The responses of consumers to caring and noncaring experiences during hospitalization.

The current focus of health care reform is on improving quality of care, health care processes, and outcomes while decreasing costs. Researchers have found that 'caring' is an important component of quality health care from the consumer's perspective. Patient responses to 'caring' experiences may facilitate recovery and well-being. Responses to 'noncaring' may actually interfere with therapeutic outcomes and the patient's well-being. Experiences during hospitalization can greatly influence the consumer's perception of the quality of health care received, and his or her ability to cope and adapt in an unfamiliar and sometimes threatening environment. This study describes the responses of consumers to 'caring' and 'noncaring' experiences during hospitalization from the perspective of consumers. The researcher interviewed 20 patients who had undergone orthopedic surgery in an inpatient setting at approximately 5 days postadmission to the orthopedic unit, and again 8 weeks later in their home environment. Participants were asked to describe their responses to caring and noncaring experiences during hospitalization; how they elicit caring from providers; what they do to prevent or protect themselves from noncaring; and what helps them recover from noncaring experiences. The researcher also examined how Swanson's mid-range theory of caring fit with consumers' descriptions of caring and noncaring experiences in an orthopedic surgical setting. Four themes emerged from responses to caring experiences: 'The Way,' 'Mutual Knowing,' 'Demonstrating Expertise,' and 'Being in Tune.' The themes emerging from noncaring experiences are, 'The Way,' 'Not Knowing Me,' 'Doubting the Provider's Expertise,' and 'Being Unresponsive.' Patients responded to caring experiences by being encouraged to get through or endure, having decreased anxiety and more calming, developing a positive attitude, having hope for recovery, understanding the plan of care, building trust, and perceiving healing faster. In contrast, when receiving noncaring patients described feeling emotionally upset, suffering physically, not understanding the plan of care, losing trust and security, feeling unsafe, having anxiety about subsequent health care and providers, and utilizing protective and preventive approaches to cope and protect themselves. Interventions emerged that may allow providers to begin to facilitate recovery from noncaring. Responses to caring and noncaring greatly influenced the consumer's well-being, perception of the quality of health care received, and his or her satisfaction.