Assessing the Consultation and Relational Empathy (CARE) Measure in sexual health nurses’ consultations

Abstract

BackgroundIncreasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the ‘human’ aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses.MethodsPatient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman’s correlation and principal component analysis. Internal consistence was assessed through Cronbach’s alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland.ResultsFemale patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of ‘not applicable’ and missing responses’ were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach’s alpha showed the measure’s high internal consistency (Cronbach’s alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses.ConclusionsWithin this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses.

Testing two competitive models of empathic communication in cancer care encounters: A factorial analysis of the CARE measure

“…Descriptive statistics indicate a ceiling effect as 22% of the sample reported the maximum score of 50. This finding is not surprising and has already been reported in other CARE measures validations carried out in nurses (Bikker, Fitzpatrick, Murphy, Forster, & Mercer, 2017), in osteoarthritis patients (Kersten et al, 2012) and in primary care settings (Crosta Ahlforn et al, 2017;Mercer et al, 2004;van Dijk et al, 2016). Finally, in a recent meta-analysis with various healthcare practitioners, the mean score of the CARE measure was above 40 out of 50, which is very high (Howick et al, 2017).…”

“…In primary care settings, items 9 and 10 have higher proportions of this answer than other items do (e.g. Bikker et al., 2017; Crosta Ahlforn et al., 2017; van Dijk et al., 2016). These items seem to pertain to empowerment or shared decision‐making (Fung & Mercer, 2009; Mercer et al., 2008), which would not systematically be addressed in every day primary care consultations, when there is no medical decision to undertake.…”

Factors Associated With the Provision of Sexual Health Care by Nursing Students in Hospitals: An Analytical Cross-Sectional Study

“…These findings indicate that we should work on improving health education relating to nurses' handling of patients' sexual problems. These studies also revealed that the main factors contributing to the sexual health care-related problems faced by nurses and nursing students included the lack of sexual health care knowledge, skills, and experience, and the lack of sexual health care education and training; these factors often led nursing students and professionals into awkward situations when they were discussing sexual health issues, and also prevented them from actively conducting sexual health care activities (Bartlik, Rosenfeld, & Beaton, 2005;Bikker, Fitzpatrick, Murphy, Forster, & Mercer, 2017;Wu, et. al., 2013).…”

Relationship Between Orthopedic Surgeon’s Empathy and Inpatient Hospital Experience Scores in a Tertiary Care Academic Institution

“…Similarly, over half (50.4%) of our patients rated their surgeon as perfectly empathic, highlighting the ceiling effect. A more recent study by Bikker et al found that the CARE measure has a notably greater ceiling effect (55%) than the JSPPPE (18%), suggesting that the CARE had a limited ability to discriminate variations in high perceived empathy ( 35 ). Furthermore, the JSPPPE showed better distribution ( 35 ), suggesting that it may be more suitable for the orthopedic surgery context.…”

“…A more recent study by Bikker et al found that the CARE measure has a notably greater ceiling effect (55%) than the JSPPPE (18%), suggesting that the CARE had a limited ability to discriminate variations in high perceived empathy ( 35 ). Furthermore, the JSPPPE showed better distribution ( 35 ), suggesting that it may be more suitable for the orthopedic surgery context. Because the CARE measure has been widely used in other populations as opposed to the JSPPPE, which was specifically adapted only to the physician (nonsurgeon), the CARE measure was deemed the most appropriate measure for our study.…”