60 ASSESSMENT AND EVALUATION
an integral component of contemporary nursing education and a stan-
dard for accreditation (Garbin, 1991; National League for Nursing
Accrediting Commission, 2001; Commission on College Nursing Educa-
tion, 2002). Daggett, Butts, and Smith (2002) suggested that evidence-
based clinical practice and educational outcomes for nursing students are
interconnected. Measuring educational outcomes and using the resultant
data to continuously improve end-of-program competencies contribute
to quality patient care and fulfill an important social responsibility of
Educational outcomes evaluation is the “systematic process of col-
lecting and interpreting information as a basis for decisions about learn-
ers” (Oermann & Gaberson, 1998, p. 3). The National League for
Nursing Accrediting Commission (NLNAC) has defined program evalu-
ation as “the constant assessment and refinement of the program through
a combination of process-focused and outcomes-focused approaches”
(p. 3). It forms the basis for judging the quality and ultimately the
value of a program. The recent emphasis on evidence-based quality
improvement has shifted the focus of program evaluation to a student
outcomes-focused approach. Educational outcomes are the result of the
teaching and learning process; they are frequently measured formatively
with tools such as quizzes, examinations, skills assessments, and written
papers. Summative evaluation, on the other hand, occurs at the end of
a course or program to determine if objectives have been met and are
the basis for curricular revision. End-of-program evaluation of students’
performance, a form of summative evaluation, occurs at graduation and
“provides culminating information about internal educational effective-
ness” (Lenburg, 1991, p. 35).
Students’ performance on key indicators at the time of graduation
is an essential component of comprehensive outcomes assessment. Sum-
mative evaluation of concepts considered central to the program’s curric-
ulum and based on that program’s philosophy and objectives provides
important evidence of programmatic success. Such evaluation helps
meet the mandate of producing competent clinicians who ground their
practice in research. “The most significant indicators of success are
whether or not graduates can meet professional expectations” for prac-
tice (Lenburg, 1991, p. 35). One such practice expectation is caring.
Caring and its associated values, attitudes, and behaviors is consid-
ered a major component of professional nursing education (American
Association of Colleges of Nursing [AACN], 1998) and has been de-
WANT TO GRADUATE NURSES WHO CARE? 61
scribed as the essence of nursing (Watson, 1979, 1985). The nursing
curricular revolution of the 1980s (Tanner, 1990), together with the
American Nurses Association’s (ANA) revised Social Policy Statement
for Nurses (2003), have promoted the renewed focus on caring and
caring knowledge. The curricular revolution encouraged nurse educators
to revise curricula to meet the needs of a significantly changed health care
system. New pedagogies emerged such as Toward a Caring Curriculum: A
New Pedagogy for Nursing (Bevis & Watson, 1989) that challenged
nursing educators to teach, role model, and develop innovative learning
strategies that promote caring. The Social Policy Statement for Nurses
(ANA, 2003) acknowledges that “provision of a caring relationship that
facilitates health and healing” (p. 5) is an essential feature of nursing
Caring content is typically integrated throughout nursing curricula
but is rarely included in skills labs or other competency-based examina-
tions. It is frequently assessed formatively during students’ clinical
courses. However, minimal end-of-program evidence exists about nurse
caring resulting in a paucity of knowledge about graduates’ competency
in this crucial area. The purposes of this chapter then are to discuss
what is known about nurse caring in the educational environment and
to suggest methods for assessing the learning outcome of students’
competence in caring on graduation.
REVIEW OF RELEVANT LITERATURE
Although caring exists in a generic sense in all cultures (Leininger,
1988), the caring that exists in nursing practice is embedded in the
daily work of nurses and has as its aim health and healing (Duffy, 2002).
Caring competence in nurses, better known as clinical caring processes
(Watson, 2002b), represent those values, attitudes, and behaviors that
engender “feeling cared for” by recipients. Clinical caring processes are
relationship-centered and incorporate physical acts, being with (inter-
acting), connecting, and knowing another (Duffy, 2003). Caring is theo-
rized to make a difference in patients’ sense of well-being, dignity,
healing abilities, and self-knowledge, while simultaneously benefiting
nurses (Watson, 1985). Caring is an expectation of patients and families
and is the predominant adjective used by nursing students and nurses
to characterize nursing practice (Duffy, 2003). Nurse caring is consid-
62 ASSESSMENT AND EVALUATION
ered the core or essence of nursing (Watson, 1985) and the basis for
Measurement of Nurse Caring
Over the past two decades, nurse caring has been studied both qualita-
tively and quantitatively. Early qualitative studies have helped define,
assess the importance of, and evaluate the meaning of caring in various
patient populations (Cronin & Harrison, 1988; Larson, 1987; Reiman,
1986; Swanson-Kaufman, 1986). Quantitative studies have added to the
knowledge base regarding the measurement of nurse caring (Cronin &
Harrison, 1988; Coates, 1997; Duffy, 1990; Wolf, 1986). Various mea-
sures of nurse caring have been developed, albeit with differing concep-
tual foundations and in specialized populations; they are currently
organized in a recent publication (Watson, 2002a). Additionally, studies
focused on nurse caring and patient outcomes have begun to link nurse
caring with patient satisfaction, and other positive patient outcomes
(Duffy, 1992; Issel & Kahn, 1998; Latham, 1996; Larson & Ferketich,
1999). The obvious implication is that health care outcomes are en-
hanced as a result of human caring interactions with nurses.
Nurse Caring in Schools of Nursing
Educational studies of caring can be grouped into two broad categories:
experiences of caring and caring teaching strategies. Hanson and Smith’s
(1996) phenomenological study identified three themes of faculty caring
based on interviews with nursing students: recognition, connection, and
confirmation. The congruence of these characteristics with Watson’s
carative factors (Watson, 1979, 1985) implies that faculty should strive
for connectedness with students in an effort to maximize learning.
In Beck’s (2001) metasynthesis of caring within schools of nursing,
14 qualitative studies were analyzed. Using a meta-ethnographic method,
four major themes emerged: caring among faculty, faculty–nursing stu-
dent caring, caring among nursing students, and caring between nursing
students and patients. The central component of these themes was
“reciprocal connecting” which consisted of presencing, supporting, shar-
ing, competence, and uplifting effects. This synthesis of caring knowl-
WANT TO GRADUATE NURSES WHO CARE? 63
edge in education was limited by the small sample size, but, nevertheless,
provided a model for creating caring environments in schools of nursing.
Beck suggested that experiencing caring in the educational environment
is contagious and even has a “trickle down effect” (p. 108) that can be
translated into the practice environment.
Teaching caring is controversial; yet, several studies were found that
suggested strategies that proved successful. In an early study, Darbyshire
(1994) investigated the use of the arts and humanities to arouse a deeper
appreciation of caring. Using a phenomenological approach, the author
concluded that the students experienced this course as inclusive and
cohesive; it allowed them to be open to new ways of learning about a
concept already known. Simonson (1996) also used a phenomenological
approach to study how faculty communicates caring to students.
Through interviews with faculty and students and classroom observa-
tions, she found patterns that were congruent with Watson’s carative
factors. She concluded that faculty must exhibit caring as “a way of
being” if they wished to teach it. Similarly, Gramling and Nugent (1998)
suggested that knowledge of caring is attained through role modeling.
They used Watson’s carative factors in a reflective journaling process
together with a didactic caring unit that was placed in a professional
nursing course early in the program. They found that when caring is
introduced early, together with the concept of health, and modeled and
reinforced throughout the curriculum, students’ performance shifted
Grams, Kosowski, and Wilson (1997) used student/faculty groups
to study how to create a caring community in nursing education. The
aim was to allow students to experience caring through these groups.
Using a phenomenological approach, including interviews with 25 sub-
jects, the authors identified three patterns, namely, the creation of a
caring community, experiencing reciprocity, and being transformed.
Characteristics of the student/faculty relationships included mutual re-
spect, helpfulness, attentive presence, recognition, connection, affirma-
tion, meeting needs, role modeling, and genuineness. They concluded
that students learn caring through faculty role modeling and must expe-
rience it if they are to practice caring.
64 ASSESSMENT AND EVALUATION
Similarly, Schaffer and Juarez (1996) developed a strategy to en-
hance caring in the learning environment and also concluded that the
use of opportunities for genuine dialog between students and faculty
resulted in increased communication, support, and reciprocal relation-
ships. In this study, a sample of 42 seniors and 34 juniors met in small
groups with a faculty facilitator four times a semester. This was purposely
scheduled during class time to assure adherence. The authors concluded
that teaching caring involves more than “how to” but includes role
modeling. They believed the intervention was worth the 16 hours of
Pullen, Murray, and McGee (2001) reported on a new teaching and
learning strategy employed after students expressed concerns about
faculty. Issues such as inconsistency of grading, perceived lack of pa-
tience, and unavailability created anxiety in students regarding perfor-
mance in the skills laboratory. Using Watson’s carative factors, a pilot
study was instituted for five faculty members who agreed to mentor
one to five students each during the skills laboratory course. The consis-
tency of a mentor who developed a trusting relationship and nurtured
faith/hope resulted in decreased student anxiety and increased skill
competence. Although limited, the authors concluded that use of the
“care” group had the single most important effect on students’ improve-
ment in performance.
Hoover (2002) investigated a 15-week course developed to assist
students’ capacity to be caring practitioners. Twenty-five students partic-
ipated; focus group interviews of 30–60 minutes each were audiotaped
and transcribed for each session. Findings of this study included the
identification of interesting themes. First, students reported increased
self-awareness related to clarification of values and connecting relation-
ships. Second, a professional impact was reported in which an increased
knowledge of caring and holistic practice was obtained. Hoover con-
cluded that this work provided evidence that caring practices may be
enhanced through education.
In summary, nurse caring behaviors in nursing education have been
studied (Table 4.1), albeit qualitatively, and using one predominant
method. Faculty caring through role modeling seems to enhance stu-
dents’ caring behaviors, while students’ knowledge of caring increases
through innovative teaching methods. The available literature has pro-
vided nursing faculty with preliminary evidence about teaching and
learning nurse caring; however, gaps and inconsistencies remain in terms
WANT TO GRADUATE NURSES WHO CARE? 65
TABLE 4.1 Summary of Educational Studies: Teaching and Learning
Study Design Sample Results
Beck, 2001 Meta- 14 qualita- Four major themes; unifying compo-
analysis us- tive studies nent = “reciprocal connection”
Darbyshire, Phenomeno- Small Students who experienced the use of
1994 logical arts and humanities opened up to
new ways of learning caring
Gramling & Evaluation NA Knowledge of caring attained
Nugent, methodo- through faculty role modeling; caring
1998 logy introduced early in the curriculum
and reinforced throughout
Grams, Phenomeno- 25 students Student/faculty groups identified 3
Kosowski,& logical patterns: creation of caring commu-
Wilson, nity, experiencing reciprocity, and be-
1997 ing transformed
Hanson & Phenomeno- Small Three themes emerged: recognition,
Smith, 1996 logical connection, and confirmation
Hoover, Focus 25 students After 15-week course students re-
2002 Groups ported increased self-awareness and
increased knowledge of caring, sug-
gesting caring can be enhanced
Pullen, Evaluation 10–15 stu- Consistency of caring faculty mentor
Murray, & pilot study dents in decreased student anxiety and in-
McGee, skills lab creased skill competence
Schaffer & Evaluation 42 seniors Teaching caring includes not only
Juarez, 1996 methodo- and 34 ju- “how to” but role modeling
Simonson, Phenomeno- Small Consistent with Watson’s (1985) car-
1996 logical ative factors; faculty should exhibit
caring as a “way of being”
68 ASSESSMENT AND EVALUATION
are apparent. Intermediate outcomes represent a change in students’
behaviors, emotions, or knowledge while terminal outcomes are those
major end-result concepts that affect the future of a program. Such
variables as satisfaction, personal growth, specific student learning out-
comes, and resource use are examples. There are reciprocal interactions
between intermediate outcomes and terminal outcomes (see Figure 4.1).
Intermediate outcomes often include attainment of specific learning
goals but also can include feelings about the learning process. Of impor-
tance is the intermediate outcome—feeling “cared for.” “When one feels
‘cared for,’ a sense of security develops making it easier to learn, change
behaviors, and take risks” (Duffy & Hoskins, 2003, p. 83). Students
who feel “cared for” while in the learning environment have reported
less anxiety and more skill acquisition (Pullen et al., 2001). Although
not reported in the literature, faculty who feel “cared for” in the work
environment may report increased satisfaction.
The major proposition of the model is that relationships character-
ized by caring contribute to positive educational outcomes. Furthermore,
the structure-process-outcomes components are a function of time and
circumstance and are not simply a linear chain of events. Ongoing
feedback and revisions are consistent with a continuous search for
With a foundational model as a guide, several approaches for assessment
of nurse caring behaviors are recommended, culminating in end-of-
program summative evaluation. Measuring nurse caring can be accom-
plished from the perspective of the student, the faculty, and most im-
portant, the recipients of caring (patients). Although subjective, student
self-reports of nurse caring can provide a baseline at program entry and
then be followed annually (or more frequently) to determine improve-
ment. This allows for trending by program level and over time.
The Caring Abilities Index (CAI) (Nkongho, 1990) is an example
of an instrument that can be used for student self-report. This instrument
is a 37-item tool that quantifies a person’s degree of caring ability
relative to others. The conceptual basis for the CAI is Mayerhoff’s (1971)
philosophy of caring in which eight indicators comprise the concept
and form the basis for item development. Content validity was estab-
lished and factor analysis revealed three distinct subscales, namely,
knowing, patience, and courage. Coefficient alphas for each of the sub-
WANT TO GRADUATE NURSES WHO CARE? 69
scales range from .71–.90 with an overall alpha of .81. Test–retest relia-
bility at 2-week intervals was .75. The close item responses (1 strongly
disagree to 7 strongly agree) are summed and interpreted as low, me-
dium, and high caring.
Faculty perceptions of students’ caring behaviors are paramount
and are typically used in the formative clinical evaluation process. As
experts in nursing and role models of nurse caring, faculty members
can assess (through observation) students’ interactions with patients,
families, and members of the health care team. Such assessment, when
communicated to students through constructive feedback, provides an
important viewpoint through which revised behaviors can be developed.
Ongoing faculty assessment of students’ caring behaviors can also be
assessed by faculty through written reflections, clinical logs, and care
plans. Finally, students’ caring behaviors can also be assessed by faculty
during verbal presentations and interactions with peers in the classroom.
Probably the most important measure of nursing students’ caring
competence is patients’ perceptions. Determining how patients and their
families perceive students’ interactions is a direct measure of their (stu-
dents’) ability to translate the concept of caring to the bedside. Using
tools for measuring nurse caring during the educational process provides
faculty and students alike with opportunities to better understand how
patients and families perceive their care. An example instrument is the
Caring Assessment Tool (CAT-version II) developed by this author
(Duffy, 1990). This 100-item instrument has established validity and
reliability, is theoretically based and assesses patients’ perceptions of
nurse caring. Twenty minutes are generally required to complete the
questionnaire and a 5-point Likert scale is summed for a total score.
Evaluations of patients’ perceptions of student nurse caring behav-
iors can be carried out during clinical nursing courses. Although not
technically considered research, because patients are involved in comple-
tion of questionnaires, faculty members should become aware of clinical
sites’ policies regarding data collection. In some cases, the process may
require approval from the Internal Review Board.
Nurse Caring and the Program Evaluation Plan
As an important indicator of a quality nursing curriculum, assessing
students’ caring competence can best be accomplished both formatively
and summatively. The school’s evaluation plan should reflect the facul-
ty’s decisions about responsibility, frequency of assessment, specific
70 ASSESSMENT AND EVALUATION
measurements, and acceptable criteria. Choosing instruments that are
practical and have established psychometric properties is essential. For-
mative assessment of students’ caring competence is best evaluated from
multiple points of view. From the students’ perspective, self-assessment
data can be gathered on admission and then annually thereafter to
Clinical evaluation tools can be amended to include an objective
measure of nurse caring that is consistent across the program. Such a
measure can be as simple as one item (Figure 4.2) with higher scores
expected as students progress in the program or composed of multiple
items that are summed for a total score. Faculty evaluation of students’
caring competencies can then be easily assessed in each clinical course
and compared across the program. To prevent faculty and patient bur-
den, one summative evaluation is recommended at the culmination
of the program from the perception of the patient. Scores from such
evaluations should be shared with students and used by faculty (along
with the other evaluations) to provide feedback about performance and
make judgments about the effectiveness of the curriculum in preparing
Finally, students’ perceptions of faculty caring behaviors (e.g., feel-
ing “cared for”) can be assessed using established instruments. As noted
in the literature review, creating caring environments during the educa-
tional process and role modeling caring seem to raise awareness and
facilitate learning. Assessing students’ perceptions of faculty caring can
yield important data about the structure and process of the educational
program. The Caring Assessment Tool–Educational Version (CAT-edu)
(Duffy, 2002) is an example instrument for evaluating this valuable
educational outcome. The CAT-edu is a 94-item instrument scored in
Demonstrates caring to facilitate spiritual, mental, and physical health.
FIGURE 4.2 Faculty assessment of student nurse caring behaviors.
Adapted from The Catholic University of America Performance Evaluation Tool. Reprinted
WANT TO GRADUATE NURSES WHO CARE? 71
Likert format designed to capture students’ perceptions of faculty caring.
Validity and reliability have been established.
NURSING EDUCATIONAL RESEARCH
This comprehensive approach to assessing students’ caring competencies
together with ongoing educational research will build an evidence-based
foundation for assuring an important learning outcome. To that end,
responding to a call for educational research from the National League
for Nursing, I proposed and was awarded funding to investigate how best
to assess the caring competencies of senior nursing students. Features of
this ongoing study, Caring Competencies of Graduating Baccalaureate
Students, are noted as follows:
This study seeks to answer the following questions:
1. What is the feasibility of using the Caring Assessment Tool—
Version II (CAT-version II) among senior baccalaureate
2. How do self-reports, faculty perceptions, and patient percep-
tions of student nurse caring behaviors vary among senior
baccalaureate students during their final clinical course?
3. What are the relationships between selected student variables
and patients’ perceptions of student nurse caring behaviors?
4. How do senior baccalaureate students describe the experience
of participating in an ongoing research project?
This nonexperimental, correlational study used a purposive sample
of 50 students selected voluntarily from two schools of nursing during
the students’ final clinical course. Five instruments were used: a demo-
graphic form, the CAI (Nkongho, 1990), the CAT-version II (Duffy,
1990), the Faculty Assessment Tool (The Catholic University of America,
2000), and a Student Evaluation Form. After approval from the Human
Subjects Committees of the two schools of nursing and associated clinical
agencies, the principal investigator met with the teaching faculty of the
clinical courses to review the study protocol (see Table 4.2). Students
were recruited during class time and offered a 1-hour review class of
their choice as an incentive for participation. In addition, student sub-
jects received an analysis of their patients’ perceptions of nurse caring
at the end of the study.
72 ASSESSMENT AND EVALUATION
TABLE 4.2 Summative Evaluation of Baccalaureate Students’ Nurse
Caring Behaviors Study Protocol
After IRB approval from clinical agencies and student selection:
1. Prior to clinical course, faculty will attend a 1-hour training session to
include procedure for administration of CAT to patients, faculty responsi-
bilities, and the required one-item faculty evaluation of students’ nurse
2. During class time, the principal investigator (PI) will administer the Stu-
dent Demographic Form and the CAI to student subjects.
3. Student subjects will attend a 30-minute educational session regarding
interacting with patients for the purpose of research including informed
4. During the final clinical course, student subjects will select three pa-
tients whom they have cared for at least once and discuss with faculty
the appropriateness of patients for study.
5. Once approved by faculty, student subjects will complete the patient in-
formed consent procedure.
6. After obtaining patient informed consent, student subjects will adminis-
ter the CAT to the three patients.
7. Faculty will accompany the student subjects to the first patient CAT
8. At course completion, faculty will complete the one-item student evalua-
tion of nurse caring.
9. At course completion, student subjects will complete the Student Evalua-
10. The 1-hour review class will be performed by the PI at a time of the stu-
dent subjects’ convenience during the semester.
Those students expressing a desire to participate in the study com-
pleted an informed consent, the Demographic Form, and the CAI. After
attending an educational session, student subjects selected a minimum
of three patients who they cared for at least once in their clinical course.
After conferring with the instructor and obtaining patient informed
consent, the students administered the CAT-version II to the three
selected patients. At the completion of the data collection period, student
subjects completed the Student Evaluation Form to help the researcher
evaluate the feasibility of the process. Faculty members completed the
Faculty Assessment Tool at the completion of the course.
WANT TO GRADUATE NURSES WHO CARE? 73
The study design was chosen not only to summatively assess gradu-
ating students’ caring competencies, but also to provide students experi-
ence in the informed consent and data collection process and to assess the
practicalities of the methodology. Consequently, the study has several
limitations. The purposive sample limits the results to this sample only.
Self-selection of patient subjects by the students may lead to bias, and
students may inadvertently alter their interactions with these patients,
thereby influencing the study results. Partial control for this has been
built into the study methodology by measuring the mean total scores
on the CAT-version II obtained from three patients.
Preliminary results include a mean student age of 22.9 years, all
female, with 85% generic students who have less than 12 months of
clinical experience. Mean scores on the CAI were 208, indicating a
moderate degree of self-reported student caring. An inverse relationship
was found between student total years of education and self-reported
caring competencies (r = −.43, p < .001). No other significant relation-
ships were noted among student demographic variables and self-reported
In terms of feasibility, approval from clinical site Internal Review
Boards took longer than anticipated and the time required during clinical
courses for student administration of the CAT-version II was a barrier.
Faculty willingness to facilitate the process was crucial. Those students
who completed the process indicated that the experience was helpful
in terms of learning the informed consent process, and they seemed
better informed about their patients’ perceptions of nurse caring behav-
iors. Some used the results to revise their practice and suggested that
the process be introduced and followed earlier in the educational pro-
gram. The study is ongoing until the summer of 2005, when final results
will be presented.
Despite the noted limitations, empirical evidence will be generated
from the study’s results, yielding important evidence about a major
curricular concept. This information will strengthen the evaluation
model in the two schools of nursing and provoke examination of associ-
ated structure and process variables. Results will add to the validity and
reliability of CAT-version II and its usefulness in program evaluation.
The different perspectives of nurse caring will help determine the appro-
priate approach for further study and will inform other nursing educa-
tional researchers. Future studies may be designed based on these results
74 ASSESSMENT AND EVALUATION
with larger probability samples that may lead to a comparative database.
As one approach to assessing caring competencies at graduation, this
study provides a blueprint for future program evaluation.
Because nurse caring has been linked to patient outcomes, students’
competence upon graduation from nursing programs must be assured.
Programmatic evaluation, then, should include caring as an important
(if not crucial) student learning outcome that is evaluated both forma-
tively and summatively. The nursing educational literature has provided
models for promoting caring environments for learning, faculty role
modeling, and specific teaching strategies that have successfully im-
proved students’ caring practices. This chapter has provided a framework
and several approaches to assessing students’ caring competencies. In
addition, an ongoing educational study is discussed that seeks to under-
stand how best to assess nursing students’ caring competencies. Results
of this study will provide further direction to nurse educators and
stimulate new inquiries.
Although evaluation of nursing students’ caring competencies pre-
sents challenges for nursing educators, the suggested approaches may
assist in program evaluation. Data gathered in a comprehensive manner
and used in curricular revision provides evidence of an essential practice
expectation. Strengthening the link between student learning outcomes
and clinical practice ultimately contributes to meeting the needs of
patients and their families for caring interactions with nurses.
American Association of Colleges of Nursing (AACN). (1998). The essentials of
baccalaureate education for professional nursing practice. Washington, DC:
American Nurses Association (ANA). (2003). The social policy statement for nurses.
Washington, DC: Author.
Beck, C. T. (2001). Caring within nursing education: A metasynthesis. Journal of
Nursing Education, 40, 101–109.
Bevis, E. O., & Watson, J. (1989). Toward a caring curriculum: A new pedagogy for
nursing. New York: National League for Nursing Press.
76 ASSESSMENT AND EVALUATION
Latham, C. P. (1996). Predictors of patient outcomes following interactions with
nurses. Western Journal of Nursing Research, 18, 548–564.
Leininger, M. (1988). Leininger’s theory of nursing: Culture care diversity and
universality. Nursing Science Quarterly, 1, 152–160.
Lenburg, C. (1991). Assessing the goals of nursing education: Issues and approaches
to evaluations outcomes. In M. Garbin (Ed.), Assessing educational outcomes
(pp. 25–51). New York: National League for Nursing Press.
Mayerhoff, M. (1971). On caring. New York: Harper & Row.
Nkongho, N. (1990). The caring ability inventory. In O. Strickland & C. Waltz
(Eds.), Measurement of nursing outcomes (pp. 3–5). New York: Springer Publish-
National League for Nursing Accrediting Commission (NLNAC). (2001). Planning
for ongoing systematic evaluation and assessment of outcomes. New York: Author.
Oermann, M. H., & Gaberson, K. (1998). Evaluating and testing in nursing education.
New York: Springer Publishing Co.
Pullen, R., Murray, P., & McGee, K. (2001). Care groups: A model to mentor novice
nursing students. Nurse Educator, 26, 283–288.
Reiman, D. J. (1986). Non-caring and caring in the clinical setting. Topics in Clinical
Nursing, 8, 30–36.
Schaffer, M., & Juarez, M. (1996). A strategy to enhance caring and community in
the learning environment. Nurse Educator, 21(5), 43–37.
Simonson, C. (1996). Teaching caring to nursing students. Journal of Nursing Educa-
tion, 35, 100–104.
Swanson-Kaufman, K. (1986). Caring in the instance of unexpected early pregnancy
loss. Topics in Clinical Nursing, 8, 37–46.
Tanner, C. (1990). Reflections on the curriculum revolution. Journal of Nursing
Education, 29, 295–299.
The Catholic University of America School of Nursing (2000). Clinical performance
behavior tool. Washington, DC: Author.
Watson, J. (1979). Nursing: The philosophy and science of caring. Denver, CO: Univer-
sity of Colorado Press.
Watson, J. (1985). Nursing: Human science and human care: A theory of nursing.
Norwalk, CT: Appleton-Century-Crofts.
Watson, J. (2002a). Instruments for assessing and measuring caring in nursing and
health sciences. New York: Springer Publishing Co.
Watson, J. (2002b). Theory of human caring. Retrieved June 17, 2003 from
Wolf, G. (1986). The concept of caring and nurse-identified caring behaviors. Topics
in Clinical Nursing, 8, 84–93.