Watson's caring theory and instrument development

Caring has been identified as a construct critical to contemporary nursing practice. However, the limited number of existing measurement instruments has limited research . regarding caring. The purpose of this study was to further determine the reliability and validity of the Caring Behaviors Assessment (CBA) and to validate the theory on which it was based. The CBA was developed using Watson' (1979) theory of carative nursing. Watson's theory identified 10 carative factors which served as the basis for the instrument's 7 subscales. The instrument was administered to a convenience sample of 104 adults hospitalized on the medical-surgical units of a large metropolitan hospital. The subjects• ages were distributed from 21 to over 91 years of age and there were equal numbers of men and women. Most subjects has been hospitalized for fewer than 5 days and had from 1-4 prior hospitalizations. A wide variety of medical diagnoses was represented. A methodological design was used and study findings indicated the CBA was a valid and reliable instrument. The alpha coefficient for the complete instrument was .9566. The alpha coefficients for the subscales ranged from .7825 for the Existential/Phenomenological Forces Subscale to .8867 for the Humanism/Faith-Hope/Sensitivity Subscale. Items 27 and 49 had item to total correlations less than .3 and items 35, 36, 38, and 44 had 9 item to total correlations greater than .7. Items 35-37 were from the Teaching/Learning Subscale. Construct validity of the instrument was evaluated through factor analysis. Fifty-six items loaded on factor 1 which indicated than one construct was being measured, however 23 items loaded on more than one factor. Four factors with 3 or more items loading at the .4 level or better were identified. The factor analysis did not support the existence of 10 discreet carative factors or subscales. The factor with most items loading on it was characterized as caring. The CBA was shown to be a reliable instrument which can be utilized in a variety of settings to assess patients' perceptions of caring behaviors. The need for caring in all areas of nursing practice can be supported by additional studies examining the concept.