Clarifying caring relationships in nursing: An umbrella review to advance outcome measurement in acute and critical care.
Abstract
Background
Caring relationships are foundational to nursing practice but remain difficult to define and measure, particularly in acute and critical care.
Purpose
The purpose of this review was to synthesize existing concept analyses of caring relationships in nursing to clarify the concept and to inform future outcome measurements.
Methods
An umbrella review of published concept analyses was conducted using Joanna Briggs Institute methodology. Searches were performed across multiple databases. Eligible publications were concept analyses focused on caring or nurse-patient relationships in nursing. Data were extracted and synthesized using content analysis and interpretive description.
Discussion
Ten concept analyses met inclusion criteria. The synthesis identified shared antecedents related to person needs, nurse characteristics, and environmental conditions; defining attributes including intentional engagement, knowing the person, compassion, therapeutic communication, and individualized care; and consequences for patients and families, nurses, and healthcare organizations. Empirical referents reflected patients' and nurses' experiences, such as feeling known, satisfaction, well-being, coping, professional fulfillment, and quality of care. Few pragmatically useful measures were identified; however, selected items from the Hospital Consumer Assessment of Healthcare Providers and Systems and Consumer Assessment of Healthcare Providers and Systems, as well as the Watson Caritas Patient Score, demonstrated alignment with attributes of caring relationships.
Conclusions
Caring relationships in nursing constitute an active, intentional, and ethically grounded process that facilitates health, recovery, resilience, and well-being. Clarifying this concept provides a foundation for refining existing patient-reported experience measures with measures to make relational nursing care visible and measurable in acute and critical care settings.