The COVID-19 pandemic presented an unprecedented challenge to healthcare systems globally, particularly in China, where the initial outbreak placed a heavy burden on medical resources. The high death rate and lack of effective treatments during the early stages of the pandemic resulted in significant psychological stress for patients, characterized by anxiety, irritability, loneliness, and helplessness. High-quality nursing care was urgently needed to address both the physical and psychological needs of these patients. However, the pandemic also created unique challenges for nurses, including the need for extensive personal protective equipment (PPE), which limited communication and increased the physical burden of providing care. While self-evaluation methods are commonly used to assess nurses' perceptions of care quality, these are susceptible to bias. Patient perspectives are crucial for a complete understanding of care quality as they directly influence clinical outcomes and nurse-patient relationships. Previous studies comparing nurse and patient perceptions of care quality have yielded inconsistent results, highlighting the need for further research, especially in emergency settings like the COVID-19 pandemic. This study aimed to describe the quality of caring behaviors as perceived by both nurses and patients, compare the consistency of their evaluations, and identify factors influencing these perceptions during the COVID-19 pandemic in Wuhan, China.

Existing literature highlights the importance of considering both nurses' and patients' perspectives on care quality. Self-evaluation by nurses often reveals high levels of reported caring behaviors, but this may be influenced by social desirability bias. Patient perceptions, however, provide a more critical and objective assessment, impacting clinical outcomes and the nurse-patient relationship. Studies examining these perceptions have produced mixed results regarding the congruence between nurse and patient assessments, with some indicating higher nurse ratings, some showing similar ratings, and others reporting higher patient ratings. Few studies have directly compared these perceptions in public health emergencies, especially the COVID-19 pandemic, making this research particularly important.

A cross-sectional study was conducted using an online survey administered from March 17 to April 13, 2020, in five Wuhan hospitals (three designated hospitals and two mobile cabin hospitals). A convenience sample of nurses and patients was recruited. Inclusion criteria for nurses included being a registered nurse, working in a designated hospital for at least one week, providing direct COVID-19 patient care, and willingness to participate. Patients needed a confirmed COVID-19 infection, at least one week of hospitalization, age 18 or older, ability to read and speak Chinese, and willingness to participate. The survey included a background information sheet and the Chinese version of the Caring Behaviors Inventory (CBI-24), which assesses four dimensions of caring behaviors: assurance of human presence, professional knowledge and skills, patient respectfulness, and positive connectedness. Data were analyzed using SPSS 18.0. Descriptive statistics, t-tests, ANOVA, and multiple linear regression analysis were used to compare group differences and identify factors associated with caring behaviors. Ethical approval was obtained, and informed consent was secured from participants.

A total of 235 nurses and 126 patients participated. Both nurses and patients reported high overall quality of care (mean CBI-24 scores above 5 on a 1-6 scale), although nurses rated care quality significantly higher than patients (p<0.05). The gap was most prominent in expressive caring behaviors (patient respectfulness and positive connectedness). Both groups rated the item "spending time with the patient" the lowest. For nurses, significant factors associated with higher self-evaluated caring behaviors included female sex, participation in hospital-organized ethical training, and being dispatched to Wuhan from outside the city. Senior nurses and nurses with more experience reported lower self-evaluated caring behaviors. For patients, inpatient setting (designated hospital vs. mobile cabin hospital) and communication mode (face-to-face vs. other) were significantly associated with higher ratings of caring behaviors. Multiple linear regression analysis confirmed these associations, showing statistically significant effects for several variables.

The high overall ratings of caring behaviors, despite the pandemic's challenges, may be attributed to exceptional humanistic care policies implemented during the crisis, including increased efforts for patient treatment, provision of necessities, and adequate PPE for nurses. The lower scores on "spending time with the patient" may reflect the competing priorities of infection control and the increased emotional support needs of isolated patients. The inconsistency between nurse and patient self-evaluations might stem from social desirability bias among nurses and more stringent patient expectations. The importance of expressive caring behaviors, which were rated lower by patients, highlights the need to enhance nurses' skills in this area through training and ongoing support. Differences in patient ratings based on hospital type and communication mode emphasize the need to adapt care delivery to suit varying patient needs and resource availability. The lower ratings by senior nurses require further qualitative investigation.

This study demonstrates that despite the extraordinary circumstances of the COVID-19 pandemic, both nurses and patients perceived nursing care quality as high. However, inconsistencies exist, notably in the time spent with patients and expressive caring behaviors. Future research should explore these discrepancies using qualitative methods and examine how to improve communication strategies and training to better meet patient expectations and needs in similar high-pressure settings.

The study's convenience sample may limit the generalizability of the findings. Online data collection may introduce biases. The absence of data on patient fear levels and hospital type could be confounding variables. While quantitative data provides valuable comparisons, future qualitative research could offer richer insights.