THE QUALITY-CARING MODEL
The Quality-Caring Model(C)11 exposes the hidden value of nursing (caring), guides practice, and provides a foundation for outcomes evaluation and research. In this model, the evidence-based practice environment of present-day healthcare is simultaneously merged with the caring processes of nursing. Caring values, attitudes, and behaviors dominate the process of care and establish the foundation for 2 key relationships. The independent patient-nurse relationship is primary and includes all interactions and interventions for which nurses are accountable and implement autonomously.11 Collaborative relationships include "those activities and responsibilities that nurses share with other members of the healthcare team."11(p82) Together, these 2 "relationship-centered professional encounters"11(p83) dominate the process of nursing and, in concert with certain structural variables, are hypothesized to influence quality healthcare outcomes.
The model places relationships, particularly the patient-nurse relationship, at the core of the therapeutic process. It is an evolving, developmental process that seeks to understand the unique perspective of patients/families. Through caring relationships, nurses interact, connect, and come to know the context, meaning of illness, beliefs, and preferences of patients and families.12 As a result, individuals feel "cared for" and are more willing to share, work together, change old patterns, and adhere to new regimens.
Implementing controversial practice models has been a traditional charge of nursing administrators13; yet, the challenge in applying the model is the creation of caring environments where relationships not only matter but they are also primary. The model posits that nursing's primary role is initiating, cultivating, and sustaining caring relationships with patients and families. Second, nursing has a responsibility to cocreate caring relationships with members of the healthcare team in order to foster cohesive teams for effective caregiving. Since the model places these activities at the core of nursing work, operationalizing it has major implications for the practice of nursing in acute care. The model suggests a major redesign, with implications not only for nurses but also for other health team members.