Do nurse performance appraisals reflect caring behaviors? Evidence from an Indonesian hospital

Introduction: Nurses' caring behavior is central to the quality and humanistic orientation of nursing services. However, many hospital performance appraisals remain task-oriented and may insufficiently reflect caring competencies essential to patient-centered care. This study examined the association between nurses' caring behavior and Individual Performance Index (IPI) scores and identified caring dimensions requiring improvement. Methods: A cross-sectional study was conducted among 228 nurses in a public hospital in Jakarta, Indonesia, recruited through simple random sampling. Caring behavior was measured using the Caring Behavior Inventory (CBI-42), and IPI was self-entered by nurses based on their most recent official monthly appraisal report. Spearman's rank correlation was used (two-tailed, α = 0.05). Results: = 0.680), although both measures were generally high (median CBI = 3.50 [2.00-4.00]; median IPI = 1.00 [0.80-1.10]). Positive connectedness (3.44) and attentiveness to others' experiences (3.50) were comparatively lower than the other caring dimensions. Discussion: Current appraisal systems may not adequately capture caring competencies. Integrating explicit caring indicators into nurse performance evaluation may strengthen workforce development and support patient-centered health systems. Conclusion: Nurse performance appraisal scores were not significantly associated with caring behavior, suggesting that existing appraisal systems may not adequately reflect caring competencies in nursing practice. Incorporating explicit caring-related indicators into performance evaluation may improve the alignment between assessed performance and the humanistic goals of nursing care.