Caring in nursing practice: the development of a conceptual framework

This article reports the results of a qualitative research study which explored patients' experience of caring. To elicit stories relating to the experience of caring, a hermeneutic approach was selected incorporating a narrative method. One-to-one interviews were conducted with 24 patients in their homes, shortly after discharge from hospital. The findings uncovered a number of categories comprising the experience of caring in nursing. This resulted in the development of the conceptual framework based on Donabedian's constructs of structure, process and outcome. Structures included nurse attributes, organizational issues, and patient attributes. Processes comprised the activities of caring, which included providing for patients' physical and psychological needs, being attentive, getting to know the patient, taking time, being firm, showing respect, and the extra touch. The outcomes emanated from the process of caring and included a feeling of well-being, patient satisfaction, and effect on the environment. The conceptual framework emphasizes a potential link between the three constructs. Data from narrative analysis suggest a positive linear relationship between the structures required for the process that lead to patient outcomes. When compared to current theoretical literature, the findings support elements of existing theories. These include the importance of the nurse attributes for professional caring (structure), the activities of caring, which can be viewed as nurse interventions and the dual nature of caring, which encompasses attitudes and actions (process).