ORIGINAL ARTICLE
Quality of caring interactions between nurses and patients during the COVID-19 pandemic: A cross-sectional survey with nurses and patients in acute and community care
Jutta Ernst PhD,
Heidi Petry PhD, RN,
Rahel Naef PhD, RN,
Corresponding Author
Jutta Ernst PhD
Senior researcher
Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
Correspondence
Jutta Ernst, Center for Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Email: [email protected]
Search for more papers by this authorHeidi Petry PhD, RN
Head of the Center for Clinical Nursing Science and Professor of Nursing
Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorRahel Naef PhD, RN
Professor of Implementation Science in Nursing (UZH IFIS), and Research Group Head (UHZ CCNS)
Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
Search for more papers by this authorJutta Ernst PhD,
Heidi Petry PhD, RN,
Rahel Naef PhD, RN,
Corresponding Author
Jutta Ernst PhD
Senior researcher
Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
Correspondence
Jutta Ernst, Center for Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Email: [email protected]
Search for more papers by this authorHeidi Petry PhD, RN
Head of the Center for Clinical Nursing Science and Professor of Nursing
Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
Search for more papers by this authorRahel Naef PhD, RN
Professor of Implementation Science in Nursing (UZH IFIS), and Research Group Head (UHZ CCNS)
Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
Search for more papers by this authorFirst published: 03 January 2025
Abstract
Aims
To describe the characteristics and quality of caring interactions between nurses and patients during the earlier phases of the COVID-19 pandemic in acute and home care settings.
Background
Nurse–patient interaction (NPI) plays an important role in effective, person-centered care delivery and has been impacted by the COVID-19 pandemic.
Methods
The survey was part of a multimethod study and used a cross-sectional design. It included both nurses and patients receiving care during the first wave of the COVID-19 pandemic (March–June 2020) at a university-affiliated tertiary care hospital and two large public home care agencies. Data were collected from July to October 2020, using the Individualized Care Scale (ICS), patient and nurse versions. The ICS is a 5-point Likert-type scale divided into two dimensions: ICS-A and ICS-B with 17 items each. The ICS-A subscale assesses patients’ or nurses’ perceptions of patient individuality as supported by specific nursing activities. The aim of the ICS-B subscale, conversely, is to assess perceptions of how individuality is maintained in the care either provided or received. Inferential statistics were used for comparisons between settings and populations. The study followed the STROBE checklist for cross-sectional studies.
Results
The survey was completed by 443 nurses and 295 patients. Patients’ perception of “nurses support their individuality” was moderate (ICS-A 3.42, range 1–5), as was their perception of “nurses provide individual care to patients” (ICS-B 3.89, range 1–5). Nurses’ own perception of supporting individuality was found to be high (ICS-A 4.30, range 1–5), as was the mean score of their actual provision of individual care (ICS-B 4.21, range 1–5), which was statistically significantly higher than the ratings of patients. Nurses working in home care rated individuality and individual care statistically significantly higher than those working in acute care.
Conclusion
The findings suggest that during the earlier phases of the pandemic, Swiss nurses perceived their support of patient individuality and individual care to be higher than their European peers had prior to the pandemic and higher than patients did. However, those engaged in the provision of care within a hospital setting perceived the level of individuality and individual care to be lower than those engaged in the provision of care within a home care setting.
Implications for nursing and health policy
It is evident that nurses’ efforts and contributions to the quality of care require organizational recognition and support. Their commitment should be recognized and supported by leadership and policymakers.
CONFLICT OF INTEREST STATEMENT
The authors declare that there is no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The authors confirm that the data supporting the findings of this study are available upon reasonable request made to the corresponding author.
REFERENCES
- Alemdar, D.K. & Aktas, Y.Y. (2018). Perceptions of Turkish nurses and patients regarding individualized care: a comparison study. Nursing & Health Care, 4, 098.
- Alici, C.B. & Koc, Z. (2020). Quality of life and satisfaction affect individualized nursing care perceptions in intensive care. Psychology, Health & Medicine, 25(2), 148–159. https://doi.org/10.1080/13548506.2019.1654110
- Allande-Cusso, R., Fernandez-Garcia, E. & Porcel-Galvez, A.M. (2022). Defining and characterising the nurse-patient relationship: a concept analysis. Nursing Ethics, 29(2), 462–484. https://doi.org/10.1177/09697330211046651
- Arslan, B.K. (2015). Patients' perception of individualized care and satisfaction with nursing care levels in Turkey. International Journal of Caring Sciences, 8(2), 369.
- Barr, L.L.B., Christian, R., Palokas, M. & Hinton, E. (2022). COVID-19 challenges and changes for home care agencies and providers: a scoping review protocol. JBI Evid Synth, 20(5), 1385–1391. https://doi.org/10.11124/JBIES-21-00146
- Bayer, N. & Baykal, U. (2018). Quality perception of nurses in the hospitals receiving quality certificate. Health Science Journal, 12(4), 1–8. https://doi.org/10.21767/1791-809X.1000578
10.21767/1791-809X.1000578 Google Scholar
- Berg, A., Suhonen, R. & Idvall, E. (2007). A survey of orthopaedic patients’ assessment of care using the individualised care scale. Journal of Orthopaedic Nursing, 11(3–4), 185–193. https://doi.org/10.1016/j.joon.2007.08.002
10.1016/j.joon.2007.08.002 Google Scholar
- Blanco-Nistal, M.M., Tortajada-Soler, M., Rodriguez-Puente, Z., Puente-Martínez, M.T., Méndez-Martínez, C. & Fernández-Fernández, J.A. (2021). Patient perception of nursing care in the context of the COVID-19 crisis. Enfermeria Global, 20(4), 26–43. https://doi.org/10.6018/eglobal.479441
10.6018/eglobal.479441 Google Scholar
- Bridges, J., Nicholson, C., Maben, J., Pope, C., Flatley, M., Wilkinson, C., Meyer, J. & Tziggili, M. (2013). Capacity for care: meta-ethnography of acute care nurses' experiences of the nurse–patient relationship. Journal of Advanced Nursing, 69(4), 760–772. https://doi.org/10.1111/jan.12050
- Bucco, T. (2015). The relationships between patients' perceptions of nurse caring behaviors, nurses' perceptions of nurse caring behaviors and patient satisfaction in the emergency department Seton Hall University.
- Bukecik, E. & Terzioglu, F. (2021). Individualized care: perceptions of gynecologic oncology patients and nurses. Journal of Cancer Education, 36(4), 811–818. https://doi.org/10.1007/s13187-020-01708-2
- Burhans, L.M. & Alligood, M.R. (2010). Quality nursing care in the words of nurses. Journal of Advanced Nursing, 66(8), 1689–1697. https://doi.org/10.1111/j.1365-2648.2010.05344.x
- Chappell, N.L., Reid, R.C. & Gish, J.A. (2007). Staff-based measures of individualized care for persons with dementia in long-term care facilities. Dementia, 6(4), 527–547. https://doi.org/10.1177/1471301207084372
10.1177/1471301207084372 Google Scholar
- Charalambous, A., Radwin, L., Berg, A., Sjovall, K., Patiraki, E., Lemonidou, C., Katajisto, J. & Suhonen, R. (2016). An international study of hospitalized cancer patients' health status, nursing care quality, perceived individuality in care and trust in nurses: a path analysis. International Journal of Nursing Studies, 61, 176–186. https://doi.org/10.1016/j.ijnurstu.2016.06.013
- Danaci, E. & Koc, Z. (2020). The association of job satisfaction and burnout with individualized care perceptions in nurses. Nursing Ethics, 27(1), 301–315. https://doi.org/10.1177/0969733019836151
- Danielis, M., Peressoni, L., Piani, T., Colaetta, T., Mesaglio, M., Mattiussi, E. & Palese, A. (2021). Nurses' experiences of being recruited and transferred to a new sub-intensive care unit devoted to COVID-19 patients. Journal of Nursing Management, 29(5), 1149–1158. https://doi.org/10.1111/jonm.13253
- Dinc, L. & Gastmans, C. (2013). Trust in nurse-patient relationships: a literature review. Nursing Ethics, 20(5), 501–516. https://doi.org/10.1177/0969733012468463
- Drapeaux, A., Jenson, J.A. & Fustino, N. (2021). The impact of COVID-19 on patient experience within a Midwest hospital system: a case study. Journal of Patient Experience, 8. https://doi.org/10.1177/23743735211065298
- Duclos, A., Gillaizeau, F., Colombet, I., Coste, J. & Durieux, P. (2008). Health staff perception regarding quality of delivered information to inpatients. International Journal for Quality in Health Care, 20(1), 13–21. https://doi.org/10.1093/intqhc/mzm063
- Engel, F.D., da Fonseca, G.G.P., Cechinel-Peiter, C., Backman, C., da Costa, D.G. & de Mello, A. (2023). Impact of the COVID-19 pandemic on the experiences of hospitalized patients: a scoping review. J Patient Saf, 19(2), e46–e52. https://doi.org/10.1097/PTS.0000000000001084
- Faul, F., Erdfelder, E., Buchner, A. & Lang, A.G. (2009). Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
- Federal Office for Public, H. (2020). Coronavirus: people at especially high risk. Federal Office for Public Health. https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/krankheit-symptome-behandlung-ursprung/besonders-gefaehrdete-menschen.htm
- Feo, R., Conroy, T., Marshall, R.J., Rasmussen, P., Wiechula, R. & Kitson, A.L. (2017). Using holistic interpretive synthesis to create practice-relevant guidance for person-centred fundamental care delivered by nurses. Nursing Inquiry, 24(2), e12152. https://doi.org/10.1111/nin.12152
- Gilmore, K.J., De Rosis, S. & Nuti, S. (2020). Do patient preferences change in a pandemic? Exploring Italian patient reported experience data during the covid-19 crisis. Value in Health, 23, S682–S682. https://doi.org/10.1016/j.jval.2020.08.1689
- Humphreys, J., Schoenherr, L., Elia, G., Saks, N.T., Brown, C., Barbour, S. & Pantilat, S.Z. (2020). Rapid implementation of inpatient telepalliative medicine consultations during COVID-19 pandemic. Journal of Pain and Symptom Management, 60(1), e54–e59. https://doi.org/10.1016/j.jpainsymman.2020.04.001
- Idvall, E., Berg, A., Katajisto, J., Acaroglu, R., Luz, M.D., Efstathiou, G., Kalafati, M., Kanan, N., Leino-Kilpi, H., Lemonidou, C., Papastavrou, E., Sendir, M. & Suhonen, R. (2012). Nurses' sociodemographic background and assessments of individualized care. Journal of Nursing Scholarship, 44(3), 284–293. https://doi.org/10.1111/j.1547-5069.2012.01463.x
- Key, T., Kulkarni, A., Kandhari, V., Jawad, Z., Hughes, A. & Mohanty, K. (2021). The patient experience of inpatient care during the COVID-19 pandemic: exploring patient perceptions, communication, and quality of care at a university teaching hospital in the United Kingdom. Journal of Patient Experience, 8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8205368/pdf/10.1177_2374373521997742.pdf
- Kitson, A.L., Muntlin Athlin, A. & Conroy, T. (2014). Anything but basic: nursing's challenge in meeting patients' fundamental care needs. Journal of Nursing Scholarship, 46(5), 331–339. https://doi.org/10.1111/jnu.12081[CrossRef]
- Koberich, S., Suhonen, R., Feuchtinger, J. & Farin, E. (2015). The German version of the Individualized Care Scale—assessing validity and reliability. Patient Prefer Adherence, 9, 483–494. https://doi.org/10.2147/PPA.S77486
- Lyng, H.B., Ree, E., Wibe, T. & Wiig, S. (2021). Healthcare leaders' use of innovative solutions to ensure resilience in healthcare during the Covid-19 pandemic: a qualitative study in Norwegian nursing homes and home care services. BMC Health Services Research, 21(1), 878. https://doi.org/10.1186/s12913-021-06923-1
- Markkanen, P., Brouillette, N., Quinn, M., Galligan, C., Sama, S., Lindberg, J. & Karlsson, N. (2021). It changed everything’’: The safe home care qualitative study of the COVID-19 pandemic's impact on home care aides, clients, and managers. BMC Health Services Research, 21(1), 1055. https://doi.org/10.1186/s12913-021-07076-x
- Martínez-Angulo, P., Rich-Ruiz, M., Jiménez-Mérida, M.R. & López-Quero, S. (2024). Active listening, shared decision-making and participation in care among older women and primary care nurses: a critical discourse analysis approach from a gender perspective. BMC Nursing, 23, 401.
- McCance, T., Slater, P. & McCormack, B. (2009). Using the caring dimensions inventory as an indicator of person-centred nursing. Journal of Clinical Nursing, 18(3), 409–417. https://doi.org/10.1111/j.1365-2702.2008.02466.x
- MillsteinJeffrey, H. (2020). Reimagining the patient experience during the COVID-19 pandemic. Nejm Catalyst Innovations in Care Delivery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371288/
- Mize, D. (2018). The meaning of patient-nurse interaction for older women in healthcare settings: a qualitative descriptive study. Int J Nursing Older People, 13(1), e12167. https://doi.org/10.1111/opn.12167
- Molina-Mula, J. & Gallo-Estrada, J. (2020). Impact of nurse–patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3). https://doi.org/10.3390/ijerph17030835
- Nilsen, M.L., Sereika, S.M., Hoffman, L.A., Barnato, A., Donovan, H. & Happ, M.B. (2014). Nurse and patient interaction behaviors' effects on nursing care quality for mechanically ventilated older adults in the ICU. Research in Gerontological Nursing, 7(3), 113–125. https://doi.org/10.3928/19404921-20140127-02
- Obregon-Gutierrez, N., Puig-Calsina, S., Bonfill-Abella, A., Forrellat-Gonzalez, L. & Subirana-Casacuberta, M. (2022). Care left undone’’ and quality of care during the COVID-19 pandemic: Influential factors and modulating strategies. Enfermería Clínica, 32(1), 4–11. https://doi.org/10.1016/j.enfcle.2021.06.004
- Oh, H., Uhm, D.C. & Yoon, Y.J. (2016). Workplace bullying, job stress, intent to leave, and nurses' perceptions of patient safety in South Korean hospitals. Nursing Research, 65(5), 380–388. https://doi.org/10.1097/NNR.0000000000000175
- Petroz, U., Kennedy, D., Webster, F. & Nowak, A. (2011). Patients' perceptions of individualized care: evaluating psychometric properties and results of the individualized care scale. Canadian Journal of Nursing Research, 43(2), 80–100. https://www.ncbi.nlm.nih.gov/pubmed/21888007
- Petry, H., Pelzelmayer, K., Ernst, J., Thuerlimann, E. & Naef, R. (2023). Nurse–patient interaction during the Covid-19 pandemic: creating and maintaining an interactive space for care. Journal of Advanced Nursing, 79(1), 281–296. https://doi.org/10.1111/jan.15486
- Pöhler, A. (2010). Übersetzung und psychometrische Überprüfung der Individualized Care Scale (ICS)[Translation and psychometric testing of the Individualized Care Scale (ICS)]. Berlin: Charite-Universitätsmedizin Berlin.
- Rathnayake, S., Dasanayake, D., Maithreepala, S.D., Ekanayake, R. & Basnayake, P.L. (2021). Nurses' perspectives of taking care of patients with Coronavirus disease 2019: a phenomenological study. PLoS ONE, 16(9), e0257064. https://doi.org/10.1371/journal.pone.0257064
- Riviere, M., Dufoort, H., Van Hecke, A., Vandecasteele, T., Beeckman, D. & Verhaeghe, S. (2019). Core elements of the interpersonal care relationship between nurses and older patients without cognitive impairment during their stay at the hospital: a mixed-methods systematic review. International Journal of Nursing Studies, 92, 154–172. https://doi.org/10.1016/j.ijnurstu.2019.02.004
- Rosen, M.A., DiazGranados, D., Dietz, A.S., Benishek, L.E., Thompson, D., Pronovost, P.J. & Weaver, S.J. (2018). Teamwork in healthcare: key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433–450. https://doi.org/10.1037/amp0000298
- Ryan, C. & McAllister, M. (2017). Enrolled nurses' experiences learning the nurse preceptor role: a qualitative evaluation. Collegian, 24(3), 267–273. https://doi.org/10.1016/j.colegn.2016.04.001
- Schroeder, K., Norful, A.A., Travers, J. & Aliyu, S. (2020). Nursing perspectives on care delivery during the early stages of the COVID-19 pandemic: a qualitative study. International Journal of Nursing Studies Advances, 2, 100006. https://doi.org/10.1016/j.ijnsa.2020.100006
- Sousa, V.D. & Rojjanasrirat, W. (2011). Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. Journal of Evaluation in Clinical Practice, 17(2), 268–274. https://doi.org/10.1111/j.1365-2753.2010.01434.x
- Srulovici, E. & Drach-Zahavy, A. (2017). Nurses' personal and ward accountability and missed nursing care: a cross-sectional study. International Journal of Nursing Studies, 75, 163–171. https://doi.org/10.1016/j.ijnurstu.2017.08.003
- Staudacher, D., Rettke, H., Brenner, G. & Petry, H. (2023). “Was kommt noch auf uns zu?” Fremdeinsätze im Team Nursing-System während der ersten Pandemiewelle: Eine qualitative Studie. Pflege, 79, 281–296.
- Stimpfel, A.W., Sloane, D.M. & Aiken, L.H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs (Project Hope), 31(11), 2501–2509. https://doi.org/10.1377/hlthaff.2011.1377
- Suhonen, R., Berg, A., Idvall, E., Kalafati, M., Katajisto, J., Land, L., Lemonidou, C., Schmidt, L.A., Valimaki, M. & Leino-Kilpi, H. (2010). Adapting the individualized care scale for cross-cultural comparison. Scandinavian Journal of Caring Sciences, 24(2), 392–403. https://doi.org/10.1111/j.1471-6712.2009.00712.x
- Suhonen, R., Charalambous, A., Berg, A., Katajisto, J., Lemonidou, C., Patiraki, E., Sjovall, K., Stolt, M. & Radwin, L.E. (2018). Hospitalised cancer patients' perceptions of individualised nursing care in four European countries. European Journal of Cancer Care, 27(1), e12525. https://doi.org/10.1111/ecc.12525
- Suhonen, R., Efstathiou, G., Tsangari, H., Jarosova, D., Leino-Kilpi, H., Patiraki, E., Karlou, C., Balogh, Z. & Papastavrou, E. (2012). Patients' and nurses' perceptions of individualised care: an international comparative study. Journal of Clinical Nursing, 21(7–8), 1155–1167. https://doi.org/10.1111/j.1365-2702.2011.03833.x
- Suhonen, R., Gustafsson, M.L., Katajisto, J., Valimaki, M. & Leino-Kilpi, H. (2010). Individualized care scale–nurse version: a Finnish validation study. Journal of Evaluation in Clinical Practice, 16(1), 145–154. https://doi.org/10.1111/j.1365-2753.2009.01168.x
- Suhonen, R., Papastavrou, E., Efstathiou, G., Tsangari, H., Jarosova, D., Leino-Kilpi, H., Patiraki, E., Karlou, C., Balogh, Z. & Merkouris, A. (2012). Patient satisfaction as an outcome of individualised nursing care. Scandinavian Journal of Caring Sciences, 26(2), 372–380. https://doi.org/10.1111/j.1471-6712.2011.00943.x
- Suhonen, R., Schmidt, L.A., Katajisto, J., Berg, A., Idvall, E., Kalafati, M., Land, L., Lemonidou, C., Valimaki, M. & Leino-Kilpi, H. (2013). Cross-cultural validity of the Individualised Care Scale—a Rasch model analysis. Journal of Clinical Nursing, 22(5–6), 648–660. https://doi.org/10.1111/j.1365-2702.2012.04238.x
- Suhonen, R., Schmidt, L.A. & Radwin, L. (2007). Measuring individualized nursing care: assessment of reliability and validity of three scales. Journal of Advanced Nursing, 59(1), 77–85. https://doi.org/10.1111/j.1365-2648.2007.04282.x
- Theys, S., Van Hecke, A., Akkermans, R. & Heinen, M. (2021). The Dutch Individualised Care Scale for patients and nurses: a psychometric validation study. Scandinavian Journal of Caring Sciences, 35(1), 308–318. https://doi.org/10.1111/scs.12853
- Thomas, D., Newcomb, P. & Fusco, P. (2019). Perception of caring among patients and nurses. Journal of Patient Experience, 6(3), 194–200. https://doi.org/10.1177/2374373518795713
- Thomas, S., Quirk, L., Blevins, C., Quatrara, B. & Letzkus, L. (2017). Incongruence in perceptions: identifying barriers to patient satisfaction in the intensive care unit. Dimensions of Critical Care Nursing, 36(6), 349–354. https://doi.org/10.1097/DCC.0000000000000267
- Tuczynska, M., Staszewski, R., Matthews-Kozanecka, M., Zok, A. & Baum, E. (2022). Quality of the healthcare services during COVID-19 pandemic in selected European countries. Frontiers in Public Health, 10. https://www.ncbi.nlm.nih.gov/pubmed/35646786
10.3389/fpubh.2022.870314 Google Scholar
- Vandenbroucke, J.P., Elm, E.v., Altman, D.G., Gøtzsche, P.C., Mulrow, C.D., Pocock, S.J., Poole, C., Schlesselman, J.J., Egger, M. & Initiative, S. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Annals of Internal Medicine, 147(8), W-163–W-194. https://doi.org/10.7326/0003-4819-147-8-200710160-00010-w1
- Wensing, M., Zwahlen, M., Niquille, A., Gureau, A. & Abolhassani, N. (2022). Synthesis working paper: quality of care. Swiss National Science Foundation.
- Wiechula, R., Conroy, T., Kitson, A.L., Marshall, R.J., Whitaker, N. & Rasmussen, P. (2016). Umbrella review of the evidence: what factors influence the caring relationship between a nurse and patient? Journal of Advanced Nursing, 72(4), 723–734. https://doi.org/10.1111/jan.12862
- Wong, E.L., Wang, K., Cheung, A.W., Graham, C. & Yeoh, E.K. (2023). Thinking beyond the virus: perspective of patients on the quality of hospital care before and during the COVID-19 pandemic. Frontiers in Public Health, 11, 1152054. https://doi.org/10.3389/fpubh.2023.1152054
- Younas, A., Inayat, S. & Masih, S. (2023). Nurses' perceived barriers to the delivery of person-centred care to complex patients: a qualitative study using theoretical domains framework. Journal of Clinical Nursing, 32(3-4), 368–381. https://doi.org/10.1111/jocn.16245
- Zhang, H., Xie, F., Yang, B., Zhao, F., Wang, C. & Chen, X. (2022). Psychological experience of COVID-19 patients: a systematic review and qualitative meta-synthesis. American Journal of Infection Control, 50(7), 809–819. https://doi.org/10.1016/j.ajic.2022.01.023
