Oluma and Abadiga BMC Nursing (2020) 19:19

https://doi.org/10.1186/s12912-020-0407-2

RESEARCH ARTICLE Open Access

Caring behavior and associated factors

among nurses working in Jimma University
specialized hospital, Oromia, Southwest
Ethiopia, 2019
Adugna Oluma* and Muktar Abadiga

Abstract
Background: Nursing care behavior and nurse’s perception of effective care behavior is an act, conduct, and
mannerism enacted by professional nurses that convey concern, safety, and attention to the patient. Behavior
associated with caring has a paramount role in linking nursing interaction to the client in experiences but, the
concept is ambiguous and elusive toward different scholars to reach on common understanding. Only a few
studies have been done on the caring behavior and associated factors globally, and no study was done in this
study area. Therefore; the purpose of this study was to assess caring behavior and its associated factors among
nurses working in Jimma University specialized hospital, southwest Ethiopia.
Methods: An institutional-based cross-sectional study design was conducted on a sample of 224 nurses working in
Jimma university specialized hospital from March 20–April 20, 2019. Data were collected by a self-administered
questionnaire. Descriptive statistics including frequency table, mean, standard deviation and percentage were
employed. Bivariate and multiple linear regression analysis was used with regression coefficient (β), coefficient of
the determinant (R2), CI 95% and p < 0.05 were used for statistical significance.
Results: The overall proportion of nurses caring behavior was 80.3% which was mostly measured in terms of
professional –technical (82.9%) and psychosocial (81.3%) dimension. Job satisfaction as personal satisfaction (beta =
1.12, p = 0.00), professional satisfaction, (beta = 1.07, p = 0.00), joint participation in caring process (beta = 0.58, p =
0.00,) satisfaction with nurse management (beta = 0.85, p = 00) were significantly associated with caring behavior.
Conclusion: The proportion of nurses who had a high perception of caring behavior was found to be lower. Thus,
all predictors have their own effect on enhancing job satisfaction, improving and creating conducive management
and working environment to increase caring behavior. Further comparative studies involving multidisciplinary and
patient point of view were recommended.
Keywords: Caring, Caring behavior, Nurses, Jimma, Ethiopia

* Correspondence: [email protected]
School of Nursing and midwifery, Institute of Health Sciences, Wollega
University, Nekemte, Ethiopia

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Oluma and Abadiga BMC Nursing (2020) 19:19 Page 2 of 7

Background There was a study that describes factors inclined

Caring is a principal and unique concept in nursing which caring behaviors including the technique used for assign-
is described as human acts of doing something with people, ing nurses for patients, lack of time and support from
for people, to people and as people. It can be effectively other colleagues. It is also known that the frequency of
demonstrated and practiced interpersonally that result in visiting the patients might lead to a higher nursing care
the satisfaction of human needs. It represents an attitude of provision than others that induces a significant effect on
occupation, concern, responsibility and affective involve- nurses caring behaviors [9].
ment with the others. Nursing care behavior and nurse’s Studies undertaken among hospitalized patients showed
perception of care behavior is an act, conduct, and trait those professional nurses and patients’ perceptions of car-
enacted by professional nurses that provide concern, pro- ing are not similar. Patients focused on the technical as-
tection, and attention to the patient [1]. pects of nurses’ work in particular, physically ill patients
Conceptually, caring behaviors have two major com- stress task-orientated behaviors whereas nurses value
ponents. The first component is instrumental behaviors psycho-social skills. Major dimensions of determinants in-
which are associated with technical and physical behav- fluencing nurses’ perception of caring behavior were the
iors. The second components are expressive behaviors nurse’s characteristics, educational background, workload,
that deal with psychosocial and emotional behaviors job satisfaction and working place [10–12]. Another study
which include the provision of loyalty, confidence, hope, showed factor influencing nurses caring behaviors where
and emotional kindness for the patients [2]. the care environment, low staffing and support for nurses
Caring is universal as well as central in the art and sci- in the working environment [13, 14].
ence of nursing practice that includes all aspects of de- Even though caring is an important concept in nursing, it
livering nursing care to patients. Caring is a basic nurses’ is complex, an intangible concept and difficult to measure.
attitude and daily life events as a professional and indi- Culture and values affect the understanding of the concept
vidual which occur when a nurse comes in contact with of caring. There is also a paucity of research on specific
a client and expressed through actual nursing acts and programmatic efforts to enhance nurses caring behaviors
behaviors. Thus, caring requires the spiritual, moral, per- among nurses. Therefore, this study was aimed to assess
sonal and social engagement of a nurse with a commit- caring behavior and associated factors among nurses in
ment to self and other community [3]. Jimma University specialized hospital, southwest Ethiopia.
Nurses have a professional responsibility to give high-
quality nursing care for a better patient outcome. All nurs- Methods
ing activities are verified through nurses caring behaviors. Study setting and population
However, the lack of professional caring of nurses leads to This study was conducted in Jimma University specialized
reduced wellbeing and the health of the patients. Therefore, Hospital from March 20–April 20, 2019. The institutional-
nurses caring behaviors can influence patient satisfaction based cross-sectional study design was employed on 224
and perceived quality of nursing care [4, 5]. A study showed nurses working in Jimma university specialized hospital. All
that approximately 10–30% of general hospital nurses rated nurses in Jimma University specialized Hospital was the
the quality of care on their ward as fair/poor and up to 50% source population and the sampled nurses working in dif-
felt that the quality of patient care had deteriorated [6]. ferent wards present during the data collection was the
There was a study that indicated nurses are more em- study population. All nurses working for more than
phasized on the expressive aspects of caring such as listen- 6 months in the hospital were included Nurses who were
ing to the patient and less observable aspects of care like not present during data collection period were excluded
patient monitoring. Complaints of poor attitude among from the study. Nurses who were not willing to take part in
health care workers toward patient care were increasing the study due to inclination and other unknown reason
because of the perception that health care professionals were also excluded from participating in the study.
are increasingly giving impersonal care especially in over-
crowded settings [7]. Sample size determination and sampling techniques
The concept of caring and caring behaviors has different The sample size of the study was calculated using the for-
perceptions among patients served for various cases. Study mula for estimation of a single population proportion with
showed that patients with cancer problems emphasized the assumptions of 95% Confidence Level (CL), marginal
more for affective caring actions whereas intensive care error (d) of 0.05. Taking a proportion of 0.682 (68.2%) from
patients perceived equally the technical and compassion the previous study conducted in Gondor [14], and by add-
serves. However, patients in the emergency unit emphasized ing a non-response rate of 10%, a total of 224 nurses were
more to technical aspects. A patient in medical-surgical care enrolled in the study after using the correction formula. A
deals more to physical caring competency and the practical simple random sampling method was used to select the
ability to deliver the general well being [8]. study participants who were involved in this study.
Oluma and Abadiga BMC Nursing (2020) 19:19 Page 3 of 7

Data collection tool and procedures majority of 87(39.7%) were working in surgical wards and as
Data was collected using a structured questionnaire. well as orthodox Christian 84 (38.4%) followers. (Table 1).
Data collection tools consist of five-part questionnaires:
Demographic related questions, Caring dimension in-
ventory scale adapted from the previous study originally Level of nurses caring behavior
developed by Lea and Watson in 1996 with the reliability Caring behavior was measured in terms of a psycho-
of Cronbach alpha 0.90 [15]. The job satisfaction scale is social, professional-technical, appropriate and inappro-
taken from the job satisfaction scale developed by Warr priate aspect of caring behavior. In the current study
et al. 1979 [16]. Interaction scale is adapted from the caring behavior was measured in terms of emotional
nurse-physician collaboration scale developed by Rei (psychosocial) and affective (technical-professional) di-
Ushiro 2009 [17] which has the reliability of Cronbach mension. Thus, the mean and average mean score of
alpha of 0.80 [17] and Work Environmental Scale each component were psychosocial 40.75 ± 8.94 (81.5%)
adapted from tools developed by Moos, 1994 [18]. A and professional –technical 24.87 ± 5.55 (82.9%). The
Close-ended self-administered structured questionnaire mean and standard deviation of the overall scale was
was distributed to participants by trained data collectors. 100.36 ± 19.24 (80.3%). The level of agreement with car-
Data was collected by 3 BSc nurses and 1 supervisor for ing behavior was measured in terms of low, medium and
the duration of approximately one-month duration. high through calculating the mean difference of their
agreement. So, low70 (32%), medium 79(36.1%).
Data processing and analysis
The data were cleaned and entered into Epi data version Table 1 Socio- demographic characteristics of nurses working
3.1 and then exported to SPSS window version 20.0 for in Jimma University specialized Hospital, 2019 (n = 224)
analysis. Univariate analysis like simple frequencies ta- Variables Category Number Percent
bles, percentages, mean, standard deviation, bar chart, Sex Male 108 49.3
radar chart and pie chart were used extensively. Bivariate Female 111 50.7
linear regression analysis was used to determine inde- Ethnicity Oromo 147 67.1
pendent predictors on outcome variable with regression Amhara 64 29.2
coefficient (B). Significance was concerned at p-value <
Others 8 3.7
0.05 with 95% confidence interval. Multiple linear re-
gression analysis by the coefficient of the determinant Marital status Married 87 39.7
(R2) was used to predict the outcome variable with the Single 132 60.3
backward fitness approach in order to get the final sig- Educational status Diploma 123 56.2
nificant predictors. Bachelor degree 96 43.8
and above
Data quality control Language Afan Oromo 111 50.7
Data were cleaned, coded and checked for consistency Amharic 92 42.0
and completeness. The principal investigator prepared
Others 16 7.3
the template and entered data using Epi Data version
Age (year) 15–24 175 79.9
3.1. Finally, after missing value and incorrect entry
checked the data was exported to SPSS version 20. Five ≥34 44 20.1
percent (5%) of the questionnaire was pre-tested on Work experience (year) 0–5 186 84.9
nurses at Shenen Gibe hospital. One-day training was ≥6 33 15.1
also given for data collectors and supervisor. Working unit Medical ward 59 26.9
Surgical ward 87 39.7
Results
Pediatric ward 54 24.7
Socio-demographic characteristics of respondents
Two hundred twenty-four participants participated giving a Intensive care, psychiatry 19 8.7
and maternity
response rate of 97.8%. The majority of the respondents
111(50.7%) were female and with regards to marital status, Religion Orthodox 84 38.4
two thirds 132 (60.3%) were single respondents. Most of the Muslim 71 32.4
respondents186 (84.9%) had work experience less than Protestant 58 26.5
5 years. Majority111 (50.7%) were fluent speakers of Afan Others 6 2.7
Oromo followed by Amharic 92 (42%) language. Concern- Position Staff nurse 196 89.5
ing their educational status majority 123(56.2%) hold dip-
Nurse leader (manager) 23 10.5
loma and staff nurses. The study also showed that the
Oluma and Abadiga BMC Nursing (2020) 19:19 Page 4 of 7

Job satisfaction among the respondents

The mean and standard deviation of each component of
job satisfaction were professional satisfation18.46 ± 5.04
(73.54%), personal satisfaction 18.91 ± 4.53 (75.64%) and
satisfaction with motivation and prospect 17.35 ± 4.86
(69.4%) (Fig. 1).

Interactions (nurses- physicians) related factors

The mean score of interactions related factors with re-
spect to joint participation in decision-making process
24.82 ± 5.85, joint participation in client care 21.30 ±
5.23, sharing patient information 18.37 ± 4.35 and collab-
orative working 14.59 ± 3.64. The average percentages of
the mean of all components were: joint participation in
decision-making process70.91%, joint participation in
client care 71%, sharing patient information 73.48% and
collaborative working 72.95% (Fig. 2).

Fig. 2 Pie chart illustrating Interaction components among nurses

Caring environment (organizational factors) working in Jimma University specialized hospital, 2019
Each component has the mean and standard deviation of
satisfaction with staffing and support 15.62 ± 6.01 (average Multivariate linear regression analysis
mean of 62.48%) and satisfaction with nurse management Variables significantly associated with caring behavior in
19.01 ± 6.99 (average mean of 63.57%) (Fig. 3). the multivariate analysis include religion, being working
in a surgical ward, personal satisfaction, professional sat-
isfaction, satisfaction with staffing and support satisfac-
Bivariate linear regression analysis tion with staffing joint participation care process. Hence,
Bivariate linear regression analysis revealed significantly a unit increases in personal satisfaction increase caring
associated variables with caring behavior at p < 0.05. behavior by an average of 1.12(beta = 1.12, p = 0.00, CI at
Among background variables, age, religion (orthodox), 95%) whereas a unit increase in professional satisfaction
working unit (surgical and pediatric wards), professional increase caring behavior by an average of 1.07(beta =
satisfaction, personal satisfaction, satisfaction with mo-
tivation and prospect, joint participation in decision-
making process, joint participation in client care, sharing
patient information, collaborative working, satisfaction
with nurse management, number of patient per shift and
plan to leave the hospital were variable significant at bi-
variate level (Table 2).

Fig. 1 Bar graph illustrating Job satisfaction among nurses working Fig. 3 Pie chart illustrating caring environments among nurses
in Jimma University specialized hospital, 2019 working in Jimma University specialized hospital, 2019
Oluma and Abadiga BMC Nursing (2020) 19:19 Page 5 of 7

Table 2 Bivariate linear regression analysis of factors associated Table 3 Multiple linear regression analysis of factors associated
with caring behaviour among nurses in Jimma University with caring behaviour among nurses in Jimma University
specialized hospital, 2019 (n = 224) specialized hospital, 2019 (n = 224)
Variables Outcome variable: Variables Outcome variables: Caring behaviour
caring behavior
Background variables Unstandardized P-value CI at 95%
Unstandardized B P- value CI at 95% B
Background variables Work unit (surgical ward) −6.730 0.002 (−11.025,
−2.436)
Age 15–24 (year) 6.646 0.04 (0.299.12.993)
Work unit (Intensive −7.834 0.054 (−15.447,
Age > =25(year) 6.646 0.04 (0.299.12.993) care, psychiatry and −0.220)
Religion (orthodox) 6.780 0.010 (1.649,11.911) maternity wards)
Surgical ward −6.941 0.009 (−12.106, Job satisfaction variable
−1.776)
Personal satisfaction 1.119 0.00 (0.611,1.627)
Pediatric ward 7.614 0.011 (1.744,13.484)
Professional satisfaction 1.072 0.00 (0.604,1.539)
Job satisfaction
Interaction
variables
(interdisciplinary)
Satisfaction with 1.278 variable
prospect and Joint participation in 0.584 0.007 (0.159,1.009)
motivation
caring process
Professional satisfaction 1.766 0.00 (1.314,2.219)
Care environment
Personal satisfaction 1.888 0.00 (1.378,2.397) (organization)
Interaction Satisfaction with nurse 0.852 0.00 (0.399,1.304)
(interdisciplinary) management
variables Satisfaction with staffing −1.140 0.00 (−1.657,
Joint participation in 0.963 0.00 (0.543,1.384) and support −0.623)
decision making
Joint participation in 1.239 0.00 (0.776,1.702)
client care Caring behavior = 16.25–6.730 (Being working in surgi-
Sharing patient 1.196 .0.00 (0.626,1.766) cal ward) + 1.12 (Personal satisfaction) + 1.07 (Professional
information satisfaction) + 0.58 (Joint participation in caring process)
Collaborative working 1.598 0.00 (0.924,2.272) + 0.85 (Satisfaction with nurse management) -1.14 (Satis-
Care environment faction with staffing and support) + 4.35.
(organizational)
variables
Discussion
satisfaction with nurse 0.49 0.008 (0.128,0.853) The finding of this study showed that the proportion of
management
nurses who had caring behavior was 80.3%. A relatively
Workload and intention high proportion of nurses had professional – technical
to leave variables
(82.9%) caring behavior compared to psychosocial
Number of patients 0.904 0.00 (0.502,1.306)
per shift
(81.5%) caring behavior. This indicates that nurses more
perceived concrete observable aspects of caring behavior
Plan to leave the −6.146 0.019 (−11.276,
hospital −1.017) than expressive caring behavior. This finding is similar
to study conducted in Gondor and Sweden in which
nurses have perceived the technical- professional aspect
1.07, CI at 95%). Similarly, a unit increase in joint par- of caring behavior than psychosocial caring behavior.
ticipation in caring process increase caring behavior by This similarity might be due to the nature of their pro-
an average of 0.58(beta = 0.58, p = 0.00, CI at 95%) as fession in which nurses pay special attention mainly in-
well with regard to organizational factors, a unit increase volving practical caring rather than motivational concern
satisfaction with nurse management increase caring be- [14]. However, this finding is in contrast with the study
havior by an average of 0.85(beta = 0.85, p = 00, CI at done in Japan and Jordan, in which a high proportion of
95%). Overall the variance by 41% of caring behavior is nurses have perceived a psychosocial (emotional) aspect
due to the effect of all predictors as summarized in the of caring behavior. This might be because of the differ-
final model of the study (R2 = 0.412, p = 0.00, F = ence in organization nature, prevailing attitude given by
16.250). This indicates that variance by average 59% of society [7, 19]. The finding of the study also revealed
caring behavior was due to other factors (Table 3). that nurses’ job satisfaction was associated with caring
Accordingly, the final model of the study: behavior. Nurses who had personal satisfaction with
Oluma and Abadiga BMC Nursing (2020) 19:19 Page 6 of 7

their job had high caring behavior which is consistent Abbreviations

with a study conducted in Gondor on the perception of CARE-Q: Caring assessment report evaluation questions; CBA: Caring
behavior assessment; CBI: Caring behavior inventory; CDI: Caring dimension
caring behavior [14, 20]. inventory; DNCB: Determinants of nurse caring behavior; ICU: Intensive care
On the other hand, a cohort study conducted in South unit; JUSH: Jimma University Specialized Teaching Hospital; OPD: Outpatient
Africa revealed that caring behaviors related to job dis- department; USA: United State of America

satisfaction reflected in increased duration absenteeism Acknowledgments

[21]. In this study, caring behavior is positively associ- We would like to acknowledge Jimma University for financial support. We
ated with collaborative working as measured joint par- also would like to acknowledge Jimma University Specialized hospital. We
are also grateful to the study participants who voluntarily agreed to be
ticipation in the client care process among nurses and interviewed and participated in the study.
physicians (B = 0.54, p < 0.007, CI95%) which is similar
to the study conducted by Lu et al. [22]. However, the Authors’ contributions
study conducted in Slovenian hospital showed those AO was involved in conceptualizing and designing of the study. MA was
involved in organizing, field supervision and writing the manuscript. Both
nurses and physician involvements in teamwork were authors were involved in result writing and analyzing the finding, reviewing
low compared with the current study [23]. These varia- and approving the final manuscript.
tions might be due to the difference in organizational
support, leadership style and the level of salary. Funding
This research work was funded by Jimma University. The funder didn’t
With regard to caring environment, nurses caring be- participate in designing and data collection, analysis, writing, and submission
haviors were significantly associated with caring environ- of the article for publication.
ment as measured presence empowering nursing leader
Availability of data and materials
management, staffing and support (B = 0.85, P = 0.00) The data used during this study are available from the corresponding author
which is consistent with study conducted in New York, on reasonable request.
Korea, and Saudi Arabia found that nurses who viewed
the working environment as empowering were more Ethics approval and consent to participate
The study was reviewed and approved by the Institutional Review Boards of
likely provide high caring behavior [3, 5, 16]. In line with Jimma University Ethical review board. The purpose of the study was
these findings, a study conducted in Australia also indi- explained to medical director and staffs of the hospital and permission was
cates a relationship between a nurse’s autonomy and obtained. All nurses were provided written consent, clearly stating the
objectives of the study and their right to refuse to participate in the study.
strong ward management with caring behavior [2, 24]. No minors were involved in the study and the consent was obtained from
The current study also indicates the presence of inverse the participants themselves.
relation with working units like intensive care unit, psy-
chiatric and maternity wards which is inconsistent with Consent for publication
Not applicable.
the study conducted by Ferrous H. Omar [25]. This dis-
parity might be due to presence strictly followed up, un- Competing interests
favorable behavior clients in the psychiatric ward, and The authors declare that they have no competing interests.
the presence of workload leads to a low perception of Received: 12 July 2019 Accepted: 24 February 2020
caring behavior.

Limitation of the study References

1. Watson J. Nursing: the philosophy and science of caring. Boston: Little,
The cause and effect relationship cannot be confirmed Brown & Company; 1979.
in this study since the research design is cross-sectional 2. Arthur D, Randle J. The professional self-concept of nurses: A review of the
in nature. literature. Austrian J Adv Nurs. 2007;24(3):60–4.
3. Watson J. Caring science and human caring theory: transforming personal
and professional practices of nursing and healthcare. J Health Hum Serv
Conclusion Adm. 2009;31(4):466–82.
The proportion of nurses who had a high perception of 4. Suliman WA, Omer T, Thomas L. Applying Watson's nursing theory to assess
patient perceptions of being cared for in a multicultural environment. J
caring behavior was found to be lower. This study Nurs Res. 2009;17(4):293–300.
found that nurses’ personal and professional satisfac- 5. Leininger’s M. Culture care theory: a major contribution to advance transcultural
tion with their job was positively related to caring be- nursing knowledge and practices. J Transcult Nurs. 2002;13(3):189–92.
6. Chana N, Kennedy P, Josses Z. Nursing staff emotional well being and
havior. Moreover, nurses caring behavior enhanced caring behavior. J Clin Nurs. 2015;4(1):2835–48.
with increased empowered nurse’s management in co- 7. Masayuki M, Mieko O, David RE, Ayako O, Takeo K. Caring Behaviors
ordinating, planning, controlling the whole process of Perceived by Nurses in a Japanese Hospital. J Nurs Studies N C N J. 2005;
4(1):13–4.
caring behavior. Furthermore, caring behavior was posi- 8. Zamanzadeh V, Azimzadeh R, Rahmani A, Valizadeh L. Oncology patients’ &
tively associated with joint participation in client care professional nurses’ perceptions important nurse caring behaviors. BMC Nur.
especially among nurses and physician which is the 2010;9(10):9–10.
9. Aiken LH, Cimiotti JP, Smith HL, Flynn L, Neff DF. Effects of nurse staffing
most pivotal role in the provision of quality care ser- and nurse education on patient deaths in hospitals with different nurse
vices for the client as a team. work environments. Med Care. 2011;49(4):1047–53.
Oluma and Abadiga BMC Nursing (2020) 19:19 Page 7 of 7

10. O’Connell E, Landers M. The importance of critical care nurse’s caring

behaviors as perceived nurses and relative. Intensive Cri Care Nurs. 2008;
24(1):349–58. https://doi.org/10.1016/j.iccn.
11. Hajinezhad ME, Azodiin P. Nurse Caring Behaviors from Patients’ and Nurses’
Perspective. Eur J Nat So Sci. 2014;3(4):1010–7.
12. Salimi S, Azimpour A. Determinants of nurses’ caring behaviors (DNCB):
preliminary validation of a scale. J Caring Sci. 2013;2(4):269–78.
13. Institute of Medicine. Keeping patients safe: transforming the work
environment of nurses. Washington: National Academies Press; 2004. p. 435.
14. Ashenafie TD, Tebeje NB. Perceiption of caring behavior. Asian Pac J. 2015;
2(1):17–24.
15. Watson J. Assessing and Measuring Caring in Nursing and Health Science.
2nd edition. New York: Springer Publishing Company, LLC. The Watson
caring science institute; 2008.
16. Warr et al. Confirmatory factor analysis of job satisfaction scale. The
Australian psychological society. 1979;50(2):122–9.
17. USHIRO R. Nurse–physician collaboration scale: development and
psy-chometric testing. J Adv Nurs. 2009;65(7):1497–508. https://doi.
org/10.1111/j.1365-2648.2009.05011.x.
18. Moos. Work environmental factors affecting staff nurse retention; 1994.
19. Michie, Williams. Keeping the patient safe; transforming the work nurses. C
work environments. Washington: National academy press; 2004. p. 435.
20. Pillay R. Work satisfaction of professional nurses in South Africa: a
comparative analysis of the public and private sectors. Biomed J Central.
2009;7(1):7–15.
21. Lu H, While K. Bari ball K. job satisfaction among nurses: a literature review.
Int J Nurs Stud. 2005;42:211–27.
22. Skela Savič B, Pagon M. Model of factors influencing successful change;
implementation in Slovene hospitals. J Manage Inform Hum Resour. 2007;
40(1):63–75.
23. von Essen L, Sjödén PO. The importance of nurse caring behaviors as
perceived by Swedish hospital patients and nursing staff. Int J Nurs Stud.
2003;40(1):487–97.
24. Ranse K, Grealish L. Nursing students’ perceptions of learning in the clinical
setting of the dedicated education unit. J Adv Nurs. 2007;58(2):171–9.
25. Omari FH, AbuAlRub R, Ayasreh IR. Perceptions of patients and nurses
towards nurse caring behaviors in coronary care units in Jordan. J Clin Nurs.
2013;22(1):3183–319.

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