Examining Nursing Presence in the Acute Care Setting as an Indicator of Patient Satisfaction with Nursing Care
Nursing presence is conceptualized as occurring within the nurse-patient relationship when the nurse acknowledges the uniqueness of the patient, within his or her context of being and chooses to intervene on the patient's behalf with a patient who allows the nurse into a reciprocal relationship. Nursing presence is described as occurring in varying levels and nurse expertise is suggested as one antecedent. Quantification of nursing presence would be useful in examination of nursing care outcomes, quality management and research. The Presence of Nursing Scale, PONS (Kostovich, 2002) was used in this study to test its reliability and determine its validity against a single-item measure of patient satisfaction with the care given by a particular nurse. In the 75-patient sample, the PONS was found to be reliable (Cronbach's alpha = .937). The correlation between the PONS and patient satisfaction with care scores was tested using a Spearman's rho and found to be large and statistically significant, p < 0.01. The relationship between the PONS scores and levels of nurse expertise was explored to explain PONS scores along the scale continuum. A nurse expertise level (NEL) was calculated for the 24 registered nurse participants based on a peer-reported novice to expert skill acquisition level (Benner, 1982), specialty certification, longevity of practice and leadership duties. Qualitative data from participant interviews helped to explain the quantitative findings. In the lower quartile of PONS scores, patients felt as objects of the nurses' work, attended to only when called by the patient. Toward the middle of the scale continuum, patients experienced a professional relationship with their nurse and had confidence in the nurse's skill and knowledge. Nurses reported professional satisfaction in helping patients achieve health care goals. At the higher end of the scale, patients felt watched over and experienced stress reduction and encouragement. The PONS appeared to measure levels of nursing presence in the context of the daily work of the bedside nurse. Specific nursing behaviors were associated with levels of presence, suggesting it is possible to teach a nurse to be present with patients.
Acute Care Nurses, nurse-patient relationship, nursing, nursing presence, patient satisfaction, patients
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