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Implementation and Evaluation of the RECAP Framework: A Quality Improvement Initiative
Courtenay R Bruce1, Natalie N Zuniga-Georgy1, Nathan Way2
1System Patient Experience, Houston Methodist System, Houston, TX 77030, USA.
Nursing Reports (Pavia, Italy)
|February 26, 2026
Summary
A new course effectively taught nursing staff narration of care (NOC), improving patient experience scores in areas like care transitions and communication. Observed practice changes aligned with course goals, though causality requires further study.
Area of Science:
- Nursing Education
- Patient Experience
- Healthcare Communication
Background:
- Narration of Care (NOC) is a crucial nursing skill involving real-time verbal explanation of tasks.
- Limited research exists on effective methods for teaching and evaluating NOC.
- This study focuses on the implementation and observed outcomes of a NOC training course.
Purpose of the Study:
- To describe the implementation of a discussion-based course for nursing staff (nurses and PCAs) on effective narration of care.
- To assess changes in patient experience and observed practices following the course implementation.
Main Methods:
- A mixed-methods, pre- and post-implementation design was used across seven hospitals over six months.
- Quantitative data included HCAHPS scores and structured observations of nurse-patient interactions.
- Qualitative data from course evaluations were thematically analyzed and integrated with quantitative findings.
Main Results:
- 95% of 4185 staff reported increased knowledge and rated the course highly.
- Significant improvements were observed in HCAHPS domains: care transitions, cleanliness, medication communication, discharge communication, and restfulness.
- Practice observations indicated increased use of NOC-aligned behaviors, with opportunities for further improvement.
Conclusions:
- The course rollout coincided with improvements in patient experience measures and observed nursing practices.
- While positive changes were noted, the uncontrolled study design prevents definitive causal inference.
- Further research with controlled designs is recommended to establish causality.
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