A range of extant empirical measurements that include caring attributes, caring behaviors, patients’ perceptions, and satisfaction with nurses’ caring exists. As a result of the diversity of approaches, caring is treated in different ways, and there are varying conceptual notions that underline their developments. Most all of the measurements included here have reports of reliability and validity, and there is an attempt to note the conceptual-theoretical developmental origin of the instruments. This book presents some of the major background facts about each tool’s development and the latest source citations for research using the tool. The ordering of the instruments is chronological ordering. The final section of the book provides a comprehensive blueprint matrix of all the instruments. The matrix blueprint and copies of selected measurements make this compendium a useful and functional resource for anyone wishing to obtain information, summary data, and access to empirical instruments that measure caring.
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This chapter outlines the key elements of the caring dimensions inventory (CDI) along with latest citations of the work, referred to as the Edinburgh CDI. The CDI is a quantitative tool to measure caring that was developed at the University of Edinburgh, Scotland. The conceptual-theoretical basis for the tool was guided by an empirical rather than theoretical approach to caring that acknowledges some of the general caring theory literature. The theoretical approaches used were those that supported the operationalization of caring through specific taxonomies and measurements. Several studies using this instrument have been reported, although the authors indicate that they have not systematically gathered information on the extent of its use. In the development of the CDI, general categories of care were developed from the literature review. The four most popular themes were used to classify the CDI questions, as they were believed to describe general categories of care.
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Development of the Caring Factor Survey (CFS), an Instrument to Measure Patient’s Perception of Caring
The Caring Factor Survey (CFS) is a tool that examines the construct of caritas, which literally means divine care/love. This chapter reviews the initial psychometric testing of the CFS that was a result of studies conducted in 2006 and 2007. Development of psychometrically sound instruments is essential to articulate the place care has within the increasingly mechanistic environment of healthcare. The CFS has been used in specific contexts to test the processes of caring: hospice, long-term care, care of patients receiving electroconvulsive therapy, patients with coronary heart disease, and labor and delivery. The CFS has also been used to create six derivation works such as caring for self, caring for coworkers, and caring of the manager. A search for the CFS or any derivation work in Google Scholar will provide many more resources for building an argument on the impact of the caritas processes being enacted on self and others.
The Student Perspectives of Caring Online tool was developed based upon author’s early interest in how nursing faculty may convey and model caring in online education. The tool is based on two pilot studies that explored student perceptions related to caring behaviors demonstrated by nursing instructors in online classroom settings. A 25-item Likert-type survey for a larger study was created based on the findings of the two pilot studies. In the larger study, emailed messages requesting participation were sent to 750 undergraduate RN students in 5 different institutions of higher education, and 122 students completed the survey. After the larger study was completed, internal consistency was assessed. Construct and content validity were achieved during the pilot study process and subsequent development of the main survey items. Online education technology and practices are continually evolving. This tool can and should be adapted to reflect ongoing changes related to online education.
The Caring Efficacy Scale (CES) was currently a consultant in the area of measurement and program evaluation. It was designed to assess an individual’s confidence in (or sense of efficacy about) his or her ability to express a caring orientation and establish a caring relationship with patients. The conceptual theoretical basis for the scale is Bandura’s self-efficacy theory from the discipline of social psychology and Watson’s theory of transpersonal human caring from nursing. The most current version of the instrument is intended to be used to evaluate outcomes of nursing education in a new advanced program with a formal caring philosophy and caring curriculum. This tool is guided by theories from both social psychology and nursing caring theory. It has been tested in nursing education and clinical care settings. It has psychometric sophistication in its development, use, and refinement. The Likert form makes it relatively easy to use.
The Caring Assessment Tools (Caring Assessment Tool [CAT], Caring Assessment Tool-administrative version [CAT-admin], and the Caring Assessment Tool-educational version [CAT-edu]) were originally developed based on Watson’s Theory of Human Caring. For the three instruments, closed-response 5-point Likert-type scale items are used. Each item measures the frequency with which the behavior occurs in the work/learning environment. Scores range from 1 (never) to 5 (always). Each tool has a different range of total scores based on the total number of items. This total score characterizes interval-level data, which allow for inferential correlational and comparative analyses. Ongoing development of caring behavior tools, such as caring capacity and caring intention tools, is being considered. Most importantly, as assessments of a unique domain of nursing, the tools provide researchers, students, and others with opportunities to advance the evidence base for nursing practice and improve the quality of patient care.
This chapter provides a point of view about construct validity and caring measurement research. It describes the psychometric methods and processes associated with instrument construct validity. The psychometric methods are: theoretical linkage to a well-articulated theory; content validity; pilot testing; sample size and quality; and reliability assessment. The processes associated with instrument construct validity are: factor analysis; known group validity; convergent or concurrent validity; and predictive validity. Today the authors of the measurements are linked by a common book and by the Internet, but they still experience severe problems of limited funding and limited opportunities to perform large-scale psychometric studies with the rigor expected from the scientific community. The use of multiple studies with appropriate measures of instrument validity and a wealth of evidence as to content, criterion, and construct validity is evidence of a greater degree of construct validity.
During this era where new formal models of healthcare are emerging, human caring remains a critical indicator of patient experience and related outcomes. Assessing and measuring human caring is a complex and dynamic phenomenon. Healthcare systems and society are increasingly dependent on having new standards of human caring to assure ethical, relational integrity as core to human health and healing. Human caring, glimpsed through empirical measurement, whether qualitative or quantitative, may help us see what has long been hidden from the profession, the healthcare system, the public consciousness, as well as science. Capturing human caring is diverse and complicated, especially when the dominant biotechnical culture tends to focus on external indicators of treatment and cure. Empirical evidence of caring captured in an elusive practice world that is unstable, unseen, chaotic, and changing can provide a tangible grasp and glimpse of nursing’s relational contribution to both science and public health welfare.
The Caring Behaviors Inventory (CBI) was the second empirical measurement instrument of caring to be reported in the nursing literature. The first version of the CBI was a Likert-scaled instrument with total scores ranging from 42 to 168. The CBI is one of the earliest to be developed with clarity of conceptual-theoretical basis, along with ongoing testing and refinement of the instrument. It is one of the few instruments in caring that provides supporting evidence for empirical validation of Watson’s transpersonal caring theory. The instrument has been reported to be among those with the shortest length of time; it has consistent language, with easy to understand instructions, and easy to analyze results, which have been used in descriptive, correlational, cross-sectional, predictive, comparative descriptive, and mixed methods design studies. The CBI has been described as useful in determining perceptions of nurse caring in patients and nurses in hospitals and nurse practitioners.
The caring attributes, professional self-concept, and technological influences (CAPSTI) scale was developed through a pilot study using a convenience sample of nurses from Hong Kong, Beijing, and Macau. The themes and language that emerged from this sample were reviewed for content validity by a sample of experts. Specific items emerged from a combination of sources: the literature, the sample, and the experts. The CAPSTI has been reported to be reliable and valid, helping to create a composite picture of caring among nurses in various countries and cultures. The refined CAPSTI-2 is emerging as a reliable and valid measure for nursing studies on caring attributes, and normative databases are being developed in various branches of nursing and in various cultures. This offers useful direction for both descriptive and experimental studies in the future, and the instrument may prove to be a useful predictor of nursing performance both clinically and educationally.