Background:  The Labor, Delivery and Recovery unit (LDR) of INOVA Fairfax Hospital (IFH) is a 22-bed unit in a large teaching hospital in suburban Virginia.  It delivers over 11,000 neonates annually. 
Purpose:  The purpose of the intervention was to incorporate Jean Watson’s Theory of Human Caring (THC) into nursing care on the LDR.
Educational Component
The LDR’s Human Caring Committee (HCC) received formal education about the THC, then chose key concepts to include in staff education:  the ten Clinical Caritas Processes (CCPs), the transpersonal nurse-patient relationship, the caring moment (Cara, 2003; Watson, 2005), and thinking of patients as persons, not problems (Jonsdottir, 2004; Foster, 2007).
Education was multimedia and longitudinal. HCC members performed inservices during shift reports, handed out pamphlets, erected posters of the CCPs, posted doorsigns outside patient rooms with CCPs and inspirational messages, led Power Point presentations for new hires and demonstrated Caritas Circles during shift reports.
Multimedia Implementations of the THC
Like other units implementing the THC, the LDR created a Caring Lounge, installed a mechanism (Compliments on Caring bulletin boards) on which nurses (and patients) could encourage other nurses, initiated quiet times (Caritas Circles during shift changes) during which nurses could meditate on caring (Attending Caring, 2003), and posted signs and posters with the CCPs and inspirational quotes (Woodward, 2004; Bent, Burke, Eckman, Hottmann, McCabe, and Williams, 2005).  Uniquely, the HCC also videotaped staff describing caring moments (and played the tape at shift changes), recorded and gave out for free relaxation CDs with music and inspirational quotes,  and posted bulletin boards on which staff could post pictures of their own children (to inspire them to care for others’ babies as they would their own).
Research
Two HCC members conducted a descriptive, exploratory, pretest-posttest study, with a convenience sample of 106 LDR nurses (in all shifts and all roles, representing 76% of LDR nurses) and 200 LDR patients using the Caring Efficacy Scale (CES) for nurses and the CARE-SAT for patients.  Both tools were Likert-scale surveys, and demographic questions were added, and the CES was revised (with author permission) to reflect the LDR setting.  Data was analyzed using means, Pearson’s r, t-tests, and ANOVA.  Although the posttest will be performed from October 2008 through December 2008, the pretest showed interesting results.  The revised CES had a Cronbach’s alpha of 0.880, and the mean caring efficacy score was 154.3 (out of a highest possible self-efficacy rating of 180).  There were no significant differences among nurses’ demographics in CES scores. Mean scores for individual questions were lower for questions regarding suspending personal beliefs, communicating with patients from different backgrounds, relating to patients from different cultures, “getting through” to “difficult” patients, and using creative ways to care. The mean CARE-SAT score was 4.69 (out of 5.00), indicating patients “somewhat agreed” that their nurses were caring.  The research was a convenience sample at this suburban hospital with LDR nurses and English-speaking patients 18 years and older.  Therefore, results only should be generalized to this population.