Constructing a caring training content for nurse managers: a Delphi study

Caring is often considered a synonym for nursing. Interest in caring has grown exponentially from nursing theorists, researchers, clinicians, and educators.1 Caring has been directly related to quality of care, healthcare economics, patient outcomes, administration practices, and nurse and patient satisfaction.2,3,4,5,6,7 Nurse mangers play a pivotal role in nursing care, and they are responsible for promoting efficient, effective, safe, and compassionate nursing care.8 Nurse managers are in positions between doctors and nurses, between hospital leaders and nurses, and between other nurses. They have been at the top, the bottom, and in between, where they must make appropriate decisions while continuing their nursing management.2,9 Nurse managers have sufficient power and organizational influence to obtain the resources necessary to promote nursing caring practices.10,11 Leininger12 believed that nurse managers and administrators can embody caring and improve patient care by insisting on a caring philosophy from top to bottom within the nursing service. Results from phenomenological study10,13 also revealed that staff nurses experienced difficulties in caring for their patients when they, themselves, have not felt cared for or appreciated by their nurse manager. Similarly, quantitative research of Wade et al.14 also showed that caring attributes of managers was a statistically significant predictor of nurses’ job enjoyment. Thus, some authors argued that nurse managers needed to have enough caring knowledge, caring ability, and caring skills to make sure that they can better portray their role, care for their staff, take care of their patients and families, and also enhance the organization culture.15,16,17

It is regretful that nurse mangers are faced with the dilemma of how to take good care of their first-line nurses,2,17,18 and there are also evidences in the recent literature that clinical nurses consider that they do not generally get enough support from their nurse managers.13,19,20,21,22,23,24 It prompted us to explore a practical and effective way to solve this problem. In a previous study, we also explored the caring training experiences and expectation of 453 nurse managers in 14 hospitals in the Hubei Province in China. Results showed that 96.9% nurse managers need caring training and 37.7% nurse managers have not been trained in the caring field. Although it is widely accepted that a caring training is integral to nursing continuing education,6,25,26 there is an apparent dearth of a standardized caring training for nurse managers. It is urgent to develop consistent training content for nurse managers to acquire caring knowledge, improve caring ability and skills, inspire caring behavior, enhance the organization climate, and improve nurse and patient satisfaction.

Caring in education has been emphasized as the first place for teaching and learning the values of the nursing profession.27 In the past several decades, caring in nursing education was conspicuously identified and adopted by schools and hospitals. Many countries initiated the efforts, such as Canada, Japan, and China, especially the United States. Many organizations in America made great efforts on developing nursing caring education. A literature review revealed that the majority of nursing caring education programs were based on Waston’s theory, and grounded in American, they could be classified into four groups according to the target audience: most of them focused on nursing students,25,28,29,30,31,32,33,34 several of them focused on clinical nurses,26,3536,37,38,39 and a few of them focused on nursing educators40,41 and nursing administrators.42 Some paradigms exist. The Weber State University, USA, offers a BSN course focused on Jean Watson’s definition of caring. It includes caring for self, others, peers/co-workers, nursing leadership, local/world communities, the environment, and Web-based interactions.28 The course created for nurse educators at Inova Alexandria Hospital41 was a noteworthy exception. It not only focused on offering a caring training for nurse educators to help them influence nurses in their wards but also had a continuing caring training last along for 3 years to make sure that affective growth occurred for both clinicians and educators. Implementation included core content in a 30-minute training session, large-scale leadership conferences, and consistent educator support (pilot units in patient areas and outpatient areas). Nursing researchers also had described some theoretical aspects of caring education. More and more scholars were committed to develop the online courses and video courses.43 Through the literature review, it was not difficult to find that most literature concentrated on caring education for nursing students and clinic nurses, with little description of the education program for nurse managers. Summarizing the caring program content in nursing education, we found that caring education was a gradual, systematic, and continuous process that causes the caring education effectual. It was regrettable that still no literature identified what content and skills should be included in caring training content for nurse managers.

We used e-mail to invite 24 experts for participation in the study. In all, 23 people agreed to participate, and 22 experts (a response rate of 91.7%) from 14 provinces (Hubei, Jiangsu, Henan, Beijing, Shanghai, Guangdong, Yunnan, Sichuan, Hunan, Liaoning, Shaanxi, Shanxi, Shandong, and Fujian) completed the second round. Dropout occurred between the first round and second round among the groups of nursing administrators and females.

A multidisciplinary panel has identified the necessary items for nurse managers in the caring training field, which was the first step for caring education for nurse managers. The contents would serve as a guideline to healthcare institutions. Nurse managers can choose any module to have a system learning according to their practical needs, totally or separately.

Based on the training contents, there is still need to explore the effective teaching method and the appropriate way to measure the effect of the training. An empirical study should be conducted in the future. Additional research is required to revise the contents to make sure the integrity and integration of the content.

There were two limitations existing in the present research: one was the selection of experts and another was the questionnaire. At present, the Chinese nursing experts in human caring are rather limited, and the academic level of Chinese nurses is lower than that of nurses from other countries, so the resource of expert selection was limited in this study, and the size of sample was also smaller than the researcher’s original plan. The questionnaire, which was designed by the research team, may not contain all essential components in caring training contents and may still miss some items.