Evaluating the quality of caring: structure, process, and outcome.

It may not be possible to attribute certain patient outcomes to the process of caring. However, there is progress in that direction. For example, the components and indicators of the process of caring, as perceived by the patient and the nurse, have been described in a number of recent studies, and several nursing leaders (eg, Benner, Watson) have suggested language and philosophic frameworks within which caring processes can be examined, studied, and tested. But more needs to be done. The individual nurse can no longer be held accountable for ensuring a caring relationship in the absence of educational, organizational, and professional structures that create a milieu in which caring is possible. Hence more attention to the structural components of caring is needed. Last, we must begin to think of caring as a process, not as an end in itself. As with all aspects of nursing practice, the relationship of care to patient outcomes deserves more attention. A first step is to define these patient outcomes and goals; then we can begin to link the caring process to them.