Objectives: To assess the level of caring ability of practicing pharmacists and to examine differences in caring ability by sex, degree earned, practice setting, years in practice, and whether the pharmacist provides clinical services.
Design: Descriptive survey study.
Participants: The survey was mailed to a stratified random sample of pharmacists registered in Illinois (n = 1,200).
Main Outcome Measures: Caring Ability Inventory (CAI) score. Information was also gathered regarding respondents' practice setting, number and types of clinical services provided, and demographic characteristics.
Results: Of the 1,076 deliverable surveys, 323 were returned completed and used in the analysis (response rate = 30%). Mean CAI score ± standard deviation was 203.0 ± 17.7. Statistical analyses revealed no significant differences in CAI score by sex, degree earned, or practice setting. A significant and positive correlation was found between years in practice and CAI score. Pharmacists who provided disease management and other clinical services scored significantly higher on the CAI than pharmacists who did not.
Conclusion: Pharmacists exhibit relatively high levels of caring ability as assessed by the CAI. Further inquiry into the nature of caring and its implications for pharmacy practice is needed.
Pharmaceutical care. The phrase and its underlying meaning have been the principal concern of innumerable articles, discussions, curriculum planning meetings, pharmacy classes, and continuing education programs for over a decade. First described by Hepler and Strand as "the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life," pharmaceutical care implies direct contact between pharmacists and patients, and pharmacists' assumption of responsibility for therapeutic outcomes. Although not explicitly stated in this definition, "caring" has been identified as an integral component of pharmaceutical care. The American Pharmacists Association and the American Society of Health-System Pharmacists have each acknowledged caring as a dimension of pharmaceutical care. Policy statements regarding pharmaceutical care issued by these professional organizations include phrases such as "patient's welfare paramount," "personal concern for the well-being of another person," and "one-to-one relationship between a caregiver and a patient."
Although it is clear that providing pharmaceutical care requires a commitment to the patient's health and well-being, it is not understood how the "care" in pharmaceutical care is defined or what the current levels of pharmacists' caring ability are. Reich, in his discussion of pharmaceutical care, called on scholars and educators to "develop a vision of care." He added that these opinion leaders "need to decide what it means to care about -- while also taking good, technical pharmaceutical care of the patient." Reich's vision of care includes caring for and caring about the patient.
A long and steady stream of research has been published on caring in nursing and medicine. In the nursing literature, Leininger defined caring as "expressing attitudes and actions of concern for [patients], in order to support their well-being, alleviate undue discomforts, and meet obvious or anticipated needs." One can easily comprehend how this definition might be translated into specific nursing behaviors.
Pharmacy, on the other hand, is just beginning to understand how pharmacists translate the care in pharmaceutical care into specific interpersonal behaviors. For example, Berger stated, "Probably nothing is more powerful in communicating caring than understanding, and thus legitimizing, the concerns of the patient." Understanding implies empathizing with a patient and focusing on individual patient characteristics in a nonjudgmental way. In her recent article reviewing the literature on caring and citing the need to define care in pharmaceutical care, Galt suggested, "Care and caring are ultimately defined as acts or behaviors which are a response to the values and needs of the individual, with professional care specifically intended to improve or maintain a person's health." She also listed specific behaviors that demonstrate pharmacists' caring. These behaviors range from personal behaviors, such as "praying for the patient," to professional responsibilities, such as "act to improve the patient's therapeutic regimen to better achieve desired outcomes." As yet unknown are the degree to which pharmacists are exhibiting these behaviors and the effects engaging in these suggested caring behaviors have on patient well-being.
Nickman noted that "little has progressed with educational methods and courses that actually help students understand the meaning of caring for and about another human being." In a recent study, Fjortoft and Zgarrick tested a model, the Caring Ability Inventory (CAI; described further in Methods below), that attempted to predict level of caring ability in undergraduate pharmacy students. For the purpose of the present study, we adapted the CAI as a measure of pharmacists' caring ability. It is our assumption that in order to deliver pharmaceutical care, pharmacists must have a certain level of caring ability. Before that assumption can be tested, it is necessary to assess pharmacists' caring ability.