Kaiser Permanente, Northern California
Caritas Consortium 2013

Linking Caritas to HCAHPS: From Theoretical Construct to
E...
Linking Caritas to HCAHPS: From Theoretical
Construct to Empirical Survey Outcomes
Intent to Contribute Statement:
Context...
Linking Caritas to HCAHPS: From Theoretical
Construct to Empirical Survey Outcomes
… Continued
We evaluated seven of the c...
Linking Caritas to HCAHPS: From Theoretical
Construct to Empirical Survey Outcomes
Inspired Contributor(s) 1 :
 Jean Ann ...
Linking Caritas to HCAHPS: From Theoretical
Construct to Empirical Survey Outcomes
Watson Caring Theory
• The theoretical framework in which nursing care is
delivered at KP RWC Medical Center

• The theory...
CMS HCAHPS
• The Centers for Medicare and Medicaid Hospital
(CMS) Consumer Assessment of Healthcare
Providers and Systems ...
Purpose
• To propose a conceptual model of how the theory
and the evaluation of inpatient satisfaction might be
connected ...
Substruction
• Using a process called substruction, a conceptual
model was created to illustrate how the two might
be link...
Key Words of the Theory
• Relationships
• Connections
• Authentic
• Caring
• Healing
• Trusting

• Helping
Page 10

(Const...
Ten Caritas Processes™

(Concepts)

1. Embrace altruistic values and Practice loving
kindness with self and others.
2. Ins...
Ten Caritas Processes™

(Concepts)

4. Develop helping – trusting- caring relationships.
5. Promote and accept positive an...
Ten Caritas Processes™

(Concepts)

Share teaching and learning that addresses the
individual needs and comprehension styl...
HCAHPS Dimensions of Care

(Sub-Concepts)

• Communication-Nurses & Doctors
• Responsiveness

• Pain Management (Communica...
8 Dimensions of the HCAHPS Survey
Dimension (sub-concepts)

Survey Items (Empirical Indicators)

1.

Communication-Nurses
...
8 Dimensions of the HCAHPS Survey
Dimension (sub-concepts)

Survey Items (Empirical Indicators)

5.

Communication-New Med...
Watson Science of Caring & HCAHPS
Abstraction Level
Constructs →
(Caritas Key Words)
↓

Relationships −

Connections

Conc...
Conclusion
• The model can be used to help visually explain how
constructs and concepts of the Watson Science of
Caring Th...
References
• Dulock, HL, Holzemer, WL. Substruction: improving the
linkage from theory to method. Nurs Sci Q 1991
Summer;4...
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Linking Caritas to HCAHPS: From Theoretical Construct to Empirical Survey Outcomes

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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.

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

  1. 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. 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. 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. 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. 5. Linking Caritas to HCAHPS: From Theoretical Construct to Empirical Survey Outcomes
  6. 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. 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. 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. 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. 10. Key Words of the Theory • Relationships • Connections • Authentic • Caring • Healing • Trusting • Helping Page 10 (Constructs)
  11. 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. 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. 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. 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. 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. 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. 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. 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. 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
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