This document describes a project at Kaiser Permanente's Redwood City Medical Center to link Jean Watson's caring science theory to patient satisfaction measures in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Using a process called substruction, the project team created a conceptual model that maps the concepts of Watson's 10 Caritas processes to the 8 dimensions of care in HCAHPS. This visual model aims to help nurses understand how caring science principles relate to concrete aspects of patient experience measured by HCAHPS, with the goal of improving nursing practice and increasing patient satisfaction scores. The project team anticipates this model will provide a mechanism for nurses to mentally connect caring science and HCAHPS
Linking Caritas to HCAHPS: From Theoretical Construct to Empirical Survey Outcomes
1. Kaiser Permanente, Northern California
Caritas Consortium 2013
Linking Caritas to HCAHPS: From Theoretical Construct to
Empirical Survey Outcomes
Caritas in Action
How Caring Science informs and inspires KP caregivers and affirms our commitment to provide our
patients and their families exceptional care
2. Linking 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.
3. Linking Caritas to HCAHPS: From Theoretical
Construct to Empirical Survey Outcomes
… Continued
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.
4. Linking Caritas to HCAHPS: From Theoretical
Construct to Empirical Survey Outcomes
Inspired Contributor(s) 1 :
Jean Ann Seago
Ada Walker
-----Service Area: San Mateo
Medical Center: RWC
Affiliation: PCS
-----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, Researc
h and Metrics
5. Linking Caritas to HCAHPS: From Theoretical
Construct to Empirical Survey Outcomes
6. 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
Page 6
7. 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
Page 7
8. 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
Page 8
9. Substruction
• Using a process called substruction, a conceptual
model was created to illustrate how the two might
be linked
Concepts
Sub-Concepts
Empirical Indicators
Page 9
Constructs
Measurement
10. Key Words of the Theory
• Relationships
• Connections
• Authentic
• Caring
• Healing
• Trusting
• Helping
Page 10
(Constructs)
11. 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
Page 11
12. Ten Caritas Processes™
(Concepts)
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.
Page 12
13. Ten Caritas Processes™
(Concepts)
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
7.
Page 13
14. 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
Page 14
15. 8 Dimensions of the HCAHPS Survey
Dimension (sub-concepts)
Survey Items (Empirical Indicators)
1.
Communication-Nurses
1.
Courtesy, Respect, Listen, Explain
2.
Communication-Doctors
2.
Courtesy, Respect, Listen, Explain
3.
Responsiveness-Staff
3.
Call Button Soon Enough; Toilet
Help Soon Enough
4.
Pain Management
4.
How often, pain well controlled;
How often staff did everything
they could to help pain
Page 15
16. 8 Dimensions of the HCAHPS Survey
Dimension (sub-concepts)
Survey Items (Empirical Indicators)
5.
Communication-New Meds
5.
Before giving med- tell Reason;
Before giving med-tell Side Effects
6.
Hospital Environment
6.
Room & Bathroom Clean; Area
around room Quiet at night
7.
Discharge Information
7.
Communicate about needed help;
Written information about
symptoms or potential problems
8.
Overall Rating
8.
Worst Hospital→Best Hospital
Page 16
17. Watson Science of Caring & HCAHPS
Abstraction Level
Constructs →
(Caritas Key Words)
↓
Relationships −
Connections
Concepts
(Caritas Processes) → #4-Helping, Caring
#5-Authentic Listening
#10-Understanding Pat. View
↓
−
Authentic
↓
SubConcepts → Communication − Communication − Responsiveness
(HCAHPS Dimensions) Nurses
Doctors
Hosp. Staff
↓
Empirical
→
Indicators
(Survey Items)
↓
−Courtesy/
−Courtesy/
Respect
−Listen
−Explain
Respect
−Listen
−Explain
↓
−Call Button
Soon Enough
−Toilet Help
Soon Enough
↓
Measurement →
(1-4; 0-10; Y/N)
1-4
1-4
1-4
↓
Scoring
Caring
−
Healing
#6-Scientific Prob Solv #5-Authentic Listen #5-Authentic Listen #8-Healing Envir #7-Teaching/
#8-Dignity
#6-Scientific Prob Solv #6-Scientific Prob Solv #9-Human Needs Learning
#9-Human Needs
#9-Human Needs
#7-Teaching, Learning
#10-Understand Pat. View
↓
↓
−
→ Percentage of 4s, Yeses, and 9s or 10s; aka “topbox”
↓
−
Pain
−
Management
↓
↓
Communication
New Meds
↓
−
↓
Healing
− Discharge −
Environment Information
↓
↓
↓
−How often, pain
−Before giving, new −Room &
−Communicate
well controlled
med reason
Bathroom Clean about needed help
−How often, staff did −Before giving, new −Area around −Written Information
everything they could med side effects room Quiet
about symptoms
to help with pain
at night
or potential
problems
1-4
1-4
1-4
Y/N
All
↓
Overall
↓
−Worst
Hospital
↓
−Best
Hospital
0-10
18. 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
Page 18
19. 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.o
rg/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.
Page 19