Mistreatment of nurses by patients and its impact on their caring behaviors: The roles of psychological detachment and supervisor positive gossip

BACKGROUND

Mistreatment by patients is a detrimental phenomenon predominant in healthcare organizations. However, there is a lack of nursing literature regarding the underlying mechanisms and boundary conditions that exist between mistreatment by patients and its detrimental consequences.

AIM

By integrating the Job Demands-Resources Model and the Conservation of Resources Theory, the study aimed to unveil the mediating role of psychological detachment from work in the relationship between mistreatment by patients and nurses' caring behaviors, as well as the moderating effect of supervisor positive gossip.

METHODS

This multicenter, cross-sectional study involved 341 nurses from five hospitals across two cities in Egypt. Data were collected using an introductory information form, the Mistreatment by Patients Scale, the Psychological Detachment Scale, the Caring Behaviors Scale, and the Supervisor Positive Gossip Scale. The study's hypotheses were tested using the PROCESS macro.

RESULTS

The results showed that mistreatment by patients was negatively related to nurses' caring behaviors via an increased psychological detachment. Further, higher levels of supervisor positive gossip were shown to weaken the direct effect of mistreatment by patients in increasing nurses' psychological detachment, as well as the indirect negative effect of mistreatment by patients on nurses' caring behaviors via psychological detachment.

CONCLUSIONS

Mistreatment by patients contributes to nurses' psychological detachment and decreased caring behaviors; however, these negative outcomes can be mitigated by supervisor positive gossip.

IMPLICATION FOR NURSING POLICYMAKING

Nursing managers should adopt strategies to deter the rise of mistreatment by patients, and utilize positive gossip to support nurses exposed to such mistreatment to alleviate its consequences.

Cultural adaptation and validation of the caring behaviors assessment tool into Spanish

BACKGROUND

The aim of the research was to translate, culturally adapt and validate the Caring Behaviors Assessment (CBA) tool in Spain, ensuring its appropriateness in the Spanish cultural context.

METHODS

Three-phase cross-cultural adaptation and validation study. Phase 1 involved the transculturation process, which included translation of the CBA tool from English to Spanish, back-translation, and refinement of the translated tool based on pilot testing and linguistic and cultural adjustments. Phase 2 involved training research assistants to ensure standardized administration of the instrument. Phase 3 involved administering the transculturally-adapted tool to a non-probabilistic sample of 402 adults who had been hospitalized within the previous 6 months. Statistical analyses were conducted to assess the consistency of the item-scale, demographic differences, validity of the tool, and the importance of various caring behaviors within the Spanish cultural context. R statistical software version 4.3.3 and psych package version 2.4.1 were used for statistical analyses.

RESULTS

The overall internal consistency of the CBA tool was high, indicating its reliability for assessing caring behaviors. The subscales within the instrument also demonstrated high internal consistency. Descriptive analysis revealed that Spanish participants prioritized technical and cognitive aspects of care over emotional and existential dimensions.

CONCLUSIONS

The new version of the tool proved to be valid, reliable and culturally situated, which will facilitate the provision of objective and reliable data on patients beliefs about what is essential in terms of care behaviors in Spain.

The mediating role of moral reasoning in spiritual intelligence and caring behaviors in Iranian emergency nurses

Moral reasoning is necessary to the nursing profession. Therefore, this study aimed to investigate the mediating role of moral reasoning in spiritual intelligence and caring behaviors among Iranian emergency nurses. In this descriptive-analytical study structural equation modeling (SEM) is employed for the data analysis. the minimum required sample size determined by the number of parameters of the model was 18. Considering that 5 to 15 samples were required for each of the parameters; the required sample size was 272. Nurses working in the emergency department of all hospitals in Qom, Iran, were selected by convenience sampling. Demographic characteristics inventory, King's Spiritual Intelligence Self-Report Inventory, Crisham's Nursing Dilemma Test, and Wolf's Caring Behaviors Inventory used for data collection. SPSS (V20) and Mplus were used to analyze the data. The results showed that a significant direct relationship was observed between moral reasoning and caring behaviors. According to SEM results, direct and indirect effects were observed of spiritual intelligence on caring behavior It is therefore recommended managers and hospital officials pay meticulous attention to spiritual intelligence and the power of decision-making in nurses to improve their caring behaviors.

The impact of job burnout on nurses' caring behaviors: Exploring the mediating role of work engagement and job motivation

AIM

To investigate the influence of job burnout on nurses' caring behaviors, with a specific focus on the serial mediating role of work engagement and job motivation.

BACKGROUND

Job burnout is a prevalent issue among nurses and poses significant challenges to their ability to deliver compassionate care. However, the underlying mechanisms that explain the relationship between job burnout and nurses' caring behaviors, which could provide valuable insights for developing targeted interventions and strategies to support nurse well-being and ensure the consistent provision of compassionate care, remain underexplored.

METHODS

A cross-sectional design was used to gather data from 520 clinical nurses working in various acute healthcare settings in the Philippines. Mediation analyses were conducted using the PROCESS Macro with Model 6.

RESULTS

Nurses exhibited high levels of caring behaviors (M = 4.219); however, they experienced moderate levels of job burnout (M = 2.342). Job burnout had a negative effect (β = -0.0603, p = 0.0482) on nurses' caring behaviors. Work engagement and job motivation sequentially mediated the relationship between job burnout and nurse caring behaviors (β = -0.0126, p < 0.05).

CONCLUSIONS

Higher levels of job burnout were associated with a decreased demonstration of nurses' caring behaviors. Job burnout among nurses led to a decrease in their level of work engagement and job motivation, ultimately impacting their ability to provide caring behaviors to patients.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Organizations should prioritize creating a positive work environment and implementing theory-driven strategies to address job burnout, which can foster work engagement and job motivation among nurses, thereby providing crucial support for them in delivering high-quality, compassionate care to patients.

Organizational display rules in nursing: Impacts on caring behaviors and emotional exhaustion through emotional labor

AIM

To examine the impact of display rules on nurses' caring behaviors and emotional exhaustion and the mediating role of emotional labor (surface/deep acting).

BACKGROUND

Hospitals often implement emotional display rules for nurses with the expectation of performance benefits. However, these rules may have an impact on nurses' caring behaviors and emotional exhaustion.

METHODS

This cross-sectional correlational study included a sample of 746 nurses from five hospitals and used the STROBE checklist. Relationships between display rules, emotional labor, caring behaviors, and emotional exhaustion were analyzed using structural equation modeling.

RESULTS

Display rules did not directly affect caring behaviors or emotional exhaustion. Emotional labor mediated the relationships. Display rules were associated more with surface acting. Deep acting increased caring behaviors and reduced emotional exhaustion; surface acting had the opposite effect.

CONCLUSIONS

Findings challenge the assumption that display rules effectively promote caring behaviors. Display rules lead to emotional labor and emotional exhaustion. Reducing display rules, emotional labor, and surface acting while supporting deep acting may alleviate emotional exhaustion.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Nurse managers should review the nature and implementation of emotional display rules and explore ways to reduce emotional labor, encourage deep acting, mitigate the negative impact of surface acting, and ultimately improve nursing caring behaviors.

Patients' perceptions of caring behaviors at referral hospitals in Ethiopia: A cross-sectional survey

Objective

The purpose of this study was to determine patients' perceptions of nurse caring behaviors and to identify factors associated with these perceptions.

Methods

A cross-sectional study was conducted at three referral hospitals in Ethiopia. A consecutive sample of male and female patients (n = 652, response rate 98.8%) was interviewed using the Amharic version of the Caring Behaviors Inventory-16 (CBI-16, including four subscales: Assurance, Knowledge and skill, Respectful, and Connectedness) and the Patient Satisfaction Instrument (PSI). Socio-demographic and clinical factors associated with perceptions of caring behaviors were identified using multiple linear regression analysis.

Results

Patients' perceptions of nurse caring behaviors were high (total Mean = 4.86, SD = 0.72). Behaviors related to the Assurance subscale were rated the highest. The multiple linear regression analysis result showed several socio-demographic and clinical factors statistically significantly associated with patients' perceptions of caring behaviors (total mean scores). Patients who were 40-49 years (B = -0.19, P = 0.012) and single (B = -0.13, P = 0.03) scored lower on total CBI-16 scores. Whereas, patients who had a higher educational level (B = 0.35, P = 0.001), cared for at surgery units (B = 0.11, P = 0.027), and reported having spent more time with a nurse in the past 8-h shift (B = 0.16, P < 0.001) were more likely to have higher perceptions of the care they received. The CBI-16 was positively correlated with satisfaction with received care, as measured with the Patient Satisfaction Instrument (r = 0.62, P < 0.001).

Conclusion

Hospitalized patients in Ethiopia have overall high perceptions of nurse caring behaviors, especially with regard to physical-based caring, while their expectations of emotional-focused care are lower. We identified patients who were in need of care, patients aged 40-49 years and single. The time spent with nurses plays a pivotal role in patients' perceptions of nurse caring behaviors.

The relationship between professional values, ethical sensitivities and caring behaviors among nursing students: A structural equation modeling approach

AIM

To examine the relationship between professional values, ethical sensitivity and caring behaviors among nursing students and determine whether professional values play a moderator role in the relationship between ethical sensitivity and caring behaviors among nursing students.

BACKGROUND

Developing professional nursing values, ethical sensitivity and caring behaviors is critical in nursing programs from the first year to graduation to prepare students for increasingly complex and diverse work environments.

DESIGN

A cross-sectional study using structural equation modeling. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used.

METHODS

This study was conducted with 189 undergraduate nursing students. The study was conducted in a four-year nursing faculty in the Mediterranean region of Turkey from February to June 2022. Data were collected using a personal information form, the Nurses' Professional Values Scale, the Moral Sensitivity Questionnaire and the Caring Behaviors Assessment Tool Nursing Version-Short Form.

RESULTS

We found that nursing students' perceptions of professional values and caring behaviors were high and their ethical sensitivity was moderate. Nursing students who are successful in high school have higher professional values. In addition, it was determined that nursing students who chose the nursing profession because of altruism had higher perceptions of caring behaviors. A positive relationship exists between professional values, ethical sensitivity (r = -0.258, p < 0.001) and caring behaviors (r = 0.431, p < 0.001) (p < 0.05). Professional values have a positive effect on ethical sensitivity and caring behaviors.

CONCLUSION

Professional values, ethical sensitivity and caring behaviors are relationships and professional values positively predict nursing students' ethical sensitivities and caring behaviors. As the professional value perceptions of nursing students increase, their ethical sensitivity and caring behaviors increase. Improving the curricula in a way that will improve professional values may enable nursing students to increase their ethical sensitivity and caring behaviors. The research contributes to a broader understanding of nursing education curriculum content.

Online education and improvement of caring behaviors of nurses in pediatric wards: a quasi-experimental study

BACKGROUND

Nurses working in pediatric wards should communicate with children well and have appropriate caring behaviors according to the age of their patients, so distance education is very suitable for them due to its availability. This study aimed to determine the effect of online education on the principles of pediatric nursing care on the caring behaviors of nurses working in pediatric wards.

METHODS

This interventional (quasi-experimental) study used a simple random method to select 70 nurses working in pediatric wards and pediatric intensive care units in Kerman. The nurses in the intervention group received online training in the sky room three days a week, while nurses in the control group received routine pediatric care. The study instruments were the demographic information questionnaire and the Caring behaviors Questionnaire, which were completed by two groups before and one month after the intervention. Data were analyzed with SPSS 25. The significance level was set at P < 0.05.

RESULTS

The independent samples t-test indicated no significant differences in the mean scores of care behaviors between the intervention (256.61 ± 5.16) and control groups (257.52 ± 3.99) before the intervention (P = 0.23) but indicated a significant difference in the mean scores of caring behaviors between the intervention (275.69 ± 6.52) and control groups (254.21 ± 3.15) after the intervention. Therefore, online education increased the score of caring behaviors in the intervention group.

CONCLUSION

Distance education had an impact on the caring behaviors of nurses in pediatric wards and we recommend the use of e-learning to improve the caring behaviors and the quality of care of nurses.

Illuminating Emergency Nurses' Perceptions of Stigma, Attribution, and Caring Behaviors Toward People With Mental Illness Through the Lens of Individualized Care: A Cross-sectional Study

INTRODUCTION

Emergency nurses' negative attitudes and lack of caring have been identified as factors affecting the experience of individuals with mental illness in emergency departments. This study examined the relationships between emergency nurses' perceptions of stigma, attribution, caring behaviors, and individualized care toward people with mental illness.

METHODS

A cross-sectional study was conducted among 813 nurses working in United States emergency departments. Data were collected using a demographic questionnaire; the Mental Illness: Clinicians' Attitudes Scale-4; the Attribution Questionnaire; 24-Item Caring Behaviors Inventory; and the Individualized Care Scale-Nurse version. Data analyses consisted of descriptive and correlation statistics and multiple linear regression.

RESULTS

The findings from the final regression analysis revealed that caring had a significant relationship with individualized care (version A: β = 0.70, P < .001; Version B: β = 0.73; P < .001). Stigma and attribution had significant inverse relationships with individualized care (β = -0.07, P < .01; β = -0.06, P < .05, respectively).

DISCUSSION

The results of this study indicated that emergency nurses' perception of individualized care toward people with mental illness is mostly associated with the nurses' level of caring behaviors toward this population. Stigma and attribution had little to no effect. Findings from this study reinforce nurses' altruistic and caring qualities. The findings suggest the need for a possible paradigm shift from antistigma training to trainings that prioritize caring behaviors toward mental illness. This could ultimately improve health equity, safety, and overall outcomes for people with mental illness.

Student perceptions of faculty caring in online nursing education: A mixed-methods study

BACKGROUND

As the prevalence of online nursing education increased, so did the need for faculty to understand student perceptions of faculty behaviors that demonstrate caring and promote student success. Literature from both education and nursing journals supported this study.

OBJECTIVES

Primary objectives were to identify how the value of caring is made visible in online learning, to understand how students prioritized faculty caring behaviors and to identify any significant differences in perceptions related to student demographics. A secondary objective was to provide professional development tools for faculty who teach nursing students in the online environment.

DESIGN

Mixed methods.

SETTING

A College of Nursing within a large public university in the Southeastern United States.

PARTICIPANTS

One hundred and forty-one (141) nursing students pursuing graduate degrees (MSN or DNP) participated in the student survey and 15 participated in the focus groups/interviews; 28 faculty members responded to the survey.

METHODS

A validated survey tool was used to identify how students prioritized faculty caring behaviors. Facilitator-led focus groups were used to gain additional insights. Faculty members were surveyed to compare faculty and student priorities. Descriptive and correlational analyses were performed.

RESULTS

Graduate nursing students perceived a course that is well-designed, with clear instructions and communication, and a supportive environment, to be evidence of faculty caring. There were significant differences in student responses when analyzed by demographic characteristics such as gender and race. Student perceptions aligned with previous research on this topic; faculty and student perceptions differed in some areas.

CONCLUSION

Quantifying graduate student perceptions about faculty caring behaviors provided information that is used for faculty professional development. Further research is needed to explore perceptions of faculty caring in different student populations. Multi-site studies to explore race and gender differences in perception are also recommended.

The effect of an empowerment program on the moral sensitivity and caring behaviors of emergency nurses in Iran

AIM

The present study aimed to evaluate the effect of an empowerment program on the moral sensitivity and caring behaviors of nurses in emergency departments in Iran.

BACKGROUND

Emergency department is often a high stress environment. Nurses who worked in the emergency departments are expected to work under pressure to many standards, guidelines and protocols related to patient care. It will expose emergency department nurses to psychological pressures and moral conflicts. A nurse's sensitivity to ethical issues is necessary to provide humane care; it is considered to be a professional competence for nurses.

METHODS

This study had a controlled quasi-experimental design. Data were collected before, immediately after, and 1 month after the intervention using a moral sensitivity questionnaire and a caring behavior questionnaire. A total of 131 emergency department nurses from 4 teaching hospitals were divided into an intervention group and a control group. The intervention group received six 60-minute training sessions; the control group did not receive the training.

RESULTS

The mean moral sensitivity and caring behavior scores for both groups increased significantly immediately and 1 month after the intervention. However, the significance was higher in the intervention group than in the control group. A comparison of the mean moral sensitivity and caring behavior scores between the groups immediately and 1 month after the intervention did not show a statistically significant difference.

CONCLUSIONS

Implementing a training program on ethical issues could thus have a significant impact on the clinical performance of nurses, which could be maintained through follow-up.

Caring in process: A 3-year qualitative longitudinal study of nursing students

AIM

This paper aims to describe caring perceptions and behaviors among student nurses in Italy as they progress through their nursing education.

BACKGROUND

As nursing students are potential nurses of the future, there is an expectation that in addition to appropriate academic qualifications, they will develop appropriate caring behaviors/attitudes. However, there has been some evidence that the educational process does not always modify their caring perceptions/behaviors or that the direction of the change is not always positive.

DESIGN

A qualitative longitudinal design with three data collection points, was performed from October 2013 to October 2016 at the University of Verona, Trento Campus.

METHODS

Semi-structured interviews were conducted at the time of entry into a 3-year bachelor's degree program in nursing and at the end of the second and third years. Observation of the students during their clinical practice was carried out at the end of each of the three years of education. Thirty students commenced the study and 24 finished. Data were analyzed using a phenomenological approach.

RESULTS

The iterative process of analyzing interviews and observations resulted in nine themes collectively from all three stages: establishing a trusting relationship with the patient, satisfying the patient's needs, paying attention, being respectful, being competent, giving time, being concerned with the emotional dimension, acting within context to facilitate caring actions and giving information.

CONCLUSIONS

At the end of the third year the students' concept of caring was enhanced; their initial generic or lay view of caring turned into an intentional, competent, conscious, accountable and realistic caring approach.

Investigation of the relationship between nursing students' disgust sensitivity and caring behaviours

AIM

This study aimed to investigate the disgust sensitivity of nursing students, the factors affecting this sensitivity, their caring behaviors and the relationships between these components.

BACKGROUND

Disgust sensitivity has been conceptualized as the degree of disgust felt in response to various stimuli. Nursing students often encounter recognized disgust triggers in clinical practice, such as feces, mucus, urine, foul-smelling wounds and contact with the dead. The nursing students' disgust sensitivity can affect the way they think and may affect their care behaviors.

DESIGN

The study used a descriptive cross-sectional design and was conducted with nursing students in a Turkish university nursing program (n = 577).

METHODS

The study data was collected through the Disgust Sensitivity Scale-Revised Form and the Caring Assessment Questionnaire.

RESULTS

Of the students in the study, 59.6% stated that they experienced disgust while providing care. A negative relationship was found between students' total scores from the Disgust Scale and the Caring Assessment Questionnaire (p < 0.01). The students' disgust sensitivity level was high and the higher the disgust sensitivity, the fewer caring behaviors they exhibited.

CONCLUSIONS

In light of these findings, it can be said that the caring behaviors of nursing students are negatively influenced by disgust sensitivity. Hence, nurse educators need to evaluate students' disgust sensitivity, help students to identify and address their disgust emotions, deal with disgust management strategies together and be aware of when students need support.

Experiences of gynecologic oncology nurses regarding caring behaviors: a hermeneutic phenomenological study

PURPOSE

This study aims to explore the caring behaviors experiences of gynecologic oncology nurses.

METHODS

This study was conducted with phenomenological hermeneutical approach. This study was carried out 14 nurses working on women with gynecologic cancer. Data were collected through individual interview method by using semi-structured interview guide. Data were analyzed using a phenomenological hermeneutical method.

RESULTS

Caring behaviors experiences of gynecologic oncology nurses were explained by the themes "missed caring behaviors", "transition from work-centered to care-centered approach", and "transition to caring-healing approach". The first theme, "missed caring behaviors" included two subthemes: "focusing on routines" and "superficial relationships". The second theme, "transition from routine to care-centered" included three subthemes: "barrier perception", "off the record" and "controlled attachment". The last theme, "transition to caring-healing" consisted of the subthemes "ideal care conscience", "presenting presence", "looking through her window", "healing with caring behaviors". The main theme was reached as "caring behaviors: the focus of nursing".

CONCLUSION

This study suggests that gynecologic oncology nurses need to adequately and efficiently improve on caring behaviors in an intense caring environment.

Perception of futile care and caring behaviors of nurses in intensive care units

OBJECTIVES:

Futile medical care is considered as the care or treatment that does not benefit the patient. Staff of intensive care units experience moral distress when they perceive the futility of care. Therefore, this study aimed to determine the relationship between perceptions of nurses regarding futile medical care and their caring behaviors toward patients in the final stages of life admitted to intensive care units.

METHOD:

This correlation, analytical study was conducted with 181 nursing staff of the intensive care units of health centers affiliated to Mazandaran University of Medical Sciences, Mazandaran, Iran. The data collection tool included a three-part questionnaire containing demographic characteristics form, perception of futile care questionnaire, and caring behaviors inventory. To analyze the data, statistical tests and central indices of tendency and dispersion were investigated using SPSS, version 19. Pearson's correlation coefficient, partial correlation, t-test, and analysis of variance tests were performed to assess the relationship between the variables.

ETHICAL CONSIDERATIONS:

The study was reviewed by the ethics committee of the Mazandaran University of Medical Sciences. Informed consent was obtained from participants.

RESULTS:

Our findings illustrated that the majority of nurses (65.7%) had a moderate perception of futile care, and most of them (98.9%) had desirable caring behaviors in taking care of patients in the final stages of life. The nurses believed that psychosocial aspects of care were of utmost importance. There was a significant negative relationship between perception of futile care and caring behavior.

CONCLUSION:

Given the moderate perception of nurses concerning futile care, and its negative impact on caring behaviors toward patients, implementing suitable interventions for minimizing the frequency of futile care and its resulting tension seems to be mandatory. It is imperative to train nurses on adjustment mechanisms and raise their awareness as to situations resulting in futile care.

The impact of occupational stress on nurses' caring behaviors and their health related quality of life

Background

Nursing is perceived as a strenuous job. Although past research has documented that stress influences nurses’ health in association with quality of life, the relation between stress and caring behaviors remains relatively unexamined, especially in the Greek working environment, where it is the first time that this specific issue is being studied. The aim was to investigate and explore the correlation amidst occupational stress, caring behaviors and their quality of life in association to health.

Methods

A correlational study of nurses (N = 246) who worked at public and private units was conducted in 2013 in Greece. The variables were operationalized using three research instruments: (1) the Expanded Nursing Stress Scale (ENSS), (2) the Health Survey SF-12 and (3) the Caring Behaviors Inventory (CBI). Univariate and multivariate analyses were performed.

Results

Contact with death, patients and their families, conflicts with supervisors and uncertainty about the therapeutic effect caused significantly higher stress among participants. A significant negative correlation was observed amidst total stress and the four dimensions of CBI. Certain stress factors were significant and independent predictors of each CBI dimension. Conflicts with co-workers was revealed as an independent predicting factor for affirmation of human presence, professional knowledge and skills and patient respectfulness dimensions, conflicts with doctors for respect for patient, while conflicts with supervisors and uncertainty concerning treatment dimensions were an independent predictor for positive connectedness. Finally, discrimination stress factor was revealed as an independent predictor of quality of life related to physical health, while stress resulting from conflicts with supervisors was independently associated with mental health.

Conclusion

Occupational stress affects nurses’ health-related quality of life negatively, while it can also be considered as an influence on patient outcomes.

The View of Nurses toward Prioritizing the Caring Behaviors in Cancer Patients

INTRODUCTION

There are many opportunities for nurses to assist improving patient's ex-perience of cancer. In fact, in every stage of cancer process, nurses can provide the re-quired and necessary cares and supports by representing substantial caring behaviors. Thus, by identifying and understanding the importance of caring behaviors which led to nurse-patient effective interactions, nurses would be able to care better for patients and so to enhance patients' satisfaction toward nursing services. However, a few studies have ever been done about perception of oncology nurses about prioritization of caring behaviors.

METHODS

This was a descriptive study done among all the nurses of oncology wards (n = 40) in Shahid-Ghazi-Tabatabaei Hospital of Tabriz in 2009. Data collection performed using Larson's CARE-Q tool that assessed the importance of caring beha-viors in six subscales as the following: "Monitors and follows through", "Explains and facilitates", "Physical and emotional comforts", "Trusting relationship", "Anticipates" and "Being accessible".

RESULTS

In this study, the importance of caring behaviors was evaluated in moderate to high level and the priorities of care dimensions were deter-mined. "Monitors and follows through" and "Being accessible" received a high priority and "Anticipates", "Explains and facilitates", "Physical and emotional comforts" and "Trusting relationship" were given the low priority by nurses.

CONCLUSION

The difference of caring prioritization by the nurses of this study compared to other studies can be attributed to the influence of cultural background on caring. Considering the high prioritizing of "Monitors and follows through" and "Being accessible", nursing service officials and planners are recommended to attempt providing prerequisites of these two caring aspects.