Oncology patients ’ and nurses ’ perceptions of caring About the authors

The concept of caring is central to the practice of nursing. Recent focus on patient-centred care highlights the importance of viewing caring from the patient’s perspective. A comparative descriptive cross-sectional study was conducted to determine if there was a difference in oncology patients’ and nurses’ perceptions of caring. The Caring Behaviors Inventory-Elders (CBI-E) directly derived from Watson’s Theory of Human Caring was administered to patients and nurses from in-patient medical-surgical units. This paper reports on a subset of 19 patients and 15 nurses from the oncology unit. There were significant differences between patients’ and nurses’ perceptions on overall caring and on several individual behaviours. In order to provide true patient-centred care, innovative approaches to addressing these differences are needed. Background Caring is a concept adopted in the early 1800s by Florence Nightingale. Since that time, it is generally acknowledged worldwide that the concept of caring is central to the practice of nursing. There is, however, no single definition of what it means to care (Beck, 1999; Dyson, 1996). To borrow from McCaffery’s (1972) widely accepted definition of pain, caring is whatever the person experiencing it says it is (p. 8). Caring theories generally identify two general categories of caring behaviours: those that reflect activities or technical competence and those that reflect attitudes and behaviours or the affective aspects of caring (Wilkin & Slevin, 2004). Radwin, Farquhar, Knowles, and Virchick (2005) analyzed qualitative data from 461 patients reflecting cancer patients’ descriptions of nursing care. Several concepts emerged including “caring” and “professional” (Radwin et al., p. 162). The concept caring was defined as showing compassion, concern and kindness while the concept professional was defined as demonstrating expected standards in knowledge, skill, and demeanour. Research has revealed differing perceptions of what patients and nurses consider to be caring behaviours. Baldursdottir and Jonsdottir (2002) found that a sample of 182 patients who had received emergency department service considered clinical competence to be the most important nurse caring behaviour. Holroyd, Cheung, Cheung, Luk, and Wong (1998) found similar results in a sample of 29 Chinese patients in acute care settings. Patients ranked items related to giving treatments and medicines on time as most important. Although patients still expected nurses to be kind and compassionate, patients placed greater emphasis on ability to competently carry out necessary skills. Attree (2001) found, in a qualitative study of patients’ and relatives’ perspective on good and not so good care, that the nature of the care provided and the interpersonal qualities of caring were the major themes. Henderson et al. (2007) found, through both observation and direct questions, that patients felt cared for when nurses responded to specific requests. Studies of nurses have shown that nurses consistently emphasize the humanistic side of the caring relationship rather than the technical aspects (Bassett, 2002; Bertero, C., 1999; Dyson, 1996; Wilkin & Slevin, 2004; Yam & Rossiter, 2000). Studies comparing oncology nurses’ and patients’ perceptions of caring have found both similarities and differences (Chang, Lin, Chang, & Lin, 2005; Larsson, Widmark-Petersson, Lampic, von Essen, & Sjoden, 1998; von Essen, Burstrom, & Sjoden, 1994; WidmarkPetersson, von Essen, & Sjoden, 2000). Larsson et al. found, in an inpatient oncology unit, that nurses stressed the emotional aspects of caring more than did patients and that patients rated the informational aspects of caring higher than did nurses. However, in another study employing matched pairs of cancer patients and nurses, there was no difference in the task-oriented dimension of caring (von Essen, Burstron, & Sjoden, 1994). Widmark-Petersson et al. (2000) found, in a dyadic study of patients with cancer and their nurses, that patients regarded the subscales “accessible” and “explains and facilitates” as significantly more important than the nurses thought they did. Although much has been studied about the concept of caring in nursing, much remains to be investigated. There has been a recent focus in health care toward true patient-centred care, as an indicator of quality. The Institute of Medicine (IOM) was chartered in 1970 by the United States government as an independent advisor to improve the nation’s health. The IOM (2001), in its report Crossing the Quality Chasm, defined patient-centred care as care in which treatment recommendations and decisions are respectful of and responsive to patients’ preferences, beliefs, and values. Focus on patient-centred care requires adaptation to patient perceptions. True patient-centred care then requires congruency in patients’ and nurses’ perceptions of care. Perceptions relatives au caring chez les patients et les infirmières en oncologie