Caring behavior and associated factors among nurses working in Jimma University specialized hospital, Oromia, Southwest Ethiopia, 2019

Caring is a principal and unique concept in nursing which is described as human acts of doing something with people, for people, to people and as people. It can be effectively demonstrated and practiced interpersonally that result in the satisfaction of human needs. It represents an attitude of occupation, concern, responsibility and affective involvement with the others. Nursing care behavior and nurse’s perception of care behavior is an act, conduct, and trait enacted by professional nurses that provide concern, protection, and attention to the patient [1].

Conceptually, caring behaviors have two major components. The first component is instrumental behaviors which are associated with technical and physical behaviors. The second components are expressive behaviors that deal with psychosocial and emotional behaviors which include the provision of loyalty, confidence, hope, and emotional kindness for the patients [2].

Caring is universal as well as central in the art and science of nursing practice that includes all aspects of delivering nursing care to patients. Caring is a basic nurses’ attitude and daily life events as a professional and individual which occur when a nurse comes in contact with a client and expressed through actual nursing acts and behaviors. Thus, caring requires the spiritual, moral, personal and social engagement of a nurse with a commitment to self and other community [3].

Nurses have a professional responsibility to give high-quality nursing care for a better patient outcome. All nursing activities are verified through nurses caring behaviors. However, the lack of professional caring of nurses leads to reduced wellbeing and the health of the patients. Therefore, nurses caring behaviors can influence patient satisfaction and perceived quality of nursing care [4, 5]. A study showed that approximately 10–30% of general hospital nurses rated the quality of care on their ward as fair/poor and up to 50% felt that the quality of patient care had deteriorated [6].

There was a study that indicated nurses are more emphasized on the expressive aspects of caring such as listening to the patient and less observable aspects of care like patient monitoring. Complaints of poor attitude among health care workers toward patient care were increasing because of the perception that health care professionals are increasingly giving impersonal care especially in overcrowded settings [7].

The concept of caring and caring behaviors has different perceptions among patients served for various cases. Study showed that patients with cancer problems emphasized more for affective caring actions whereas intensive care patients perceived equally the technical and compassion serves. However, patients in the emergency unit emphasized more to technical aspects. A patient in medical-surgical care deals more to physical caring competency and the practical ability to deliver the general well being [8].

There was a study that describes factors inclined caring behaviors including the technique used for assigning nurses for patients, lack of time and support from other colleagues. It is also known that the frequency of visiting the patients might lead to a higher nursing care provision than others that induces a significant effect on nurses caring behaviors [9].

Studies undertaken among hospitalized patients showed those professional nurses and patients’ perceptions of caring are not similar. Patients focused on the technical aspects of nurses’ work in particular, physically ill patients stress task-orientated behaviors whereas nurses value psycho-social skills. Major dimensions of determinants influencing nurses’ perception of caring behavior were the nurse’s characteristics, educational background, workload, job satisfaction and working place [10‐12]. Another study showed factor influencing nurses caring behaviors where the care environment, low staffing and support for nurses in the working environment [13, 14].

Even though caring is an important concept in nursing, it is complex, an intangible concept and difficult to measure. Culture and values affect the understanding of the concept of caring. There is also a paucity of research on specific programmatic efforts to enhance nurses caring behaviors among nurses. Therefore, this study was aimed to assess caring behavior and associated factors among nurses in Jimma University specialized hospital, southwest Ethiopia.

The finding of this study showed that the proportion of nurses who had caring behavior was 80.3%. A relatively high proportion of nurses had professional – technical (82.9%) caring behavior compared to psychosocial (81.5%) caring behavior. This indicates that nurses more perceived concrete observable aspects of caring behavior than expressive caring behavior. This finding is similar to study conducted in Gondor and Sweden in which nurses have perceived the technical- professional aspect of caring behavior than psychosocial caring behavior. This similarity might be due to the nature of their profession in which nurses pay special attention mainly involving practical caring rather than motivational concern [14]. However, this finding is in contrast with the study done in Japan and Jordan, in which a high proportion of nurses have perceived a psychosocial (emotional) aspect of caring behavior. This might be because of the difference in organization nature, prevailing attitude given by society [7, 19]. The finding of the study also revealed that nurses’ job satisfaction was associated with caring behavior. Nurses who had personal satisfaction with their job had high caring behavior which is consistent with a study conducted in Gondor on the perception of caring behavior [14, 20].

On the other hand, a cohort study conducted in South Africa revealed that caring behaviors related to job dissatisfaction reflected in increased duration absenteeism [21]. In this study, caring behavior is positively associated with collaborative working as measured joint participation in the client care process among nurses and physicians (B = 0.54, p < 0.007, CI95%) which is similar to the study conducted by Lu et al. [22]. However, the study conducted in Slovenian hospital showed those nurses and physician involvements in teamwork were low compared with the current study [23]. These variations might be due to the difference in organizational support, leadership style and the level of salary.

With regard to caring environment, nurses caring behaviors were significantly associated with caring environment as measured presence empowering nursing leader management, staffing and support (B = 0.85, P = 0.00) which is consistent with study conducted in New York, Korea, and Saudi Arabia found that nurses who viewed the working environment as empowering were more likely provide high caring behavior [3, 5, 16]. In line with these findings, a study conducted in Australia also indicates a relationship between a nurse’s autonomy and strong ward management with caring behavior [2, 24]. The current study also indicates the presence of inverse relation with working units like intensive care unit, psychiatric and maternity wards which is inconsistent with the study conducted by Ferrous H. Omar [25]. This disparity might be due to presence strictly followed up, unfavorable behavior clients in the psychiatric ward, and the presence of workload leads to a low perception of caring behavior.

The proportion of nurses who had a high perception of caring behavior was found to be lower. This study found that nurses’ personal and professional satisfaction with their job was positively related to caring behavior. Moreover, nurses caring behavior enhanced with increased empowered nurse’s management in coordinating, planning, controlling the whole process of caring behavior. Furthermore, caring behavior was positively associated with joint participation in client care especially among nurses and physician which is the most pivotal role in the provision of quality care services for the client as a team.