. .
Nursing Research January/February 2006 Vol 55, No 1, 18–25
Caring Behaviors Inventory
A Reduction of the 42-Item Instrument
Ying Wu 4 June H. Larrabee
b Background: Caring traditionally has been at the center of
nursing. Effectively measuring the process of nurse caring
is vital in nursing research. A short, less burdensome di-
mensional instrument for patients’ use is needed for this
purpose.
b Objectives: To derive and validate a shorter Caring Behav-
iors Inventory (CBI) within the context of the 42-item CBI.
b Methods: The responses to the 42-item CBI from 362 hospi-
talized patients were used to develop a short form using
factor analysis. A testYretest reliability study was con-
ducted by administering the shortened CBI to new samples
of patients (n = 64) and nurses (n = 42).
b Results: Factor analysis yielded a 24-item short form (CBI-
24) that (a) covers the four major dimensions assessed by
the 42-item CBI, (b) has internal consistency (" = .96) and
convergent validity (r = .62) similar to the 42-item CBI, (c)
reproduces at least 97% of the variance of the 42 items in
patients and nurses, (d) provides statistical conclusions
similar to the 42-item CBI on scoring for caring behaviors
by patients and nurses, (e) has similar sensitivity in de-
tecting between-patient difference in perceptions, (f) ob-
tains good testYretest reliability (r = .88 for patients and r =
.82 for nurses), and (g) confirms high internal consistency
(" 9 .95) as a stand-alone instrument administered to the
new samples.
b Conclusion: CBI-24 appears to be equivalent to the 42-item
CBI in psychometric properties, validity, reliability, and
scoring for caring behaviors among patients and nurses.
These results recommend the use of CBI-24 to reduce
response burden and research costs.
b Key Words: caring & instrument & nursing & validation
C aring is the core of nursing because of its benefits to
both nurses and patients. Caring is central to most
nursing interventions, necessary for cure to take place, the
moral and ethical basis of nursing, and the essence of
nursing (Benner & Wrubel, 1989; Condon, 1988; Fry,
1988; Watson, 1988). Moreover, patient-perceived nurse
caring is a major predictor to overall satisfaction with hos-
pital care (Larrabee et al., 2004; Otani & Kurz, 2004).
18
Copyr ight © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
4 Heidi P. Putman
Effectively measuring nurse caring is critical for monitoring
the quality of caring and evaluating the effectiveness of
nursing.
Beck (1999) reviewed the CINAHL database from
1982 to 1997 and identified six instruments used to mea-
sure nurse caring behaviors. These instruments include a
checklist completed after observing a nurseYpatient inter-
action for 30 minutes (McDaniel, 1990), a visual analogue
scale rated by patients (Hinds, 1988), and four Likert
scales. Among the four Likert scales, one is a nurse scale
(Nyberg, 1990); two are patient scales with 39 and 61
items, respectively (Cronin & Harrison, 1988; Latham,
1996); and one is suitable for dual assessment by patients
and nurses, the 42-item Caring Behaviors Inventory (CBI;
Wolf, Giardino, Osborne, & Ambrose, 1994). The CBI
can be used to compare nurse self-evaluation and patient
judgments. In fact, patients’ perceptions on caring could
provide more important input to nursing practice and
research because patients are the recipients of the care. Self-
evaluation by nurses might be affected by social desirability
tendency (i.e., the tendency to make the response look
good; Reynolds, 1982). Furthermore, recent research on
developing patient-centered nursing models highlights the
importance of patients’ perceptions on the quality of caring
(Anthony & Hudson-Barr, 2004; Webster & Cowart,
1999).
Unfortunately, the three Likert scales available for
use by patients are long, and patient burden becomes a
serious concern. Wolf’s CBI originally contained 75 items
describing actions and attitudes in the nursing process.
Respondents were asked to rate each item in 6 levels from
1 = never to 6 = always. The inventory was developed in
1981 using a sample of 97 registered nurses (Wolf, 1981).
It was reduced later to 43 items and was reviewed by a
panel of nurses (Andrews, Daniels, & Hall, 1996).
Subsequently, combining data from 278 nurses and 263
patients, Wolf et al. (1994) conducted a factor analysis on
the 43 items, which resulted in the latest version of CBI.
With 42 items, this CBI is used to assess five dimensions of
Ying Wu, PhD, is Research Assistant Professor; June H. Larrabee,
PhD, RN, is Professor of Nursing; and Heidi P. Putman, DNSc,
RN, is Assistant Professor of Nursing, West Virginia University
School of Nursing, Morgantown.
Nursing Research January/February 2006 Vol 55, No 1
Nursing Research January/February 2006 Vol 55, No 1
caring: BAssurance^ of human presence,
professional BKnowledge and Skill,^
BRespectful^ deference to other, positive
BConnectedness,^ and BAttentiveness^ to
the other’s experience. The 42-item CBI
showed high testYretest reliability (r = .96)
and internal consistency (" = .96). Caring is the core of
Researchers have identified the CBI
as highly reliable, friendly to use,
nursing because of its
and valuable in providing a quantifica- benefits to both nurses
tion of nurse caring in global and
and patients.
dimensional measures (Andrews et al.,
1996; Coulombe, Yeakel, Maljanian, &
Bohannon, 2002). However, the length
of the questionnaire is a concern, par-
ticularly among acutely ill patients. The
length may have contributed to the qqq
failure of many patients to complete
all items (Coulombe, 2002). Recently, Coulombe et al.
(2002) derived an abbreviated version of CBI using regres-
sion and suggested a selection of six items. The reliability completed the questionnaire without help.
of this six-item scale when presented solely to a sample
remains to be determined. Moreover, the six items describe
nurse attitudes in the caring process (nonbehavioral) and
this single-construct scale allows only a global measure-
ment. Nurse caring, reflecting the richness of persons-
in-relationship, requires a multidimensional approach for
measurement (Boykin & Schoenhofer, 1990; McBride,
1989; Watson & Lea, 1997). Therefore, a less burdensome,
multidimensional scale for obtaining patients’ perceptions
on nurse caring behaviors is needed.
In this study we develop and validate a shorter CBI
within the context of the 42-item CBI. Because the context
of the CBI has been developed with input from nurses alone
(Wolf, 1986), validation of the instrument among patients
was needed. Using homogeneous nurse or patient samples
might reaffirm the dimensions of nurse caring (Beck, 1999;
Wolf et al., 1994). Accordingly, our analysis strategies
included the following stages: (a) 362 patient responses to
the 42-item CBI were used to shorten the instrument by
factor analysis, (b) validation of the shortened form was
examined among the 362 patients and the 90 nurses, and
(c) testYretest reliability of the shortened CBI was con-
ducted in new samples of 64 patients and 42 nurses.
Methods
Procedure
Data used for constructing a shortened CBI were collected
during 2000 for the cross-sectional study of inpatient
hospital nursing care (Larrabee et al., 2004). The 42-item
CBI was administered to 362 hospitalized patients from
medical, surgical, and intensive care step-down units at an
academic medical center in northern West Virginia. The
42-item CBI was also administered to 90 registered nurses
working on the study units to assess caring behaviors rated
by nurses. Patient selection criteria were as follows: 18
years of age or older, able to speak and read English,
without a psychiatric diagnosis, and admitted to one of the
study units for at least 24 hours. Nurse participants must
have been employed on the study units for at least 3
Copyr ight © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Caring Behaviors Inventory 19
months prior to completing the ques-
tionnaire. Eligible patients were
approached by one of three data collec-
tors (graduate student nurses). After
obtaining informed consent, the data
collector assessed the patient’s reading
ability using a quick (G 5 minutes)
screening instrument, the Rapid Esti-
mate of Adult Literacy in Medicine
(Davis et al., 1993), which included
three lists of words about common
medical words, lay terms for body
parts, and illnesses. The reading ability
was scored based on the number of
correct pronunciations among all given
words. Patients (n = 182) who had low
reading levels, left their reading glasses
at home, or felt too ill to complete the
questionnaire without assistance were interviewed by data
collectors. The rest of the patients and all the RNs
A repeated measure study for obtaining testYretest re-
liability of the shortened CBI was conducted during 2004 in
the same hospital. The new version was administered to
patients and nurses on two occasions. Eligibility criteria of
participation for patients and nurses were the same as
described above. From the list of eligible patients provided
by a nurse working in the study units, 66 were randomly
selected for the survey. Because of the relative unpredict-
ability of patient discharges, the testYretest data from
patients were collected 24 hours apart. From the list of
eligible nurses provided by the unit manager or their rep-
resentative, 56 nurses were randomly selected to be sur-
veyed. Because some nurses worked only 1 or 2 days a week,
testYretest data from nurses were collected 5 days apart.
All data were collected in a confidential manner;
patient identifiers were accessible only to the data collec-
tors and the principal investigator. The survey study in
2000 and the testYretest study in 2004 were approved by
the university’s Institutional Review Board.
Patient Measurements
Patient demographics items included age, gender, employ-
ment status, marital status, income, and years of education.
The number of days hospitalized was calculated by sub-
tracting the admission date from the data collection date.
Pain intensity at time of interview was measured by the
Patient’s Worst Pain Scale (Cleeland et al., 1994), rated
from 0 = no pain to 10 = the worst pain I have ever had.
The five-item Satisfaction with Life Scale (Diener, Emmons,
Larsen, & Griffin, 1985) was included also (" = .9). The
mean value of the five items (range 1Y5) was used in the
analysis, with a higher score indicating higher level of
satisfaction.
A global measurement of patient satisfaction with nurs-
ing care was assessed by the question, BOverall, how good
was the nursing care that you received?^ from the patient’s
judgments of nursing care surveyVa modified version of
the Nursing and Daily Care subscale (Meterko, Nelson,
& Rubin, 1990). Response options ranged from 1 = poor
to 5 = excellent.
20 Caring Behaviors Inventory Nursing Research January/February 2006 Vol 55, No 1

q q
TABLE 1. Characteristics of the Two Patient TABLE 2. CBI-24 and Its Factor Structure
Samples (N = 362 patients)

Survey in TestYretest in F1 F2 F3 F4
2000 (N = 362) 2004 (n = 64)
Factor 1VAssurance
Age (years) Returning to the patient voluntarily .60 .29 .24 .36
17Y30 64 (18) 6 (9) Talking with the patient .51 .34 .44 .32
30Y50 125 (35) 27 (42) Encouraging patient to call if there .68 .34 .36 .03
50Y87 173 (48) 31 (48) are problems
Male gender 184 (51) 29 (45) Responding quickly to the .62 .27 .18 .43
Race patient’s call
White 351 (97) 62 (97) Helping to reduce the .67 .36 .28 .24
Black 6 (2) 2 (3) patient’s pain
Asian 3 (1) 0 (0) Showing concern for the patient .69 .29 .45 .16
Native American Indian 2 (1) 0 (0) Giving the patient’s treatments and .67 .27 j.02 .36
medications on time
Residential setting
Relieving the patient’s symptoms .59 .30 .38 .29
City 197 (54) 22 (35)
Factor 2VKnowledge and Skill
Rural 165 (46) 41 (65)
Knowing how to give shots, .33 .76 .07 .17
Employed 191 (54) 33 (53)
IVs, etc.
Marital status
Being confident with the patient .18 .73 .40 .18
Single 91 (26) 7 (11)
Demonstrating professional .28 .75 .22 .22
Married 180 (51) 39 (61) knowledge and skill
Divorced 38 (11) 7 (11) Managing equipment skillfully .34 .72 .14 .20
Widowed 40 (11) 11 (17) Treating patient information .39 .51 .16 .07
Separated 7 (2) 0 (0) confidentially
Days hospitalized Factor 3VRespectful
1 92 (25) 4 (6) Treating the patient as an .16 .15 .77 .18
1Y2.5 79 (22) 12 (19) individual
3Y6 127 (35) 30 (48) Attentively listening to the patient .21 .16 .82 .18
Q7 63 (17) 16 (26) Supporting the patient .33 .16 .65 .37
Pain level at interview Being empathetic or identifying .20 .40 .57 .47
0 (no pain) 80 (22) 24 (38) with the patient
1Y3 (light) 141 (39) 20 (31) Allowing the patient to express .22 .42 .54 .42
feelings about his or her disease
4Y7 (moderate) 119 (33) 15 (23)
and treatment
8Y10 (intense) 19 (5) 5 (8)
Meeting the patient’s stated and .45 .27 .54 .36
Income unstated needs
G $10,001 110 (37) 10 (26) Factor 4VConnectedness
$10,001Y$20,000 75 (25) 10 (26) Giving instructions or teaching .18 .19 .17 .73
$20,001Y$30,000 58 (20) 7 (18) the patient
$30,001 or more 54 (18) 11 (29) Spending time with the patient .39 .02 .21 .72
Education (years) Helping the patient grow .15 .19 .33 .71
G9 37 (10) 7 (11) Being patient or tireless with .33 .39 .21 .54
10Y13 242 (68) 35 (57) the patient
14Y21 78 (22) 19 (31) Including the patient in planning .13 .47 .32 .50
his or her care
Values are presented as n (%). Eigenvalue 12.67 1.51 1.13 1.00
Percentage of variance 53 6 5 4

Study Samples study in 2004 (64 paired data) are presented in Table 1.
Characteristics of the two-patient samples for the cross- The mean age of the 362 patients was 48.5 years. Among
sectional survey in 2000 (N = 362) and the testYretest the 66 patients participating in the repeated measure

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Nursing Research January/February 2006 Vol 55, No 1 Caring Behaviors Inventory 21

q
TABLE 3. Comparisons Between the Two Instruments for Scale Internal Consistency, Mean Score,
and Standard Deviation

Patients (N = 362) Nurses (N = 90)

" Mean (SD) (min, max) " Mean (SD) (min, max)
Overall CBI index
CBI-42 .98 4.33 (0.59) (1.33, 5) .98 4.11 (0.58) (1.83, 5)
CBI-24 .96 4.29 (0.61) (1.14, 5) .96 4.10 (0.58) (2.09, 5)
d .04 .01
Assurance
CBI-42 .95 4.33 (0.66) (1.45, 5) .96 4.19 (0.66) (1.58, 5)
CBI-24 .92 4.34 (0.65) (1.14, 5) .92 4.19 (0.62) (1.88, 5)
d j.01 0
Knowledge and skill
CBI-42 .87 4.55 (0.55) (1.60, 5) .84 4.35 (0.49) (3, 5)
CBI-24 .87 4.59 (0.53) (1.80, 5) .83 4.40 (0.49) (3, 5)
d j.04 j.05
Respectful
CBI-42 .90 4.32 (0.60) (1.27, 5) .94 4.05 (0.62) (1.83, 5)
CBI-24 .91 4.34 (0.65) (1.14, 5) .92 4.19 (0.62) (1.88, 5)
d j.02 j.14
Connectedness
CBI-42 .90 4.22 (0.68) (1.11, 5) .91 3.89 (0.62) (1.60, 5)
CBI-24 .82 3.93 (0.84) (1.25, 5) .87 3.69 (0.68) (1.83, 5)
d .29**** .20*

Note. CBI-42 refers to the original Caring Behaviors Inventory with 42 items. CBI-24 refers to the shortened version with 24 items. The score differences (d) were
examined by t test. *p G .05; ****p G .0001.

study, 64 returned both test and retest surveys. The mean
age of these patients was 50.0 years. Both samples were
predominantly White (97%) and all patients were from
West Virginia.
The 90 nurses responding to the 42-item CBI had a
mean age of 34.6 years (range 20Y64 years) and 93.3%
were female. Among the 56 nurses participating in the
repeated measure study, 42 returned both test and retest
surveys. Their mean age was 40 years (range 23Y57 years)
and 90% were female.
the items with loadings smaller than .4 on any factor were
deleted. Items that loaded on more than one factor with
close loadings greater than .4 were removed also because
these items were not a pure measure of any one dimension.
The factor analysis procedure was conducted again on the
q
TABLE 4. Validation of the Two Instruments
Among Patients (N = 362): Pearson
Correlation Coefficients

Analysis The 24 items The 42 items

The responses to the 42 items of the CBI were collapsed
into five levels by combining the options of never and Convergence
almost never because of very low frequencies on these Patient satisfaction .62**** .63****
options. Mean value was used for scoring caring behaviors Association
in the five dimensions and at the overall level.
Age .26**** .25****
Exploratory factor analysis was performed on the 42
items using Varimax rotation. The number of meaningful Education j.11* j.11*
factors to retain was determined by the eigenvalues-one Satisfaction with life .19*** .17***
criterion (Ferketich & Muller, 1990; Polit & Hungler, Pain level at interview j.11* j.11*
1999). Any factor that displays an eigenvalue greater than
1.00 accounts for a greater amount of variance, and such a Note. *p G .05, **p G .01, ***p G .001, ****p G .0001.
factor is worth retaining. To reduce the number of items,

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22 Caring Behaviors Inventory Nursing Research January/February 2006 Vol 55, No 1

q
TABLE 5. Test–Retest Reliability, Internal Consistency of CBI-24 In the New Samples

Patients (n = 64) Nurses (n = 42)

Cronbach " Cronbach "
Time 1 Time 2 Pearson r Time 1 Time 2 Pearson r
Overall CBI index .98 .98 .88 .95 .96 .82
Assurance .95 .97 .91 .91 .90 .78
Knowledge and Skill .93 .96 .80 .83 .83 .67
Respectful .95 .94 .79 .88 .92 .80
Connectedness .84 .88 .84 .81 .86 .73

remaining items to identify the factor structure for the
shortened CBI.
Convergent validity indicates whether a measure related
to other observed variables consistently with theoretically
derived predictions (Streiner & Norman, 1999). Patient sat-
isfaction with caring was used as a convergent variable of
nursing care behaviors (Wolf, Colahan, & Costello, 1998):
BCaring was integral to the humanizing characteristic of
advocacy and could have been related to a patient’s satis-
faction^ (p. 100). Recent research by Larrabee et al. (2004)
confirms that patient-perceived caring was a primary pre-
dictor of patient satisfaction with caring. Therefore, we

FIGURE 1. Comparisons of scoring by the two

instruments across varying patient characteristics
(N = 362). CBI-42 refers to the original Caring
Behaviors Inventory with 42 items. CBI-24 refers to
the shortened version with 24 items. CBI-24 CBI-42.
, CBI-24; , CBI-42.

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Nursing Research January/February 2006 Vol 55, No 1 Caring Behaviors Inventory 23

calculated the Pearson coefficient correlation of CBI-24 its moderate correlations with patient characteristics in-
and the patient satisfaction score to assess convergent cluding age (r = .23), satisfaction with life (r = .19),
validity. Previous studies also indicated that patients’ education (r = j.11), and pain level at time of interview
perceptions on caring behaviors were influenced by age, (r = j.11). The patients who were older, who felt less pain
gender, and degree of pain (Baer & Lowery, 1987; Latham, at time of interview, who received less education, and who
1996). For further examination of construct validation, we reported higher levels of satisfaction with life were related
assessed the bivariate associations of CBI-24 with each of to significantly higher scoring on perceived nurse caring. In
these patient characteristics. The results were compared addition, the strengths of association of these variables
against those from the 42-item CBI. with CBI-24 were similar to those of the original scale (see
Internal consistency of the two instruments among Table 3). The comparable patterns of relationship provided
patient and nurse populations was assessed by Cronbach’s further evidence of validity for both CBIs.
", which tested whether all the items in a scale measured The overall index of CBI-24 reached high internal
the same concepts (Streiner & Norman, 1999). consistency for both patients and nurses (" = .96). For the
The mean scores of the two instruments, showing four subscales, " values ranged from .82 to .92. Patients’ "
caring behaviors rated by patients and nurses respectively, values were close to nurses’ " values. In addition, the "
were compared. When the CBI was used primarily to assess values of CBI-24 closely mirrored those of the original
population levels of perceived caring rather than individual scale, except for the Connectedness subscale (see Table 4).
opinions, group t test was appropriate for examining Test-retest reliability is shown in Table 5, Pearson
significance of the score difference. correlation coefficients between scores
Because patients’ feeling of being cared ranged from .67 to .91 for the overall
for was expected to be different based score and the four dimensional scores
on patient characteristics, sensitivities of among patients and nurses, indicating
the two instruments (Ferketich, 1991) good response stability. The " values
in response to potential between-patient With the new ranged from .83 to .98 among patients
difference were examined by mean and nurses, indicating high internal
score profiles over patient groups. four-factor structure consistency reliability.
Pearson correlation coefficients of in the shorter version
the CBI-24 scores obtained at Time 1 Comparison of Descriptive Statistics
and Time 2 were calculated. The " value proposed in this study, No significant difference in sample
of CBI-24 as a stand-alone instrument distinctions among mean scores was found when using the
was examined again in the new samples two instruments for measuring caring
of patients and nurses. the dimensions behaviors at overall level and on di-
become clearer. mensional levels including Assurance,
Knowledge and Skill, and Respectful
Results dimensions (see Table 4). The CBI-24
CBI-24 and Its Factor Structure derived a lower mean (3.9 vs. 4.2) when
qqq assessing connectedness behavior. Be-
Of the 362 patients responding to the
42-item CBI, 4 patients who answered cause patients with different ages and
less than 20 questions were excluded. Factor analysis pain levels showed larger difference in CBI scores, the
yielded a 24-item short form (CBI-24). Among the 18 trends of scoring by the two instruments over age and pain-
items discarded, one item BCalling the patient by his/her level groups are displayed in Figure 1. Parallel profiles
preferred name^ did not load on any factor (loadings G .4) demonstrated that the two instruments have similar
and 17 items loaded on more than two factors with very sensitivity in detecting between-patient differences in per-
close loadings (e.g., BUsing a soft, gentle voice with the ceptions of overall caring behaviors.
patient^ was loaded on three factors with loadings .41, .46,
and .46). The minimum eigenvalue criterion of 1.0
Discussion
suggested four factors for the remaining 24 items. The
eigenvalues ranged from 1.0 to 12.67. The four factors The CBI-24 derived from this study using factor analysis
explained 68% of the total variance in the 24 items. Each (a) covers the four major dimensions assessed by the 42-
of the 24 items was loaded on only one factor with loading item CBI; (b) reaches high levels of internal consistency and
exceeded .5, indicating that the items in a factor were well convergent validity similar to the 42-item CBI; (c) repro-
clustered. The clusters of items were similar to the original duces at least 97% of the variance of the 42 items in
CBI although a few items were permuted (see Table 2). The patients and nurses; (d) provides statistical conclusions
CBI-24 reached R2 of .98 in regression for the 42-item CBI similar to the 42-item CBI on scoring for caring behaviors
using 358 data from patients, and R2 of .97 using 90 data by patients and nurses; (e) has similar sensitivity in
from nurses. detecting between-patient differences in perceptions; (f)
obtains good testYretest reliability; and (g) confirms high
Validity and Reliability internal consistency as a stand-alone instrument adminis-
Convergent validity of CBI-24 was demonstrated by its tered to the new samples of patients and nurses.
significant relationship with patient satisfaction score (r = This study also addresses the concerns about the
.62). Construct validity of CBI-24 was demonstrated by validation of the 42-item CBI on a homogeneous patient

Copyr ight © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
24 Caring Behaviors Inventory
sample (Wolf et al., 1994). The consistent results of
convergent validation across the two instruments among
patients reinforce the reliability of the CBI. Previous
research on nurse caring reveals that patients with higher
levels of pain received more supportive nursing care (Baer
& Lowery, 1987; Latham, 1996). Wolf et al. (1998) also
indicated that it was easier to care for more seriously ill and
dependent patients than those who were less so. Patients
with the most intense pain (Levels 9 and 10) rated higher
on perceived caring behaviors than others (see Figure 1),
which was remarkably consistent with the theoretical
results. The ability of both CBIs to detect such perception
differences suggests the accuracy of the CBIs in reflecting
the amount of nursing actions, providing further evidence
for validation of the CBIs among the patient population.
Factor analysis based on patient data resulted in a
compression of the five dimensions assessed by the 42-item
CBI into four major dimensions describing the ingredients
of caring identified by nurses, patients, and nurse research-
ers (Cronin & Harrison, 1988; Larrabee & Bolden, 2001;
Wolf, 1986): (a) be readily available to a patient’s need and
security, assessed by the Assurance subscale; (b) demon-
strate conscience and competence, assessed by the Knowl-
edge and Skill subscale; (c) attend to the dignity of the
person, assessed by the Respectful subscale; and (d) provide
constant assistance to patients with readiness, assessed by
the Connectedness subscale. Attentiveness to other’s expe-
riences with four items in the long version is combined into
the new subscales. One of the four items, BRelieving the
patient’s symptoms,^ was loaded on the new Assurance
subscale. Three other items (BPaying special attention to
patient during first times, as hospitalization, treatment,^
BPutting patient first,^ and BGiving good physical care^)
were dropped based on our homogeneous patient data. In
fact, this factor accounted for the smallest variance (3% of
the total variance) among the five subscales in the original
factor analysis using combined data from nurses and
patient (Wolf et al., 1994). With the new four-factor
structure in the shorter version proposed in this study,
distinctions among the dimensions become clearer.
This study is limited by sampling only from surgical
and medical nursing units and from restricted geographic
location. Use of the CBI-24 in a greater variety of clin-
ical environments would offer possibilities to test the
scale in larger samples from diverse populations. Also, it
may be necessary to further confirm the testYretest reli-
ability due to the short time interval between tests in cur-
rent study.
In summary, CBI-24 appears to be equivalent to the
42-item CBI in psychometric properties, reliability, and
scoring for caring behaviors when applied to patient and
nurse populations. These results recommend the use of the
CBI-24 to reduce response burden and research costs.
Evaluating the effectiveness of intervention studies requires
this measure not only to be reliable and valid, but also to
be able to detect meaningful changes in behaviors. Further
research using the CBI-24 in intervention studies to test its
sensitivity in response to nurse behavioral changes is
needed. Meanwhile, ongoing debates and developments
on conceptualization of caring (Lea & Watson, 1996; Lea,
Watson, & Deary 1998) will continuously challenge and
Copyr ight © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Nursing Research January/February 2006 Vol 55, No 1
refine the indicator of this concept, the Caring Behaviors
Inventory. q
Accepted for publication May 23, 2005.
This project was supported by a West Virginia Univeristy seed grant.
The authors thank Zane Robinson Wolf for allowing the use of the
Caring Behaviors Inventory, and Amy Sparks and Amy Myers for
their assistance in data collection.
Corresponding author: Ying Wu, PhD, Research Office, West Virginia
University School of Nursing, PO Box 9640, Morgantown, WV
26506-9640 (e-mail: ywu@hsc.wvu.edu).
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