Correlates of hospitalized patients' perceptions of service quality

The purpose of this study was to examine hospital patients' perceptions of service quality in relation to four independent variables: (a) nurses' perceptions of human resource practices, (b) nurses' perceptions of autonomy in practice, (c) patient satisfaction with nursing care, and (d) patients' perceptions of organizational climate for service. The sample consisted of 102 nurse–patient dyads in an acute care hospital. Patients responded to the Modified Health Care Service Performance Instrument, the revised LaMonica–Oberst Patient Satisfaction Scale, and the Organizational Climate for Service Semantic Differential. Nurses responded to the Employee Turnover Diagnostic and the Dempster Practice Behaviors Scale. Two of the four correlational hypotheses were supported. Patient satisfaction with nursing care and patients' perceptions of organizational climate for service were each positively related to patients' perceptions of service quality. A multivariate regression hypothesis was not supported. Failure to support two theoretically based correlational hypotheses may be related to methodological problems experienced with dyadic research. © 1998 John Wiley & Sons, Inc. Res Nurs Health 21: 339–349, 1998     

Care dependency of children in Egypt

Aims. This study aimed to modify the Care Dependency Scale so that it could be used for children, to apply its Arabic version to Egyptian children to test the reliability and validity of the modified scale and to compare the care dependency of disabled and non‐disabled Egyptian children. Background. A higher dependence of children in their daily tasks undoubtedly places a greater burden on their caregivers. To estimate the extent of the problem of care dependency, data from different countries and proper standard instruments are required. Method. The Care Dependency Scale was modified for children by Delphi technique. This study assessed the care dependency of non‐disabled children compared with children with physical and mental disabilities using the modified version of the Care Dependency Scale for paediatrics. The total sample included 260 Egyptian school‐age children (50·8% of whom were disabled and 49·2% were non‐disabled). Results. Reliability was examined in terms of internal consistency using Cronbach's alpha (0·91). Inter‐rater reliability revealed moderate to very good Kappa statistics between 0·57–0·89. Content validity and criterion validity were evaluated. Differences regarding care dependency were found between disabled and non‐disabled children. Conclusion. The psychometric properties of the Care Dependency Scale for paediatrics support its usefulness in measuring the care dependency of children in Egypt. This study provides an Arabic version of the Care Dependency Scale for paediatrics that is easy to administer and may be useful to measure the care dependency in various Arabic countries. Relevance to clinical practice. The findings raise concerns regarding the extent to which disabled and also non‐disabled school‐age children are care dependent leading to an increased burden of care on nurses or on caregivers in general. The Care Dependency Scale for Paediatrics can help nurses conduct an appropriate assessment of children's care dependency so that any nursing care can be planned according to the children's needs.     

Development and testing of a patient‐centred care competency scale for hospital nurses

This study aimed to develop and test the psychometric soundness of a patient‐centred care competency (PCC) scale for hospital nurses. A cross‐sectional questionnaire survey was conducted among 594 nurses in two teaching hospitals (response rate 99.5%). Reliability and validity analyses were performed. The PCC scale consisted of 17 items divided into four subscales: respecting patients' perspectives (6 items), promoting patient involvement in care processes (5 items), providing for patient comfort (3 items) and advocating for patients (3 items). The Cronbach's alpha coefficient of the entire scale was 0.92, and those for the subscales were 0.85, 0.81, 0.84 and 0.80, respectively. Multitrait scaling analysis indicated that the four subscales had satisfactory convergent and discriminant validity. Significant correlations were found between total PCC scores and overall self‐ratings of patient‐centred care performance (r = 0.60, P < 0.001). The PCC scale was therefore determined to be a highly valid and reliable tool.     

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.     

Patients' and health care professionals' attitudes towards the PINK patient safety video

Rationale, aims and objectives Patients can play an important role in reducing health care harm. Finding strategies to encourage patients to take on an active role in issues related to the quality and safety of their care is therefore essential. The aim of this study was to examine patients' and health care professionals' attitudes towards a video aimed at promoting patient involvement in safety‐related behaviours. Method A within‐subjects design was used where participants were required to complete a questionnaire pre and post screening of a patient safety video. Participants are 201 patients aged 19–103 years (mean 52) and 95 health care professionals aged 23–48 years (mean 32). Main outcome measures include (i) patients' willingness to participate and perceived importance in participating in safety‐related behaviours; and (ii) health care professionals' willingness to support patient involvement. Results After watching the video patients elicited more positive attitudes towards asking doctors and nurses if they had washed their hands and notifying them about issues to do with personal hygiene. No significant effects were observed in relation to patients notifying staff if they have not received their medication or if they were in pain or feeling unwell. In relation to health care professionals, doctors and nurses were more willing to support patient involvement in asking about hand hygiene after they had watched the video. Conclusion Video may be effective at changing patients' and health care professionals' attitudes towards patient involvement in some, but not all safety‐related behaviours. Our findings suggest video may be most effective at encouraging involvement in behaviours patients are less inclined to participate in and health care professionals are less willing to support.     

Translation and validation of two evidence-based nursing practice instruments

THORSTEINSSON H.S. (2012) Translation and validation of two evidence‐based nursing practice instruments. International Nursing Review 59 , 259–265 Background: Using existing instruments when assessing nurses' readiness for evidence‐based practice facilitates comparison of research findings and adds to nursing knowledge in a global context. Aim: The study aims to: (1) translate the Information Literacy for Evidence Based Nursing Practice^© (ILNP^©) questionnaire and the Evidence‐based Practice Beliefs Scale^© (EBP Beliefs Scale^©), (2) assess their appropriateness for use in Iceland, and 3) estimate the psychometric properties of the translated EBP Beliefs Scale [Icelandic‐EBP Beliefs Scale (I‐EBP Beliefs Scale)]. Methods: The instruments were evaluated for appropriateness and relevancy before translation, and the ILNP^© was modified to fit the Icelandic context. Translation followed recommended approaches, including back‐translation. Pilot testing of both instruments ensued. A random sample of 540 nurses answered and returned the questionnaires. Reliability and validity of the I‐EBP Beliefs Scale were tested on 471 complete I‐EBP Beliefs Scale. Data were collected in 2007. Results: The translated instruments demonstrated clarity and conciseness; however, the ILNP^© needed to be further modified. For the I‐EBP Beliefs Scale, Cronbach's α was 0.86 and Spearman–Brown r was 0.87. Principal components analysis supported the I‐EBP Beliefs Scale's construct validity and unidimensional structure. Criterion validity was established by known‐groups comparison (t‐tests and one‐way analyses of variance). Conclusions: The ILNP^© and the EBP Beliefs Scale^© can be used in contexts other than those for which they were developed. The I‐EBP Scale is a psychometrically sound instrument and its performance supports the validity of the original scale. The instruments can be used to gather valuable information about nurses' readiness for evidence‐based practice.     

Adapting the Individualized Care Scale for cross‐cultural comparison

Scand J Caring Sci; 2010; 24; 392–403
Adapting the Individualized Care Scale for cross‐cultural comparison Rationale: Cross‐cultural comparative studies using reliable and valid instruments can increase awareness of the differences and similarities between health worker’s ability to respond to patients’ individual needs within different health systems. This will enable a better understanding of cultural perspectives in individualized nursing care. Aim: To describe the translation and adaptation process of the Individualized Care Scale (ICS) and examine its reliability and validity in a cross‐cultural study. Design: A cross‐sectional comparative study. Settings: Twenty‐seven orthopaedic and trauma in‐patient units at 14 hospitals in 5 countries. Participants: A total of 1126 patients were included in the study: Finland (n = 425), Greece (n = 315), Sweden (n = 218), UK (n = 135) and USA (n = 33). Methods: A systematic forward‐ and back‐translation procedure using bilingual techniques, a committee approach, pretest techniques and pilot testing were used with a convenience sample to produce a valid ICS for each participating group. Psychometric evaluation of the adapted ICS was based on means, SD, missing data analysis, Cronbach’s alpha coefficients and average inter‐item correlations. Construct validity was examined using sub‐scale correlations to total scales and principal components analysis. Results: The use of the range of options and the sub‐scale mean scores ranging from 2.72 to 4.30 demonstrated the sensitivity of the scale. Cronbach’s alpha coefficients (0.77–0.97) and average inter‐item correlations (0.37–0.77) were acceptable. The sub‐scale correlations to total scales were high (0.83–0.97). The underlying theoretical construct of the ICS was demonstrated by the explained variances ranging from 58% to 79%. Conclusions: The ICS shows promise as a tool for evaluating individualized care in European cultures. The international expansion of an existing instrument developed for one country facilitates comparative studies across countries. There is a need to further test the construct validity and appropriateness of the ICS in different settings in European and nonwestern cultures.     

A vignette study to examine health care professionals' attitudes towards patient involvement in error prevention

Background Various authorities recommend the participation of patients in promoting patient safety, but little is known about health care professionals' (HCPs') attitudes towards patients' involvement in safety‐related behaviours. Objective To investigate how HCPs evaluate patients' behaviours and HCP responses to patient involvement in the behaviour, relative to different aspects of the patient, the involved HCP and the potential error. Design Cross‐sectional fractional factorial survey with seven factors embedded in two error scenarios (missed hand hygiene, medication error). Each survey included two randomized vignettes that described the potential error, a patient's reaction to that error and the HCP response to the patient. Setting Twelve hospitals in Switzerland. Participants A total of 1141 HCPs (response rate 45%). Measurements Approval of patients' behaviour, HCP response to the patient, anticipated effects on the patient–HCP relationship, HCPs' support for being asked the question, affective response to the vignettes. Outcomes were measured on 7‐point scales. Results Approval of patients' safety‐related interventions was generally high and largely affected by patients' behaviour and correct identification of error. Anticipated effects on the patient–HCP relationship were much less positive, little correlated with approval of patients' behaviour and were mainly determined by the HCP response to intervening patients. HCPs expressed more favourable attitudes towards patients intervening about a medication error than about hand sanitation. Conclusions This study provides the first insights into predictors of HCPs' attitudes towards patient engagement in safety. Future research is however required to assess the generalizability of the findings into practice before training can be designed to address critical issues.     

Patient satisfaction with nursing care and its relationship with patient characteristics

The aim of this study was to assess patient satisfaction with nursing care and the relationship between patient satisfaction and patient characteristics. This cross‐sectional study was conducted at a 1100‐bed tertiary care teaching hospital in Turkey. Data were collected using the Newcastle Satisfaction with Nursing Care Scales and a patient information form. Overall, data indicated a high level of patient satisfaction. Hospitalization affected the Experience of Nursing Care Scale independently, while the type of ward, sex, income, and education independently affected the Satisfaction with Nursing Care Scale. Patients who underwent surgical procedures, male patients, the 40–59‐year‐old age group, those who had low levels of education or income, and patients who were hospitalized for long periods were most satisfied. Patients' sex, age, income, duration of hospitalization, and ward type were important factors that affected their satisfaction with nursing care. The characteristics of patients who have a low level of satisfaction with nursing care should be assessed and taken into consideration by nurses.     

Patients' Attitudes Toward Medical Student Participation Across Specialties: A Systematic Review

Phenomenon: Medical students commonly participate in patient care in a variety of different settings. However, a systematic review of patients' attitudes toward medical student participation across specialties has not been performed. Approach: The authors searched 7 databases (CINAHL, Cochrane Library, ERIC, MEDLINE, PsycINFO, Scopus, and Web of Science) between January 1, 1999, and August 5, 2014. Two authors independently screened the results and selected articles that were written in English, were published in a peer-reviewed journal, and used a structured or semistructured survey or interview to determine patients' attitudes toward medical student participation in their care. Study quality was assessed using the Medical Education Research Study Quality Instrument. Findings: Fifty-nine studies were included. Average study quality was low. Sixty-one unique evaluation instruments were used, and 34 instruments (56%) lacked validity data. Patient satisfaction was not significantly affected by medical student participation. However, patients' acceptance of medical student participation varied widely between studies and depended on the type of participation. The most common reason for acceptance was a desire to contribute to the education of others, and the most common reason for refusal was concerns about privacy. Minorities were more likely to refuse medical student participation. Patients preferred to be informed before medical students participated in their care. Insights: Patient satisfaction is not significantly affected by medical student participation. However, patient satisfaction may be a poor surrogate marker of patients' acceptance of medical students. Future research should employ validated evaluation instruments to further explore patients' attitudes toward medical student participation.     

Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany

Objectives Patients' self‐report of medicine taking is a feasible method of assessing their adherence to prescribed pharmacological treatment. Aim of this study was to assess whether the German version of the Medication Adherence Report Scale (MARS‐D) is an appropriate instrument for measuring patient adherence. Methods After translation into German, the questionnaire was sent to 1488 patients with chronic diseases and patients with risk factors of cardiovascular disease. Reliability and validity of the MARS‐D were assessed and compared with the psychometric properties of the original English version. The relationship between patients' characteristics and adherent behaviour was estimated using bivariate correlation and a linear regression model. Results The MARS‐D was analysed if patients were taking medicines and the MARS‐D was complete leaving 523 (35.1%) analysable questionnaires. Internal consistency of the MARS‐D (Cronbach's α 0.60–0.69) was satisfactory and comparable to the English original (Cronbach's α 0.69–0.90). Test–retest reliability was satisfactory (Pearson's r 0.61–0.63), however, lower than in the English sample (r = 0.97). Convergent validity was low but showed statistical significance. Patient socio‐demographic characteristics had weak influence on MARS‐D score indicating high reported adherence for older patients (P < 0.05), patients with German mother tongue (P < 0.05) and high number of medicines (P < 0.01). Conclusions Preliminary psychometric evaluation of the MARS‐D is encouraging. MARS‐D is an appropriate measure to detect patients at risk of non‐adherence. The MARS‐D could be used in routine care to support communication about the medication taking behaviour, as self‐report of non‐adherent behaviour corresponds to the facts.     

Barriers to Pain Management among Lithuanian Cancer Patients

Objectives: The objectives of this study are (1) to describe Lithuanian cancer patients' barriers to pain management as well as pain management outcomes, (2) to check the reliability and validity of the questionnaires used in Lithuanian for the first time, and (3) to formulate patient‐centered recommendations for better cancer pain management. Methods: Thirty patients from the Pain Clinic of Kaunas University of Medicine Hospital responded to the Lithuanian versions of: (1) Brief Pain Inventory pain scale, (2) Barriers Questionnaire‐II, (3) Hospital Anxiety and Depression Scale, (4) Modified version of the Perceived Involvement in Care Scale, and (5) Medication Adherence Report Scale. Results: The translated questionnaires had fear internal consistency reliability and construct validity. Reported average (standard deviation [SD]) pain intensity among Lithuanian cancer patients was 3.9 (1.30) on a scale 0–10. The mean (SD) scores of anxiety and depression among the surveyed patients were 8.7 (4.86) and 7.5 (5.05) on a scale 0–21, respectively. The percentage of the patients, who reported stopping taking pain medicine because of its side effects, was 33.3%. The biggest patients' concerns were about physiological consequences and harmful effects of opioid use. The average (SD) level of perceived communication among Lithuanian patients was 3.1 (0.95) on a scale 0–5, whereas the average level (SD) of self‐reported adherence to pain medication among Lithuanians was 13.0 (3.65) on a scale 4–20. Conclusions: The authors believe, that to improve cancer pain management in Lithuania (1) more attention should be paid to psychological status of patients, (2) patients should be more educated about the need and consequences of opioid use for cancer pain, and (3) adherence to pain management regimens should be improved.     

Patient involvement in blood transfusion safety: patients' and healthcare professionals' perspective

Background : Blood transfusion is one of the major areas where serious clinical consequences, even death, related to patient misidentification can occur. In the UK, healthcare professional compliance with pre‐transfusion checking procedures which help to prevent misidentification errors is poor. Involving patients at a number of stages in the transfusion pathway could help prevent the occurrence of these incidents. Objectives : To investigate patients' willingness to be involved and healthcare professionals' willingness to support patient involvement in pre‐transfusion checking behaviours. Measures : A cross‐sectional design was employed assessing willingness to participate in pre‐transfusion checking behaviours (patient survey) and willingness to support patient involvement (healthcare professional survey) on a scale of 1–7. Participants : One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 male) and 123 healthcare professionals (doctors, nurses and midwives) involved in giving blood transfusions to patients. Results : Mean scores for patients' willingness to participate in safety‐relevant transfusion behaviours and healthcare professionals' willingness to support patient involvement ranged from 4·96–6·27 to 4·53–6·66, respectively. Both groups perceived it most acceptable for patients to help prevent errors or omissions relating to their hospital identification wristband. Neither prior experience of receiving a blood transfusion nor professional role of healthcare staff had an effect on attitudes towards patient participation. Conclusion : Overall, both patients and healthcare professionals view patient involvement in transfusion‐related behaviours quite favourably and appear in agreement regarding the behaviours patients should adopt an active role in. Further work is needed to determine the effectiveness of this approach to improve transfusion safety.     

Predictors of doctor‐rated and patient‐rated gout severity: gout impact scales improve assessment

Rationale, aims and objectives Our objective was to describe the factors associated with doctor‐rated and patient‐rated gout severity to explain how doctor assessment involving patient‐reported outcomes can improve the clinical management of gout. Methods Patients completed a newly validated gout‐specific health‐related quality of life instrument, the Gout Impact Scale (GIS) and other questions regarding their gout. Both patients and their doctors gave an overall gout severity assessment. We conducted correlation analyses between each predictor of interest and the two different severity ratings (doctor‐rated severity and patient‐rated severity). Stepwise multiple regressions were performed to determine the best predictors for doctor‐rated and patient‐rated severity, respectively. Results Doctor‐rated severity more closely correlated with objective clinical and laboratory findings, particularly the presence of tophi, which was not a leading factor in patient‐rated severity assessments. Patient‐rated severity more closely correlated with the domains of the GIS, which expressed the impact of gout on health‐related quality of life. Conclusion Doctors might have a better understanding of their patients' level of disease impact if they incorporate an instrument such as the GIS in their evaluation of gout severity and their decisions regarding aggressiveness of treatment. The increased use of patient‐reported outcomes measures has the potential to improve quality of care and patient satisfaction, as well as reduce costs of health care utilization.     

Long‐Term Care Quality‐of‐Life Scale utility in community home care

This study aimed to test the utility of the Long‐Term Care Quality‐of‐Life assessment scale within community home care contexts and to compare the scale against the World Health Organization Quality‐of‐Life scale in terms of reliability and validity. Both scales were administered concurrently to 109 older adults receiving home care. Analysis revealed the Long‐Term Care Quality‐of‐Life scale to have good test–retest reliability, modest but acceptable internal consistency, and pairwise comparison between the Long‐Term Care Quality‐of‐Life and World Health Organization Quality‐of‐Life scales' scores suggesting moderate‐to‐strong correlation of criterion validity and comparability between scales. The results showed that the assessment of individual perceptions of life quality within home care contexts can be monitored and recorded, and that Long‐Term Care Quality‐of‐Life scale monitoring in home and residential care can identify opportunities for quality‐of‐life support and care continuity, even with transitions between care services and systems. The implications of the present study lie in having access to a validated quality‐of‐life assessment scale that can be used across care contexts to support evidence‐based practice, continuity of care, and acknowledgement of individual circumstances in services and care planning.     

佩尔梅危重患者活动评分量表的汉化及信效度检测

目的译制中文版佩尔梅危重患者活动评分量表,并对其信度、效度进行初步检测。方法采用双人翻译-回译法进行翻译并修订英文版佩尔梅危重患者活动评分量表后,使用中文版佩尔梅危重患者活动评分量表对100例SICU患者进行评估,并对结果进行信度、效度检测。结果中文版佩尔梅危重患者活动评分量表保留13条目,共有4个维度。内容效度指数为0.9923,结构效度分为4个公因子,即遵嘱运动、运动障碍、床上活动、床下活动,累积方差贡献率为77.367%,各条目的因子载荷值为0.453~0.964。该量表的评定者间信度相关系数为0.993,Cronbach’sα系数为0.853,4个维度的Cronbach’sα系数为0.612~0.946。结论中文版佩尔梅危重患者活动评分量表具有良好的信效度,适合中国文化背景下作为危重患者活动评估工具。