Thesis advisor: Dorothy A. Jones / A metasynthesis of 90 published qualitative studies was conducted on the nurses’, students’, and patients’ perception of nurse caring. A mid-range theory of Nurse Caring emerged from the data, including three attributes: Presence, Concern for the Other, Knowledgeable, Competent Care, and Respect for the Person. The Nurse Caring Patient Scale (NCPS) was developed from patient descriptors within the metasynthesis. NCPS was tested to establish the psychometric properties of the instrument with 341 adult acute in-patients of a northeastern United States metropolitan teaching medical center. Initial reliability for total NCPS was .92. Factor analysis using principal components analysis with varimax rotation resulted in a parsimonious three factor solution that accounted for 50.49 % of the total variance. The final NCPS was 23 items with an alpha of .91. Component 1 (Presence, Concern for the Other) was comprised of 11 items with an alpha of .89. Component 2 (Knowledgeable, Competent Care) contained five items with an alpha of .77. Component 3 (Respect for the Person) had seven items and an alpha of .73. Participants were asked to write about an experience with a nurse. Components of caring and uncaring experiences described by participants did not add to the body of data from the metasynthesis or to the items of the NCPS. This study was limited by sample population, and the items of NCPS may be applicable only to those included in the synthesized qualitative studies. The metasynthesis of qualitative studies and mid-range theory of Nurse Caring add to the theoretical concept of caring by including the patients’ perceptions of the nurse-patient encounter. Components of Nurse Caring add competency, and respect to presence with the patient for a comprehensive definition of caring. NCPS offers nurses and administrators a valid reliable measure for patient perceptions of quality of care and satisfaction that were until now unseen and unmeasured. The theory of Nurse Caring provides nurse educators with a framework for nursing curricula, since the theory incorporates all aspects of nursing practice within its definition. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Culturally responsive teaching (CRT) was birthed from the framework of multicultural education. Multicultural Education is a broad framework that focuses on equity amongst race, ethnicity, gender, sexual orientation, socioeconomics, disabilities, and other groups who identified as marginalized. Culturally responsive teaching encompasses the ability to acknowledge cultural differences, expand diversity of thought, all while having a caring relationship with students. The literature says that both of the multicultural education and CRT, help foster inclusive classrooms and spaces on campus. CRT also notes that a teacher’s ability to care about students influences positive outcomes for learning. For the last 30 years, CRT has been studied from the perspective of K-12 students. While this research is important the researcher argues that culturally responsive teaching is needed at the university. All research questions for this study were created through the lens of multicultural education, CRT, and Nodding’s Caring Theory. Since CRT is typically examined with minority students only, the researcher explored both minority and White students at Mississippi State University to understand if the techniques were equitable and inclusive for all learners. A total of eight focus groups were held between Fall 2017 to Fall 2019 with 39 total participants, undergraduate (n=28) and graduate students (n= 11). Participants included mostly minority students (n=21) and females (n= 21). While there were some major differences between undergraduate and graduate CRT experiences, there were more commonalities that arose when theming occurred. Students from all focus groups were able to identify at least five out of the six characteristics of culturally responsive teaching; however, minority students were able to talk about feelings of exclusion inside and outside of the classroom, as it pertained to the racial and ethnic identity. Minority students were better able to identify what culturally responsive teaching means and what it looks like in practice. Minority students were also more reflective in their responses around feeling included and excluded both inside and outside of the classroom. All students wanted a teacher that cared for them and to make the course material relevant to their lives.

As older couples age, often one partner becomes more competent and able to care for the other, in which case they are able to remain in their homes. In one township in the northeastern United States, the caregiving role had a significant effect on the lives of elderly men who care for their wives. The purpose of this quantitative project study was to determine the relationship between perceived stress burden and perceived level of social support services and between perceived stress burden and use of support services by elderly male spousal caregivers residing in active adult communities. Watson's theory of caring provided the theoretical foundation for this study. A correlational design was used and data were collected from 82 elderly male spousal caregivers with (a) the Zarit Burden Interview; (b) the Multidimensional Scale of Perceived Social Support; and (c) a checklist, Support Services in Your Area. Descriptive analysis indicated that participants carry a large stress burden, particularly emotional stress (Zarit Burden score of 36.58/65), enjoy strong social support (Multidimensional Scale score of 45.47/75), and use few community services. Pearson's product-moment correlation revealed no significant relationship between perceived stress burden and perceived social support or between perceived stress burden and use of community services, indicating that men feel emotional stress but the feelings are not related to their use of community services. As community services were not used by elderly male caregiver spouses, a workshop for professionals was developed to help the professionals expand programs and services that may have value for these men in their caregiver role. This study has social significance because satisfaction with the caregiver role has consequences for the health and financial well-being of the elderly and for U.S. society.

As older couples age, often one partner becomes more competent and able to care for the other, in which case they are able to remain in their homes. In one township in the northeastern United States, the caregiving role had a significant effect on the lives of elderly men who care for their wives. The purpose of this quantitative project study was to determine the relationship between perceived stress burden and perceived level of social support services and between perceived stress burden and use of support services by elderly male spousal caregivers residing in active adult communities. Watson's theory of caring provided the theoretical foundation for this study. A correlational design was used and data were collected from 82 elderly male spousal caregivers with (a) the Zarit Burden Interview; (b) the Multidimensional Scale of Perceived Social Support; and (c) a checklist, Support Services in Your Area. Descriptive analysis indicated that participants carry a large stress burden, particularly emotional stress (Zarit Burden score of 36.58/65), enjoy strong social support (Multidimensional Scale score of 45.47/75), and use few community services. Pearson's product-moment correlation revealed no significant relationship between perceived stress burden and perceived social support or between perceived stress burden and use of community services, indicating that men feel emotional stress but the feelings are not related to their use of community services. As community services were not used by elderly male caregiver spouses, a workshop for professionals was developed to help the professionals expand programs and services that may have value for these men in their caregiver role. This study has social significance because satisfaction with the caregiver role has consequences for the health and financial well-being of the elderly and for U.S. society.

PURPOSE The purpose of this study was to explore how primary care registered nurses address unmet social needs in patients. SPECIFIC AIMS Explore how RNs in a safety-net, primary care setting develop an awareness of and address patient's unmet social needs. Describe how information about unmet social needs are integrated into nursing assessment and intervention activities, and are shared with other members of the health care team. Describe the challenges primary care RNs face when addressing unmet social needs. FRAMEWORK Critical caring theory provided the framework for this study. DESIGN This study used a descriptive, qualitative design. Semi-structured interviews were conducted with seventeen nurses working in 11 different safety-net primary care clinics within a hospital-based system. RESULTS Three major themes emerged. Key findings included the importance of the nurse-patient relationship, the establishment of trust, and a caring, nonjudgmental approach to patients with unmet social needs. Nurses used knowledge of unmet needs to coordinate patient care, provide social support, and work collaboratively with care team members to refer patients to resources within the health care system and in the community. CONCLUSION Unmet social needs contribute to adverse health outcomes, and addressing social and medical needs is critical to eliminating health inequities and reducing health care costs. In this study, primary care nurses described relationships with patients that allowed for the sharing of sensitive information, leading the nurse to identify and address unmet social needs that could impact patient health.

The intent of this thesis was to examine compassion fatigue in nurses through analysis of research studies conducted within the past five years in an effort to identify predisposing factors to the experience of compassion fatigue. Individual and institutional factors were identified as well as current strategies to assist with management of compassion fatigue. Findings indicated that being new to practice, having a trait negative affect, being younger in age, having a history of exposure to trauma and working in high emotionally stressful units predisposed individuals to the experience of compassion fatigue. Institutional factors included a lack of managerial support, organizational commitment, group cohesion, work engagement and conflicting expectations of the nurse. Institutional interventions to assist in mitigating compassion fatigue include improving managerial support, developing group cohesion and communication and providing continuing education opportunities. Institutions can also assist by offering training in resiliency techniques such as negative thought pattern identification, meditation, peer-to-peer discussions, journaling about traumatic experiences, identification and maintenance of personal/professional boundaries and physical wellness through exercise and yoga. These proposed interventions address institutional accountability in health care worker wellness as defined by the quadruple aim. Such interventions also address use of Watson’s Caring Theory to emphasize the importance of nurse wellness as essential to creating caring nurse-patient relationships.