Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)

Committee Chair

Gayle Casterline


A 134 bed hospital in a rural community had a continuous struggle to meet defined goals on the hospital consumer assessment of healthcare providers and systems survey (HCAHPS). The hospital’s medical unit consistently performed lower in the communication with nurses HCAHPS domain than other nursing departments in the organizations. Between 2015 and 2017 the overall communication with nurse’s score in the HCAHPS domain of the medical unit ranged between 74-79%. Nursing staff were task oriented, focusing on the next task to be done instead of the current moment and interaction with the patient. A literature review revealed that consistent themes involving patient communication, nurse satisfaction, intensity of patient illnesses, and hospital marketability all have an impact on HCAHPS. Patient perceptions of care and interactions with nurses emerged as the most dominant theme found in the evidence demonstrating this as an important focus of the intervention to address the indicated problem. Many best practices were recognized in the literature as having a positive impact on patient satisfaction, however bedside reporting addressed all of the critical elements of the nurse patient relationship. An analysis of the literature review showed supportive evidence that bedside reporting would have a positive impact on the communication with nurse’s domain in HCAHPS. A bedside report intervention implemented utilizing the participatory model and guided by caring science produced key findings which demonstrated positive outcomes for patients, staff, and the organization. The participatory model allowed the bedside report process to be designed based on frontline staff members’ knowledge of the actual unit workflow. The early identification of potential barriers by the bedside report team also allowed for the team members to participate and lead staff engagement initiatives based on caring science. The Communication with Nurses domain in HCAHPS indicated an overall positive increase from 70.9% to 89.0% of patient indicating the top score of “always”. Data from the key question within the Communication with Nurses Domain in HCAHPS Nurses listened carefully to you indicated an increase from 68.3% to 85% of patients indicating the top score of “always” and data from the question Nurses explained things in ways you understand indicated an increase from 63.9% to 81.3% of patients selecting the top score of “always” According to the Watson Caritas Patient Survey Tool results, patients perceived that staff always met their needs with caring kindness over 90% of the time (n=103). A Staff Perception of Bedside Report survey (n=60) designed by the project leader indicated that staff perceived the bedside report process created a caring encounter between nursing and improved communication between staff and patients. Managing interruptions and patient needs during the bedside report were found to be important for successful implementation and workflow. The use of participatory model and a caring science concepts and a structured timeline allowed for staff collaboration, staff preparation, successful implementation, staff engagement, and plans for sustainability.

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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