الفهرس 
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Abstract
Caring is considered a fundamental human need as well as an important component of the nursing profession. Caring is central to nursing practice. Effective care can achieve healing, health, personal and family growth, a feeling of wholeness, and inner peace that enable patients to overcome disease, trauma, and life changes. Nursing care is demonstrated through nurses caring behaviors. Nurses should apply caring behaviors while providing nursing care to patients in order to achieve patient satisfaction, improve nursing care quality, and change patients‘ plans to return to the institution again for care (Akansel & Watson, 2021; Thomas et al., 2019).
According to Watson‘s Human Caring/Caring Science theory, the goal of nursing is to help the patient achieve greater harmony between his mind, body, and spirit. This harmony can be attained through compassionate interactions, such as a transpersonal caring relationship. Nursing care creates a therapeutic connection between nurses and their patients, which helps nurses recognize the patient’s problems, come up with solutions, create a plan, and implement and assess the plan. Also, through this caring relationship, nurses will be able to express their professional identity, find meaning and value in their work, and achieve satisfaction with their jobs (J. Watson, 1979, 2009a).
Most caring behaviors are classified into two distinct groups: instrumental and expressive behaviors. Instrumental caring behaviors are related to technical and physical behaviors focusing on the physical and medical requirements of patients, such as medication and treatment. Nurses must possess the necessary skills and knowledge to meet the health needs of patients, and a lack of either would be considered negligent and necessitate disciplinary measures. However, purely instrumental tasks might objectify a person (Afaya & Gross, 2017; Jagoda, 2019) .
While expressive caring behaviors are more psychosocially oriented, they add a qualitative difference to the way activities are carried out and reflect a commitment to values like respect for the individual’s distinct identity and needs, such as providing emotional support and empathy, being aware of the patints’ demands, and honoring their privacy and exclusive requirements Both instrumental and expressive elements contribute equally to the achievement of excellence in nursing practice. If the nurse deals with the patient as a physical object rather than as a person whom she cares about, much of the therapeutic effect of her activities is lost (Azizi-Fini et al., 2012; Shalaby et al., 2018).
Nursing staff members who practice caring behaviors report higher levels of satisfaction and wellbeing, which helps them better comprehend the perspectives of their patients and, as a result, deliver higher-quality care. By enhancing their interactions with patients, enhancing their sense of professional and personal fulfillment, and enhancing their passion for nursing, caring behaviors help nurses socially as well. Nurses develop their sense of self and learn to treat others and themselves with compassion (Almukhaini et al., 2020; Nowell et al., 2021) .
In contrast, a lack of caring behaviors can make nurses feel like robots, afraid, oblivious, and exhausted, which is bad for patient satisfaction, worsens their health, disturbs their psychological calm, and lengthens their stay in the hospital. When there are no caring behaviors displayed towards patients, they feel humiliated, alone, frightened, and helpless (Karlsson et al., 2020).
However, nurses perceive and exhibit these caring behaviors and set their priorities according to their patients’ needs. Previous studies on caring showed that no caring component is better than the other (Afaya & Gross, 2017; Vujanić et al., 2020).
A higher level of satisfaction for both nurses and patients could result from the adoption of particular nurse-patient interaction models based on caring behaviors in healthcare systems (Yetti & Nuraini, 2019) .
Aim of the study
The current study aims to identify the perception of coronary care nurses towards nurse caring behaviors in coronary care units.
Setting:
This study was carried out at the coronary care units (CCUs) at the Alexandria Main University Hospital and Smouha University Hospital; these hospitals include well-equipped CCUs and are regarded as primary destinations for the majority of heart disease patients. The coronary care unit at Alexandria Main University (first floor in the medical building) contains 14 beds in two separate rooms. The first one contains 6 beds, the second contains 8 beds, and the number of coronary care nurses working in it is 30. As regards the coronary care unit at Smouha University Hospital, it contains 10 beds, and the number of coronary care nurses working in it is 25.
Subjects:
The study subjects included all staff nurses with at least one year of experience and more who provided direct care to patients and who worked in the above-mentioned units and were present at the time of gathering data. The subjects included in the study were 55 nurses who were identified to take part in the survey. They were distributed as follows: (30) from the Alexandria Main University Hospital and (25) from Smouha University Hospital, and divided into the following categories: professional nurses (n = 38), technical nurses (n = 11), and practical nurses (n = 6).
Tools of the study:
A self-administered questionnaire was developed by the researcher to fulfill the aim of the study, consisting of two portions.
Part 1: Nurses’ demographic and clinical profile:
This section was used to collect data associated with the major demographic variables of nurse participants, which include age, gender, educational level, past work experience, current CCU work experience duration and setting, and attendance at pre- and in-service training programs regarding nurse caring behaviors.
Part 2: Nurse Caring Behaviors Assessment:
This part is a structured interview schedule that was adapted from the Caring Behavior Assessment Scale (CBAS), which was developed in 1988 by Cronin and Harrison. They used the experience of four scholars at ease with Watson’s theory to evaluate both the face and content validity of the CBA scale. Furthermore, each behavior was scored by the expert panel using the subscale allocated to it; elements with interrater reliabilities lower than 0.75 were classified into appropriate subscales. Cronbach’s alpha coefficients for CBA subscales ranged from 0.66-0.90.
The CBAS scale was used in this study to identify the perception of coronary care nurses towards caring behaviors in the CCUs of the selected hospitals. It has 70 items categorized under 7 domains of caring behaviors based on Watson‘s carative factors as follows: humanism, faith, hope, and sensitivity (19 items); establishment of a trusting therapeutic relationship (7 items); expression of feelings (6 items); teaching and learning process (15 items); provision of a healthy protective environment (7 items); physical human needs (10 items); and spiritual care (6 items). Items of the CBAS are rated on a 5-point Likert scale from 1 to 5 (where 1 is the least important caring behavior and 5 is the most important caring behavior).
Scores obtained for each domain and for all domains were summed up and converted into percent scores. In the current study, the CBAS was somewhat modified, which included rephrasing all items on the original tool such that each statement reflected the nurses’ perception rather than the patients’, as shown in the original.
Method:
The research was submitted to the Ethical Research Committee, Faculty of Nursing, and Alexandria University for ethical approval.
After explaining the purpose of the study, the Vice-Dean of the Faculty of Nursing at the University of Alexandria granted official authorization to gather the essential data for the study, which was directed to the administrative authorities of the Main University Hospital and Smouha University Hospital. The tool used was translated into Arabic and validated for its validity by a jury of five specialists in the department of critical care and emergency nursing, Faculty of Nursing.
The tools were tested for their internal consistency and reliability using Cronbach’s alpha coefficient, which proved to be strongly reliable.
A pilot study was conducted on 5% of nurses (n = 6) who weren’t incorporated in the overall study sample to verify and assure the clarity, practicality, and feasibility analysis of the tools; identify potential problems and obstacles that may be encountered throughout data collection; and determine the time required to complete the questionnaire. In considering the results of the pilot study, no changes were made to the tools, and they were released in their final form.
Data collection:
Data was collected in this study using a self-administered questionnaire. It was distributed by hand to the study nurses in their work settings. Before the questionnaire was distributed, necessary instructions were provided to nurses, and each study subject spent roughly 15–20 minutes completing the questionnaire. The data was collected over a two-month period, from August 2021 to November 2021.
The following were the most important results of the present study:
The majority of nurses (85.5%) were female, with the highest percentage (45.5%) being under the age of 30.
The majority of nurses (69.1%) have a bachelor’s degree in nursing, More than half of all nurses (63.3%) participated in NCB training programs, and a significant percentage of nurses (72.7%) had at least one year of experience and were assigned to two or three patients every shift.
”Establishment of a trusting therapeutic relationship” was ranked by coronary nurses as the second most important caring behavior.
Nurses consider the subscale ”Spiritual Care ”as the least significant subscale.
The most important caring behavior was to ”do treatments or give medications at the scheduled time” (mean score 4.40 ± 1.08), which belonged to the ”Human needs assistance ”subscale, which was in line with ranking the studied nurses on this subscale as the first according to its importance.
”Give patients indications and means to treat or prevent certain side effects of their medications or treatments” (mean score 4.40 ± 0.89) was the second most important caring behavior as perceived by the patient, which belonged to the ”Teaching/Learning ”category.
Three items later were chosen from the ”Establishment of a Therapeutic Relationship” subscale as more important caring behaviors, which were ”Respect my engagements”, ””Introduce myself by stating clearly my name and function”, and ”Answer as soon as it is convenient when patients call me ”, with a mean score of 4.38 ± 0.95, 4.20 ± 1.16 and 4.18 ± 1.14, respectively.
The least important caring behaviors as perceived by coronary care nurses belonged to the subscale ”Allowance for Existential-Phenomenological Spiritual Forces ”, such as ―Help patients to look for a certain equilibrium or balance in their life” and ”explore the meaning that they give to their health condition, with a mean score of 4.31 ± 1.03, 4.18 ± 1.26 and 4.18 ± 1.04 respectively.
Nurses with a bachelor’s degree in this study assessed the ”therapeutic relationship” subscale higher than technical nurses and nurses with a diploma degree. There were no significant differences regarding education in relation to other cognitive subscales.
There is a statistical significance between the years of experience of the coronary nurses and their perceptions towards ”the therapeutic relationship”, ”expression of positive and negative feelings”, ”health teaching ”and ”patients’ physical needs”, ”, Nurses with up to 15 years of work experience rated procedures related to these caring behaviors significantly higher compared to the respondents with less than 5 years of work experience.
There is no statistical significance between nurses’ attendance at previous training courses regarding nurse caring behaviors and their perceptions of them.
Recommendations were given based on the results of the present study to identify the perceptions of coronary care nurses towards nurse caring behaviors in coronary care units. For nursing practice, applying caring behaviors to ensure high quality nursing care and enhance patient satisfaction.
For hospital administrators, providing a healthy work environment that is characterized by open communication through a schedule for staff meetings and workshops with their managers to encourage nurses to apply caring behaviors as a non-pharmacological strategy to achieve high quality nursing care and promote patient satisfaction Publish nurse-caring behaviors at all units of hospitals. Providing training programs, workshops, and conferences for clarifying nurses’ roles in nursing care.
For nursing education, incorporate nurse-caring behaviors into both undergraduate and postgraduate curriculum and staff development in healthcare institutions. Develop educational programs to educate healthcare providers about the importance of caring behaviors.
Regarding nursing research, replicate this study with a large probability sample. Assess the caring behavior of critical care nurses. Assess factors affecting the caring behavior of critical care nurses at CCU. Develop a more complete and short quantitative tool to measure nurse caregiving behaviors for future research. Investigate the nurse’s reasons for not complying with caring behaviors in all practices. Evaluate patients‘ satisfaction regarding nurses‘ caring behaviors.