Research Article

iMedPub Journals 2017

Journal of Healthcare Communications
www.imedpub.com ISSN 2472-1654 Vol. 2 No. 4: 36

DOI: 10.4172/2472-1654.100076

Patient Perceptions of the Caring Kathryn Miller*

Environment School of Nursing, Liberty University, Virginia,
USA

Abstract *Corresponding author:

Kathryn Miller
As technology at the point of care increases to ensure greater efficiency,
effectiveness and patient safety, the impact of such technology needs to be
explored for impact on patient perception of the caring environment. The evidence
 [email protected]
based practice pilot project based on the Iowa Model sought to answer if an
ergonomic change in use surrounding technology improved patient perceptions Executive Director of Clinical Affairs, School
of the caring environment. of Nursing, Liberty University, Lynchburg, VA
24515, USA.
Keywords: Caring; Computers; Patient perception; Nursing care; Caring
environment
Tel: (434) 592-4772

Received: July 11, 2017; Accepted: August 03, 2017; Published: August 13, 2017
Citation: Miller K. Patient Perceptions of
the Caring Environment. J Healthc Commun.
Introduction 2017, 2:4.

Grounded in the clinical relationship of the nurse patient dyad

and patient perceptions of a caring environment, this proposed of time being spent at the patient bedside. This may not be the
scholarly project sought to pilot evidence based practice protocol case. Nor should it be assumed that positive gain in the areas of
surrounding the patient perception of the caring environment. safety, efficiency and efficacy by way of MCW use at the point of
The Institute of Medicine’s (IOM) standard for evidence based care has come at no cost associated with the loss in authentic
practice to guide policy at the point of care [1] along with findings human caring as perceived by the patient.
of increased safety, quality and efficacy with mobilized computer
workstations at the point of care were considered, compared and If, in the addition of technology at the point of care, a caring
challenged by the interpersonal caring behavior associated with environment is lost or perceived to be lost, the way in which the
respect and authentic presencing of nurses [2]. same technology can and should be used must be reevaluated.
Forward progress in the ergonomic use of healthcare informatics
Background must improve quality and safety without undermining the
caring relationship established within the nurse patient dyad.
Although much is noted in the literature regarding nursing as a
profession of caring, less is found on patient perceptions of that The writer concluded a moderate amount of evidence revealing
relationship of caring, and technological factors that influence need for pilot study to evidence for improved practice change
it. Little was found in the literature search that combined with alternative techniques in the use of MCWs and patient
perceptions of a caring environment, the nurse patient dyad perceptions of a caring environment.
and the variable use of a Mobile Computer Workstation (MCW)
at the point of care. Current literature reveals investigation and Purpose
documentation of increased efficient and effective nursing care The purpose of this pilot project was to implement an evidence
delivery as well as increased patient safety with the incorporation based practice change surrounding MCW ergonomic use at the
of mobile computer workstations. This is both well established point of care and to evaluate for improved patient perceptions
and accepted with gain of immediate access to medication, supply of a caring environment. Objective of the pilot was to examine
storage, and electronic documentation, requiring fewer detours patient perceptions of a caring environment where MCWs are
to storage rooms and less interruption of time management. used at the point of care.
Fewer medication errors with the use of mobile electronic
scanning are undeniable [3]. Problem statement
However, the writer notes assumptions that increased safety, The importance of this topic is found in the importance of the
efficiency and efficacy of nurse workflow equate greater amounts patient [4]. If in fact healthcare is to be patient centered, the

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Journal of Healthcare DE MEDICINA
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perception of the patient must be understood and ways to of the study were to examine patient perceptions of the caring
maximize the patient perception of a caring environment without environment where the use of MCWs was modified at the point
compromising the increased quality and safety that technology of care to determine if differences existed in patient perception
offers must be found. Key to the nurse patient dyad is the concept of the caring environment.
of a relationship of trust. If the patient does not perceive an
This evidence based practice project piloted the implementation
environment of caring, trust may be inhibited and quality of care
of an interventional ergonomic technique for nurse use with
may suffer.
MCW surrounding adult patients admitted to acute medical
Timeliness of this evidence based practice project is remarkable surgical units and sought to answer if such ergonomic use
as the IOM requirement for evidence to support practice and improved patient perception of a caring environment. Project
improve safety ignites the need for increased informatics and plan included implementation of ergonomic use of MCW at the
supportive technology. It is most relevant in this continual point of care. The two ergonomic positions of use were defined
change environment of informatics technology adoption, that as (1) Intervention of sitting at the patient bedside with MCW not
further study of not only the care but caring nature of the new physically coming between the nurse and the patient; (2) Control
environment and the patients’ perceptions of that environment of standing with MCW physically between nurse and patient.
be accomplished to fully qualify this adoptive change as Measurable outcome of primary population sample is identified
sustainable improvement. as patient perception of the caring environment. Secondary
population noted as nurses utilizing interventional ergonomic
Substantiation of MCWs as healthcare informatics technology at
techniques with MCW use provided outcome data on nurse
the point of care is well documented in the literature review from
perception of intervention through end of pilot survey.
the quantitative perspective. Evidence noting a mismatch of nurse
and patient perceptions of the caring environment and stymied Target population consists of all adult medical surgical patients in
delivery of humanistic needs in the presence of technology acute care settings currently receiving care by providers who use
necessitates further research at the point of care [2]. This pilot MCWs at the point of care. Inclusion criteria for sample include
study contributes to the overall body of knowledge surrounding patients admitted or transferred to medical surgical unit, 18
patient perceptions of the caring environment where MCWs are years of age or older, alert and oriented with ability for informed
used at the point of care. consent. Exclusion criteria on the basis of protection for patients,
whose autonomy is diminished, consisted of nonuse of patients
Clinical question who are pregnant, or unable to give informed consent due to
Development of clinical question following the Patient- alteration in orientation. Those on air borne precaution use of
Intervention-Comparison-Outcome-Timeline (PICOT) format negative pressure rooms will also be excluded [8].
suggested by Mateo and Foreman [5] reveals clinical question Sample sites include two medical surgical units in two hospitals
central to the project: For medical surgical patients, will among a four hospital system. Sample sites where selected based
ergonomic use of the mobile computerized workstation improve on geographic proximity to each other, and inclusion of general,
patient perception of the caring environment? Additional clinical medical/surgical units. Protection of human subjects is noted in
questions surrounding the pilot change include; 1) Is patient accordance with the Collaborative Institutional Training Initiative
perception of the caring environment different per age group with [9].
ergonomic use of the MCW; 2) Is patient perception of the caring
environment different per gender with ergonomic use of the All nursing staff, unit managers, and volunteers of medical
MCW; 3) Is patient perception of the caring environment different surgical units participating in the research study were advised of
per ethnicity with ergonomic use of the MCW; and 4) What is the key principles associated with Collaborative Institutional Training
second population, nurse perception of the intervention. Initiative (CITI) prior to start date to ensure risks to patients were
minimized. Understanding of vulnerable population groups and
Design the required respect, beneficence, and justice for each patient
were introduced and reinforced during staff training that occurred
The project was designed as an evidence-based practice project. as part of regularly scheduled unit meetings. No compensation
The Iowa Model of Evidence Based Practice to Promote Quality was made to participants, data collectors, or project leader. Risk
Care [6] was used with permission from the University of Iowa. to participants of the pilot study was noted by the Institutional
The project followed the Iowa Model flowchart [7]. Design was Review Board of record, as no greater than assumed in everyday
consistent with a pilot project and therefore utilized an unknown life.
number of potential participants during a set thirty-day period.
Setting
Methodology
Two medical surgical units within two separate hospitals as part
Focusing on the phenomenon associated with the nurse-patient of a four-hospital system were setting for the evidence based
dyad and the caring environment, this evidence-based practice practice pilot project. Populations within these two hospitals
project followed a quasi-experimental methodology for data differ little geographically and little socioeconomically. Hospital
collection and analysis where outcome of interest concentrated system organizational strategic plan focused on the value of
on patient perception of the caring environment and the change patient centered care with standards of behavior to include
MCW ergonomic use had on such patient perceptions. Objectives communicating with clarity and creating connection [10].

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Tools anonymously by the patient at discharge, sealed and given to

discharge staff when exiting hospital unit. Discharge staff placed
Primary population sample of medical surgical patients were all surveys in a locked drop box at the unit nursing station. All
measured for outcome of patient perception of the caring surveys were collected by the project leader at the end of the
environment using a survey filled out by the patient anonymously, data collection period.
sealed in an envelope, and deposited in a locked box on the
unit at time of discharge. Variables of the study concentrated Secondary population sample of nurses implementing
on the nurse patient dyad with patient perception of a caring interventional ergonomic use of MCW were measured for
environment. With a focus on nursing as opposed to physician outcome of nurse perception of intervention using a simple
specific verbiage, and with dependent variable noted as patient survey filled out anonymously and submitted to project leader at
perceptions of needs met through care of nursing, survey tool for staff meeting post intervention and data collection period.
proposed project instrumentation was the Patient Perception of
Hospital Experience with Nursing (PPHEN). The tool is noted as a Findings
15-question Likert scale and was used with obtained permission
from its developer, Dr. Harriet Kitzman, University of Rochester, Primary sample
Rochester, NY, USA [11]. With a total combined 380 patients discharged from the two
Appropriateness of the tool is remarkable with all 15 items of the units during the 30 day data collection period, 32% participated
survey directly associated with care provided by the nurse. Items by handing in a survey with initial sample size N=122. Table 1
four and 15 specify wording to include phrasing such as, “the reveals that 46.7% of patients surveyed were from hospital one
nurses gave me their undivided attention while caring for me” and totaled fifty-six patients. Hospital two contributed 52.5% of
and “the nurses actions made me feel cared for” [12]. Content patients surveyed and totaled sixty three patients. One survey
of the survey is applicable and consistent with project aim and was noted with missing PPHEN data, another was missing all data,
focus. Although content validity of the tool was not noted by Lynn and another with all variables noted as not applicable. Another
et al. [13], internal consistency when items reduced from 125 to survey was empty for control or intervention, turned in on white
paper. Both the survey with all empty PPHEN and missing PPHEN
eventual 15 item instrument, “the PPHEN was found to be [one]-
data points were omitted.
dimensional, reliable “=94 and have evidence of construct validity”
based on Cronbach’s alpha. Readability and interpretability was The independent variable was defined as ergonomic use of
confirmed. According to Lynn et al., limitations to the PPHEN MCW at the point of care. The two positions of use were defined
instrument include lack of large patient basis for generalization as: (1) sitting at the patient bedside with MCW not physically
and its one-dimensional nature. positioned between the nurse and the patient, (2) standing with
MCW physically between nurse and patient. These independent
Survey asked the degree to which patients agree with statements
variables utilized nominal, dichotomous level measurement.
surrounding nursing care. Survey answer choices will use a Likert Position one was noted as intervention. Position two as active
scale ranging from 1-6 where 1: Agree; 2: Somewhat agree; 3: control [5].
Undecided; 4: Somewhat disagree; 5: Strongly disagree; 6: Not
applicable. Three demographic questions, separate from the This random group assignment to the control group or
PPHPEN, including age, gender and ethnicity were included in intervention group is noted below in Table 2 revealing 47.5% of
the survey. Waiver of signed informed consent was approved by sample as control and 51.7% as intervention.
the Institutional Review Board (IRB). Participants were provided Total number of sample is seen in Table 3 with 120 valid
an information sheet, consistent with parent organization participants, N=120 signifying omission of two surveys for missing
Institutional Review Board template, containing all elements of PPHEN data. The number of valid participants in the control group
consent form, signature line deferred [12]. equaled 57 and number of valid participants in the intervention
Instrument was printed on color-coded paper to distinguish group equaled 62. These combined equal one less than reported
sample groups. Blue surveys were given to even room numbers N due to one survey group assignment unknown.
as active control group and orange to odd room numbers Statistical Package for the Social Sciences [14] was used to
participating in the intervention. Surveys with information analyze data and evaluate difference between groups. A
sheet were given as part of the discharge packet, completed
Table 1 Sample by hospital.
Hospital

Frequency Percent Valid percent Cumulative percent

Hospital one 56 46.7 47.1 47.1

Valid Hospital two 63 52.5 52.9 100.0
Total 119 99.2 100.0 -
Missing System 1 0.8 - -
Total 120 100.0 - -

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Table 2 Sample by group assignment.

Frequency Percent Valid percent Cumulative percent
Control Group 57 47.5 47.9 47.9
Valid Intervention Group 62 51.7 52.1 100.0
Total 119 99.2 100.0 -
Missing System 1 0.8 - -
Total 120 100.0 - -

Table 3 Sample process summary.

Cases
Group assignment Valid Missing Total
N Percent N Percent N Percent
Control Group 56 98.2% 1 1.8% 57 100.0%
Perception of Caring Environment
Intervention Group 62 100.0% 0 0.0% 62 100.0%

statistician assisted with input, analysis, and reporting of all data. to better demonstrate each level of the demographic variables.
Generalization of the test results was limited as the normality The variable of age is noted in Table 5. A total of 116 participants
of the scores combined revealed a positive skew questioning revealed their age. 33.6% of the sample was between the ages of
the normality assumption. Although scores would decrease in 65 and 79, 23.3% were between 50 and 64 years old, 18.1% of the
normality with greater number of test participants, Figure One participants were between 18 and 34 years, 16.4% of participants
histogram denotes remarkable question to the assumption of were between 35, 49 years old, and the smallest percentage of
normality. However, the assumption of homogeneity of variance the sample, 8.6% were 80 years old or older.
was assessed by the Levene test, F=0.427, p=0.515; p being>0.05
The bar graph seen in Figure Two allows visualization of the sample
allowed equal variation to be assumed. The normality assumption
by age and further denotes the age group most represented
was tenable. Therefore, the standard t test results were reported
being that of the 65-79 year old age group. The least represented
(Figure 1).
age group, those 80 years and older (Figure 2).
Results for independent t test The overall regression equation with Age as predictors did not
An independent samples t test was completed using Statistical significantly predict Perception of Caring Environment; R=0.201,
Package for the Social Sciences (SPSS) to measure whether mean R2=0.040, adjusted R2=0.005, F (4, 110) =1.157, p=0.334.
Perception of Caring Environment differed significantly between The following regression equation was generated where the
the interventional group whose nurse sat at the patient bedside constant term, 4.611, represents the mean Perception of Caring
with MCW not physically coming between the nurse and the Environment of the group Age 80+. Each predictor term represents
patient, and the control group, whose nurse stood with MCW the b coefficients for their respective age groups: Perception of
physically between nurse and patient [14]. The assumption Caring Environment’=4.611-0.273 (Age 18-34) +0.118 (Age 35-
of homogeneity of variance was assessed by the Levene test, 49) -0.340 (Age 50-64) +0.062 (Age 65-79) [15].
F=0.427, p=0.515; this showed no significant violation of the Interpretations of each b coefficient for age revealed that if a
equal variance assumption. The mean Perception of Caring patient is between ages 18-34, he/she is more likely to report a
Environment did not differ significantly, t (116) =-0.395, p=0.694, slightly lower score on Perception of Caring Environment when
two-tailed. The mean Perception of Caring Environment for the compared to the group of age 80+ but were not statistically
Intervention group (M=4.5083, SD=0.98618) was about 0.075850 significant, p=0.453. If a patient is between ages 35-49, he/she
higher than mean Perception of Caring Environment for the is more likely to report a slightly higher score on Perception of
Control group (M=4.4325, SD=1.101792). The effect size, as Caring Environment when compared to the group of age 80+ but
indexed by η2, was 0.001343236; this is a very small effect. The
were not statistically significant, p=0.749. If a patient is between
95% CI for the difference between sample means had a lower
ages 50-64, he/she is more likely to report a slightly lower score
bound of -0.456539 and an upper bound of 0.30484 [15]. This is
on Perception of Caring Environment when compared to the
noted in Table 4 and revealed that while the intervention group
group of age 80+ but were not statistically significant, p=0.336. If
rated their perception of the caring environment higher than
a patient is between ages 65-79, he/she is more likely to report a
the control group, the mean difference in Perception of Caring
slightly higher score on Perception of Caring Environment when
Environment was not statistically significant.
compared to the group of age 80+ but were not statistically
Multiple regression analysis significant, p=0.854. If patient’s age is 80+, he/she is more likely to
score 4.611 on Perception of Caring Environment. The predictors
Age: To examine the effect of the demographic variables to for age only accounts for 4% of variance of Perception of Caring
the Perception of Caring Environment, three separate multiple
Environment, which indicates a small effect, size [15].
regressions were conducted. Dummy coded variables were
utilized and three separate regression analysis were conducted Gender: Gender was reported by only 117 participants. Table 6

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Figure 1 Perception of caring environment.

Figure 2 Bar graph age of participants.

revealed 56.4% of participants as female, with 43.6% as male. Environment than female but were not statistically significant,
This slightly higher female population was further depicted in the p=0.419. If a patient is female, she is more likely to score 4.428
bar graph noted in Figure 3. on Perception of Caring Environment. The predictor for gender
only accounts for 0.6% of variance of Perception of Caring
The overall regression equation with Male as a predictor did not Environment, which indicates a small effect size [15].
significantly predict Perception of Caring Environment; R=0.076,
R2=0.006, adjusted R2=-0.003, F (1, 114)=0.657, p=0.419. The Ethnicity: The overall regression equation with Ethnicity groups
as predictors did not significantly predict Perception of Caring
following regression equation was generated. Perception of
Environment; R=0.104, R2=0.011, adjusted R2=-0.016, F (3,
Caring Environment’=4.428+0.152 (Male). The constant term, 112) =0.408, p=0.747. Table 8 revealed descriptive statistics of
4.428, represents the mean Perception of Caring Environment 117 participants who reported their ethnicity. An overall 81.2%
of the female group. Table 7 reveals that if a patient is male, conveyed ethnicity of White/non-Hispanic, 13.7 percent reported
he is more likely to report a slightly higher Perception of Caring as African American, 0.9% stated ethnicity as Native American,
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Figure 3 Bar graph of gender.

Table 4 Group statistics.

Group assignment N Mean Std. deviation Std. error mean
Control Group 56 4.4325 1.10179 0.14723
Perception of Caring Environment Intervention Group 62 4.5083 0.98618 0.12525

Table 5 Age of patient participants.

Frequency Percent Valid percent Cumulative percent

18-34 years 21 17.5 18.1 18.1
35-49 years 19 15.8 16.4 34.5
50-64 years 27 22.5 23.3 57.8
Valid
65-79 39 32.5 33.6 91.4
80+ years 10 8.3 8.6 100.0
Total 116 96.7 100.0 -
Missing system 4 3.3 - -

Total 120 100.0 - -

Table 6 Gender frequency.

Frequency Percent Valid percent Cumulative percent
Male 51 42.5 43.6 43.6
Valid Female 66 55.0 56.4 100.0
Total 117 97.5 100.0 -
Missing system 3 2.5 - -
Total 120 100.0 - -

Table 7 Gender coefficients.

Co-efficientsa
Unstandardized coefficients Standardized coefficients Correlations
Model t Sig.
B Std. error Beta Zero order Partial Part
1. (Constant) 4.428 0.124 35.694 0.000
0.076
2. Male 0.152 0.187 0.81 0.419 0.076 0.076 0.076
Dependent variable: perception of caring environment
a

and 4.3 reported as other. It is remarkable that there was no to the fact that no one reported that option. SPSS automatically
term or category represented for Asian and Pacific Islanders due excluded that particular category.

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Table 8 Ethnicity frequency.

What is your ethnicity?
Frequency Percent Valid percent Cumulative percent
White/non-Hispanic 95 79.2 81.2 81.2
African American 16 13.3 13.7 94.9
Valid Native American 1 0.8 0.9 95.7
Other 5 4.2 4.3 100.0
Total 117 97.5 100.0 -
Missing system 3 2.5 - -
Total 120 100.0 - -

Frequencies for ethnicity were recognized as skewed and further between the nurse and the patient allowed for better connection
displayed by the bar graph seen in Figure 4. The following among the dyad.
regression equation was generated where the constant term,
Question three of the nurse survey asked if altered ergonomic
4.923, represents the mean Perception of Caring Environment of use of the MCW allowed for increase in patient-centered care.
the other group. Each predictor term represents the b coefficients These results, depicted in Table 13, report 22.2% of the nurses
for their respective ethnicity [15]. remained undecided, while 61.1% agree that altered ergonomic
Perception of Caring Environment’=4.923-0.451 (White/non- use of the MCW allowed for increased patient-centered care.
Hispanic) -0.464 (African American) +0.077 (Native American).
Discussion of Implications and Signifi-
Interpretations of each b coefficient is noted: If a patient was
identified as a White/non-Hispanic, he/she is more likely to report cance
a slightly lower score on Perception of Caring Environment when Policy that encourages individual actions of healthcare
compared to the other group but were not statistically significant, professionals surrounding ergonomic use of MCWs can be used to
p=0.331. If a patient was identified as an African American, he/ drive practice improvement that increases patient perception of
she is more likely to report a slightly lower score on Perception the caring environment [16]. At the organization level, increased
of Caring Environment when compared to the other group but understanding of patient perceptions of the caring environment
were not statistically significant, p=0.371. If a patient identifies as where mobile computer workstations are used at the point of care
a Native American, he/she is more likely to report a slightly higher and increased knowledge of the difference between ergonomic
score on Perception of Caring Environment when compared to
use of a mobile computer workstation and patient perception
the group Other but were not statistically significant, p=0.944. If
of the caring now has the potential to positively affect patient
a patient was identified to the other group, he/she is more likely
satisfaction scorecard outcomes and reimbursement.
to score 4.923 on Perception of Caring Environment. This was
seen as the constant on Table 9. The predictors for Ethnicity only Increased understanding of gender, ethnicity and age
account for 1.1% of variance of Perception of Caring Environment, demographics on perception of the caring environment where
which indicates a small effect size [15]. MCWs are utilized offers increased opportunity for patient
centeredness in target population segments. Evidence based
Secondary sample practice, disseminated and implemented at the point of care
Staff nurses were surveyed as secondary population data at little to no cost to the nurse or organization has increased
collectors. All twenty nurses attending the staff meetings post data understanding of patient perceptions that influence patient
collection period received a survey, and all nurses anonymously satisfaction surrounding organizational reimbursement [17].
returned the survey. Table 10 depicted the descriptive statistics A difference in fact exists and individual behavioral actions
for this sample where 50 % were noted from each participating deliberate towards the preservation of perceived caring within
hospital unit. Simple survey to nurse’s post data collection the nurse patient dyad are documented in this pilot study results.
period sought to understand the second sample perception of Further studies are needed that allow for generalization of
the intervention. Missing data from nurse survey did not equate findings.
omission of survey from sample. Each question was analyzed for
frequency alone. Question one results were noted in Table 11 Limitations
revealing that 65% of the twenty nurses agreed that movement
of the MCW to never physically come between the nurse and the Limitation is noted with only two hospitals participating. Notation
patient alone increased communication between the dyad. is made that both hospitals were part of the same health system
and demographics of participants were not greatly diverse. A
Question two outcomes revealed in Table 12 show that 65% of small effect size of this pilot study is also noted as limitation.
nurses surveyed agreed that ergonomic positioning to lower Uncontrolled variables of nurse personality, gender, and
themselves to eye level while not allowing the MCW physically experience level are also noted confines of the study [15].

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Figure 4 Bar graph of ethnicity.

Table 9 Ethnicity coefficients.

Co-efficientsa
Unstandardized coefficients Standardized coefficients
Correlations
Model
B Std. error Beta Zero order Partial Part
t Sig.
4.923 0.450 10.939 0.000
Constant

-0.451 0.462 -0.178 -0.0977 0.331 -0.046 -0.092 -0.092

White
African_American -0.464 0.516 -0.161 -0.0899 0.371 -0.014 -0.085 -0.084
Native_ American 0.077 1.102 0.007 0.070 0.070 -0.047 0.007 0.007
Note: a: Dependent variable: perception of caring environment.

Table 10 Nurses as secondary sample.

Hospital
Frequency Percent Valid percent Cumulative percent
Hospital one 10 50.0 50.0 50.0
Valid Hospital two 10 50.0 50.0 100.0
Total 20 100.0 100.0 -

Table 11 Nurse survey question one.

Frequency Percent Valid percent Cumulative percent
Agree 13 65.0 65.0 65.0
Somewhat agree 2 10.0 10.0 75.0
Valid Undecided 3 15.0 15.0 90.0
Strongly disagree 2 10.0 10.0 100.0
Total 20 100.0 100.0 -

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Table 12 Nurse survey question two.

Frequency Percent Valid percent Cumulative percent
Agree 13 65.0 65.0 65.0
Somewhat agree 4 20.0 20.0 85.0
Valid Undecided 2 10.0 10.0 95.0
Strongly disagree 1 5.0 5.0 100.0
Total 20 100.0 100.0 -

Table 13 Nurse survey question three.

Frequency Percent Valid percent Cumulative percent
Agree 11 55.0 61.1 61.1
Somewhat agree 2 10.0 11.1 72.2
VaZlid Undecided 4 20.0 22.2 94.4
Somewhat disagree 1 5.0 5.6 100.0
Total 18 90.0 100.0 -
Missing system 2 10.0 - -
Total 20 100.0 - -

Conclusion 5 Mateo M, Foreman M (2014) Research for advanced practice nurses:

From evidence to practice (2nd edn.). Springer, NY, USA.
Pilot project intervention increased patient perception of the 6 Titler M, Kleiber C, Steelman V, Rakel B, Budreau G, et al. (2001) The
caring environment. The perception of the caring environment Iowa model of evidence-based practice to promote quality care. Crit
was higher for those intervention patients whose nurse did not Care Nurs Clin North Am 13: 497-509.
allow the MCW to physically come between them and their
7 https://uihc.org/iowa-model-revised-evidence-based-practice-pro-
patient and who sat eyelevel with their patient. However, the
mote-excellence-health-care
improvement was not statistically significant in size. Age, gender
and ethnicity were also noted as variables that affected patient 8 https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/
perception. However, none of these measured demographics index.html
revealed statistically significant differences [15]. 9 https://www.citiprogram.org/
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