New measures of diabetes self‐care agency,diabetes self‐efficacy,and diabetes self‐management for insulin‐treated individuals with type 2 diabetes

Aims and objectives. To develop and refine three new scales that measure diabetes self‐care agency, diabetes self‐efficacy and diabetes self‐management to reflect the American Diabetes Association current standards of diabetes care and the American Association of Diabetes Educators self‐care behaviours. And, to establish the clarity, consistency and content validity of the scales. Background. There is a need to have valid and reliable instruments or scales to assess an individual’s diabetes self‐care agency, self‐efficacy and self‐management to plan appropriate interventions that can be effective in improving glycaemic control and delaying or preventing diabetes‐related complications. Design. A methodological design was used to conduct this study. Methods. Ten clinicians and 10 insulin‐treated individuals with type 2 diabetes (T2DM) from a diabetes care center in the southern USA participated in this study. Analysis consisted of inter‐rater agreement to determine clarity and consistency with standards of diabetes care and content validity of individual items on the scales (I‐CVI) and the overall scales (S‐CVI/Ave) to determine relevance for current diabetes care practice. Results. All I‐CVI and S‐CVI/Ave of the DSES exceeded the minimum acceptable criteria. All I‐CVI and the S‐CVI of the DSMS also exceeded the minimum accepted criteria, except for one item that had I‐CVI = 0·70. Evaluation of the items and the directions of the scales by the sample of insulin‐treated individuals with T2DM exceeded the minimum criteria of 80% inter‐rater agreement. Relevance to research and clinical practice. Further psychometric testing of the scales with samples of insulin‐treated individuals with diabetes is warranted and will lay the groundwork for further research and clinical practice to enhance the capability, confidence and actual performance of diabetes self‐management activities among insulin‐treated individuals with T2DM. Conclusions. The scales can be used by diabetes care providers to assess and follow‐up individuals with diabetes who need intense case management. They also can be the measures of choice to conduct future research to test the effects of interventions among insulin‐treated individuals with T2DM.     

Reliability and validity of the nutritional form for the elderly (NUFFE)

AIM: The aim of this study was to test the reliability and validity of the Nutritional Form for the Elderly (NUFFE). BACKGROUND: The prevalence of undernutrition among older people in nursing homes and hospitals reaches high levels. Assessment of older patients' nutritional status is an important task for nurses in clinical care. To use a simple nutritional assessment instrument for older people is one approach for nurses. Examples of such instruments are the well validated Mini Nutritional Assessment (MNA) and the newly developed NUFFE. METHODS: A total of 114 consecutively chosen, newly admitted older patients in an elder care rehabilitation ward in western Sweden were interviewed using the NUFFE and MNA. Arm and calf circumferences, body mass index (BMI), and presence of pressure sores and skin ulcers were noted as part of the MNA on admission. Weight was monitored and BMI calculated on discharge. Serum albumin levels on admission and discharge were used if these were available in the records. Reliability of the NUFFE was measured as homogeneity. Criterion related validity, concurrent validity, construct validity, and predictive validity were assessed with different statistical methods. The regional research ethics committee approved the study. RESULTS: The results showed that the NUFFE is a fairly reliable and valid instrument for identifying actual and potential undernutrition among older patients. CONCLUSION: The NUFFE is a simple tool for nurses to use to assess older patients with the aim of detecting undernourished individuals and those at risk for undernutrition. When doing a nutritional assessment with the NUFFE, the BMI ought also to be calculated. The assessment could also be combined with food intake recording for a period of time.     

Psychometric validation of Emotional Reaction Instrument‐English to measure American children’s emotional responses to hospitalisation

Aims and objectives.  The aim of this study was to test the initial psychometric properties of the Emotional Reactions Instrument‐English with hospitalised American children, ages 7–12 years, in the USA. Background.  Children’s negative emotional responses have been a subject of concern for paediatric clinicians and researchers, especially because negative emotional responses following or during hospitalisation are associated with adverse patient outcomes. Existing self‐report paediatric instruments have a number of limitations including lack of clinical feasibility and psychometric evidence. Design.  A survey and psychometric approach was used to test initial reliability and validity of the Emotional Reactions Instrument‐English. Methods.  Two hundred hospitalised American children, 7–12 years of age, who were admitted to a Children’s Hospital in the USA were recruited for this study. The children were administered the Emotional Reactions Instrument‐English, the Facial Affective Scale, and a demographic form. Results.  Internal consistency was supported by a Cronbach’s alpha of 0·83 for the total scale. Alpha coefficients for subscales ranged from 0·59–0·82. Construct validity was tested with exploratory factor analysis. Through principal component analysis, four factors were identified that explained 64% of the variance. Concurrent validity was supported by most items in the Emotional Reactions Instrument‐English being significantly correlated with the Facial Affective Scale (r = 0·18–0·59). The instrument can be administered to hospitalised children in 5–10 minutes. Conclusions.  The results of this exploratory study provide initial support for the psychometric adequacy of the Emotional Reactions Instrument‐English with hospitalised American children ages 7–12 years. Further testing of the Emotional Reactions Instrument‐English is required to validate the subscales and evaluate the instrument’s use with children of different ages, race and ethnicity. Relevance to clinical practice.  This study introduces a new, clinically feasible instrument to measure children’s diverse emotional responses to hospitalisation.     

Two new tools for self‐care in ostomy patients and their informal caregivers: Psychosocial,clinical, and operative aspects

Stoma patients and their caregivers need to be autonomous in stoma care, but there are few instruments for measuring the level of self‐care. This study aims to develop and test the psychometric properties of the Ostomy Self‐Care Index (OSCI) and the Caregiver Contribution to Self‐Care in Ostomy Patient Index (CC‐OSCI), from a clinical, operative and psychosocial perspective. A multicentre validation study was conducted on a convenience sample of 468 ostomy patients and 227 caregivers. The signed informed consent forms were obtained before data collection. Tool validation was performed by testing content validity, construct validity, criterion and internal consistency. Two indexes were developed, building on the self‐care theory of chronic illness. For the OSCI, 32 items were developed and grouped into four 5‐point Likert scales: maintenance, monitoring, management and confidence. For the CC‐OSCI, 22 items were developed and grouped into three 5‐point Likert scales: maintenance, monitoring and management. The content validity indexes for the OSCI and CC‐OSCI were 95% and 93%, respectively. Exploratory factor analysis showed appropriate factor loadings (OSCI: min 0.395 to max 0.852; CC‐OSCI: min 0.442 to max 0.841). Criterion validity was established through significant correlation between levels of quality of life, complications, readmissions and self‐care in patients and caregivers. Strong internal consistency was found for the overall index, and within the scales (OSCI: α = 0.975; CC‐OSCI: α = 0.972). The OSCI and CC‐OSCI are valid and reliable indexes. Further studies specifically aimed at predicting the level of self‐care are especially recommended.     

Psychometric properties of the Norwegian Person‐centred Climate Questionnaire from a nursing home context

Background: The physical and psychosocial environments in nursing homes influence the residents’ everyday life as well as their well‐being and thriving. The staff’s perceptions of and relationships with the residents are crucially important to quality care. Quality care is described often as person‐centred. Few measurement tools exist that focus on person‐centred care in nursing homes. Objective: The aim of this study was to evaluate the psychometric properties of the Norwegian version of the Person‐centred Climate Questionnaire–Staff version (PCQ‐S). Design: This study had a cross‐sectional survey design. Participants and Settings: Two hundred and nine healthcare and support staff in five nursing homes in the eastern part of Norway. Methods: The Swedish PCQ‐S was translated into Norwegian with forward and backward translation. The relevance of the items included in the questionnaire was assessed by an expert panel of 10 nursing home care staff, because the questionnaire has not been used in this context previously. A psychometric evaluation using statistical estimates of validity and reliability was performed. The discriminatory capacity of the questionnaire was also tested. Results: The content validity index was satisfactory (0.78). The PCQ‐S showed high internal consistency reliability in that Cronbach’s α was satisfactory for the total scale (0.92) and the three subscales (0.81, 0.89 and 0.87). The test–retest reliability was also satisfactory as evident from a Spearman’s correlation coefficient of 0.76 (p < 0.01) between the total PCQ scores at test and retest. The Norwegian version retained the original factor structure of the Swedish version. Conclusion: As the psychometric evaluation showed satisfactory validity and reliability scores, this study supports the Norwegian version of the PCQ‐S when applied to a sample of nursing home staff.     

Development and testing of four instruments to assess prior conditions that influence nurses' adoption of evidence‐based pain management practices

Aim. This paper is a report of the development and testing of the psychometric properties of a set of four instruments measuring prior conditions influencing nurses’ decisions to adopt evidence‐based pain management practices. Background. Nurses do not use evidence‐based pain management practices consistently. Their adoption of pain management practices depends on several prior conditions. Prior conditions are factors that influence the need to learn more about an innovation and begin the adoption process. Method. Four instruments were developed, collectively known as Carlson’s Prior Conditions Instruments, to assess the four theoretically‐derived prior conditions of previous practice, felt needs/problems, innovativeness and norms of the social system that influence nurses’ decisions to adopt evidence‐based pain management practices. Item‐to‐total correlations and Cronbach’s alpha were used to determine internal consistency reliability. Construct validity was examined through principal components factor analysis with varimax rotation. Data were collected as part of a larger study in 2005. Results. Content validity of the four instruments was supported through review by experts. The instruments were distributed to nurses (n = 187). Each instrument demonstrated internal consistency (alpha range = 0·731–0·825). Factor analysis demonstrated that the Felt Needs/Problems and Norms of the Social System Instruments were unidimensional, with six and seven items respectively. The Previous Practice Instrument (11 items, three factors) and Innovativeness Instrument (six items, two factors) were multidimensional. Conclusion. Initial psychometric testing revealed adequate estimates of reliability and validity for Carlson’s Prior Conditions Instruments. Further research is needed using the tools with nurses in different countries and cultures to test and confirm the constructs.     

Psychometric properties of the extended Care Dependency Scale for older persons in Egypt

Aim. The aim of this study was to determine the validity and reliability of the modified Arabic Care Dependency Scale for self‐assessment of older persons in Egypt and to compare these self‐assessments to proxy assessments by care givers and family members. Background. The Care Dependency Scale is an internationally used instrument to measure care dependency. The Arabic version may improve data collection on this phenomenon in the Middle East where the population is ageing. Design. A cross‐sectional study with a sample of 611 older persons living in Greater Cairo. Participants belonged to three groups: nursing home residents, home care recipients and non‐care recipients; 459 participants were also rated by proxies and 171 repeated their self‐assessment after two weeks. Methods. The correlation between sum scores of the Care Dependency Scale and the Activities of Daily Living scale was calculated to establish criterion validity. Construct validity was determined by comparing care recipients and non‐care recipients with regard to their Care Dependency Scale sum scores and by exploratory factor analysis. Intraclass coefficients were used to assess test‐retest reliability of self‐ratings for each item. Mean differences between self and proxy assessment were calculated. Results. The Care Dependency Scale had a strong correlation to the Activities of Daily Living scale and is able to distinguish between care recipients and non‐care recipients. Factor analysis revealed one factor for basic needs and one factor for psychosocial needs. ICC values were >0·7 for most items related to the factor for basic needs among care recipients. Proxy assessment yielded higher care dependency than self assessment. Conclusion. Care Dependency Scale items for basic needs are suitable to assess care dependency among Egyptian care recipients. Relevance to clinical practice. Assessment of care dependency is useful to obtain data for appropriate resource allocation among care recipients.     

Pain in older persons with severe dementia. Psychometric properties of the Mobilization–Observation–Behaviour–Intensity–Dementia (MOBID‐2) Pain Scale in a clinical setting

Scand J Caring Sci; 2010; 24; 380–391
Pain in older persons with severe dementia. Psychometric properties of the Mobilization–Observation–Behaviour–Intensity–Dementia (MOBID‐2) Pain Scale in a clinical setting Background: To assess pain in older persons with severe dementia is a challenge due to reduced self‐report capacity. Recently, the development and psychometric property testing of the Mobilization–Observation–Behaviour–Intensity–Dementia (MOBID) Pain Scale was described using video‐recording. The purpose of this article was to present the further development of this instrument. In MOBID‐2 Pain Scale, the assessment of inferred pain intensity is based on patient’s pain behaviours in connection with standardized, guided movements of different body parts (Part 1). In addition, MOBID‐2 includes the observation of pain behaviours related to internal organs, head and skin registered on pain drawings and monitored over time (Part 2). Objective: The aim of this study was to examine psychometric properties of the MOBID‐2 Pain Scale, like inter‐rater and test–retest reliability, internal consistency, as well as face‐, construct‐ and concurrent validity. Subjects and Setting: Patients with severe dementia (n = 77) were examined by 28 primary caregivers in clinical practice, who concurrently and independently completed the MOBID‐2 Pain Scale. Characteristics of the patients’ pain were also investigated by their physicians (n = 4). Results: Prevalence of any pain was 81%, with predominance to the musculoskeletal system, highly associated with the MOBID‐2 overall pain score (rho = 0.82). Most frequent and painful were mobilizing legs. Pain in pelvis and/or genital organs was frequently observed. Moderate to excellent agreement was demonstrated for behaviours and pain drawings (κ = 0.41–0.90 and κ = 0.46–0.93). Inter‐rater and test–retest reliability for pain intensity was very good, ICC (1, 1) ranging 0.80–0.94 and 0.60–0.94. Internal consistency was highly satisfactory; Cronbach’s α ranging 0.82–0.84. Face‐, construct‐ and concurrent validity was good. Overall pain intensity by MOBID‐2 was well correlated with physicians’ clinical examination and defined pain variables (rho = 0.41–0.64). Conclusion: On the basis of pain behaviours, standardized movements and pain drawings, MOBID‐2 Pain Scale was shown to be sufficiently reliable, valid and time‐effective for nurses to assess pain in patients with severe dementia.     

Reliability,validity and factor structure of the Appraisal of Self‐Care Agency Scale – Revised (ASAS‐R)

Rationale, aims and objectives Self‐care agency is a fundamental concept in nursing and health care research. Having self‐care agency enhances an individual's health‐promoting behaviours and/or specific capabilities for chronic disease self‐management. The purpose of this study was to continue the development and psychometric testing of the Appraisal of Self‐Care Agency – Revised (ASAS‐R). Methods A cross‐sectional methodological design was used to examine the reliability, validity and factor structure of the ASAS‐R among individuals from the general population. The sample consisted of 629 adults who were randomly selected to conduct an exploratory factor analysis (EFA; n = 240) and a confirmatory factor analysis (CFA; n = 389) of the scale. A demographic questionnaire, the ASAS‐R and the Health‐Promoting Lifestyle Profile (HPLP‐II) were the measures used to collect the data. Results The final 15‐item three‐factor ASAS‐R had an overall Cronbach's alpha (α) of 0.89. The three factors extracted, rotated and scored in this study were labelled: having power for self‐care, developing power for self‐care and lacking power for self‐care. All inter‐items and item‐to‐total correlations met recommended criteria of r = 0.30 to r = 0.70, except for one of the items that had an item‐to‐total correlation of 0.71, slightly exceeding the maximum recommended item‐to‐total correlation. The three factors had Cronbach's alphas of 0.86, 0.83 and 0.79, respectively. The three factors together explained 61.7% of the scale items variance. Each item of the scale had a strong factor loading ranging from 0.52 to 0.81. All measures of model fit exceeded the recommended criteria, indicating that the 15‐item ASAS‐R had a very good fit (χ²/d.f. = 1.97, GFI = 0.94, AGFI = 0.92, CFI = 0.96, TLI = 0.95, RMSEA = 0.05, RMR = 0.05 and the PCLOSE = 0.48). Conclusions The 15‐item three‐factor ASAS‐R is a short, reliable and valid instrument to measure self‐care agency among individuals from the general population, but further psychometric evaluation is needed among individuals with chronic diseases, especially those with diabetes mellitus.     

Self-care ability among home-dwelling older people in rural areas in southern Norway

Scand J Caring Sci; 2012; 26; 113–122
Self‐care ability among home‐dwelling older people in rural areas in southern Norway Introduction: The growing number of older people is assumed to represent many challenges in the future. Self‐care ability is a crucial health resource in older people and may be a decisive factor for older people managing daily life in their own homes. Studies have shown that self‐care ability is closely related to perceived health, sense of coherence and nutritional risk. Aim: The aim of this study was to describe self‐care ability among home‐dwelling older individuals living in rural areas in southern Norway and to relate the results to general living conditions, sense of coherence, screened nutritional state, perceived health, mental health and perceived life situation. Methods: A cross‐sectional survey was carried out in rural areas in five counties in 2010. A mailed questionnaire, containing background variables, health‐related questions and five instruments, was sent to a randomly selected sample of 3017 older people (65+ years), and 1050 respondents were included in the study. Data were analysed with statistical methods. Results: A total of 780 persons were found to have higher self‐care ability and 240 to have lower self‐care ability using the Self‐care Ability Scale for the Elderly. Self‐care ability was found to be closely related to health‐related issues, self‐care agency, sense of coherence, nutritional state and mental health, former profession, and type of dwelling. Predictors for high self‐care ability were to have higher self‐care agency, not receiving family help, having low risk for undernutrition, not perceiving helplessness, being able to prepare food, being active and having lower age. Conclusions: When self‐care ability is reduced in older people, caregivers have to be aware about how this can be expressed and also be aware of their responsibility for identifying and mapping needs for appropriate support and help, and preventing unnecessary and unwanted dependency.     

Psychometric properties of the Swedish version of the selection,optimization, compensation questionnaire

Scand J Caring Sci; 2013; 27; 460–467 Psychometric properties of the Swedish version of the selection, optimization, compensation questionnaire Background: The model of selection, optimization and compensation has been proposed as a model of adaptive management strategies throughout the lifespan. Aim: The aim of this study was to test the psychometric properties of a translated Swedish version of the 12‐item selection, optimization, and compensation (SOC) questionnaire. Method: The 12‐item SOC questionnaire is composed of four subscales: elective selection (ES), loss‐based selection, optimization and compensation. A convenience sample of 122 Swedish‐speaking people, aged 19–85, participated in a study of the validity and reliability of the SOC questionnaire. Cronbach’s alpha coefficient, corrected item–total correlation and Cronbach’s alpha if item deleted were used for reliability testing. Two other scales, the ways of coping questionnaire and Rosenberg’s self‐esteem scale, were used to test convergent validity, and the geriatric depression scale was used to test discriminant validity. Stability over time was evaluated using a test–retest model with a 2‐week interval. Results: The 12‐item SOC questionnaire showed a Cronbach’s alpha value of 0.50, and the subscales ranged from α = 0.16 to α = 0.64. Two items in the ES subscale had negative values on the corrected item–total correlation and showed substantial improvement (>0.05) in Cronbach’s alpha when item deleted. When these two items that influenced internal consistency were deleted, Cronbach’s alpha rose to 0.68. Conclusion: The Swedish version of the 12‐item SOC questionnaire showed deficiencies in a test of internal consistency because of two items in the ES subscale, and these two items were deleted. A consequence of the reduction is a weakening of the ES subscale and thereby to some extent the SOC questionnaire in total. Further testing is advisable. However, the 10‐item SOC questionnaire was acceptable in a test of validity and reliability.     

A systematic review of instruments measuring patients′ perceptions of patient‐centred nursing care

This systematic review identified and evaluated instruments measuring patients' perceptions of patient‐centred nursing care. Of 2629 studies reviewed, 12 were eligible for inclusion. Four instruments were reported: The Individualized Care Scale, the Client‐Centred Care Questionnaire, the Oncology patients' Perceptions of the Quality of Nursing Care Scale and the Smoliner scale. These instruments cover themes addressing patient participation and the clinician–patient relationship. Instruments were shown to have satisfactory psychometric properties, although not all were adequately assessed. More research is needed regarding test–retest reliability, convergent and discriminant validity, validity with known groups and structural validity using confirmatory factor analysis.     

The validity and reliability of an instrument to assess nursing competencies in spiritual care

Aim. This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses’ competencies in providing spiritual care. Background. Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature. Design. Survey. Method. The participants were students from Bachelor‐level nursing schools in the Netherlands (n = 197) participating in a cross‐sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbach’s alpha and the average inter‐item correlation. In addition, the test–retest reliability of the instrument was determined at a two‐week interval between baseline and follow‐up (n = 109). Results. The spiritual care competence scale comprises six spiritual‐care‐related nursing competencies. These domains were labelled:
1 assessment and implementation of spiritual care (Cronbach’s α 0·82)
2 professionalisation and improving the quality of spiritual care (Cronbach’s α 0·82)
3 personal support and patient counseling (Cronbach’s α 0·81)
4 referral to professionals (Cronbach’s α 0·79)
5 attitude towards the patient’s spirituality (Cronbach’s α 0·56)
6 communication (Cronbach’s α 0·71). These subscales showed good homogeneity with average inter‐item correlations >0·25 and a good test–retest reliability. Conclusion. This study conducted in a nursing‐student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale. Relevance to clinical practice. The spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care.     

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.     

Development of the Nursing Practice Readiness Scale for new graduate nurses: A methodological study

AimTo develop a scale to assess nursing practice readiness and verify its validity and reliability.BackgroundPractice readiness refers to the attitude and characteristics of new employees that enable them to successfully adapt to the workplace. For new graduate nurses to receive on-the-job training appropriate to their individual competency level, a scale to assess nursing practice readiness is needed.DesignA methodological study was conducted in two phases: (1) development of the scale through a literature review and interviews related to nursing practice readiness; (2) confirming construct validity, criterion-related validity and reliability of the developed scale.MethodsData were collected from 430 new graduate nurses in South Korea. The validity and reliability of the scale were verified using maximum likelihood exploratory factor analysis with promax factor rotation, confirmatory factor analysis using maximum likelihood estimation, Pearson correlation, analysis of variance and Cronbach’s alpha.ResultsThe Nursing Practice Readiness Scale consisted of 35 items for five factors: clinical judgment and nursing performance, professional attitudes, patient-centeredness, self-regulation and collaborative interpersonal relationship. Confirmatory factor analysis results revealed an adequate model fit. Construct validity and criterion-related validity were verified and all factors achieved a Cronbach’s α greater than 0.80.ConclusionsThe developed scale can evaluate educational outcomes and determine the need for additional support, which can improve the workplace adaptation of new graduate nurses, patient safety and quality of care.