Organizational values

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NRS-451V Lecture 4

 

Organizational Culture and Values

Introduction

Organizations rely on managers and leaders to fulfill their mission today and their vision of the future. The focus for this week will be on the roles of nurse managers and leaders in health care organizations, theories that underlie the practice of management and leadership, as well as the use of power in an organization.

Role of the Manager

The role of the manager is to ensure that the mission of the organization, which focuses on providing excellent care for clients, is fulfilled through the effective and efficient coordination of resources. Managers are responsible and accountable for ensuring that competent staff are provided with the tools and processes required to accomplish the work. To perform this role, managers are given the authority to make decisions that directly influence these factors within their scope of responsibility.

The functions of the management role include planning, organizing, staffing, directing, and controlling (Marquis and Huston, 2009). Within each of these functions, decisions must be made to optimize the care provided while maintaining fiscal responsibility. Planning is required to determine the best ways to fulfill the organization’s mission. As in client care, this step includes assessing the current situation and identifying actual or potential issues. Organizing provides the framework within which care is provided. Staffing refers to determining both the overall number and skill mix (e.g., numbers of licensed and unlicensed personnel required to care for a specific client population) needed as well as ensuring adequate shift-to-shift staffing. Directing includes assuring the work is being accomplished, whereas controlling encompasses both quality management and adherence to the budget. In this course, elements of each of these functions will be explored.

Role of the Leader

The role of the manager is often viewed as one that works to maintain the status quo and ensure smooth day-to-day operations which are critical to the organization. A leader is viewed as one who encourages growth in the organization. The word itself implies movement and there is no need for a leader to simply get people to where they already are.

Leadership remains a vague concept, but ideas about what makes a great leader abound. Warren Bennis offers this definition “Leadership is a function of knowing yourself, having a vision that is well communicated, building trust among colleagues, and taking effective action to realize your own leadership potential” (The Teal Trust, n.d.). Throughout the definitions and discussions of leadership, two major themes emerge: 1) leaders are responsible for promoting growth, and 2) leaders work by influencing and empowering others.

Theories regarding leadership styles and their application also abound. Early in the discussion of leadership, three basic styles were defined. These classic types include authoritarian, democratic, and laissez-faire. Further exploration of these styles led to a theory of situational leadership, where the leader alters their approach based on the issues and people involved. Knowing the advantages and disadvantages of each approach and matching these to the situation should achieve better outcomes.

Current theories of leadership focus on recognition and empowerment of individuals. The challenge lies in developing a culture that fosters these collegial relationships and in preparing individuals for leadership. Not everyone in a leader’s circle of influence will be interested in becoming a leader. Some find it difficult, due to their culture or experiences, to develop a different relationship with persons viewed as authority figures (Marquis and Huston, 2009). Despite the challenges, this approach to leadership of professional staff shows promise in creating a work environment that enhances nurse satisfaction (Kerfoot, 2004).

Power and Politics

Power is defined as “the ability or capacity to act or perform effectively” (The American Heritage Dictionary, 1985, p. 971). Power is also linked to the ability to influence or control. Power is strongly linked to the roles of manager and leader since both, by definition, must be able to influence or control others in order to accomplish the mission of the organization.

People within the organization gain power in different ways. Managers are given legitimate power, otherwise known as authority, to provide rewards and consequences for staff behavior. It is well known that being given authority does not always lead to the power to manage others, as seen when staff choose not to follow policies. Bridging the gap between authority and power often requires the skill of a leader to influence people to work together and be willing to follow policies for the good of the organization or speak up when they believe the policy no longer benefits the organization. Leaders may or may not have legitimate power or authority. Leaders in this position often influence others through expert and referent power. This type of leader may be a member of the staff who is recognized as a clinical expert or who is aligned with persons in authority.

Marquis and Huston (2009) define politics as the effective use of power. Politics recognizes that all people are interdependent; no one can accomplish the work of the organization in isolation. Learning the political climate of an organization is a key to success as a manager or leader. Developing relationships with others in the organization is a critical component. This is best done in face-to-face encounters rather than by telephone or e-mail. Possessing information is also a form of power, knowing when and with who to share that information is also important. A new manager or leader will often benefit from finding a mentor who understands the political climate of the organization.

Integrating the Roles of Manager and Leader

Not all leaders are managers and not all managers are leaders. The theories of transactional and transformational leadership highlight this quite well. A transactional leader is interested in maintaining the status quo. A transformational leader is interested in promoting growth, both for themselves and for others. Although a manager is given legitimate power simply by the authority delegated to the position, this is often not sufficient for truly carrying out the mission and vision of the organization. Conversely, leadership alone, without attention to day-to-day organization, is likely to lead to chaos. Finding a balance of the roles that suit the organization and the people being managed or led is the challenge.

Conclusion

Although managers and leaders have distinct roles within an organization, the most effective people will blend the functions and roles in their work. Both managers and leaders need to develop a power base and use that power wisely within the organization to further the mission and goals. When management is effective and efficient, and leadership is characterized by vision, communication, and empowerment, then both the organization and the clients served will benefit.

References

 The American Heritage Dictionary (2nd ed.) (1985). Boston: Houghton Mifflin.

Drucker, P. F. (1999). Management challenges for the 21st century. New York: HarperCollins.

Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing: Theory and application (6th ed.). Philadelphia: Lippincott, Williams & Wilkins.

The Teal Trust. (n.d.). Our definition of leadership.

565The Journal of Continuing Education in Nursing · Vol 41, No 12, 2010

Building an Organizational Culture of Caring:
Caring Perceptions Enhanced With Education
Margaret M. Glembocki, DNP, ACNP-BC, CSC, and Karen S. Dunn, PhD, RN

As technical advances are made in the way in which health care is delivered at the bedside, the profes-
sional nurse can quickly lose focus on the caring rela-
tionships that are fundamental and essential to creating
a healing environment for self, colleagues, and patients.
Watson (2006) supported this view of nursing by stat-
ing:

Dominant institutional values and commitments are in-
formed and guided by economics, technology, medical
science, and administrative theory, instead of basic con-
siderations of what it means to be human, to be vulner-
able, to be ill, to be cured, to be cared for, to be healthy,
and to be healed. (p. 87)

Numerous authors, including Goodin (2003), have

documented the grave future of the nursing profession
because of the shortage of those entering and continuing
to practice this profession.

Currently, nurses are challenged to perform more tasks
with fewer resources, leading to decreased job satisfaction
and higher turnover rates (Christmas, 2008). Implement-
ing relationship-based care with the assistance of the Re-
igniting the Spirit of Caring (RSC) program from Cre-
ative Healthcare Management as an educational program
is believed to increase caring behaviors and lead to in-
creased nursing and patient satisfaction. Transforming an
organization to a culture of caring requires an investment
in people and time. As an organization moves toward cul-
tural change, striving for an environment that supports
professional nursing practice and promotes positive clini-
cal outcomes within the boundaries of the health care cul-
ture and bureaucracy can ultimately transform the prac-
tice environment to one of care and healing (Wade et al.,
2008). Thus, this pilot study was conducted to determine
whether the RSC program would enhance perceptions of
caring behaviors among nurses.

LitEraturE rEviEW
Caring behaviors are a central focus of nursing. Nurse

caring has been defined as “an interactive and intersub-
jective process that occurs during moments of shared

mine whether an educational intervention called Reigniting
the Spirit of Caring (RSC) from Creative Healthcare Man-
agement would enhance perceptions of caring behaviors
among nurses. A pretest/posttest within-subjects research
design was used to evaluate the educational intervention.

Methods: Investigators used the licensed RSC program
as the educational intervention. This study included 36 regis-
tered nurses employed in one Midwestern hospital.

Results: Statistical differences were found in the pretest
and posttest measurement of nurses’ perceptions of caring
behav

iors.

Conclusion: The RSC program can be used as an effec-
tive educational intervention to increase nurses’ perceptions
of caring, and the Caring Assessment for the Caregiver tool
can be used as an effective tool to measure nurses’ percep-
tions of caring behaviors.
J Contin Educ Nurs 2010;41(12):565-570.

abstract
Background: This pilot study was undertaken to deter-

Dr. Glembocki is Acute Care Nurse Practitioner, Crittenton Hos-
pital, Rochester, Michigan. Dr. Dunn is Associate Professor, Oakland
University, Rochester, Michigan.

The authors disclose that they have no significant financial interests
in any product or class of products discussed directly or indirectly in this
activity, including research support.

Address correspondence to Karen S. Dunn, PhD, RN, Associate Pro-
fessor, Oakland University, 402 O’Dowd Hall, Rochester, MI 48309.
E-mail: kdunn@oakland.edu.

Received: January 12, 2010; Accepted: April 26, 2010; Posted: July
6, 2010.
doi:10.3928/00220124-20100701-05

566 Copyright © SLACK Incorporated

vulnerability between nurse and patient” (Yeakel, Malja-
nian, Bohannon, & Coulombe, 2003, p. 434). In a quali-
tative study, Clukey, Hayes, Merrill, and Curtis (2009)
explored 10 family members’ perceptions of nurses’ car-
ing behaviors in a trauma unit. Caring behaviors reported
by these family members included: (1) nurses who were
knowledgeable; (2) nonverbal behaviors, such as tone of
voice and use of words, eye contact, offering assurance,
listening, and getting to know them as people; (3) being
skillful in keeping patients and family members comfort-
able; and (4) taking adequate time and not acting hurried
or bothered. Eight hundred fifty-five families who had
recently experienced a death of a loved one in the hospi-
tal were surveyed about their experiences with inpatient
end-of-life care. Nurses’ caring behaviors perceived by
these participants were: (1) treating patients and families
with dignity and compassion; (2) not appearing over-
worked; (3) addressing patients’ and families’ needs and
wishes; (4) being open and honest; (5) being attentive
and present; and (6) offering food and drink to visitors.
These caring behaviors were also found to be positively
associated with patient and family satisfaction (London
& Lundstedt, 2006).

Nurses have also reported what they perceive as car-
ing behaviors. Green (2004) surveyed 348 nurse practi-
tioners using a modified version of the Caring Behavior
Inventory and found that most of these nurse practitio-
ners reported caring behaviors as: (1) being respectful to
others; (2) being present, connecting, and learning about
patients and families; and (3) being professional, knowl-
edgeable, and skillful. Caring behaviors can also improve
job satisfaction among nurses. Carter et al. (2008) sur-
veyed 31 nurses who worked in an organization that was
implementing Watson’s (1988) practice model of caring.
They found that caring for colleagues was identified as
being the most essential factor in keeping staff energized
and that it increased caring behaviors with patients.

Improved health outcomes have also been reported.
A qualitative study using grounded theory methods was
conducted by Finch (2008) to develop a substantive the-
ory of nurse caring. Fourteen chronically ill hospitalized
older adult patients were interviewed. These participants
reported improvement in physical and emotional health.
Patients had less skin breakdown and fewer panic at-
tacks, and they were physically more comfortable, had
more knowledge and understanding of their disease and
treatments, were more calm and relaxed, and had an im-
proved outlook on life.

Three potential approaches have been reported in the
literature that may enhance health care providers’ rela-
tional behaviors with patients. These three approaches
are: (1) training sessions for care providers aimed at im-

proving interactional skills, (2) introduction of conti-
nuity of care models, and (3) establishment of clinically
supervised environments (McGilton et al., 2004). The
literature, however, does not provide evidence of im-
proving caring behaviors through educational seminars
that assist nurses to reflect on self and caring behaviors.
Developing a culture of shared knowledge and values
may serve as a guide to heartfelt caring practices that
are grounded in both theory and evidence (Watson,
2006). This gap in the literature warrants further explo-
ration of educational seminars to improve nurse caring
behaviors.

NursiNg sigNifiCaNCE
Modern nursing is in need of change because of the

daily demands of the health care system. The high stan-
dards of clinical competencies and tasks have taken nurses
away from the bedside and limited their ability to estab-
lish a therapeutic nurse-patient relationship (Koloroutis,
2004). This inability to connect with patients may be
the reason for the extremely high turnover rate (27.1%)
of nurses in the first year of employment (Christmas,
2008). High turnover rates in health care organizations
are costly and can cause negative outcomes in patient
safety and satisfaction. As Felgen (2004) stated:

Caring and healing cultures are those in which there is pal-
pable, visible regard for the dignity of human beings and
where relationships between the members of the health
care team and the people they serve are built on mutual
respect and a shared commitment to healing. (p. 28)

The RSC educational program may be a cost-effective
and efficient way to make nurses aware of the effect of
practicing caring behaviors and the importance of creat-
ing a caring culture with patients, with coworkers, and
within themselves, significantly improving the work en-
vironment and decreasing the rate of attrition.

thEOrEtiCaL framEWOrk
The relationship-based care (RBC) model by Kolor-

outis (2004) was used as the framework for this study.
This model “provides both philosophical foundation
and practical infrastructure to achieve organization-wide
transformation in the way care and services are provid-
ed to patients and their families” (Koloroutis, 2004, p.
13). RBC is a holistic model, with the patient and fam-
ily as the central focus, surrounded by six dimensions:
(1) leadership, (2) teamwork, (3) professional nursing,
(4) care delivery, (5) resources, and (6) outcomes. These
six dimensions, along with three key relationships (i.e.,
care provider’s relationship with patients and families,
care provider’s relationship with self, and care provider’s

567The Journal of Continuing Education in Nursing · Vol 41, No 12, 2010

relationship with colleagues), provide the organizational
structure for transformation.

According to Koloroutis (2004), the RBC model was
developed using the caring theories of Watson (1988)
and Swanson (1991). Watson’s Model of Human Car-
ing (1988) focused on the interpersonal relationship be-
tween patient and nurse. In this model, the patient is in
control of the change, and healing occurs from within
while the nurse is present and facilitates these transfor-
mations. Swanson (1991) built on this theory by adding
five caring processes and ways for nurses to put them
into practice. These five processes are (1) knowing (un-
derstanding the lived experiences of others); (2) being
with (being emotionally present); (3) doing for (doing
for others what they could do if it were possible); (4)
enabling and informing (facilitating movement through
life transitions and unfamiliar situations); and (5) main-
taining belief (maintaining the belief that others have
the capacity to work through transitions and unfamil-
iar situations). Swanson (1991) further identified caring
behaviors for each of these processes that can be used
by nurses in clinical practice.

The RBC model may transform nursing practice to
a higher level of autonomy and professionalism and
increase nurse and patient satisfaction. In addition, the
RBC model can be easily implemented into nursing
practice. Caring behaviors start from within the caregiv-
er when the sense of self feels balanced. Hence, the RSC
educational program allows for self-reflection and may
enhance perceptions of caring behaviors in nurses.

mEthOds
A pretest/posttest within-subjects research design was

used to evaluate the educational intervention. Investi-
gators used a licensed program, Reigniting the Spirit of
Caring, from Creative Healthcare Management, as the
educational intervention. It was hypothesized that nurses
who had participated in the intervention would have an
increase in scores on the Caring Assessment for the Care-
giver (CAC) tool (Wu, Larrabee, & Putman, 2006) from
pretest to posttest. If this hypothesis was found to be cor-
rect, then RSC will have enhanced perceptions of caring
behaviors within a sample of nurses. This study included
36 registered nurses employed in one Midwestern hospi-
tal. Registered nurses who had completed the 3-day edu-
cational seminar were included. Those who missed one
or more sessions were excluded.

Educational intervention
The RSC program is a 3-day educational seminar that

focuses on three main relationships in nursing: (1) rela-
tionship with self, (2) relationship with colleagues, and

(3) relationship with patients. The curriculum is based
on adult learning theory and the principles needed for
a learning organization. According to Senge, Kleiner,
Roberts, Ross, and Smith (1994), five foundational core
concepts are essential to build a learning organization:
(1) personal mastery (personal and environmental capac-
ities to achieve desired purposes and goals); (2) mental
models (continuous evaluation and improvement of per-
sonal views that govern actions and decisions); (3) shared
vision (being committed to a group with shared visions
and goals); (4) team learning (transforming communica-
tion and collective thinking skills to develop knowledge);
and (5) systems thinking (developing a common language
and way of thinking to understand interrelationships
that govern behavior and change). Implementing these
core concepts can change the way people within orga-
nizations think and interact and thus overcome barriers
that are not easily identified. Content is built on research
and theories on human caring. The RSC program is
based on the belief that through reflection and learning,
through intentional thought and action, through leader-
ship and collegial support, and by enhancing awareness
and refocusing on what matters most, people have the
power to transform work environments into cultures in
which personal responsibility prevails, healthy relation-
ships thrive, appreciation is openly expressed, and caring
and healing is the constant and core reason for existence
(Koloroutis, 2004).

The RSC program uses a facilitative approach to
learning and is taught by a team of two hospital-based
employees who have been certified. The facilitators must
complete a 5-day training course that is taught by the
developer of the program, and after completion of the
training, the facilitators are mentored with a person from
Creative Healthcare Management with the first group of
trainees. After all requirements are successfully met, the
employees are certified as RSC facilitators by Creative
Healthcare Management. Training and expectations are
the same for all facilitators.

Protection of human subjects
Institutional review board approval was obtained be-

fore the study by Oakland University and from the hos-
pital’s research committee. Written consent from study
participants was obtained before their participation in
the RSC program.

instrumentation
Participants were asked to complete a demographic

questionnaire that included participants’ gender, age,
marital status, ethnic group, religious affiliation, level
of nursing education, nursing specialty, and years of

568 Copyright © SLACK Incorporated

experience as a nurse. In addition, the CAC tool (Kol-
oroutis, 2008) was added to this questionnaire as a pre-
test and posttest. The CAC is a 25-item evaluation tool
that is divided into groups of five items that correlate
with Swanson’s five caring processes: maintaining be-
lief, knowing, being with, doing for, and enabling and
informing. Each of the five processes has five items that
include a statement on each side of a five-point Likert
scale. For example, on one side, the statement “I tend
to get my work done without concern about introduc-
ing myself, stating my role, and describing what I am
going to do” from the being with subscale would be
scored as 1, whereas the statement “I initiate a relation-
ship with the patient/family by extending a welcome
and introducing myself (including my name, role, and
how I will care for/serve them)” on the opposite side
would be scored as 5. In other words, the lower num-
bers represent a more task-focused perception of nurs-
ing practice, whereas the higher numbers represent a
more caring perception of nursing practice. It was ex-
pected that participants would take approximately 20
minutes to complete the questionnaires. Reliability of
the CAC was established in a previous study by Steele-
Moses (2010). In a sample of 514 nurses, the researcher
reported Cronbach’s alpha for the scale and subscales
as 0.92 for the total scale, 0.80 for the maintaining belief
subscale, 0.79 for the knowing subscale, 0.72 for the be-
ing with subscale, 0.76 for the doing for subscale, and
0.83 for the enabling and informing subscale (Steele-
Moses, 2010).

Procedures
Participants were voluntarily recruited from a pool

of registered nurses who were scheduled to attend three
sessions of the RSC program. The primary investigator
met with potential participants and provided verbal and
written information about this study. Written consent
was obtained before the seminar session. On the day of
the seminar, participants completed the demographic
questionnaire and the CAC tool (Wu et al., 2006) as a
pretest. Then the participants attended a 3-day, 8-hour-
per-day seminar that presented the principles of RBC.
The seminar focused on Swanson’s (1991) five caring
processes and how these processes affect the relationship
with self, the relationship with colleagues, and the re-
lationship with patients. On completion of the seminar,
the CAC tool was administered as a posttest.

data analysis
Data were analyzed with SPSS Base 16.0 software, and

the level of significance for each test was preset at .05.
Analyses for this study included descriptive statistics,

bivariate correlations, reliability analyses, and paired t-
tests.

rEsuLts
Characteristics of the sample

The sample consisted of 36 registered nurses who had
attended the RSC seminar. The mean age was 46 years
(SD = 8.72), with a range of 27 to 69 years. Most were
female (88.9%), White (69.4%), and Catholic (47.2%),
and practiced in women’s health (30.6%) and cardiac te-
lemetry (27.8%). More than half of the sample was em-
ployed full-time (58.3%). More than half of the sample
had a bachelor’s degree or higher. The average number of
years of nursing experience was approximately 21, and
the average number of years practicing at the study hos-
pital was approximately 11. Finally, the average number
of years that nurses reported practicing on their current
unit was approximately 7.5.

reigniting the spirit of Caring Program
Paired sample t-tests were calculated to compare mean

pretest scores with mean posttest scores for the total scale
and subscales. A significant increase in the mean scores
of the total scale [t(35) = -3.108, p < .05] was reported from pretest (M = 107.39, SD = 10.56) to posttest (M = 114.36, SD = 14.85). Each subscale also had significant increases in mean scores, with the exception of the being with subscale [t(35) = .000, p > .05], which was not sig-
nificant. The pretest mean score for this scale was 22.58
(SD = 2.37) and the posttest mean score was 22.58 (SD
= 2.25). For the maintaining belief subscale, the pretest
mean score was 20.86 (SD = 2.84) and the posttest mean
score was 22.58 [SD = 2.84; t(35) = -4.353, p < .05]. In this subscale, nurses reported an increase in perceptions regarding their ability to convey empathy and compas- sion for patients (M = 4.17, SD = 0.85 to M = 4.58, SD = 0.73) and an awareness of maintaining an accepting and nonjudgmental attitude toward patients (M = 4.17, SD = 0.85 to M = 4.58, SD = 0.73).

The knowing subscale pretest mean score was 21.08
(SD = 2.64) and the posttest mean score was 22.67 [SD
= 2.45; t(35) = -3.853, p < .05]. In this subscale, nurses reported an increase in perceptions related to their in- tention to spend time understanding the patient’s and family’s unique stories and circumstances (M = 3.94, SD = 0.86 to M = 4.47, SD = 0.70) and to prioritize medical and nursing care based on what the patients and families consider important (M = 4.11, SD = 0.71 to M = 4.53, SD = 0.56).

The doing for subscale pretest mean score was 21.36
(SD = 2.60) and the posttest mean score was 22.94 [SD =
2.27; t(35) = -3.578, p < .05]. In this subscale, nurses re-

569The Journal of Continuing Education in Nursing · Vol 41, No 12, 2010

ported an increase in perceptions associated with work-
ing together as a team focused on patients and families
(M = 4.03, SD = 1.06 to M = 4.50, SD = 0.70) and main-
taining high levels of knowledge and skills (M = 4.17, SD
= 0.74 to M = 4.50, SD = 0.61).

Finally, the enabling and informing subscale pretest
mean score was 21.44 (SD = 2.98) and the posttest mean
score was 22.28 [SD = 2.81; t(35) = -2.04, p < .05]. Nurses reported an increase in perceptions about risking their jobs to advocate for patients (M = 4.17, SD = 0.88 to M = 4.53, SD = 0.65) and involving patients and fami- lies in making informed decisions about their care (M = 4.36, SD = 0.87 to M = 4.61, SD = 0.73). Reliability of the CAC total scale was estimated by Cronbach’s alpha, with a being 0.90 for the pretest and 0.94 for the posttest. Cronbach’s alpha for the subscales ranged from 0.69 to 0.88 (Table).

Bivariate correlations were calculated for the relation-
ships between age, years of experience as a nurse, gender,
ethnicity, religious preference, total scale, and subscales.
No significant correlations were found between these
study variables.

disCussiON
This study was conducted to determine whether the

RSC intervention was an effective educational program
that could enhance the perceptions of caring behaviors
of nurses within an organization. The mean age of the
nurses was 46 years, which supports the findings that the
average age of nurses is increasing (American Nurses As-
sociation [ANA], 2009). The average length of practice
as a nurse in this sample was 21 years, which supports
the literature that indicates that fewer people are enter-
ing the field of nursing (Buerhaus, Staiger, & Auerbach,
2003) and that a nursing shortage is predicted (ANA,
2009). Of the 36 nurses, 22 (61.1%) had a bachelor of
science in nursing or higher, which is above the national

average of the educational level of nurses in the United
States (ANA, 2009). Most of the participants practiced in
a cardiac telemetry unit or in women’s health, which are
very diverse practice areas.

The RSC program was found to be an effective edu-
cational program that encouraged nurses to be more
aware of their caring behaviors. Significant increases in
nurses’ perception of caring behaviors were found be-
tween pretest and posttest scores on the total CAC scale
score and the subscale scores, with the exception of the
being with subscale. The participants’ perceptions of
caring behaviors that described the being with subscale
did not significantly change from pretest to posttest.
One reason for this finding could be that, on average,
these nurses were already practicing these caring be-
haviors (spending time with patients and families, using
gentle touch, and listening). Conversely, another reason
could be that the being with content within the RSC
program is in need of revision to enhance these caring
perceptions. As a whole, however, the RSC intervention
did enhance caring behaviors. These caring behaviors
included the nurses’ ability to (1) convey empathy and
compassion, (2) be more accepting and nonjudgmen-
tal, (3) spend more time with patients and families, (4)
prioritize based on patient and family needs, (5) work
as a team, (6) become experts through knowledge and
skills, (7) be patient advocates, and (8) involve patients
and family in care planning. Therefore, the RSC pro-
gram can be used as an effective educational seminar to
increase nurses’ perceptions of caring. In addition, the
CAC can be used as an effective tool to measure nurses’
perception of caring behaviors. Thus, building an orga-
nizational culture of caring through the enhancement
of caring perceptions may also improve patient health
care outcomes. Although these outcomes were not em-
pirically tested in this study, Kinnaird and Dingman
(2004) postulated that caring interactions with nursing

TAbLE

rELiaBiLity aNaLysEs, mEaN sCOrEs, aNd staNdard dEviatiONs Of thE CariNg assEssmENt fOr
thE CarEgivEr tOtaL sCaLE aNd suBsCaLEs (N = 36)

Pretest Posttest

Caring assessment for the Caregiver a M SD a M SD

Total scale 0.90 107.39 10.56 0.94 114.36 14.85

Maintaining belief subscale 0.75 20.86 2.84 0.88 22.58 2.84

Knowing subscale 0.72 21.08 2.64 0.73 22.67 2.45

being with subscale 0.70 22.58 2.37 0.73 22.58 2.25

Doing for subscale 0.69 21.36 2.60 0.76 22.94 2.27

Enabling and informing subscale 0.77 21.44 2.98 0.85 22.28 2.81

570 Copyright © SLACK Incorporated

staff may improve mortality rates, decrease length of
stay, reduce the number of adverse incidents, decrease
the number of complications, increase patient and fam-
ily satisfaction with nursing care, and improve adher-
ence to discharge planning.

A limitation of this study is the small sample size;
therefore, the results cannot be generalized to the larg-
er population of nurses. Also, it is unknown whether
the increased perceptions translated into behavioral
changes associated with how these nurses approached
patients and families postintervention. Future research
needs to be done to include more than one hospital and
a larger number of participants as well as an examina-
tion of behavioral changes in these participants.

rEfErENCEs
American Nurses Association. (2009). Nursing shortage. Re-

trieved from www.nursingworld.org/MainMenuCategories/The
PracticeofProfessionalNursing/workplace/NurseShortageStaffing/
NursingShortage.aspx

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key points
Culture of Caring
Glembocki, M. M., Dunn, K. S. (2010). Building an Organizational
Culture of Caring: Caring Perceptions Enhanced With Educa-
tion. The Journal of Continuing Education in Nursing, 41(12),
565-570.

1 Caring behaviors are a central focus of nursing.

2 Reigniting the Spirit of Caring can enhance perceptions of caring behaviors in nurses through self-reflection.
3 The Caring Assessment for the Caregiver instrument is an effective tool to measure nurses’ perceptions of caring behav-

iors.

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Prepare a 10-minute presentation (10-15 slides, not including title or reference slide) on organizational culture and values.

1. Describe how alignment between the values of an organization and the values of the nurse impact nurse engagement and patient outcomes.

2. Discuss how an individual can use effective communication techniques to overcome workplace challenges, encourage collaboration across groups, and promote effective problem solving. Incorporate how system needs and the culture of health may influence the outcomes. How does this relate to health promotion and disease prevention in the larger picture?

3. Identify a specific instance from your own professional experience in which the values of the organization and the values of the individual nurses did or did not align. Describe the impact this had on nurse engagement and patient outcomes.

While APA style format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.