Orem’s SelfCare Deficit Theory; MUST BE USED TO ADDRESS MY TYPE 2 DIABETES PATIENTS IN HISPANIC
POPULATION)
•
Consider how to frame your focus practice issue in terms of the middle range theories(WHICH
ARE THE WATSON THEORY AND OREM’S THEORY) that you have selected.
FOUR ARTICLES WILL BE DOWNLOADED TO YOUR WEBSITES WHICH THEIR REFERENCES ARE BELOW
THAT MUST BE USED TO ASK THE ABOVE QUESTIONS. Thank you
References
Townsend, C. A. (2020). Concept Analysis of Caring: Jean Watson Philosophy and Science of
Caring. Nebraska Nurse, 53(2), 14–15. https://web-a-ebscohostcom.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=10&sid=447dbe13-09e1-4e86-90da09a12a3eafc5%40sessionmgr4007
Holly Wei, Fazzone, P. A., Sitzman, K., & Hardin, S. R. (2019). The Current Intervention Studies Based on
Watson’s Theory of Human Caring: A Systematic Review. International Journal for Human Caring, 23(1),
4–22. https://doi-org.ezp.waldenulibrary.org/10.20467/1091-5710.23.1.4
Gumbs, J. (2020). Orem’s Select Basic Conditioning Factors and Health Promoting Self-Care Behavior
https://web-aebscohostcom.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=16&sid=447dbe13-09e1-4e8690da-09a12a3eafc5%40sessionmgr4007s among African American Women with Type 2
Diabetes. Journal of Cultural Diversity, 27(2), 47–52.
Kline, K. N., Montealegre, J. R., Rustveld, L. O., Glover, T. L., Chauca, G., Reed, B. C., & Jibaja-Weiss, M. L.
(2016). Incorporating Cultural Sensitivity into Interactive Entertainment-Education for Diabetes SelfManagement Designed for Hispanic Audiences. Journal of Health Communication, 21(6), 658–668.
https://doi-org.ezp.waldenulibrary.org/10.1080/10810730.2016.1153758
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The Current Intervention Studies
Based on Watson’s Theory of
Human Caring: A Systematic
Review
Holly Wei, PhD, RN
Patricia Anne Fazzone, DNSc, MPH, RN
Kathleen Sitzman, PhD, RN, CNE, ANEF, FAAN
Sonya Renae Hardin, PhD, RN, NP-C, FAAN
College of Nursing, East Carolina University, Greenville, North Carolina
Abstract: This article reviewed 19 intervention studies based on Watson’s Human Caring Theory between January 2005 and February 2018. The studies reviewed targeted on
promoting patients’, nurses’, and nursing students’ psychological health and patient care
experiences. Most (15/19; 78.95%) of the studies in this review indicated that Watson’s
caring science-based interventions could decrease patients’ emotional strains, increase
patients’ self-management confidence and emotional well-being, increase nurses’ job satisfaction and engagement, and improve nursing students’ confidence in the clinical performance and the awareness of caring behaviors. Nursing is a discipline that requires both
scientific knowledge and the art of human caring.
Keywords: Watson’s Human Caring Theory; caring science; intervention study; nursing; healthcare
Introduction
Watson’s Theory of Human Caring is a caring
science approach used to guide nursing practice, education, and research. Published in 1979,
Watson’s Theory of Human Caring (Watson,
1979) has planted a seed for postmodern nurse
caring and philosophy. Watson’s caring science
approach is meant to transform patient care from
a treatment-centered repair to a holistic mind–
body–spirit healing perspective (Sitzman & Watson, 2013; Watson, 2012). Healthcare organizations
and researchers have used Watson’s Theory of
Human Caring to guide their practice and interventions. Smith (2004) conducted a “Review of
research related to Watson’s Theory of Caring” in
2004. Since then, no systematic reviews on this
topic have been done.
An updated review of the literature about the
current interventional research projects based on
Watson’s Caring Theory is needed to meet the
gap. This article will provide an overview of the
intervention studies based on Watson’s Caring
Theory and help nurse clinicians, educators, and
researchers better understand the trend of caringbased research interventions, the effectiveness of
Pdf_Folio:4
4
International Journal for Human Caring, Volume 23, Number 1, 2019 © 2019 International Association for Human Caring
http://dx.doi.org/10.20467/1091-5710.23.1.4
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implementing Watson’s Human Caring Theory
principles, and the need for future knowledge
development. Therefore, the aim of this systematic
review is threefold: (a) to provide an overview of
published intervention studies based on Watson’s
Human Caring Theory between January 2005 and
February 2018; (b) to summarize the efficacy of the
interventions; and (c) to discuss the applicability
of the findings to nursing practice, education, and
research.
Methods
Design
This is a systematic review of the literature about
the current intervention studies based on Watson’s
Theory of Human Caring.
Search Methods
The search for this review followed the Preferred
Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guideline (Moher et al., 2009).
The first author worked closely with a research
librarian from the same university to ensure the
accuracy of the search process. The search process
included: (a) setting the purpose and the inclusion and exclusion criteria for the review; (b) selecting the databases and key terms for the search; (c)
conducting an initial search using the key terms
selected; (d) removing duplicates using a built-in
filter system of the university library databases; (e)
performing an initial screening based on the titles
and abstracts of the articles searched; (f) reading
the full-text of the remaining articles to do a final
screening based on the inclusion and exclusion criteria; and (g) searching for additional articles from
the reference list of the articles selected.
The databases used for the search included
MEDLINE via PubMed, CINAHL, MEDLINE
Complete, and PsycINFO. Search terms were a
combination of the following keywords and MeSH
terms: ”Watson’s Human Caring Theory” or ”Watson’s Theory of Human Caring,” ”intervention,”
and ”nurs*” for ”nurse,” ”nurses,” or ”nursing.”
The search query in PubMed included Watson
Human Caring Theory [Title/Abstract] OR Watson Theory of Human Caring [Title/Abstract]
AND Intervention [Title/Abstract] OR Strateg*
[Title/Abstract] OR best practices [Title/Abstract]
AND Nurs*. “Strateg*” denoted strategy or strategies. “Nurs*” was used to identify nurse, nurses, or
nursing. In PubMed, search terms can be searched
in both article titles and abstracts at the same time.
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Review of Caring Interventions
The search query for CINAHL, MEDLINE
Complete, and PsycINFO included TI [titles] Watson’s Theory of Caring OR TI Watson’s Caring Theory AND TI nurse OR TI nurses OR TI nursing
AND TI (interventions or strategies or best practices). The search query was repeated to search the
keys terms in abstracts (AB): AB [abstract] Watson’s Theory of Caring OR AB Watson’s Caring
Theory AND AB nurse OR AB nurses OR AB nursing AND AB (interventions or strategies or best
practices).
The inclusion criteria were that articles were
intervention studies based on Watson’s Human
Caring Theory, evaluated by outcome measures,
and published in English between January 2005
and February 2018. Articles were excluded if outcomes were not evaluated after caring interventions or case studies. The literature search was set
to recognize the search terms in titles or abstracts
of the articles.
Quality Appraisal
Quality appraisals of the studies included in
the review were conducted based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool (Guyatt et al.,
2011). The first author (HW) conducted the initial appraisal based on the studies’ methodologies,
consistencies, effect sizes, directness, and quality,
which was independently double-checked by the
second author (PF) for accuracy. Based on the
GRADE tool, an overall grade was given to each
study in a format of very low, low, moderate, and
high (Balshem et al., 2011; BMJ Clinical Evidence,
2018; GRADE Working Group, 2004). The grades
of quality appraisal were indicated in abstraction
Tables 1, 2, and 3.
Data Extraction and Synthesis
Data were extracted using a tabular table developed by the first author based on the purpose of
the study. Data extracted included the purpose of
the study, design, sample, setting, measurements,
interventions, and main findings of the studies.
The first author (HW) conducted the initial extraction, which was independently double checked by
the second author (PF) for accuracy.
Data synthesis was performed by grouping
studies based on the target population. The target population in this review was referred to as
5
Purpose
To examine the
effects of Watson
Caring Theory–
based care on
women’s distress,
perceived
self-efficacy,
adjustment to
infertility
To determine the
effects of a caring
intervention—a
3-minute back
massage at
bedtime on
patients’
perceptions of
nurse caring
To examine the
psycho-spiritual
influences of a
caring theorybased spiritual
intervention on a
cardiac population
ArslanOzkan,
Okumus, and
Buldukoglu
(2014) Turkey
Broscious,
Spigelmyer,
and
Breckenridge
(2015) USA
Delaney and
Barrere (2008)
USA
Quasiexperimental,
pre- and
posttest,
repeatedmeasures: T1 :
baseline; T2 :
right after
intervention;
T3 : 1 month
after
intervention
A quasiexperimental
design
Randomized
controlled
trial
Design
Caring Interventions Toward Patients
Authors/
Year/
Country
TABLE 1.
Pdf_Folio:3
Patients with
cardiovascular
disease Enrolled:
T1 : n = 46
Completed: T3 :
n = 13
Patients on an
inpatient
rehabilitation
nursing unit
Enrolled:
Int: n = 15
Con: n = 14 All
finished the
study
Women seeking
infertility
treatments
Enrolled:
Int: n = 60
Con: n = 60
Completed:
Int: n = 52
Con: n = 53
Participants
The State-Trait Anxiety
Inventory; The
Spirituality Scale
CBI
The Infertility Distress
Scale; The Turkish
fertility Self; Efficacy
Scale-Short Form; The
Turkish Fertility
Adjustment Scale
Measurements
A spirituality-based
intervention: Music
imagery sessions using
a CD, Blessings, to
promote relaxation,
spiritual awareness, and
feelings of appreciation
A 3-minute slow, gentle,
rhythmic back massage
with a uniform speed
and light pressure at a
rate of 60 strokes per
minute with a 2-in.
wide area
A Watson Caring
Theory caring-based
program: Four 45–90
minutes transpersonal
meetings/interviews
when participating
women came for
infertility treatments
Interventions
Grade Level of Evidence: Low
(Continued)
• No significant differences in anxiety or
spirituality at 1 month
T2 to T3 :
• Positive relationships between
spirituality-based music/imagery
intervention and patients’ psychological
and spiritual outcomes
Grade Level of Evidence: Very low
T1 to T2 :
• Both groups had similar responses. Three
themes emerged: offering hygienic
and comfort care; showing caring behaviors; and helping patients be relaxed and
comforted
Qualitatively:
• No statistically significant differences in
patients’ perceptions of nurse
caring between intervention and control
groups
Grade Level of Evidence: High
Quantitatively:
• No significant improvements in
distress, self-efficacy scores, or adjustment to infertility
Participants in the control (Con) group:
• Significant improvements in distress
(p < .001); self-efficacy scores (p < .001); and adjustment to infertility (p < .001) Participants in the intervention (Int) group: Results/Grade Level of Evidencea Purpose To evaluate the effectiveness of a theory-based program on women’s anxiety and distress due to failing fertility treatments To promote meaningful therapeutic relationships between hospital staff and patients Durgun Ozan and Okumus (2017) Turkey Pipe, Mishark, Hansen, Hentz, and Hartsell (2010) USA A pilot feasibility study with pre- and postintervention measures Randomized controlled trial Design Patients on a general medical unit of an academic hospital Enrolled: n = 19 Completed: n = 15 Women in infertility treatmentEnrolled:Int: n = 45 Con: n = 41 Completed: Int: n = 32 Con: n = 35 Participants Caring Interventions Toward Patients (Continued) Authors/ Year/ Country TABLE 1. Pdf_Folio:4 Linear Analog Self-Assessment Instrument; Medical Outcomes Study Social Support Survey; Herth Hope Index; Spiritual Well-Being Scale Spielberger’s State-Trait Anxiety Inventory; Distress Scale; Ways of Coping Questionnaire Measurements Watson Caring Theory– based program about Lifestory telling: Using a Tree of Life poster to portray sources of encouragement and enjoyment for patients including their memories, life events, family, and roots Watson Caring Theory– based nursing care program: Six sessions during the infertility treatment process at T1 —Pretreatment; T2— after Embryo Transfer; and T3—8th week follow up Interventions Grade Level of Evidence: Low • Improved significantly (p = .02) Spiritual well-being: (Continued) • Did not change significantly from admission to discharge Social support and hope index: • Significant improvements at discharge: overall QOL (p = .05), emotional well-being (p = .005), physical well-being (p = .02) Grade Level of Evidence: High The QOL: • Statistically significant differences between the groups on participants’ mean scores of anxiety, distress, ways of coping with stress, self-confident approach, optimistic approach, social support seeking approach, unconfident approach, or submissive approach (p < .001) After intervention at T2 and T3: • No statistically significant differences between intervention and control groups on participants’ mean scores of anxiety, distress, ways of coping with stress self-confident approach, optimistic approach, social support seeking approach, unconfident approach, or submissive approach Before intervention at T1: Results/Grade Level of Evidencea To evaluate the effectiveness of a holistic perioperative program on helping patients’ pain and anxiety To determine the effects of a caring theory–based care on anxiety, depression, hopelessness, and prenatal attachment of women after a pregnancy loss Sears, Bolton, and Bell (2013) USA Tektaş and Çam (2017) Turkey A longitudinal study design: T1 : before therapy T2 : after therapy T3 : postsurgery A randomized controlled trial Design Spielberger’s State-Trait Anxiety Inventory; An author-constructed six-item scale to evaluate the program The Beck Anxiety Scale; The Beck Depression Scale; The Beck Hopelessness Scale; The Prenatal Attachment Inventory Women who experienced a pregnancy loss: Enrolled: Int: n = 68 Con: n = 60 Completed: Int: n = 55 Con: n = 46 Measurements Patients coming to the hospital for surgery T1 /T2 : n = 111 T3 : n = 72 Participants Watson Caring Theory– based nursing care program: Five 30minute semistructured consultations during participants’ 10th/12th, 16th, 20th, 24th, and 28th weeks of pregnancy A holistic healing program based on Watson’s Theory of Caring: A 1-hour healing therapy in the perioperative suite of the hospital Interventions Grade Level of Evidence: High • Statistically significant differences between the groups on participants’ mean scores of anxiety, depression, hopelessness, and prenatal attachment (p < .001) After intervention: • No statistically significant differences between intervention and control groups on mean scores of anxiety, depression, hopelessness, and prenatal attachment Before intervention: Comparing anxiety at T1 and T3 : Significant reduction on the anxiety and physical pain (p = .001, respectively) Grade Level of Evidence: Moderate Results/Grade Level of Evidencea Notes. CBI = caring behaviors inventory; QOL = quality of life. aGrade Level of Evidence was based on studies’ following criteria: (a) methodology, (b) consistency, (c) directness, (d) effect size, and (e) quality, which was ranked from very low to high quality of evidence (Balshem et al., 2011; BMJ Clinical Evidence, 2018; GRADE Working Group, 2004; Guyatt et al., 2011). Purpose Caring Interventions Toward Patients (Continued) Authors/ Year/ Country TABLE 1. Pdf_Folio:8 One group, preand posttest design with repeated measures T0 : before intervention T1 : right after intervention T2 and T3 : 3 and 6 months after intervention respectively To study the feasibility, acceptability, and effects of a caring theory–based nursing educational program on a hemodialysis unit in Switzerland To compare perceptions of care before and after an educational session integrating Watson’s Caring Theory Delmas, O’Reilly, Iglesias, and Burnier (2016) Switzerland Desmond, Horn, Keith, Kelby, Ryan, and Smith (2014) USA A quasiexperimental preand posttest design Not specified in the article Authors evaluated the results of nurse caring efficacies pre and post a theory-based education program Design Caruso, Cisar, and To describe the Pipe (2008) USA outcomes of a caring theory-based educational approach in a hospital and outpatient clinic Purpose Staff nurses from 10 units of a community hospital n = 10 Nurses and patients on a hemodialysis unit Enrolled: Nurses: n = 9 Patients: n = 22 Completed: Nurses: n = 9 Patients: n = 16 A health system: Number of participants not provided Subjects Caring Interventions Toward Nurses and Allied Caregivers Authors/ Year/ Country TABLE 2. Pdf_Folio:9 The Caring Nurse-Patient Interaction Scale Nurse Version; HCAHPS scores The French version of the Treatment Acceptability and Preference Questionnaire; The French version of the Caring Nurse-PatientInter action Scale A questionnaire developed based on the Theory of Human Caring to assess nurses’ caring efficacy. Baseline: pre educational series Post: after the education series and 2 months later Measurements Results/Grade Level of Evidencea (Continued) A one-day caring Nurses: theory educational • Nurse’s confidence in caring seminar held attitudes and behaviors had statistically offsite in a home significant increases immediately as well setting as 6-months post the intervention education. Grade Level of Evidence: Moderate • Nurses demonstrated significantly higher humanism and were more sensitive to patients’ physical and spiritual needs Patients: An educational Nurses: program guided • The theoretical education program was by Watson’s offered at a great time of need Caring Theory: • The intervention was extremely acceptable Four sessions over and appropriate a period of 3 • The program contributed to humanistic weeks, lasting 3.5 nursing practice hours per session Grade Level of Evidence: Very low A Watson Caring Authors stated that the increase of nurses’ Theory–based caring efficacy was modest at the time of intereducation vention completion and 2-month follow-up program: A • No specific details of the increases were four-part provided education series in • The evaluation of the continuing a seminar format education program and attendance of the program were “good” according to the authors Interventions TABLE 2. Purpose To improve nurses’ satisfaction and retention by crafting a caring work environment Drenkard (2008) USA A quasiexperimental, between subjects, naturalistic, longitudinal study Design One healthcare system Int. units: four medical units Con. units: four surgical units Patients on pilot units: n = 134 pre and n = 155 post Comparison units: n = 141 pre and 127 post Employee survey 2004: n = 277 2006: n = 131 responded to both pre and postsurveys Subjects Caring Interventions Toward Nurses and Allied Caregivers (Continued) Authors/ Year/ Country Pdf_Folio:10 Nursing processes of medication administration; admission, discharge, and transfer; documentation process, and communication; The Caring Assessment Tool Version II; The Caring Factor Survey; The Healthcare Environment Survey; Employee opinion survey; The NDNQI RN satisfaction survey Measurements Grade Level of Evidence: Moderate • Scores were increased on nurses’ treating patients with courtesy and respect, and listening carefully to patients Hospital HCAHPS scores: Results/Grade Level of Evidencea Grade Level of Evidence: Moderate (Continued) • The caring interventions also improved nurses’ retention rates • No significant differences in patients’ perceptions of caring pre- or postinterventions • Nurse satisfaction scores improved significantly, especially on workload and relationships with coworkers • Patient satisfaction ranked excellent on the pilot units—from 9.9%–79.2% (pre) to 57.6%-98.7% (postinterventions) Phase I: a process Phase I: Time savings: improvement • Patients’ admission, discharge, and transphase Phase II: fer times decreased Four pilot units to • Average time to admit a patient decreased improve: (a) from 75.93 minutes to 56.13 minutes, medication an 18.2-minute reduction for admission administration; (b) • Nurses’ perceptions of time to admission, attend patients’ emotional and psychosodischarge, and cial needs improved by 16.2% transfer; (c) • Nurses’ perception of sufficient time for documentation; direct patient care improved by 13.1% and (d) communication Phase II: Interventions Not clearly specified Nelms, Jones, and To examine the Treiber (2011) USA effectiveness of a Watson Caring Theory–based program to decrease medication administration errors Norman, Rossillo, To describe the effects Not specified in and Skelton (2016) of a healing the article USA environment based on Watson’s Caring Theory Not specified in the article Patients were randomly selected into two intervention and control groups Design Dudkiewicz (2014) To determine the USA effects of a caring theory–based care approach on patient satisfaction Purpose The CBA tool; Patients were asked to rate their satisfaction with the hospital stay from 1 (not satisfied) to 5 (very satisfied) Measurements Hospital staff members HCAHPS scores; Employee engagement survey scores A medical unit No Comparing the specific number of number of participants given medication administration errors during and before the intervention Patients pending discharge hospital Group 1 (before Int.): n = 20; Group 2 (1 month after intervention): n = 20 Subjects Caring Interventions Toward Nurses and Allied Caregivers (Continued) Authors/ Year/ Country TABLE 2. Pdf_Folio:11 Using experiential teaching and learning to explore the nursing theory A Watson Caring Theory–based intervention: Nurses wore brightly colored sashes during the time of administering medication Eleven 40– 45-minute educational inservice training to inpatient nursing staff and four other departments —phlebotomy, dietary, environmental, and patient secretarial staff Interventions Grade Level of Evidence: Low (Continued) • Positive improvements in HCAHPS and employee engagement scores Grade Level of Evidence: Low • Still worried about other care obligations • Did not feel a difference in medication error-reporting Nurses reported: • Did not decrease medication administration errors Medication errors: Grade Level of Evidence: Low • Helping/trust and human needs assistance (p = .009 and p = .024, respectively) Two CBA subscales statistically significant improved: • Improved; but not statistically significant (p = .52) Patients’ perceptions of nurse caring behavior: • Statistically significant improvement 1 month after intervention (p = .013) Patients’ satisfaction with their hospital stay: Results/Grade Level of Evidencea To test the effectiveness of the Watson Caring Theory–based new nurse orientation program Phillips and Hall (2014) USA Subjects Comparative New graduate descriptive design nurses Int: n = 4 examining Con: n = 16 differences among two groups: nurses in a traditional orientation program and in the newly revised program Design Interventions Results/Grade Level of Evidencea Grade Level of Evidence: Low • No significant changes after the intervention. The Casey-Fink Watson Caring The intervention group: Graduate Nurse Theory-based • Statistically significant improvements Experience Survey nurse internship in competence and confidence scores program: A 12at 6 and 12 months in the following areas: month orientation program a. prioritizing patient care needs including a (p ≤ .05) 2-week classroom b. opportunities to practice skills and training, a procedures (p ≤ .05) specialty class c. level of comfort communicating training, a with patients and their families competency (p ≤ .05) checklist, a d. feeling excited and challenged by preceptorship the career (p ≤ .05) program, and six internship forums Retention rates: Measurements Note. CBA = caring behavior assessment; HCAHPS = hospital consumer assessment of healthcare providers and system; NDNQI = National Database of Nursing Quality Indicators. aGrade Level of Evidence was based on studies’ following criteria: (a) methodology, (b) consistency, (c) directness, (d) effect size, and (e) quality, which was ranked from very low to high quality of evidence (Balshem et al., 2011; BMJ Clinical Evidence, 2018; GRADE Working Group, 2004; Guyatt et al., 2011). Purpose Caring Interventions Toward Nurses and Allied Caregivers (Continued) Authors/ Year/ Country TABLE 2. Pdf_Folio:12 Purpose Evaluate the effectiveness of a ropes course and caring group experiences on nursing students Examine the effects of a caring theorybased teaching intervention on promoting students’ caring behaviors during the bloodpressure taking Validate a Watson Caring Theory–based simulation scenario in a psychiatric inpatient setting Birx, Wagstaff, and Van Patten (2008) USA Minnesota Baccalaureate Psychomotor Skills Faculty Group (2008) USA Hermanns, Lilly, and Crawley (2011) USA Study design was not specified in the article Students were asked to evaluate the simulation afterward Nonexperimental descriptive repeated measures design Nonequivalent control group pretest–posttest design Design Caring Interventions Toward Nursing Students Authors/Year/ Country TABLE 3. Pdf_Folio:13 A clinical group of 10 students: n = 10 Students who completed final evaluation tools: n=7 Junior-level baccalaureate nursing students in six nursing programs n = 60 Repeated measures analysis based on 59 students (1 missing data) Nursing students in a mental health course n = 68 Divided into eight groups: four intervention and four comparison groups Subjects An evaluation tool developed for the study by authors The Caring Ability Instrument; Group Cohesion Questionnaire; An open-ended questionnaire to gather reflections after the ropes course and caring group experiences Caring behaviors during blood pressure measurement Instrument; The role player survey of caring behaviors during blood pressure measurement instrument Measurements Based on the Watson Caring Theory, a simulation scenario was developed: A focused 30-minute psychiatric crisis scenario A 20-minute debriefing conference was conducted in the end Students watched two different versions of videotapes: One was endorsed by the Minnesota Division of the American Heart Association. Another one was made by the researchers of the study based on Watson Caring Theory Caring group and ropes course experiences were integrated into the first semester of an upperdivision baccalaureate nursing curriculum Interventions (Continued) “Now I know what to do” and “looking and seeing differently” Grade Level of Evidence: Low • The simulation was well received by students • Students indicated two main themes: Grade Level of Evidence: Moderate • Students demonstrated 84% of the caring items on the posttest versus 74% of the items on the pretest • Within-student pre- and post test scores on caring behavior measures demonstrated significant improvements (p < .01) Grade Level of Evidence: Very low • No significant differences between intervention and comparison groups on caring ability (p > .05) or group
cohesion (p > .05)
• Both groups showed improvements in posttests
Results/Grade Level of Evidencea
To study the
acceptability
and efficacy of
a Watson
Caring
Theory–based
education
program for
nursing
students in
Taiwan
Wu, Chin, and
Chen (2009)
Taiwan
A quasiexperimental
nonrandomized
two group preand posttest
design
Design
Full-time second
year RN to BSN
nursing students
in Southern
Taiwan Enrolled:
Int: n = 40
Con: n = 45
Completed:
Int: n = 35
Con: n = 33
Subjects
The CBA;
Qualitative
description to
evaluate the
caring course
Measurements
Intervention:
a 13-week
caring education program
based on Watson’s 10
caritas factors through
multiple teaching strategies
Interventions
Grade Level of Evidence: Moderate
Qualitative results indicated that a
caring education could help nursing
students by building caring behaviors
• Significantly higher scores
of caring behaviors after the
education program (p < .01) • Significantly higher scores of each of the CBA subscales except existential/phenomenological/spiritual forces (p = .13) • The subscales showing significant improvements: Humanism/faith-hope/ sensitivity (p = .01); Helping/trust (p < .01); Expression for positive/negative feelings (p < .01); Teaching/learning (p = .02); Support environment (p < .01); and Human needs assistance (p = .02) Students in the intervention group: Results/Grade Level of Evidencea Note. CBA = caring behaviors assessment. aGrade Level of Evidence was based on studies’ following criteria: (a) methodology, (b) consistency, (c) directness, (d) effect size, and (e) quality, which was ranked from very low to high quality of evidence (Balshem et al., 2011; BMJ Clinical Evidence, 2018; GRADE Working Group, 2004; Guyatt et al., 2011). Purpose Caring Interventions Toward Nursing Students (Continued) Authors/Year/ Country TABLE 3. Pdf_Folio:14 ID:p0435 ID:p0460 ID:ti0050 ID:ti0055 ID:p0440 ID:p0450 ID:ti0065 ID:p0465 ID:ti0060 ID:p0455 participants on whom intervention approaches were applied. Intervention approaches in this review were planned strategies that were intended to improve either nurses’ or students’ practice skills or patients’ difficulties lived such as anxiety, depression, pain, or hopelessness. Due to the heterogeneity of intervention approaches and study designs, data were synthesized narratively. The narrative synthesis was done according to a constant comparative method suggested by Miles, Huberman, and Saldaña (2014), based on which interventions and outcomes were compared across studies. The resulting synthesis included descriptions of the interventions, participants, interventions, and outcomes. Results General Characteristics of the Studies Reviewed The literature search was guided by the PRISMA (Moher et al., 2009) flow diagram. The initial search of literature retrieved 143 records. One hundred and twenty-one articles remained after duplicates were removed with database reference management filters. After titles and abstracts were screened, 38 articles were left for full-text assessment, after which 19 articles were included for review. The details of the search process are displayed in a PRISMA flow chart (Figure 1). Studies reviewed were conducted in various countries, including the United States (14 studies; 73.6