Nursing theory development is a nursing research priority . Particularly, theory guided practice is considered by Saleh  the future of nursing as a way to provide effective, efficient, and holistic care. To do so nurses must rely on theoretical principles to apply the plan care . In this article we present an adaptation of a nursing model based on research results.
The first main component of the revised quality-caring model  is humans in relationship that refers to the notion that humans are multidimensional beings. This component considers human characteristics and its influence on nursing interventions. In this study personal characteristics of nurses were considered since they were identified as important both in literature review  and in study phase 2 . Children value personal characteristics such as being friendly and approachable  or being treated with respect . Parents mentioned these characteristics as something desirable and that can be enhanced to improve satisfaction . Interestingly nurses didn’t identify any intervention that was focused on this area of improvement.
Previous experiences of hospitalization were mentioned by parents, children and nurses as an important factor that can affect satisfaction with care. Also, in literature previous experiences appear as relevant  as well as socio demographic factors . Demographic factors appeared as particularly relevant given the different development characteristics of children regarding age and gender. Age is identified as an important factor  however in our study there was no link between children’s age and satisfaction.
In this population and setting, pediatric internment units, also resources such as toys, environment of care and resource adequacy must be considered given the characteristics of school aged children. The importance of play and toys in pediatric care is well documented in literature [43, 44] and was expected to appear as an important factor in all phases of this study. Similarly, the environment of care in physical, emotional, and social dimensions were also found in literature and in results from phase 2 and 3 of this study. Adequacy of resources were primary mentioned by parents  and nurses . Parents highlight the importance of having enough nurses and time when implementing care plans and nurses highlighted how time could be a constrain to implement interventions that improve satisfaction.
Second component of revised quality caring model  is named relationship-centered professional encounters. In this component the admission care appeared as a relevant moment. In our study both parent’s and nurses mentioned the importance of having a satisfying experience when first entering the hospital unit. Also, respect appears repeatedly as the factor that most influences satisfaction  and was identified by parents in our study. Other aspects added were communication and information, family involvement, play / distraction / humor, union and family support and pain management. All these aspects were identified by children, parents, and nurses as central to a satisfying hospitalization and central in relationship with nurses. Time management is a particular area that appears in literature and was highlighted by all participants. Nurses identified time management as a constrain however, no strategies concerning this theme were suggested.
Play and humor were also identified by all participants as aspects that are central to children’s hospitalizations and influence satisfaction with care. Good sense of humor is considered a desirable nurse characteristic by hospitalized children  since it can positively reduce tension and facilitate approachability, comfort and dialogue . The importance of play to children’s well-being is unquestionable but also to family and health team .
The third component feel “cared for” is identified as a positive emotion and an important antecedent to quality health outcome  were satisfaction is included. Pain management, satisfaction with care and knowledge / information were identified as relevant factors. Pain is also a central theme in children’s hospitalizations that was mentioned by all participants. It is identified as one of the worst experiences for children  and good pain management is an expectation for both children  and parents .
Last component of the revised quality caring model is self-advancing systems and is identified as something that appears gradually as a reflection of “dynamic positive progress that enhances the systems’ well-being” . Implications in health care system include intention to re-use services and resources adequacy. The link between satisfaction with care and these two factors has already been established in literature . When patients’ own perspective is sought and taken into consideration, nursing care is more centered on patient real needs and therefore more satisfying . Articulation with community resources was also mentioned by both parents and nurses.
The awareness of these components will allow to identify factors that predict patient satisfaction. Their integration in daily clinical practice is fundamental to improve quality of care and accomplish parents and children satisfaction with nursing care.