Hrev_master Healthcare in Low-resource Settings 2024; volume 12:11870 Nurse caring with the Swanson Theory Approach and patient satisfaction in class 3 inpatient room Tita Rohita, Dedeng Nurkholik Faculty of Health Sciences, Universitas Galuh, Ciamis, Indonesia Abstract Patient satisfaction is crucial in nursing services and could be influenced by nurses’ caring behavior. This study aimed to discov- er the relationship between Swanson’s caring nurse approach and patient satisfaction in the 3rd-grade inpatient room. This quantita- tive descriptive research employed an explanatory survey with a cross-sectional approach. Purposive sampling is the sampling technique used in this research, with a total of 73 participants. Data analysis was conducted using the Chi-square test, and data were collected using an instrument. The results indicated that 47 responders (64.4%) perceived that nurses’ caring behavior was not good. Specific indicators revealed that “maintaining belief” was not good for 39 respondents (53%), “knowing” for 53 (73%), “being with” for 45 respondents (62%), “doing for” for 48 respon- dents (66%), and “enabling” for 49 respondents (67%). Regarding patient satisfaction, 43 people (58.9%) expressed being quite sat- isfied. Bivariate analysis demonstrated a significant relationship between caring nurses and patient satisfaction, with a p-value of 0.000 or p<0.05. It was recommended that nurses in the inpatient room incorporate improvements in caring behavior into nursing planning and goals. Policies related to the obligation of providing caring actions should be established to enhance patient satisfac- tion. Nurses were encouraged to consistently apply caring princi- ples, including “maintaining belief”, “knowing”, “being with”, “doing for”, and “enabling”, to ensure patients were satisfied with their care experience. Introduction Patient satisfaction is one of the most important factors for evaluating the quality of nursing services among nurses in hospi- tals.1 Nurses’ caring behavior is an important factor in nursing ser- vices because caring behavior is closely related to human relation- ships and greatly influences the quality of service and patient sat- isfaction.2-4 Caring behavior, empathy, compassion, and gentle communication will create a therapeutic relationship between nurses and clients. This way, patients will feel comfortable, so stress will be reduced and patient satisfaction will increase; in reality, the caring behavior of nurses is still not optimal, so it has a negative impact on patient satisfaction.5,6 Caring is the main point in nursing action; this refers to sever- al things such as discipline, knowledge, and professional practice.7 Nursing scholars expressed the opinion that nursing practice must be based on caring. The theory is accepted that caring is the core of a nurse’s role. Furthermore, it has been defined that caring is the absolute identity of nursing.8 It is appropriate for a nurse in carry- ing out nursing practice duties to view caring as their role and identity.9 However, some studies report that nurses have not implement- ed caring behavior well. A study conducted in hospitals nation- wide showed that 35.1% of nurses do not provide health informa- tion to patients.10 A study shows that about 10-30% of general hos- pital nurses rate the quality of care in hospitals as low and up to 50% feel that the quality of patient care has deteriorated.11 The results of research related to patient satisfaction found that some patients (50.0%) expressed dissatisfaction with nursing services.12 Based on the results of several studies, 32% of patients are still dissatisfied with the caring behavior of nurses in Ethiopia,2 while research in Indonesia as many as 66.7% said they were dissatisfied Correspondence: Tita Rohita, Faculty of Health Sciences, Universitas Galuh, Ciamis, Indonesia. E-mail: rohitatita@gmail.com Key words: caring, patient satisfaction, nurse. Contributions: TR, conceptualization, data curation, formal analysis, methodology, validation, visualization, writing - original draft, review and editing; DN conceptualization, investigation, methodology, valida- tion, and writing - original draft, review and editing. Conflict of interest: the authors declare no potential conflict of interest. Funding: this research received funding from Universitas Galuh. Ethics approval and consent to participate: ethical approval has been obtained from the Ethics Committee under reference number No.012.02/E.01/KEPK-BTH/III/2023. During research, researchers apply the principles of research ethics, namely information to consent, beneficence, respect for human rights, and non-maleficence. Before the research begins, the researcher provides an informed consent sheet and the respondent signs an agreement to participate in the research. Patient’s consent for publication: patient s' informed consent was obtained in written form for anonymized patient information to be pub- lished. Availability of data and materials: all data research results and data that have been analyzed are included in this published article. Acknowledgments: special thanks to Universitas Galuh, Ciamis Indonesia, for Supporting this research. Received: 24 September 2023. Accepted: 23 January 2024. Early access: 1 March 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:18870 doi:10.4081/hls.2024.11870 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2024;12:11870] [page 393] Non -co mmerc ial us e o nly with nurses’ caring behavior.13 Caring is a form of nurse concern for clients as a form of attention, appreciation, and being able to meet their needs.14,15 Proper nurse caring behavior allows nurses to demonstrate their professional competence to patients. Other stud- ies show factors influencing nurse caring behavior are care envi- ronment, low staffing, and support for nurses in the work environ- ment.2,16 When nurses and patients interact in nursing actions and care, caring behavior occurs. For better outcomes nurses have a professional responsibility to provide high quality nursing inter- ventions to patients. Nurses’ caring behavior will influence the quality of service and also impact patient satisfaction; If patients are satisfied with the quality of service, they will come back to the hospital again.2,17 Caring behavior, empathy, compassion and gen- tle communication will form harmonious interpersonal relation- ships between patients and nurses.18,19 Caring is a fundamental aspect of various nursing theories. Caring behavior, according to Swanson, can be seen from the five dimensions of caring, namely “maintaining confidence” (maintaining confidence in events or transitions and seeing them full of wisdom), “knowing” (trying hard to understand the meaning of events in other people’s lives), “being with” (showing feelings of empathy for others), “doing for” (working/doing something for others such as for themselves) and enabling (facilitating others in transition).20 According to Swanson’s theory caring is holistic nursing which is useful for supporting the client’s healing process and a way of establishing a caring relationship with the client and taking responsibility for the client’s condition.21 The caring behavior of nurses in class 3 rooms tends to be less than optimal because the number of patients is not balanced with the number of nurses. So, nurses’ caring behavior is closely related to patient satisfaction. Therefore, this study aimed to discover the relationship between Swanson’s approach to nurses’ caring behavior with patient satis- faction in the class 3 inpatient room. Materials and Methods Research Design The research design employed in this study was a descriptive correlational design, utilizing a cross-sectional approach. Study participants The study employed purposive random sampling to select a total of 73 respondents who were privately hospitalized in one of the hospitals located in the West Java region. Purposive sampling is carried out by selecting samples based on certain criteria that are appropriate to the research topic. The inclusion criteria pertain to patients who received treatment in the inpatient setting, were age ≥18 years, compos mentis level of consciousness, could read and write, could hear and see well, and patients who were not in critical condition and had many opportunistic infections. The calculation of the sample size is derived from the Slovin formula. This research has limitations, namely the sample is relatively small due to time constraints and this research uses primary data, namely col- lected data directly from the field by distributing questionnaires to respondents. Variable, instrument, and data collection The independent variables consisted of nurse caring behaviors according to Swanson’s approach. Swanson’s approach to nurse caring behavior includes five indicators: “knowing”, “being with”, “doing for”, “enabling”, and “maintaining belief”. The dependent variable was patient satisfaction, defined as the patient’s feelings towards the performance of health services, with indicators includ- ing responsiveness, reliability, assurance, empathy, and tangibles. Instruments to measure the variables were adapted from exist- ing ones. The research used a questionnaire that had been previ- ously tested for validity and reliability and was found to be valid and reliable. The results of the validity test for nurse caring behav- ior showed that all questions were valid, with calculated r-values ranging from 0.541 to 0.894, which were greater than the r table value of 0.444. For the patient satisfaction questionnaire, all ques- tions were deemed valid, with r-values ranging from 0.470 to 1.000. A 4-point Likert scale was employed in the instrument, with the following scoring for the agreed responses: for caring nurse 1 never, 2 sometimes, 3 often, 4 always; for patient satisfaction, 1 very dissatisfied, 2 not satisfied, 3 quite satisfied, 4 satisfied, and 5 very satisfied. Data collection was conducted by distributing questionnaires to the respondents. The respondents were asked to fill out the ques- tionnaires by themselves after they had given their consent to par- ticipate in the research through agreeing to informed consent. Data analysis Descriptive analysis is employed to provide a comprehensive depiction of the frequency distribution of nurse caring behavior and patient satisfaction levels. The Chi-square test was employed to examine the association between the nurse’s caring behavior and patient satisfaction (p<0.05). Ethical clearance The present study is grounded in the fundamental tenets of eth- ical research, including self-determination, privacy and dignity, protection from discomfort and harm, and beneficence. To main- tain confidentiality, researchers do not include names, and respon- dents are only given a code. The consent form contains an expla- nation of the research carried out, research objectives, research procedures, benefits obtained from respondents, and the risks that may occur. Only respondents who are willing to fill out and agree to the consent form voluntarily are included in the study. It received approval from the Ethics Committee under reference number No.012.02/E.01/KEPK-BTH/III/2023. Results Based on Table 1, 47 respondents (64.4%) thought that the general picture of nurses’ caring behavior was not good. Nurses’ “maintaining belief” behavior was not good for 39 respondents (53%). Nurses’ “knowing” behavior was good for 53 respondents (73%). Nurses’ “being with” behavior was not good for 45 respon- dents (62%). Nurses’ “doing for” behavior was not good for 48 respondents (66%). Nurses’ “enabling” behavior was not good for 49 respondents (67%). While, as for the results of the study for patient satisfaction, 43 respondents (58.9%) said they were quite satisfied. Based on the data processing in Table 2, the results of the bivariate analysis showed a significant relationship between caring nurses and patient satisfaction, evidenced by p=0.000, or p<0.05. Discussion The research results confirmed our hypothesis that nurses’ car- ing behavior significantly influences patient satisfaction. Caring behavior of nurses is closely related to patient satisfaction, which Transforming Healthcare in Low-Resource Settings: A Multidisciplinary Approach Towards Sustainable Solutions [page 394] [Healthcare in Low-resource Settings 2024;12:11870] Non -co mmerc ial us e o nly is one indicator of the quality of service in a hospital. Patient sat- isfaction is related to the quality of services provided by nurses to patients while hospitalized.18 Treating patients carefully, keeping patient information confidential and providing timely care and treatment is critical, along with a sense of security during hospital- ization and satisfaction with nursing services.22 Nursing care is a multidimensional concept, which describes attitudes and behavior that demonstrate interest and respect for the patient’s psychological, social and spiritual values. Caring behav- ior is a key element of the interaction between nurses and patients in nursing care. Implementing a nurse-patient interaction model based on caring behavior in the health system can improve the quality of good services, providing higher levels of satisfaction to nurses and patients.23,24 Patient satisfaction with nursing care proves that patients at the time of discharge from the hospital expe- rience a positive relationship between confidentiality of informa- tion, treatment, timely administration of drugs, safety during hos- pitalization, and satisfaction with nursing care.25 Swanson’s theory of caring is a theory structured around five caring principles (“maintaining belief”, “knowing”, “being with”, “doing for”, and “enabling”). When applied to nursing practice, each of these five stages stimulates the nurse’s attitude, which in turn improves the overall well-being of the patient.26 Some differences of opinion and agreement are found between patients regarding good nursing care. While “enabling,” such as providing information, coaching, and guidance, is more emphasized by patients, “being with” is more emphasized by nurses. “Doing for,” especially improving physical comfort, is the attribute most often mentioned in good nursing care by patients.27 Researchers assume that the services carried out by nurses must be felt and have a positive impact on patients as recipients of health services in hospitals where the better the caring behavior of nurses in the hospital, the more the patients will feel satisfied and vice versa; if the nurse’s caring behavior is not good, the patient will feel dissatisfied and will be reluctant to use these health ser- vices. Nurses who are concerned with providing nursing care to patients in hospitals are nurses who have a caring attitude (“main- taining belief”, “knowing”, “being with”, “doing for”, and “enabling”). Care, empathy, gentle communication, and nurse affection for patients will form a harmonious interpersonal rela- tionship between clients, and can help meet client needs to provide satisfaction to clients. Caring nurses can improve patient recovery because patients feel their physical, emotional, and spiritual needs are met.28 A nurse must have caring behavior in giving service to patients because the relationship between service providers and patient health is a factor that influences the satisfaction process of patients regarding the services provided and cures the patient’s ill- ness.29 The findings in this study have several important implications, namely improving nurses’ caring behavior to increase patient sat- isfaction. Nurses in inpatient rooms can incorporate increased car- ing behavior into nursing plans and goals and create policies regarding the obligation to carry out care with attention to increase patient satisfaction. This research has limitations, namely the sam- ple is relatively small due to time constraints and this research uses primary data, namely collected data directly from the field by dis- tributing questionnaires to respondents. Conclusions Patient satisfaction is a very important factor to evaluate the quality of nursing services and nurses’ caring behavior was one aspect related to nursing services because caring includes human relationships and affects patient satisfaction. Nurses who are con- cerned with providing nursing care to patients in hospitals are nurses who have a caring attitude (maintaining belief, knowing, being with, doing for, and enabling). Transforming Healthcare in Low-Resource Settings: A Multidisciplinary Approach Towards Sustainable Solutions Table 1. Caring behavior of nurses with Swanson theory approach and patient satisfaction (n=73). Variable n (%) Caring behavior of nurses Good 26 35,6 Not good 47 64,4 Nurses’ caring behavior indicators Maintaining belief Good 34 47 Not good 39 53 Knowing Good 53 73 Not good 20 27 Being with Good 28 38 Not good 45 62 Doing for Good 25 34 Not good 48 66 Enabling Good 24 33 Not good 49 67 Patient satisfaction Very satisfied 7 9,6 Satisfied 23 31,5 Quite satisfied 43 58,9 Not satisfied 0 0 Very dissatisfied 0 0 Total 73 100 Table 2. Relationship of nurse caring behavior with patient satisfaction in class 3 inpatient room. Caring nurse Patient satisfaction Sum p X2 calculate Very satisfied Satisfied Quite satisfied Not satisfied Very dissatisfied f % f % f % f % f % f % 0 19.576 Good 7 9,6 0 0.0 8 11 0 0 0 0 15 20.5 Not good 11 15.1 12 16.4 35 47.9 0 0 0 0 58 79.5 Total 18 24.7 12 16.4 43 58.9 0 0 0 0 73 100 [Healthcare in Low-resource Settings 2024;12:11870] [page 395] Non -co mmerc ial us e o nly References 1. Bakar A, Nursalam, Adriani M, et al. The development of islamic caring model to improve psycho-spiritual comfort of coronary disease patients. Indian J Public Heal Res Dev 2018;9:312-7. 2. Oluma A, Abadiga M. Caring behavior and associated factors among nurses working in Jimma University specialized hospi- tal, Oromia, Southwest Ethiopia, 2019. BMC Nurs 2020;19:1- 7. 3. Setyawan FEB, Supriyanto S, Ernawaty E, Lestari R. Organizational commitment, patient satisfaction and loyalty in the first-level health facilities. Int J Public Heal Sci 2022;11:1046-57. 4. Mariana E, Apriyani W, Supriyanto S. 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