Self-efficacy of caring for patients in the intensive care unit with delirium: Development and validation of a scale for intensive care unit nurses

BackgroundImproving the self-efficacy of intensive care unit nurses for delirium care could help them adapt to the changing situation of delirium patients. Validated measures of nurses' self-efficacy of delirium care are lackingObjectivesThe objective of this study was to develop a Delirium Care Self-Efficacy Scale for assessing nurses' confidence about caring for patients in the intensive care unit and to examine the scale's psychometric properties.MethodsDraft scale items were generated from a review of relevant literature and face-to-face interviews with intensive care unit nurses; content validity was conducted with a panel of five experts in delirium. A group of nurses were recruited by convenience sampling from intensive care units (N = 299) for item analysis of the questionnaire, assessment of validity, and reliability of the scale. Nurse participants were recruited from nine adult critical care units affiliated with a hospital in Taiwan. Data were collected from August 2020 to July 2021.ResultsContent validity index was 0.98 for the initial 26 items, indicating good validity. The critical ratio for item discrimination was 14.47–19.29, and item-to-total correlations ranged from 0.67 to 0.81. Principal component analysis reduced items to 13 and extracted two factors, confidence in delirium assessment and confidence in delirium management, which explained 66.82% of the total variance. Cronbach's alpha for internal consistency was 0.94 with good test–retest reliability (r = 0.92). High scale scores among participants were significantly associated with age (≥40 years), work experience in an intensive care unit (≥10 years), delirium education, and willingness to use delirium assessment tools.ConclusionsThe newly developed Delirium Care Self-Efficacy Scale demonstrated acceptable reliability and validity as a measure of confidence for intensive care nurses caring for and managing patients with delirium in the intensive care unit.     

Cross‐cultural validity of the Individualised Care Scale – a Rasch model analysis

Aims and objectives. The aim of this study was to investigate, using Rasch model analysis, the measurement invariance of the item ratings of the Individualised Care Scale. Background. Evidence of reliability is needed in cross‐cultural comparative studies. To be used in different cultures and languages, the items must function the same way. Design. A methodological and comparative design. Methods. Secondary analysis of data, gathered in 2005–2006 from a cross‐cultural survey using the Individualised Care Scale from Finnish, Greek, Swedish and English predischarge hospitalised orthopaedic and trauma patients (n = 1093), was used. The Rasch model, which produces calibrations (item locations and rank) and item fit statistics, was computed using the Winstep program. Results. The rank of average Individualised Care Scale item calibrations (?2·26–1·52) followed a generally similar trend (Infit ≤ 1·3), but slight differences in the item rank by country were found and some item misfit was identified within the same items. There was some variation in the order and location of some Individualised Care Scale items for individual countries, but the overall pattern of item calibration was generally corresponding. Conclusions. The Rasch model provided information about the appropriateness, sensitivity and item function in different cultures providing more in‐depth information about the psychometric properties of the Individualised Care Scale instrument. Comparison of the four versions of the Individualised Care Scale – patient revealed general correspondence in the item calibration patterns although slight differences in the rank order of the items were found. Some items showed also a slight misfit. Based on these results, the phrasing and targeting of some items should be considered. Relevance to clinical practice. The Individualised Care Scale – Patient version can be used in cross‐cultural studies for the measurement of patients’ perceptions of individualised care. Information obtained with the use of the Individualised Care Scale in clinical nursing practice is important, and valid measures are needed in evaluating patients’ assessment of individualised care, one indicator of care quality.     

Physiological vital sign differences between well newborns greater than 34 weeks gestation: A pilot study

BackgroundNewborns have their vital signs measured as part of routine care. However, there is inconsistency in accepted physiological ranges for well newborns beyond the post-delivery stabilisation period which has implications for the identification of illness.ObjectiveTo explore differences in physiological vital signs between three gestational age groups: late preterm (34⁺⁰ - 36⁺⁶), early term (37⁺⁰–38⁺⁶) and term (≥39⁺⁰) weeks gestation.DesignA single site prospective observational study.SettingA postnatal ward and special care baby unit in a major tertiary hospital in Australia.ParticipantsNewborns from 34 weeks gestation admitted to either the postnatal ward or special care baby unit.MethodsHeart rate, respiratory rate and oxygen saturation were continuously monitored for up to 6 h. Newborn temperature and blood pressure were measured twice during the monitoring period.ResultsContinuous monitoring resulted in 284,542 heart rate, 275,826 respiratory rate, 287,572 SpO₂ values, and 60 temperature and 60 blood pressure data points. Heart rate was significantly different between gestational age groups with late preterm heart rates 13.4 bpm (95% CI 6.5–20.4) higher than term newborns. Early term heart rates were 2.3 bpm (95% CI -4.6 – 9.3) higher than term newborns, although not statistically significantly different. Heart rate was significantly different based on sex with females on average 7.7 beats per minute (bpm) (95% CI 1.9–13.5) higher than males.Respiratory rate was not significantly different between gestational age groups however, on average, was −2.0 respiration rate per minute (rpm) (95% CI -6.8 – 2.7) lower for late preterm babies and −1.3 rpm (95% CI -6.0 – 3.4) lower for early term babies compared to term newborns. SpO₂ was not significantly different between gestational age groups, however, on average was −1.17 log units (95% CI -2.32 to −0.01) lower for late preterm newborns and −1.00 log units (95% CI -2.16 – 0.15) lower for early term newborns compared to term newborns. Respiratory rate and SpO₂ were neither clinically nor statistically significantly different by sex.There were no significant differences between gestational age groups for temperature (p = 0.38) or blood pressure (systolic p = 0.93, diastolic p = 0.54). No significant mean differences were observed based on sex for temperature (p = 0.57) or blood pressure (systolic p = 0.98, diastolic p = 0.40).ConclusionsThis study demonstrated a clinically significant higher heart rate in those born late preterm. This may have implications for current “one-size fits all” newborn early warning tools, as well as care of well late preterm infants in maternity units.     

Brazilian Version of Cancer Fatigue Scale: Validation of the Brazilian Version of Cancer Fatigue Scale in Patients With Breast Cancer

ContextScales to assess the fatigue in patients with cancer may help the clinical decision-making process.ObjectivesThe objective of this study was to cross-culturally adapt and determine the validity of the Brazilian version of Cancer Fatigue Scale.MethodsTranslation and cross-cultural adaptation followed the recommendations of international guidelines. One hundred fifty-one women with breast cancer participated in the validity phase and they filled out the Brazilian version of another instruments (Piper Fatigue Scale Revised, Beck Depression Inventory, Verbal Numerical Rating Scale, and Karnofsky Performance Scale). The measurement properties of reliability, internal consistency, and validity were measured.ResultsThe few discrepancies identified in the back-translation were solved by consensus, and the Cancer Fatigue Scale was successfully translated and cross-culturally adapted. The Brazilian version of Cancer Fatigue Scale showed good stability (test-retest reliability intraclass correlation coefficient = 0.95, 95% CI = 0.94–0.97 and interexaminer reliability intraclass correlation coefficient = 0.98, 95% CI = 0.97–0.99) and good internal consistency (Cronbach's alpha >0.70 for the three subscales/domains). The high correlation was found with Piper Fatigue Scale (r = 0.643) and Beck Depression Inventory (r = 0.509) in terms of validity. However, a reasonable correlation was found with Verbal Numerical Rating Scale (r = 0.302) and Karnofsky Performance Scale (r = −0.324).ConclusionHere, we validated the Cancer Fatigue Scale in breast cancer Brazilian women meaning its use for the identification and evaluation of cancer-related fatigue in patients with breast cancer.     

Psychometric properties of the Persian version of the parental stress scale: NICU

AimThe aim was to translate the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) into the Persian language and to evaluate the psychometric properties of the Persian version.MethodThe PSS: NICU was translated into Persian using the process of forward–backward translation. Thereafter, an internal panel of neonatal nurses (n = 10) assessed face and content validity and a panel of parents (n = 20) assessed content validity. A sample of 260 parents recruited from two different neonatal units completed the PSS: NICU and answered some open-ended questions in which they could comment on language and wording. Psychometric properties including internal consistency, Cronbach's alpha (if item deleted) and corrected item total were evaluated.ResultThe result indicates that the Persian version of PSS: NICU, has acceptable psychometric properties and can be considered in clinical practice in NICUs in Iran.ConclusionIn order to support parents, healthcare providers need to diagnose their sources of stress in the Neonatal Intensive Care Unit. The Persian version of the PSS: NICU can be used for this purpose.     

Development of a scale measuring the difficulties faced by nurses who care for patients with delirium in intensive care units

BackgroundDelirium in patients in the intensive care unit is associated with adverse outcomes. Nurses experience many difficulties in caring for those with delirium, which can lead to nurse burnout, prevent effective care for patients, and negatively impact the patient. The identification of factors creating challenges for nurses is, therefore, important to enable intervention.ObjectivesThe aim of this study was to develop a new scale to assess the difficulties faced by nurses caring for patients with delirium in the intensive care unit and to examine its reliability and validity.MethodsWe based our draft scale items on literature reviews and interviews. Four experts evaluated the collected items. After a pilot study, 211 nurses working in intensive care units in Japan completed the questionnaire. Subsequent statistical analysis of results included factor validity, construct validity, known-group validity, internal consistency, and test–retest reliability.ResultsExploratory factor analysis extracted a scale of 33 items with eight factors and an additional scale of four items with one factor. The analysis of construct validity suggested a possible association with the Strain of Care for Delirium Index. In the known-group validity, a comparison with two groups based on experience in the intensive care unit found significant differences among the five factors. Internal consistency (Cronbach's α = 0.68–.87) and test–retest reliability (intraclass correlation coefficients = .46–.62) were confirmed.ConclusionWe developed a difficulty scale for nurses caring for patients with delirium in the intensive care unit and confirmed its reliability and validity. The difficulty factors were developed with the intention to identify educational interventions for nurses and the introduction of new organisational resources, such as manpower and providing emotional support and feedback to nurses.     

The effect of evidence-based pain assessment protocol in pediatric emergency department on nurses' knowledge,attitudes, and practices towards pain

PurposeThis study aimed to determine the effect of the “Evidence-Based Pain Assessment Protocol in Pediatric Emergency Department” on nurses' knowledge, attitudes, and practices towards pain.MethodA pretest–posttest quasi-experimental study was conducted with 11 nurses. Before the protocol was applied, 337 nurses' records were assessed for one month. Subsequently, the nurses were educated in the Evidence-Based Pain Assessment Protocol in the Pediatric Emergency Department. After the education, the researchers assessed 315 nurses' records for one month to evaluate the protocol's effect on the nurses' clinical practice.ResultsThe study found no significant difference in the mean scores of nurses' Pediatric Pain Knowledge and Attitude Scale between the pre-and post-education periods (p > 0.05). However, there was a significant difference in the types of pain assessment tools used between these two periods (p < 0.001). In the post-education period, the frequency of both pharmacological and non-pharmacological interventions implemented increased significantly compared to the pre-education period (p < 0.001). Additionally, the study found that the frequency of nurses describing pain and reassessing pain increased significantly in the post-education period compared to the pre-education period (p < 0.001).ConclusionsThe study found that there was no significant change in the nurses' Pediatric Pain Knowledge and Attitude Scale scores before and after the training. However, it was observed that the frequency of nurses reassessing pain, using non-pharmacological interventions, and describing pain increased after the protocol was applied in the emergency department. In particular, therapeutic communication and the walking method were used more frequently in the post-training period among the non-pharmacological interventions applied by the nurses for pain.     

Effectiveness of mHealth application in improving knowledge of mothers on preterm home care

mHealth intervention can be an important tool for health education. The study aimed to determine the effectiveness of a mHealth application in improving mothers' knowledge of preterm home care. One hundred sixty mothers of preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) of a tertiary care teaching hospital in Karnataka, India participated in a randomized controlled trial. The mothers in the intervention group showed a statistically significant increase in knowledge scores (pre = 17, post = 27, (p < .001) compared to mothers in the control group (pre = 18, post = 20). Knowledge scores didn't differ across age (U = 2629.00, p .051), employment status (χ² = 3.060, p = .80), parity (χ2 = 0.025, p = .874) and socio-economic status (χ2 = 6.702, p = .57). Only education was significantly associated with baseline knowledge score (χ2 = 6.163, p = .013). The mHealth educational app effectively improved the knowledge of mothers on preterm home care.     

Italian Version of Cancer Dyspnea Scale: Cultural-Linguistic and Clinical Validation in Patients With Advanced Cancer Disease in Palliative Care Settings

ContextThe Cancer Dyspnea Scale (CDS) is a self-reported multidimensional tool used for the assessment of dyspnea, a subjective experience of breathing discomfort, in patients with cancer. The scale describes dyspnea using three distinct factors: physical, psychological, and discomfort at rest.ObjectivesTo crossculturally validate the Italian version of CDS (CDS-IT) and examine its content validity, feasibility, internal consistency, and construct validity in patients with advanced cancer.MethodsA cross-sectional study was conducted. CDS-IT was forward-backward translated, and its content was validated among a group of experts. Cronbach's α coefficients were used to assess the internal consistency. Construct validity was examined in terms of structural validity through confirmatory factor analysis, and convergent validity was examined with Visual Analogue Scale Dyspnea through the Pearson's correlation coefficient (r). Cancer Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) and Italian Palliative Outcome Scale were also tested.ResultsThe CDS-IT was crossculturally validated and showed satisfactory content validity. A total of 101 patients (mean age = 76 [SD = 12]; 53% females) were recruited in palliative care settings. CDS-IT reported a good internal consistency in the total score and its factors (α = 0.74–0.83). The factor analysis corresponded acceptably but not completely with the original study. CDS-IT strongly correlated with Visual Analogue Scale Dyspnea (r = 0.68) and moderately with Italian Palliative Outcome Scale and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (r = 0.33–0.36, respectively).ConclusionThe study findings supported the crosscultural validity of the CDS-IT. Its feasibility, internal consistency, and construct validity are satisfactory for clinical practice. The CDS-IT is available to health care professionals as a useful tool to assess dyspnea in patients with cancer.     

Personal determinants of nurses' burnout in end of life care

PurposeOur aim is to identify socio-demographic, professional exposure to dying, training degree and personal factors relevant to burnout dimensions in nurses coping with death issues.MethodA sample of 360 nurses (response rate 70.6%) from internal medicine, oncology, haematology and palliative care departments of five health institutions answered to a socio-demographic and professional questionnaire, Maslach Burnout Inventory, Death Attitude Profile Scale, Purpose in Life Test and Adult Attachment Scale.ResultsNo significant differences were found between medical departments in burnout scores except when comparing those with palliative care department which showed significant lesser levels of emotional exhaustion (t = 2.71; p < .008) and depersonalization (t = 3.07; p < .003) and higher levels of personal accomplishment (t = −2.24; p < .027).By multiple regression analysis exhaustion and depersonalization are negative, sequentially determined respectively by purpose in life, dependent attachment, fear of death attitude and by purpose in life, dependent attachment, years of professional experience and personal accomplishment by positive purpose on life and secure attachment.ConclusionWe conclude for the protective value of factors such as meaning and purpose in life, secure attachment and attitude towards death, through the various burnout dimensions that shows the need to develop under and postgraduate training strategies in these specific areas.     

Effect of tactile–kinesthetic stimulation on growth,neurobehavior and development among preterm neonates

BackgroundPreterm neonates are at risk of delayed growth and development. Hence, early tactile–kinesthetic stimulation (TKS) is required to improve their growth and development.ObjectiveTo evaluate the effect of TKS on growth, neurobehavior and development among preterm neonates.MethodAn interventional study was conducted from August 2015 to July 2017 in the neonatal unit of Dr. Cipto Mangunkusumo Hospital. Preterm neonates were recruited via random sampling and divided into two groups (the intervention group and control group). TKS was performed for 15 min, three times a day, for 10 days. The anthropometric measurements, neurobehavior (Dubowitz score) and development (Capute Scale score) of neonates in both groups were assessed.ResultsThere were 126 preterm neonates (n = 63 in each group). During the 10-day TKS period, the intervention group had a significant increment in weight and length compared to the control group (p < 0.05) at 11–14 days, at term and 3 months. Moreover, increased tone, reflexes, and improvement in behavior based on the Dubowitz score were observed during monitoring. However, the result did not differ significantly (p > 0.05). There was no significant difference in terms of cognitive and language development in both groups (Developmental Quotient of Clinical Linguistic Adaptive Milestone Scale, Developmental Quotient of Clinical Adaptive Test and Full Scale Developmental Quotient scores, p > 0.05).ConclusionTKS was significantly effective in promoting growth, particularly weight and length, among preterm neonates. However, it did not significantly influence neurobehavior and development at 3 months of chronological age.     

Development of the Nurses’ Care Coordination Competency Scale for mechanically ventilated patients in critical care settings in Japan: Part 2 Validation of the scale

ObjectivesTo confirm the validity and reliability of the nurses' care coordination competency draft scale for mechanically ventilated patients in Japan.Design/MethodIn this cross sectional observational study, a draft scale measuring care coordination was distributed to 2189 nurses from 73 intensive care units in Japan from February–March 2016. Based on the valid 887 responses, we examined construct validity including structural validity (exploratory and confirmatory factor analysis), convergent and discriminant validity and internal consistency reliability.Settings73 Intensive care units.ResultsExploratory factor analyses yielded four factors with 22 items: 1) promoting team cohesion, 2) understanding care coordination needs, 3) aggregating and disseminating information, 4) devising and clearly articulating the care vision. The four-factor model was confirmed using a confirmatory factor analysis (confirmatory fit index = 0.942, root mean square error of approximation = 0.062). Scale scores positively correlated with team leadership and clearly identified and discriminated nurses’ attributes. Cronbach’s alpha coefficient for each subscale was between 0.812 and 0.890, and 0.947 for the total scale.ConclusionsThe Nurses’ Care Coordination Competency Scale with four factors and 22 items had sufficient validity and reliability. The scale could make care coordination visible in nursing practice. Future research on the relationship between this scale and patient outcomes is needed.