Linking Caritas to HCAHPS: From Theoretical Construct to Empirical Survey Outcomes

Kaiser Permanente, Northern California

Caritas in ActionHow Caring Science informs and inspires KP caregivers and affirms our commitment to provide our

patients and their families exceptional care

Caritas Consortium 2013Linking Caritas to HCAHPS: From Theoretical Construct to

Empirical Survey Outcomes

Intent to Contribute Statement:Context: Although the theory of caring science can be useful in many aspects of nursing care, the

language of the caritas processes is viewed by some registered nurses as abstract and difficult to

conceptualize for inpatient direct care nursing practice. Patient Care Services at RWC Medical

Center embarked on a project to translate the language and ideas found in the theory into concrete

and relevant practices that could be understood and used by direct care registered nurses.

Simultaneously the leadership group sought to link the ideas of the theory with the critically

important aspects of patient satisfaction as measured by the HCAHPS (Hospital Consumer

Assessment of Healthcare Providers and Systems) surveys. Using a variation of the process of

substruction, we were able to create a single page graph that visually displays how the concepts

and ideas of the caring science theory are directly linked to the dimensions of patient satisfaction in

the HCAHPS survey and also directly relevant to the care of patients by direct care nurses.

Substruction has been used to assess whether there is congruence between the theoretical and

operational aspects of a research study. It can be used as a strategy to analyze the level s of

abstraction of the variables in the study and to hypothesize the potential relationships among the

variables.

Linking Caritas to HCAHPS: From Theoretical Construct to Empirical Survey Outcomes

We evaluated seven of the caritas processes (processes 4-10) and estimated the linkage between

the processes and the eight dimensions of the HCAHPS survey. We were able to explicitly link the

abstract theoretical constructs to the concrete survey empirical indicators.

Anticipated Outcomes: We anticipate this initial step will provide a mechanism for inpatient nurses

and managers to mentally link the caritas processes and the HCAHPS dimensions of care. As the

links becomes clearer, we anticipate that the nurses and managers will be able to use these links to

explain to others (and to themselves) how these two important groups of concepts actually are

similar and can be used to work together to better nursing practice. Ultimately, we anticipate that

this step, along with other work, will be used to increase inpatient satisfaction and as a result,

improve the HCAHPS scores.


… Continued


Inspired Contributor(s) 1 : Jean Ann Seago Ada Walker

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Service Area: San Mateo

Medical Center: RWC

Affiliation: PCS

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Year Shared: 2013

Venue: Caritas Consortium

Format: Poster, PowerPoint

ID #: E10

1 Names as listed in Lotus Notes, otherwise personal e-mails indicated

Keyword TAGs: Identifier

Consortium2013-July, San Mateo, Redwood City, Podium, Poster, Patient Care Services

Hospital Initiatives, Patients/Families

Descriptor Caritas Consciousness, HCAHPS,

Research and Metrics

Watson Caring Theory

• The theoretical framework in which nursing care is delivered at KP RWC Medical Center

• The theory provides guidance to Registered Nurses about establishing caring relationships with patients and providing patients with a holistic care experience

CMS HCAHPS

• The Centers for Medicare and Medicaid Hospital (CMS) Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a

national,

standardized,

publicly reported survey of patients' perspectives of their hospital care

• This 27-item survey is provided to each discharged hospitalized patient in the US to measure patient satisfaction

Purpose

• To propose a conceptual model of how the theory and the evaluation of inpatient satisfaction might be connected to improve patient care in hospitalized patients

Substruction

• Using a process called substruction, a conceptual model was created to illustrate how the two might be linked Constructs Concepts Sub-Concepts Empirical Indicators Measurement

Key Words of the Theory (Constructs)

• Relationships• Connections• Authentic• Caring• Healing• Trusting• Helping

Ten Caritas Processes™ (Concepts)

1. Embrace altruistic values and Practice loving kindness with self and others.

2. Instill faith and hope and honor others.3. Be sensitive to self and others by nurturing

individual beliefs and practices.

These first 3 processes are generally thought to relate to the nurse preparing herself to provide care using the Watson Theory

4. Develop helping – trusting- caring relationships.

5. Promote and accept positive and negative feelings as you authentically listen to another’s story.

6. Use creative scientific problem-solving methods for caring decision making.


7. Share teaching and learning that addresses the individual needs and comprehension styles.

8. Create a healing environment for the physical and spiritual self which respects human dignity.

9. Assist with basic physical, emotional, and spiritual human needs.

10. Open to mystery and allow miracles to enter. Understanding from the patient’s point of view


HCAHPS Dimensions of Care (Sub-Concepts)

• Communication-Nurses & Doctors

• Responsiveness

• Pain Management (Communication)

• New Medication (Communication)

• Hospital Environment (Quiet; Clean)

• Discharge Information (Communication)

• Overall Quality

8 Dimensions of the HCAHPS Survey

Dimension (sub-concepts)

1. Communication-Nurses

2. Communication-Doctors

3. Responsiveness-Staff

4. Pain Management

Survey Items (Empirical Indicators)

1. Courtesy, Respect, Listen, Explain

2. Courtesy, Respect, Listen, Explain

3. Call Button Soon Enough; Toilet

Help Soon Enough

4. How often, pain well controlled;

How often staff did everything

they could to help pain

8 Dimensions of the HCAHPS Survey

Dimension (sub-concepts)

5. Communication-New Meds

6. Hospital Environment

7. Discharge Information

8. Overall Rating

Survey Items (Empirical Indicators)

5. Before giving med- tell Reason;

Before giving med-tell Side Effects

6. Room & Bathroom Clean; Area

around room Quiet at night

7. Communicate about needed help;

Written information about

symptoms or potential problems

8. Worst Hospital→Best Hospital

Watson Science of Caring & HCAHPS Abstraction Level Constructs → Relationships − Connections − Authentic − Caring − Healing (Caritas Key Words) ↓

Concepts (Caritas Processes) → #4-Helping, Caring #6-Scientific Prob Solv #5-Authentic Listen #5-Authentic Listen #8-Healing Envir #7-Teaching/ All #5-Authentic Listening #8-Dignity #6-Scientific Prob Solv #6-Scientific Prob Solv #9-Human Needs Learning #10-Understanding Pat. View #9-Human Needs #9-Human Needs #7-Teaching, Learning ↓ #10-Understand Pat. View ↓ ↓ ↓ ↓ ↓ ↓ ↓ SubConcepts → Communication − Communication − Responsiveness − Pain − Communication − Healing − Discharge − Overall (HCAHPS Dimensions) Nurses Doctors Hosp. Staff Management New Meds Environment Information ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ Empirical → −Courtesy/ −Courtesy/ −Call Button −How often, pain −Before giving, new −Room & −Communicate −Worst Indicators Respect Respect Soon Enough well controlled med reason Bathroom Clean about needed help Hospital (Survey Items) −Listen −Listen −Toilet Help −How often, staff did −Before giving, new −Area around −Written Information ↓ −Explain −Explain Soon Enough everything they could med side effects room Quiet about symptoms −Best ↓ to help with pain at night or potential Hospital problems Measurement → 1-4 1-4 1-4 1-4 1-4 1-4 Y/N 0-10 (1-4; 0-10; Y/N) ↓ Scoring → Percentage of 4s, Yeses, and 9s or 10s; aka “topbox”

Conclusion

• The model can be used to help visually explain how constructs and concepts of the Watson Science of Caring Theory can be linked to the HCAHPS survey scores

References

• Dulock, HL, Holzemer, WL. Substruction: improving the linkage from theory to method. Nurs Sci Q 1991 Summer;4(2):83-7.

• Watson, J. Caring Science (Definitions, Processes, Theory).http://watsoncaringscience.org/about-us/caring-science-definitions-processes-theory/. Accessed April 15, 2013

• Centers for Medicare & Medicaid Services, Baltimore, MD. Accessed April 15, 2013. http://www.hcahpsonline.org.

Linking Caritas to HCAHPS: From Theoretical Construct to Empirical Survey Outcomes

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