Behavioral Care Research Articles

The needs of patients with diabetes for the prevention and treatment of foot complications in Thailand: A qualitative descriptive study.

Inadequate diabetes self-management leads to foot infections and lower extremity amputations. Effective self-care, supported by nurse-provided information, is crucial, particularly in foot care. However, the current approach in Thailand focuses more on what nurses want patients to know rather than addressing patients' actual needs. Consequently, nurses might misunderstand their patients' perspectives. Hence, nurses need to grasp patients' needs for successful foot care behavior. This study aimed to explore the needs of patients with diabetes regarding the prevention and treatment of foot complications. The study employed a qualitative descriptive design. Thirty participants classified as high risk for foot ulcers were purposively selected from Thailand's university hospitals. Focus group discussions were used for data collection between June and July 2021. Verbatim transcription and content analysis were carried out for data analysis. Four emergent themes highlighted patients' needs: 1) information-giving, 2) proactive foot screening with foot-care affirmation, 3) foot care services, and 4) relieving foot burdens and limb loss. Nurses should change their mindset to care for and continually understand patients' needs. This involves adapting educational strategies like the teach-back method and coaching while providing skill training. Offering diverse service platforms, both online and onsite education programs and counseling, is essential. Additionally, ensuring accessibility and affordability, such as establishing after-hours clinics and supplying foot care toolkits, remains crucial.

Peningkatan Caring Islami Pada Perawat

<em><span lang="EN">Nurses are the largest human resource in health services in hospitals, where nurses work 24 hours a day in rotation and continuously to provide comprehensive and professional nursing care and are ready to help patients at any time. In an effort to improve the quality of health services, nurses are required to provide the best service in the form of caring behavior or caring attitude towards others. Caring behavior given by nurses to clients can increase patient satisfaction, especially by incorporating Islamic values where Islamic values are rahmatan lil alamin or compassion for all beings regardless of race, ethnicity, nation, language and religion. RSU Yarsi Pontianak is an Islamic-based hospital in providing nursing care. In accordance with the hospital's vision "to become a hospital based on Islam with high-quality and international standard health services", Yarsi General Hospital prioritizes services that have Islamic values, especially in providing nursing care. The purpose of this community service is to increase nurses' knowledge of the application of Islamic caring at YARSI Pontianak General Hospital (RSU). Community service activities are carried out through several stages, namely the preparation, implementation and evaluation stages. The results of the initial measurement of nurses' knowledge about Islamic caring found that most nurses had sufficient knowledge, namely 55%. Whereas after being given training on Islamic caring, most of the nurses had good knowledge, namely 80%. Training is an effective and efficient activity to increase nurses' knowledge about Islamic caring. Based on the results of community service, there was an increase in nurses' knowledge after being given Islamic caring training.</span></em>

The potential for egg-guarding care in females of the damselfish, Dascyllus reticulatus, in the absence of uniparental male care.

Male damselfish typically demonstrate uniparental egg-guarding care in nature. Potential plasticity in sexual behavior has recently been reported in various teleost fish. To examine behavioral plasticity in parental care, we conducted aquarium experiments to explore the potential for egg-guarding care in the female damselfish, Dascyllus reticulatus. After initial caretaking, males were removed from the mating nests, and cohabiting females frequently exhibited egg predation on the same day. However, we confirmed that females showed significantly decreased egg-predation frequencies on the following day and showed egg-caring behaviors. All experimental females guarded their eggs until they hatched. Females subsequently spawned eggs as females even after performing parental care behaviors, indicating no progression of sex change into males. Molecular analysis of select pituitary gland hormones indicated that egg-caring females and males showed high expression levels of prolactin, suggesting its involvement in the development of parental care behaviors. The cryptic possession of caretaking ability in females may be a tactical response to the need for temporary replacement of the care roles in cases where caretaking males are removed, for example, through predation, in damselfish species living in sexually cohabiting groups.

MOTHERS KNOWLEDGE TOWARDS WOUND CARE IN THE GREATER BANDUNG AREA

Objective: Proper wound care is essential to prevent complications and worsening of the injured patient. Everyone in the family needs to possess wound care knowledge, especially the mother, who plays a role in making decisions about health care and family health behaviors. This study aims to evaluate mothers' knowledge towards wound care in the Greater Bandung Area.
 Methods: This cross-sectional study involved 100 participants with varied backgrounds and had met the inclusion criteria. The study was conducted using questionnaires distributed online to the mother community living in the Greater Bandung Area, West Java, then data processing and analysis were carried out.
 Results: The results showed that mothers in the Greater Bandung Area had a good level of knowledge (27%), average (52%), and less (21%). In addition, plasters with wound care solutions were still the mothers' main choice in wound care. Nevertheless, there are many choices of pharmaceutical dosage forms for wound care that have been developed today to optimize the wound healing process.
 Conclusion: Most of the mothers already have an average level of knowledge to good. However, there are still quite a lot of mothers who have a lack of knowledge related to wound care. Therefore, educational programs must be developed to raise awareness about wound care and management, as well as knowledge about pharmaceutical dosage forms for wound care.

Maternity Behavior and Infant Care of Coastal Communities on the Prevention of Neonatal Mortality

Background: Infant mortality is one of the targets of health problems in sustainable development. The vast majority of infant deaths are preventable, with high-quality, evidence-based interventions in the form of data. Based on the results of the Indonesian Demographic and Health Survey (SDKI) infant mortality in 2017 was 24/1,000 KH with neonatal mortality of 15/1,000. There was a decrease in the infant mortality rate (IMR) in 2017, compared to the IMR in 2012 which amounted to 32/1,000 KH and 19/1,000 KH neonatal. This study aims to analyze the behavior of childbirth and infant care through the behavior of local wisdom so as to prevent neonatal death. Methods: This study uses a quantitative observational method through a Case Control Study Design approach. The population in this study were all mothers in the coastal area of the Konawe Islands Regency. Results: Birth behavior and baby care at risk provide opportunities for neonatal events. Health agencies need to increase education to the public about risk factors, causes of neonatal death and efforts to prevent neonatal death to mothers and expectant mothers and their families to pay attention to pregnant and postpartum women. Conclusion: For the community, it is necessary to regulate the age of marriage with efforts to control it from the local government

THE RELATION BETWEEN EMOTIONAL INTELLIGENCE AND CARING BEHAVIOR IN NURSING STUDENTS OF STIKES MEDISTRA INDONESIA

Caring is an attitude, action or behavior carried out by nurses with the aim of giving feelings of emotional and physical security to others sincerely without discriminating against patients. Caring for nurses is a benchmark for patient satisfaction and also the quality of nursing services. caring behavior is not inherited or hereditary, but can be trained and developed since sitting in lectures. This caring behavior is also influenced by several factors, one of which is a person's Emotional Intelligence. Emotional Intelligence has several elements in common with the components in Caring. This research uses descriptive correlation method which is quantitative and cross sectional research design. The population in this study were nursing students from 2018 to 2022, totaling 276 students. The research sample was based on the slovin formula as many as 163 respondents were taken using Probability Sampling type stratified sampling. The research shows that there is a relationship between emotional intelligence and caring behavior of nursing students (P value = 0.000) which means that there is a significant positive relationship between emotional intelligence and caring behavior in nursing students. So suggestions for further researchers to examine other things that affect emotional intelligence and caring behavior as well as ways to keep nursing students in caring behavior. Keyword : Caring, emotional intelligent, student.

Genome-wide identification and expression analysis of C-type lectins in discus fish (Symphysodon aequifasciatus) during parental care

Discus fish (Symphysodon aequifasciatus) exhibit a unique parental care behavior: adult discus produces secretion through their skin, on which the larvae live after birth. The immune components in the skin mucus of parental discus would change during different parental care. C-type lectins (CTLs) could identify and eliminate pathogenic microorganisms and play important roles in innate immunity. Studies on CTLs of discus fish especially during parental care, however, are scarce. Here, we identified 186 CTL genes that distributed in 27 linkage groups based on discus genome. Phylogenetic analysis showed that S. aequifasciatus CTL (SaCTL) members were grouped into 14 subfamilies. A total of 80 gene replication events occurred, of which 15 pairs were subjected to segmental duplication and 65 pairs underwent tandem duplication. Ka/Ks ranged from 0.11 (SaCTL25/SaCTL158) to 0.68 (SaCTL36/SaCTL69), all undergoing purifying selection. RNA-seq analysis revealed that SaCTL members, including duplicated genes, in the skin of parental discus show distinct expression patterns in different care stages and between male and female parents. The SaCTL11 was differentially expressed in most care stages and reached the maximum after eggs spawned, but the expression of its paired SaCTL14 was low in each stage. The SaCTL39 increased first and then decreased, reaching a peak in eggs spawned, while paired SaCTL48 first decreased and then increased, reaching a peak in hatched eggs. The SaCTL50 was differentially expressed only in female fish during care, but not in male fish. These results provide new insights into the evolution and potential functional differentiation of CTLs in discus fish during parental care.

Comparison of manual, machine learning, and hybrid methods for video annotation to extract parental care data

Measuring parental care behaviour in the wild is central to the study of animal ecology and evolution, but it is often labour‐ and time‐intensive. Efficient open‐source tools have recently emerged that allow animal behaviour to be quantified from videos using machine learning and computer vision techniques, but there is limited appraisal of how these tools perform compared to traditional methods. To gain insight into how different methods perform in extracting data from videos taken in the field, we compared estimates of the parental provisioning rate of wild house sparrows Passer domesticus from video recordings. We compared four methods: manual annotation by experts, crowd‐sourcing, automatic detection based on the open‐source software DeepMeerkat, and a hybrid annotation method. We found that the data collected by the automatic method correlated with expert annotation (r = 0.62) and further show that these data are biologically meaningful as they predict brood survival. However, the automatic method produced largely biased estimates due to the detection of non‐visitation events, while the crowd‐sourcing and hybrid annotation produced estimates that are equivalent to expert annotation. The hybrid annotation method takes approximately 20% of annotation time compared to manual annotation, making it a more cost‐effective way to collect data from videos. We provide a successful case study of how different approaches can be adopted and evaluated with a pre‐existing dataset, to make informed decisions on the best way to process video datasets. If pre‐existing frameworks produce biased estimates, we encourage researchers to adopt a hybrid approach of first using machine learning frameworks to preprocess videos, and then to do manual annotation to save annotation time. As open‐source machine learning tools are becoming more accessible, we encourage biologists to make use of these tools to cut annotation time but still get equally accurate results without the need to develop novel algorithms from scratch.

Maternal care in wild toque macaques (Macaca sinica) involves prolonged lactation and interbirth intervals as adaptations to reduce maternal depletion and infant mortality in harsh environments.

Weaning age in primates has been challenging to measure and new methods, involving molecular biomarkers in feces, tissue, or teeth have contributed to a solution. Here, we used a direct approach by briefly anesthetizing 442 female toque macaques (Macaca sinica) of Sri Lanka (over a 17-year period) and manually testing their mammary tissue for the presence or absence of milk. Milk tests were related to known offspring ages and maternal care behaviors and indicated that older infants suckled milk well past the weaning age of 7 months that is often reported for food-provisioned primates. Mothers strongly rejected their infants' nursing attempts in two phases, the first at 7 months as an honest signal "giving notice" promoting a shift to greater independence from milk to solid food, and when "shutting down" at final weaning after 12-18 months. The shift to supplementary lactation coincided also with the cessation of mothers carrying their infants and a resumption of cycling. All infants up to 7.2 months suckled milk, 91% of them did up to 18 months, this continued for 42% of infants beyond 18 months, and normally none received milk after 22 months. Lactation extended into 2.2% of cycling and 10.7% of pregnant females (up to 50% of gestation). The interbirth interval was prolonged by factors predicted to draw on female metabolic energy reserves and included the duration of lactation, growth among primiparas, and dietary limitations. The last also increased menarche. Females offset the metabolic costs of lactation with increased foraging and catabolism, but infants died when lactation costs seemingly compromised maternal condition. The prolonged lactation and slowed reproduction are considered adaptations to promote infant survival and growth in an environment where the natural food supply limits population growth and competition for food and water impacts the mortality of the youngest the most.

Parental microprotections: Testing measurement equivalence in Black, Latinx, and White families

AbstractObjectiveThis study examined measurement equivalence of parental microprotections in Black, Latinx, and White families.BackgroundMicroprotections refer to the small daily caring, supportive, and loving behaviors Black parents engage in to counteract the negative effects of racism and discrimination. It is possible that this parenting practice applies to other families in which adolescents are at risk for discrimination because of social identities and/or membership in a stigmatized group (e.g., Latinx adolescents, sexual minority adolescents).MethodsParticipants were parent–adolescent dyads (N = 395) from across the United States. Adolescents were in Grades 9 through 12, and approximately one third of the families identified as Black/African American (n = 131), one third as Hispanic/Latinx (n = 132), and one third as White (n = 132).ResultsMeasurement equivalence was evaluated through a series of multigroup confirmatory factor analysis. Results showed strict measurement invariance in parent reports of parental microprotections across all three racial/ethnic groups. Adolescent reports of mothers' microprotections demonstrated strict measurement invariance and adolescent reports of fathers' microprotections achieved configural measurement invariance.ConclusionThese results support the use of the Parental Microprotections Scale in African American/Black, Hispanic/Latinx, and White families.ImplicationsParental microprotections are one way that parents can nurture hope, happiness, and health despite discrimination that adolescents may face. The Parental Microprotections Scale may be useful for family science practitioners and researchers who are interested in evaluating potential supports in adolescents and their families.

"Evaluate Knowledge Translation Care Plan on the Wound Healing and Caring Behaviors of Hospitalized Patients with Pressure Injury"

"Evaluate Knowledge Translation Care Plan on the Wound Healing and Caring Behaviors of Hospitalized Patients with Pressure Injury"

Factors related to caring behavior of nurses in the internal care room

Caring is a crucial aspect of healthcare, especially in the context of care in the internal space, where patients often experience complex health conditions that require special attention. This study investigates factors related to nurses' caring behaviour in the internal care room. roomThis type of research uses quantitative types with analytical descriptive research design through a cross-sectional approach with total sampling techniques. The results of the chi-square statistical test obtained motivation p 0.219, reward p 0.020, and length of work p: 0.008It can be concluded that there is a relationship between reward and length of work with the caring behaviour of nurses in the internal care room. Appreciation and length of work influence the caring behaviour of nurses in the internal care room. Length of work provides extensive experience and knowledge, while rewards increase nurses' motivation and job satisfaction. Combining these two factors can create a caring environment and positively impact patients in the internal care room.

Hospital health care workers’ use of facial protective equipment before the COVID-19 pandemic, implications for future policy

Prepandemic routine use of facial (respiratory and eye) protective equipment (FPE) by health care workers was suboptimal. Understanding factors affecting routine use would facilitate escalation to high level use during infectious disease emergencies. This study explored health care workers FPE-related knowledge, attitudes and behaviors. Mixed methods were used in a respiratory ward and adult and pediatric emergency departments (EDs), prior to the COVID-19 pandemic. Study design and thematic analysis were based on the theoretical domains framework. Emergent themes were categorized, using the COM-B behavior model, into capability(C), opportunity(O) and motivation(M), which influence behavior(B). 22 emergent themes, representing factors influencing FPE use, were mapped to theoretical domains framework domains. Personal experience and departmental cultures influenced motivation. Compared with respiratory ward staff, ED clinicians were less knowledgeable about FPE; the unique ED environment and culture inhibited opportunities and motivation for FPE use. Eye protection was infrequently used. Optimal FPE use is challenged by ED care models and settings. Changes are needed to translate pandemic-related improvements into routine care of other respiratory infections. This study identified key determinants of FPE behavior. A review of context-specific FPE guidance for ED by infection prevention and control professionals would help to promote practicable, sustainable compliance.

The mediating role of moral reasoning in spiritual intelligence and caring behaviors in Iranian emergency nurses.

Moral reasoning is necessary to the nursing profession. Therefore, this study aimed to investigate the mediating role of moral reasoning in spiritual intelligence and caring behaviors among Iranian emergency nurses. In this descriptive-analytical study structural equation modeling (SEM) is employed for the data analysis. the minimum required sample size determined by the number of parameters of the model was 18. Considering that 5 to 15 samples were required for each of the parameters; the required sample size was 272. Nurses working in the emergency department of all hospitals in Qom, Iran, were selected by convenience sampling. Demographic characteristics inventory, King's Spiritual Intelligence Self-Report Inventory, Crisham's Nursing Dilemma Test, and Wolf's Caring Behaviors Inventory used for data collection. SPSS (V20) and Mplus were used to analyze the data. The results showed that a significant direct relationship was observed between moral reasoning and caring behaviors. According to SEM results, direct and indirect effects were observed of spiritual intelligence on caring behavior It is therefore recommended managers and hospital officials pay meticulous attention to spiritual intelligence and the power of decision-making in nurses to improve their caring behaviors.

Effect of Juvenile Hormone on Worker Behavioral Transition in the Red Imported Fire Ant, Solenopsis invicta (Hymenoptera: Formicidae).

The division of labor among workers is a defining characteristic of social insects and plays a pivotal role in enhancing the competitive advantage of their colony. Juvenile hormone (JH) has long been hypothesized to be the essential driver in regulating the division of labor due to its ability to accelerate behavioral transitions in social insects, such as honeybees. The regulation of behavioral transitions by JH in the red imported fire ant (RIFA), Solenopsis invicta, a typical social pest, is unclear. Through video capture and analysis, we investigated the effects of the juvenile hormone analogue (JHA) methoprene on brood care, phototaxis behavior, and threat responsiveness of RIFA nurse workers. Our results showed that the JHA application significantly reduced the time and frequency of brood care behavior by nurse workers while increasing their walking distance and activity time in the light area. Additionally, the application of JHA made ants become excited, indicating a significant improvement in their activity level (movement distance, time, and speed). Furthermore, it was observed that the application of JHA did not affect the threat responsiveness of nurse workers towards stimuli (nestmates or non-nestmates). Our study demonstrates that the application of JHA reduced brood care behavior and enhanced phototaxis in nurse workers, which may reveal the role of JH in facilitating behavioral transitions in RIFA from intranidal tasks to extranidal activity. This study provides an experimental basis for further elucidating the mechanism underlying the division of labor in social insects.

Associations between social determinants of health and diabetes self-care behaviors among insured adult patients

AimsThis study explored the association between social determinants of health (SDOH) and diabetes care behaviors among individuals with health insurance. MethodsData from 57,206 US residents, representing a population of over 25.58 million adults with health insurance and diagnosed diabetes, were included in this cross-sectional analysis of data from the 2017 Behavioral Risk Factor Surveillance System. Logistic regression models were constructed to evaluate the likelihood of various diabetes care behaviors given the presence of several SDOH (e.g., food insecurity, poverty, housing insecurity, rurality). ResultsMost respondents exercised, ate vegetables, saw a provider for diabetes-related care in the last year, and reported checking their feet and testing their blood sugar daily. Not feeling safe (odds ratio (OR) 1.77, 95 % confidence interval (CI) 1.04, 3.01) was related to never checking blood sugar. Experiencing frequent stress was associated with a lower likelihood of exercise (OR .77, 95% CI 0.60, 0.999) and lower likelihood of checking blood sugar at least once a day (OR 0.73, 95% CI 0.54, 0.99). Food insecurity was associated with lower likelihood of vegetable consumption (OR 0.63, 95 % CI 0.47, 0.85) but a higher likelihood of checking blood sugar (OR 1.80, 95 % CI 1.26, 2.57). Low-income respondents were less likely to exercise (OR 0.72, 95 % CI 0.64, 0.80) or eat vegetables (OR 0.83, 95 % CI 0.75, 0.93) but more likely to check their feet (OR 1.19, 95 % CI 1.04, 1.35) and blood sugar at least once per day (OR 1.15, 95% CI 1.01, 1.31). Those who rent their home were also more likely to check their blood sugar (OR 1.22, 95% CI 1.07, 1.37) but less likely to have eaten vegetables in the last week (OR 0.87, 95% CI 0.78, 0.97). Respondents living in rural areas were more likely to have visited a provider in the last year (OR 1.21 95% CI 1.00, 1.47). ConclusionsSDOH can adversely affect diabetes self-care behaviors, providers should assist vulnerable patients by connecting them with community resources and providing individualized care.

Hormone profiles of the African pygmy mouse Mus minutoides, a species with XY female sex reversal.

In mammals, most sex differences in phenotype are controlled by gonadal hormones, but recent work on transgenic mice has shown that sex chromosomes can have a direct influence on sex-specific behaviors. In this study, we take advantage of the naturally occurring sex reversal in a mouse species, Mus minutoides, to investigate for the first time the relationship between sex chromosomes, hormones, and behaviors in a wild species. In this model, a feminizing variant of the X chromosome, named X*, produces three types of females with different sex chromosome complements (XX, XX*, and X*Y), associated with alternative behavioral phenotypes, while all males are XY. We thus compared the levels of three major circulating steroid hormones (testosterone, corticosterone, and estradiol) in the four sex genotypes to disentangle the influence of sex chromosomes and sex hormones on behavior. First, we did not find any difference in testosterone levels in the three female genotypes, although X*Y females are notoriously more aggressive. Second, in agreement with their lower anxiety-related behaviors, X*Y females and XY males display lower baseline corticosterone concentration than XX and XX* females. Instead of a direct hormonal influence, this result rather suggests that sex chromosomes may have an impact on the baseline corticosterone level, which in turn may influence behaviors. Third, estradiol concentrations do not explain the enhanced reproductive performance and maternal care behavior of the X*Y females compared to the XX and XX* females. Overall, this study highlights that most of the behaviors varying along with sex chromosome complement of this species are more likely driven by genetic factors rather than steroid hormone concentrations.

The Health Costs of Being Born Unwanted

This study quantifies the cost of unwanted pregnancy in relation to early childhood health in 62 developing countries. The endogeneity problem is dealt with through the household fixed‐effects model that utilizes the variation in the degree of birth wantedness among children within a household. The study uncovers the serious health consequences of children born unwanted. Specifically, children from unwanted births tend to have lower height‐for‐age, weight‐for‐age, and weight‐for‐height by 0.054, 0.065, and 0.04 standard deviations, respectively. We further present suggestive evidence that these health consequences might be ascribed to inadequate prenatal care and unfavorable postpartum behaviors among unintentionally pregnant women. Because poor health in early childhood can lead to long‐term negative ramifications, it is urgent to make contraceptives accessible to reduce unwanted births as well as to implement effective measures to assist women facing unwanted pregnancies.

Distinct roles of amylin and oxytocin signaling in intrafamilial social behaviors at the medial preoptic area of common marmosets

Calcitonin receptor (Calcr) and its brain ligand amylin in the medial preoptic area (MPOA) are found to be critically involved in infant care and social contact behaviors in mice. In primates, however, the evidence is limited to an excitotoxic lesion study of the Calcr-expressing MPOA subregion (cMPOA) in a family-living primate species, the common marmoset. The present study utilized pharmacological manipulations of the cMPOA and shows that reversible inactivation of the cMPOA abolishes infant-care behaviors in sibling marmosets without affecting other social or non-social behaviors. Amylin-expressing neurons in the marmoset MPOA are distributed in the vicinity of oxytocin neurons in the anterior paraventricular nucleus of the hypothalamus. While amylin infusion facilitates infant carrying selectively, an oxytocin’s inverse agonist, atosiban, reduces physical contact with non-infant family members without grossly affecting infant care. These data suggest that the amylin and oxytocin signaling mediate intrafamilial social interactions in a complementary manner in marmosets.

KOMPENSASI, BEBAN KERJA, PENGEMBANGAN KARIER, KEPUASAN KERJA DAN PERILAKU CARING PADA PERAWAT RAWAT INAP RSUD KHIDMAT SEHAT AFIAT KOTA DEPOK TAHUN 2023

The high rate of uncaring behavior in providing nursing care to patients, to overcome this problem requires improvements in compensation, career development workload and nurse job satisfaction so that caring behavior can be realized. Quantitative method, cross sectional using smartPLS with a population of 90 nurses. The research results show that compensation has a positive effect on job satisfaction, with a t value of 1.990 which is significant at α=5%. Compensation has a positive effect on caring behavior, with a t value of 2.079 and significant at α=5%. Workload has a negative effect on career development, with tcount value is 5.980 and is significant at α=5%, Workload has a negative effect on job satisfaction, with a tcount value of 7.279 and is significant at α=5%, Workload has a negative effect on caring behavior with a tcount value of 1.990 and significant at α= 5%, Career development has a positive effect on job satisfaction, with a t-value of 1.990 and is significant at α=5%, Career development has a positive effect on caring behavior, with a t-count of 3.608 and significant at α=5%, Job satisfaction has a positive effect on caring behavior, with a t value of 2.079 and significant at α=5%, of the four variables studied, the variable that most dominantly influences the caring behavior of inpatient nurses at Khidmat Sehat Afiat Hospital, Depok City is the workload variable with a direct value of 27%. The conclusion of this research is to provide reinforcement so that the workload of nurses is proportionately adjusted to competency so that nurses' caring behavior can increase