The Caring Dimension Inventory ( CDI-29 ) : Modified Arabic Version

C l i n M e d International Library Citation: Alhadidi M, Ahmad M (2016) The Caring Dimension Inventory (CDI-29): Modified Arabic Version. Int Arch Nurs Health Care 2:048 Received: March 26, 2016: Accepted: May 18, 2016: Published: May 24, 2016 Copyright: © 2016 Alhadidi M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Alhadidi and Ahmad. Int Arch Nurs Health Care 2016, 2:048


Introduction
Caring is the essence of nursing.It is directly connecting patients' overall fulfillment and sense of well-being [1,2].It is reported that high level caring vitally enhances clients' emotional as well as physical health which, corresponds with the ultimate goal of achieving good mental and physical health status [3].Literature emphasized the importance of caring for patients' wellbeing.For example, studies indicated that a therapeutic relationship is a caring relationship, and considered an essential element in professional nursing [4,5].In spite of a lack of consensus on caring as part of the meta-paradigms of nursing, caring has appeared during the past three decades as a dominant element in nursing profession [6].Caring relies on situations, and nurses should consider the various emotions for the clients when providing the necessary care [7].The patient must be the center of the health care focus [1].

ISSN: 2469-5823
Inventory (CDI) is vital.There are few instruments identified in the published literature that may be used to measure caring.The CDI-25 is one of these instruments which was developed by Watson in 1997 [18].However, the CDI-25 was not adequately developed to measure caring for the Arab world, as well as in mental health nursing.The instrument originally was designed to assess the perception of caring by asking people to indicate their agreement to statements about their nursing practice as constituting caring.Therefore, four items focusing on a safe and therapeutic environment were added to the instrument.Then, the measure was examined to establish its validity and reliability in this study.

Setting and sampling
Data were collected from three psychiatric hospitals and one psychiatric ward; "A" hospital is a government hospital with a capacity of 220 beds, "B" hospital is a government hospital with a capacity of 125 beds, "C" hospital is a private hospital with a capacity of 75 beds.The psychiatric ward is part of a large educational and multispecialty hospital with a capacity of 10 beds.According to the data obtained from the human resources departments in the selected hospitals, the total number of nurses was 260 nurses.A list with the demographics of all nurses working in the selected hospitals was checked for the inclusion criteria (to be a registered nurse and to be from one of the Arab nationalities).The total number of eligible participants for this study was 220 nurses.Those who met the inclusion criteria received a package containing the questionnaires used in the present study.

Ethical Considerations
Ethical approval was granted to conduct this study by the relevant research ethics committees of the involved hospitals.The purpose, benefits, and risks were explained to the sample before they decided to participate.The participants were assured that their contribution would be completely voluntary.The expected time to complete the questionnaire was between 5 and 10 minutes.

Participants' characteristics
Out of the 220 eligible nurses, 205 of them (93%) completed the survey.The mean age of the participants was 33.6 years.More than half of the participants were male (n = 110; 54%).Almost threequarters of the participants were married (n = 150; 73%).Moreover, 135 (66%) participants held bachelor degrees with an average of seven years nursing experience in the mental-health field.Over half of the participants had some training in mental-health nursing (n = 105; 51%) and 58% (n = 118) received organizational and managerial support.The mean number of the participants' working time was 45.5 hours weekly.
Exploratory factor analysis (EFA) is used to group together the intercorrelated variables or items [19,20].Table 1 presents the means and standard deviations for the 29 items of the CDI scale.The highest mean was (4.74) for the item "Assess the patient who high risk for suicide, " and the lowest mean was (3.17) for the items "Sharing your personal problems with a patient." The EFA principal component analysis with Varimax rotation resulted in four latent variables with items distribution among the factors as shown in table 2. The cumulative variance for the four factors in the model was 44.67%, with the highest contribution from the first factor with 27.82%.The Cronbach's Alpha for the 29-item scale was 0.89, and it was 0.85, 0.77, 0.69, and 0.65 for the factors one to four respectively.The first factor was called "Psychosocial, " and it is composed from 10 items; the second factor was called "Technical, " and it is composed from eight items; the third factor was called "Professional, " and it is composed from six items; and the fourth factor was called "Empathy" and is composed from five items.

Discussion
For many reasons, the Caring Dimension Inventory-25 was

Factor 2 Technical
ISSN: 2469-5823 modified in this study.In addition to the original 25 items, the researchers added four items: Item 26 (assess the psychosocial aspects of the patient); item 27 (assess if the patient with a high risk of suicide), item 28 (assess if the patient with a high risk of violence) and item 29 (modify the environment to be more therapeutic).
Mental health nursing has been considered to be a demanding profession [21,22].Nurses face various challenges, such as increased patient acuteness, decreased duration of stay in hospitals, and altering patient anticipations [23,24].The primary issues that mental health nurses are experiencing while giving care includes the ability to provide a safe environment, and providing therapeutic care [16,25].Furthermore, Rey et al. (2004) reported that patients with a mental illness lean to be more challenging, acute, and distressed [26].Mental health nursing responsibilities consist of assessments, establishing a safe and therapeutic environment, and promoting stabilization [27].On the other hand, while mental health nurses endeavor to provide a safe environment, they struggle to give therapeutic care [28], frequently raising nurses' burdens, and negatively influencing their capability to provide quality care [16] because caring in a specialized area such as the psychiatric unit involves dealing with special stressful situations such as the psychological aspects [29,30] violent or aggressive [31][32][33] and suicidal [34] behaviors.
In the Principal Components Analysis with Varimax rotation, the four-factor model accounted for 45% of the variance.Our results show that the reduced version of 29 items improves the validity of the instrument in the Arab culture.Furthermore, internal consistency coefficients were relatively high in the modified version.In conclusion, the modified 29-item CDI scale is recommended for use when determining caring behaviors and nurses' perceptions of caring behaviors in the Arabic culture.However, the psychometric properties of the modified scale needs further assessment in future studies.

Summary Points
• Measurement of caring is a relatively new area in the health studies literature.
• Exploratory factor analysis indicated that the 29-item scale is better than the 25-item scale in measuring caring in the Arab culture.
• The four-factor model is valid, reliable, and empirically supported.

Table 1 :
Descriptive statistics with means and standard deviations (N = 205).