# Implementation and Evaluation of the RECAP Framework: A Quality Improvement Initiative

## TL;DR

This study implemented a training course to teach nursing staff how to better explain care to patients, and found improvements in patient experience and communication.

## Contribution

The study introduces and evaluates a discussion-based course to teach and implement narration of care (NOC) in nursing.

## Key findings

- 7341 nursing staff completed the course, with 95% reporting increased knowledge and high satisfaction.
- Five HCAHPS domains showed significant improvement post-implementation, including communication and patient experience.
- Observations revealed frequent use of NOC-aligned behaviors but also areas needing improvement, such as addressing patient concerns.

## Abstract

Background: Narration of care (NOC) refers to a nurse’s ability to explain the purposes, goals, and objectives of nursing tasks. In this project, narration of care (NOC) refers to real-time verbal explanation of nursing tasks and should not be confused with the Nursing Outcomes Classification, which uses the same acronym. Although NOC is recognized as a critical skill, little research exists on how to teach it or evaluate its use. A companion article describes the development of a NOC framework. This article focuses on implementation and observed changes during rollout. Objective: We aimed to describe the implementation of a discussion-based course designed to teach nurses and patient care assistants (PCAs)—collectively referred to as nursing staff—how to effectively narrate care, and to assess changes observed during the implementation period. Methods: We used a mixed-methods, pre- and post-implementation design across seven hospitals over six months (February–August 2023). Quantitative data included pre–post comparisons of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores (baseline: 2022; follow-up: 2024) and structured observations of nurse–patient interactions. Qualitative data from free-text course evaluations were thematically analyzed to contextualize quantitative findings. Integration occurred by comparing themes with observed practice gaps and patient experience trends. Results: Course Evaluations: In total, 7341 staff completed the course; 4185 evaluations were submitted. Ninety-five percent reported increased knowledge and rated the course highly. Common strategies cited included teach-back, reducing anxiety through NOC, active listening, and building personal connections. HCAHPS Comparisons: Five domains improved significantly post-implementation: care transitions (4.6, p = 0.001), cleanliness (3.9, p = 0.024), communication about medications (2.3, p = 0.042), discharge communication (2.7, p = 0.002), and restfulness (2.5, p = 0.015). Practice Observations: In total, 1281 observations were conducted. Observations indicated frequent use of several NOC-aligned behaviors and opportunities to improve narration of the environment and resolution of patient concerns. Conclusions: Improvements in patient experience measures and observed practices coincided with the course rollout. However, given the pre–post, uncontrolled design, causality cannot be inferred.