Caring Competency among Nurses in Private Hospitals in Santiago City: A Multidimensional Assessment across Core Nursing Practice Domains

Caring competence is a fundamental component of nursing practice that influences the quality and safety of patient care. Despite its importance, limited local evidence exists regarding the multidimensional structure of caring competence among nurses in Philippine private hospital settings. This study aimed to determine the level of caring competence among registered nurses and validate its higher-order structure based on the Quality and Safety Education for Nurses (QSEN) framework using Structural Equation Modeling (SEM). A quantitative, non-experimental, cross-sectional research design was employed among 157 registered nurses from five selected private hospitals in Santiago City, Isabela, Philippines. Data were collected using the Nurse Quality and Safety Self-Inventory (NQSSI) Scale developed by Piscotty et al. (2013). Descriptive statistics were used to determine the level of caring competence, while higher-order confirmatory factor analysis (CFA) using SEM in the Lavaan package in R was utilized to validate the proposed model. Findings revealed that nurses demonstrated a competent level of caring competence across all six QSEN domains, namely patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. Among the domains, safety (M = 4.77) and teamwork and collaboration (M = 4.70) obtained the highest mean scores. SEM results confirmed that caring competence is a robust higher-order latent construct reflected by the six QSEN domains, with strong standardized path coefficients ranging from β = 0.87 to β = 0.93. The model demonstrated excellent fit indices (CFI = 0.96, TLI = 0.95, RMSEA = 0.05, SRMR = 0.04), indicating good model fit and structural validity. Reliability and convergent validity measures also demonstrated excellent psychometric properties. The findings support the multidimensional nature of caring competence and validate the QSEN-based framework among nurses in private hospital settings. The study highlights the importance of strengthening nursing competencies through continuous professional development to improve the quality and safety of patient care.