The study recruited ten clinical nurses using purposive sampling combined with maximum variation sampling, a technique designed to capture a wide range of experiences across different departments, seniority levels, and clinical backgrounds. Data were collected through face-to-face, semi-structured interviews, a method that allows participants to speak freely while the interviewer probes specific themes. The researchers then applied framework analysis, a structured qualitative approach in which data are systematically charted against an organizing framework, in this case the five classic gaps described by the SERVQUAL model. To ensure the findings were trustworthy, the team followed Lincoln and Guba’s criteria for qualitative rigor and reported the work according to the COREQ checklist, a 32-item standard for transparent reporting of qualitative research.

The SERVQUAL model, originally developed for service industries, conceptualizes quality as the distance between what customers expect and what they perceive they received, and it breaks that distance into five diagnostic gaps: the knowledge gap between customer expectations and management’s understanding of them, the standards gap between management perception and service specifications, the delivery gap between specifications and actual service, the communication gap between what is delivered and what is promised externally, and ultimately the gap between expectation and perception. Mapping the nurses’ accounts onto this architecture, the researchers identified five core themes and thirteen sub-themes, each aligning with one or more of these gaps. The framework gave structure to complaints that might otherwise have remained anecdotal, turning individual frustrations into a diagnosable map of organizational failure points.

The first theme, a demand for optimization of medical service processes, corresponds to the knowledge gap. Nurses who became patients described convoluted admission procedures, unclear pathways between departments, and waiting sequences that seemed designed without any consideration of the patient’s perspective. As staff members, they understood the logic behind each step, yet experiencing the process firsthand revealed how disorienting and inefficient it felt from a hospital bed. This insider-outsider contrast is precisely what makes the dual perspective so valuable: managers who design processes rarely walk through them as patients, and ordinary patients lack the technical vocabulary to articulate exactly where the design breaks down.

The second and fourth themes both mapped onto the delivery gap, the distance between the service a hospital specifies and the service it actually provides. Participants pointed to shortcomings in the hospitalization environment and in service details, from physical discomforts on the ward to small failures of coordination that compounded during a stay. Separately, they described deviations in nursing professional competence and execution, moments when the care delivered did not match the professional standard that nurses themselves know should apply. That nurses criticized their own profession’s execution is notable; it suggests the delivery gap is not merely a resource problem but also one of consistency, supervision, and the everyday drift that occurs when standards are not actively enforced.

A third theme, insufficient nurse-patient communication and humanistic care, aligned with the standards gap, and the researchers interpreted its interpersonal communication component as an extension of the communication gap. Participants reported that during their own hospitalizations, explanations were thin, emotional support was scarce, and the human dimension of care, the listening, the reassurance, the acknowledgment of fear, was often absent. Technical competence was present, but the relational fabric that transforms procedures into care was frayed. This finding resonates with a large body of nursing literature showing that patients judge quality at least as much by how they are treated as by what is done to them, and it suggests that communication standards within the hospital were not sufficiently specified or operationalized.

The most striking discovery, however, emerged from a cross-cutting analysis that the authors termed being assumed to know. Because the participants were hospital employees, providers simply withheld the information, explanations, and follow-up that are routinely offered to lay patients. Staff assumed a nurse-patient already understood her diagnosis, her medications, and her discharge plan, so they skipped the briefings, the teach-back conversations, and the check-in calls that form the backbone of patient education. This silent omission manifested both as a knowledge gap, since the institution failed to recognize what this particular class of patients actually needed, and as a failure of interpersonal communication at the level of individual care encounters. The phenomenon reveals a subtle form of discrimination by expectation: being an insider paradoxically reduced the quality of care received.

The implications of being assumed to know extend well beyond the ten nurses interviewed. Any hospital employs hundreds of clinicians, administrators, and students who eventually become patients, but the underlying mechanism, tailoring communication based on assumptions about who the patient is, applies to anyone perceived as knowledgeable, including physicians treated at their own institutions, returning patients familiar with the system, and health professionals’ family members. The study suggests that patient-centered communication should be a default protocol rather than a judgment call, because assumptions about a patient’s knowledge are frequently wrong and almost never verified. A fifth theme, limited awareness of the hospital’s advantageous disciplines, was interpreted as a staff-facing extension of the knowledge gap, indicating that even employees lacked full information about the institution’s centers of excellence, a signal of internal communication weaknesses.

Methodologically, the study demonstrates the analytical power of pairing a dual-perspective population with a mature service quality framework. Framework analysis allowed the researchers to remain anchored to SERVQUAL’s five gaps while still letting new patterns, such as being assumed to know, surface from the data, and the two interpretive extensions they propose show how a decades-old model can be adapted to novel contexts. The single-center design and small sample of ten participants limit generalizability, and the authors themselves frame their findings as generating context-specific strategies that warrant further evaluation rather than as universally applicable prescriptions. Qualitative work of this kind is hypothesis-generating by design, and the natural next step is to test whether the identified gaps respond to targeted interventions, such as standardized communication checklists or process redesign informed by patient walkthroughs.

The broader significance of the research lies in its alignment with the World Health Organization’s vision of integrated, people-centered health services. Traditional quality evaluations rely heavily on patient satisfaction scores, which are known to be inflated by politeness, low expectations, and fear of consequences, and they systematically miss the latent gaps that only insiders can see. By asking nurses to evaluate their own hospital as patients, the study effectively recruited expert auditors who cannot be fooled by the facade of quality. If hospitals routinely incorporated the dual perspective of staff-turned-patients into their quality improvement cycles, they would gain a diagnostic instrument that is cheap, ethically straightforward, and uniquely sensitive to the seams where promised care and delivered care come apart. For a profession built on caring for others, the study is a reminder that the most revealing test of a hospital’s quality may be how it treats its own.

Subject of Research: Nursing service quality gaps examined through nurses' dual experiences as care providers and patients using the SERVQUAL model

Article Title: Nurse as patient: a qualitative study on nursing service quality gaps based on the SERVQUAL model

Article References: Nurse as patient: a qualitative study on nursing service quality gaps based on the SERVQUAL model. (n.d.). https://doi.org/10.1186/s12912-026-05495-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05495-x

Keywords: nursing, SERVQUAL model, service quality, qualitative research, patient experience, nurse-patient communication, hospital care, framework analysis, patient-centered care, BMC Nursing, Zhejiang University, humanistic care

Psychiatric nursing presents a distinctive set of challenges. Patients frequently experience impaired communication, emotional dysregulation, social isolation, and stigma, and establishing a trusting therapeutic relationship can be slow and difficult. Nurses in these settings rely heavily on empathy, therapeutic communication, and emotional presence, yet the demanding nature of the work exposes them to burnout, emotional exhaustion, and reduced job satisfaction when those emotional resources run dry. Previous research has hinted that aesthetics-based care, which draws on sensory experience, creativity, and reflective practice, correlates with higher levels of compassion, but rigorous educational trials in psychiatric settings have been scarce.

To address that gap, the research team recruited 90 registered nurses from a hospital workforce of roughly 170, all of whom held a bachelor’s degree or higher, had at least six months of psychiatric experience, and consented to participate. Participants were assigned to intervention or control groups of 45 each using a lottery-based allocation. Because blinding was impossible in an educational trial, the study was designed and reported as a quasi-experiment under the TREND reporting guidelines. Data were collected between June 2024 and March 2025, and remarkably, every participant completed the full study, giving a 100 percent response rate with no missing outcome data.

The intervention itself was deliberately experiential. Two nursing faculty members specializing in psychiatric nursing and aesthetics delivered four structured weekly sessions. The first introduced the concepts and theoretical foundations of aesthetics-based nursing care, tracing its history as the art of nursing. The second explored the psychological and spiritual dimensions of care, asking nurses to consider how touch, tone of voice, gestures, and deliberate word choice shape the patient experience. The third focused on empathy, therapeutic companionship, and creativity in solving clinical problems. The fourth summarized the links between aesthetics, job satisfaction, communication, and professional motivation. Between sessions, nurses in small groups of five completed reflective assignments and shared their own lived experiences of aesthetic care.

The researchers measured outcomes using two validated instruments. The Aesthetics of Nursing Care Scale, recently validated in Iran, spans 20 items across five dimensions: compassionate commitment and competence, stress-free care, humanistic attention to the patient, patient satisfaction and comfort, and admirable commitment and competence. The Compassion Competence Scale, developed by Lee and Seomun, assesses 17 items across communication, sensitivity, and insight. Both tools showed strong internal consistency in this sample. Questionnaires were completed before the intervention and again one month after the program ended, an interval chosen specifically to test short-term retention and real-world application rather than immediate post-training enthusiasm.

The results were dramatic. The overall aesthetic care score in the intervention group rose from a baseline of 43.26 to 81.02, while the control group remained essentially flat, moving only from 43.80 to 46.24 over the same period. Every one of the five aesthetic care dimensions improved significantly in the trained group, with between-group effect sizes ranging from roughly 2.0 to 4.1 on Cohen’s d, far beyond the conventional threshold of 0.8 for a large effect. The control group showed no statistically significant change on any measure. To ensure ethical fairness, the control nurses were offered an abbreviated version of the workshop after data collection concluded.

Compassion competence followed the same pattern. Total scores climbed from 40.80 to 60.73 in the intervention group while the control group rose only from 39.35 to 40.71. Communication subscale scores increased to 25.91 versus 18.17 in controls, sensitivity scores to 19.46 versus 12.28, and insight scores to 15.35 versus 10.24. The between-group effect sizes for compassion outcomes ranged from 1.26 to 1.68, again indicating substantial educational impact. No adverse events related to the training were reported during the study period.

The authors attribute these gains to the reflective and participatory character of the program. Group discussion, scenario-based learning, and the sharing of lived clinical experiences appear to encourage nurses to examine the emotional and interpersonal texture of their work, heightening self-awareness and sensitivity to patients’ needs. This aligns with prior qualitative work showing that aesthetic experience fosters more humane, empathetic connections with patients and helps convert intuitive understanding into artistic, attentive behavior. Importantly, the study suggests that compassion competence, often treated as a fixed personal quality, can be cultivated through structured education, potentially protecting nurses against the emotional labor and burnout that accumulate in psychiatric environments.

The implications extend to nursing curricula, orientation programs, and continuing professional development. Healthcare managers and educators may find that embedding aesthetics-based education into routine staff development strengthens therapeutic relationships, improves patient experiences, and nurtures a more humanistic care culture, particularly in mental health settings where trust and communication are central to recovery.

The researchers caution that the evidence has limits. The study took place at a single hospital, follow-up lasted only one month, and all outcomes were self-reported, leaving room for social desirability bias and expectancy effects, while the absence of blinding and the possibility of a Hawthorne effect cannot be excluded. Patient-centered outcomes such as satisfaction, therapeutic alliance, and clinical recovery were not measured. Larger multicenter trials with longer follow-up, objective measures, and patient-reported endpoints are needed. Even so, the scale of improvement in this trial makes a compelling case that the art of nursing, long celebrated in theory, can be systematically taught and meaningfully improved in the clinic.

Subject of Research: Aesthetics-based educational intervention to improve compassion competence and aesthetic care quality among psychiatric nurses.

Article Title: Effects of an Aesthetics‐Based Educational Intervention on Compassion Competence and Aesthetic Care Quality Among Psychiatric Nurses: A Quasi‐Experimental Study

Article References: Balideh, D., Farokhzadian, J., Miri, S., Shahraki, S. K., & Motamed‐Jahromi, M. (2026). Effects of an Aesthetics‐Based Educational Intervention on Compassion Competence and Aesthetic Care Quality Among Psychiatric Nurses: A Quasi‐Experimental Study. Nursing Open, 13(9), Article e70854. https://doi.org/10.1002/nop2.70854

Image Credits: AI Generated

DOI: 10.1002/nop2.70854

Keywords: psychiatric nursing, compassion competence, aesthetic care, nursing education, quasi-experimental study, therapeutic communication, nurse burnout, reflective learning, mental health care, Iran, humanistic care, continuing education