Caring Science and a Magnet Culture Positively Influence Patient Experience: A Theoretical Framework
Other Titles
Human Caring Science and a Magnet Culture Positively Influence Patient Experience: A Theoretical Framework [Title Slide]
Abstract
BACKGROUND: An academic hospital implemented both Watson Caring Science and a Magnet® culture to support nurse wellbeing and optimize patient outcomes.1-3 The goal was to create a culture of caring. The research challenge was how to measure culture, which is complex, intangible and often difficult to quantify. Few healthcare organizations deploy theory-driven quantitative evaluations. Most rely on atheoretical data mining rather than conceptually grounded frameworks.
PURPOSE: To develop a theoretical framework to test the hypothesis that: (1) Human Caring Culture directly influences Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS); (2) Human Caring Culture indirectly influences HCAHPS’ outcomes through Magnet aligned nursing behaviors.1-3
METHODS:
● Develop Sustainable Measurement Metrics: Validated Watson Caritas Patient Score® five items (α=.91) were added to the standard HCAHPS survey.4
●Theory-Based Operationalization: A crosswalk was developed between HCAHPS and Magnet aligned nursing behaviors (Communication, Responsiveness, Teamwork, and Patient-Centered Care Transitions).
● Conceptualize Theory-Driven Analysis: Hierarchical structural equation modeling (SEM) using Donabedian's Structure→Process→Outcome model. Structure (caring culture) → Process (Magnet aligned nursing behaviors) → Outcome (patient HCAHPS: Hospital Recommendation and Likelihood to Recommend) to test direct and indirect effects.5
RESULTS: Both SEM models demonstrated excellent fit (Comparitive Fit Index [CFI] = .96) and (Root Mean Square Error Approximation [RMSEA] = .05). Human Caring Culture exerted strong direct effects on the HCAHPS outcomes (β =.38, p< .001), and significant indirect effects through nursing behaviors (Communication and Care Transitions). Approximately 43%–46% of the total effect was mediated through nursing behaviors.
IMPLICATIONS: This theoretical framework provides a replicable blueprint for healthcare organizations to measure culture and patient-experience outcomes while building research capacity for theory-driven evaluation.
Notes
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Sigma Membership
Alpha Alpha Lambda at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Acute Care, Theory, Policy and Advocacy, Psychological Well-Being, Patient Outcomes, Health Outcome Assessment, Corporate Culture, Magnet
Recommended Citation
Lough, Mary E.; Hernandez, Grissel; Bradley, Kathleen; Yan, Alice; Munro, Cassendra; and Pines, Rachyl, "Caring Science and a Magnet Culture Positively Influence Patient Experience: A Theoretical Framework" (2026). International Nursing Research Congress (INRC). 150.
https://www.sigmarepository.org/inrc/2026/presentations_2026/150
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-12
Caring Science and a Magnet Culture Positively Influence Patient Experience: A Theoretical Framework
Toronto, Ontario, Canada
BACKGROUND: An academic hospital implemented both Watson Caring Science and a Magnet® culture to support nurse wellbeing and optimize patient outcomes.1-3 The goal was to create a culture of caring. The research challenge was how to measure culture, which is complex, intangible and often difficult to quantify. Few healthcare organizations deploy theory-driven quantitative evaluations. Most rely on atheoretical data mining rather than conceptually grounded frameworks.
PURPOSE: To develop a theoretical framework to test the hypothesis that: (1) Human Caring Culture directly influences Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS); (2) Human Caring Culture indirectly influences HCAHPS’ outcomes through Magnet aligned nursing behaviors.1-3
METHODS:
● Develop Sustainable Measurement Metrics: Validated Watson Caritas Patient Score® five items (α=.91) were added to the standard HCAHPS survey.4
●Theory-Based Operationalization: A crosswalk was developed between HCAHPS and Magnet aligned nursing behaviors (Communication, Responsiveness, Teamwork, and Patient-Centered Care Transitions).
● Conceptualize Theory-Driven Analysis: Hierarchical structural equation modeling (SEM) using Donabedian's Structure→Process→Outcome model. Structure (caring culture) → Process (Magnet aligned nursing behaviors) → Outcome (patient HCAHPS: Hospital Recommendation and Likelihood to Recommend) to test direct and indirect effects.5
RESULTS: Both SEM models demonstrated excellent fit (Comparitive Fit Index [CFI] = .96) and (Root Mean Square Error Approximation [RMSEA] = .05). Human Caring Culture exerted strong direct effects on the HCAHPS outcomes (β =.38, p< .001), and significant indirect effects through nursing behaviors (Communication and Care Transitions). Approximately 43%–46% of the total effect was mediated through nursing behaviors.
IMPLICATIONS: This theoretical framework provides a replicable blueprint for healthcare organizations to measure culture and patient-experience outcomes while building research capacity for theory-driven evaluation.
Description
This presentation describes the development of a research framework to analyze the relationships between a Human Caring Culture, a Magnet culture with aligned nursing behaviors and patient-experience outcomes. The discussion highlights the benefits of structural equation modeling (SEM) to analyze these relationships while building research capacity for theory-driven evaluation.