Developing a residential care facility version of the observable indicators of Nursing Home Care Quality Instrument

The last decade has seen a substantial growth in the development of residential care facilities (assisted living facilities). Evaluation of the quality of care in this service delivery sector has been hampered by the lack of a consensus definition of quality and the lack of reliable instruments to measure quality. Founded on extensive research on nursing home care quality, a field test of the Residential Care Facility Version of the Observable Indicators of Nursing Home Care Quality Instrument was conducted in 35 residential care facilities in Missouri. Content validity of the 34 items was rated by 4 expert raters as 3.4 on a 4-point scale of relevance. Test-retest was 0.94, interrater reliability was 0.73, and internal consistency was 0.90 for the total scale, indicating excellent results for initial field-testing. A focus group confirmed the 5 dimensions of quality of care measured by the instrument as important in residential care settings.     

A sexual health care attitude scale for nurses: development and psychometric evaluation

Background

Oncology nurses should possess a high level of sensitivity while dealing with patients’ sexual health needs. However, sexual health care is still inadequately addressed because of barriers such as conservative beliefs and incorrect assumptions regarding sexual issues. Most scales for measuring attitude toward sexual health care were insufficient to establish the instrument's validity and did not focus on oncology nurses.

Aims and objective

The purpose of this study was to develop a scale considering cultural contexts to investigate nurses’ attitude toward sexual health care in patients suffering from cancer.

Design

This study was designed for scale development.

Methods

A preliminary version of the instrument was developed through a literature review and interviews with 10 oncology nurses; this version consisted of 42 items rated on a 3-point scale. Eight experts reviewed the questionnaire for content validity and consolidated 36 items. Data were collected from 342 oncology nurses in Korea. Exploratory factor analysis was performed, and reliability was assessed using Cronbach α values. Pearson correlation coefficients were used to test the concurrent validity.

Results

Exploratory factor analysis revealed 17 items (4 factors), which account for 70.49% of the total variance. The 4 factors were (1) discomfort in providing sexual health care (7 items), (2) feeling uncertain about patient's acceptance (4 items), (3) afraid of colleagues’ negative response (3 items), and (4) lack of environmental support (3 items). Correlation of the sub-factors ranged from 0.35 to 0.63. The Cronbach α value was 0.92. Significant negative correlations were found between the attitude toward sexual health care and the Sexuality Attitudes and Belief Survey (r = −0.57, p < 0.001).

Conclusion

The scale of attitude toward sexual health care showed validity and reliability in evaluating the attitude of oncology nurses toward sexual health care and can be used to identify attitudinal barriers in nurses as well as to develop and test educational interventions for the improvement of sexual health care.     

Scale development of job stress for home care nurses

The purpose of this study was to develop a job stress scale for hospital-based home care nurses in Korea. The process was construction of the conceptual framework, development of the preliminary items, verification of the content validity, item analysis and test of the reliability. The preliminary items were based on literature review and in-depth interviews with home care nurses. As a result, eight categories and sixty items were selected. These were reviewed by seven specialists for content validity and finally fifty one items were chosen. Data was collected from 180 home care nurses who were engaged in 87 hospitals from August to September 2003. The result of item analysis one was excepted. The final item count was 50. Categories were as follows: overload work (8 items), lack of specialized knowledge and technique (5 items), ethical dilemma (4 items), role conflict (5 items), interpersonal relationships (6 items), visiting home environment (9 items), driving conditions (4 items) and lack of administrative support (9 items), The reliability of the scale by Cronbach's alpha was .948 and the domain's reliability ranged from .649 to .841. The result of this study could be used to measure the job stress of home care nurses. However, for further validity and reliability, repeated studies will be necessary.     

Development of the client-centred care questionnaire

Aim. This paper reports the development and testing of the Client‐Centred Care Questionnaire, aimed at evaluating the client‐centredness of professional home nursing care from a client perspective. Background. Client‐centred care has become an important theme in health care. To evaluate the client‐centredness of care and services from a client's perspective, there is a need for measurement instruments. Method. The questionnaire was developed on the basis of a qualitative study into client perspectives on home nursing care. Items were formulated that closely followed the aspects clients mentioned as central to client‐centred home care. A pilot study was conducted with a sample of 107 clients in three home care organizations in 2003 and 2004. These clients had chronic diseases and were expected to receive care for at least another 6 months. The questionnaire comprises 15 items. Findings. Principal components analysis and internal consistency analysis show strong internal consistency of the items. All items had strong factor loadings on one dimension, and Cronbach's alpha was 0·94. Clients tended to be most critical about their say in the practical arrangements and organization of care: which person came, how often and when? Clients of the three organizations differed in their perceptions of client‐centredness, which may indicate that the questionnaire is capable of differentiating between respondents. Conclusion. The results of this pilot study are promising. The validity of the questionnaire needs further testing.     

Patient satisfaction in home health care

Aims and objectives. To assess the current use of patient satisfaction measures in home health care and to examine the reliability and validity of current measures of patient satisfaction in home health care. Background. Patient satisfaction has been one of the widely used measures in home health care as an indicator of quality of care. A few efforts have been made to develop psychometrically sound patient satisfaction scales for use in home health care. Design. A critical review of the literature. Methods. Electronic databases were systematically searched to identify the studies or publications that measured and addressed patient satisfaction and its measurement in home health care. Results. The review of the literature showed that patient satisfaction measures have been used in the evaluation of care programmes including rehabilitation programmes, discharge and home follow‐up programmes, care process and management practices. Also, patient satisfaction measures were used to evaluate new care protocols and treatments. Conclusions. Home healthcare agencies need valid and reliable patient satisfaction scales. Frameworks of patient satisfaction are still in their early developmental stage. Only some of the variables related to patient satisfaction are explained by many frameworks. Relevance to clinical practice. Home healthcare mangers and researchers need to take in consideration the reliability and validity of measures and tools of patient satisfaction.     

Perceptions and satisfaction with Emergency Department care

A telephone questionnaire examining perceived quality of and satisfaction with Emergency Department (ED) care was administered to randomly selected patients within 60 days of their visit to a university hospital ED over a 13-month period. Patients, or the persons who accompanied them to the ED, rated overall service, nursing technical performance, physician technical performance, nursing bedside manner, physician bedside manner, and registration clerk service on a 5-point rating scale (5 = excellent, 4 = very good, 3 = good, 2 = fair, 1 = poor). Patients were also asked if they felt the care was delivered in a timely manner. A total of 618 interviews were conducted (1333 attempts to contact, 12 people declined to be interviewed). The results suggest that patient perceptions of the technical quality of care are more important than perceived timeliness of care or bedside manner in determining patient satisfaction with ED care.     

住院患者护理工作满意度量表的编制及信度效度检验

目的编制信度、效度高,实用性强和有推广价值,适用于三级甲等医院使用的住院患者护理工作满意度量表,并对其信度和效度进行评价。方法通过文献回顾、质性研究并结合专家意见构建条目池,形成初始量表。采用极端组检验法(CR法)、相关系数法、专家咨询法等,对初始量表进行条目筛选和效能评定。采用新编制的住院患者护理工作满意度量表对399例住院患者进行调查,评价量表的信度和效度。结果最终形成的住院患者护理工作满意度量表由28个封闭式条目和1个开放式条目构成,分为健康教育及指导、个人特质与服务态度、服务质量、入院接待、出院指导5个因子。量表的分半信度值为0.882,Cronbach’sα信度系数为0.939,各因子的α系数均在0.8以上,量表具有较好的内部一致性。特征值大于1的公共因子共5个,可解释的总变异为65.743%,量表结构效度良好。结论新编制的住院患者护理工作满意度量表具有良好的信度与效度,能很好地反映住院患者对护理工作的满意程度。     

The Dependency at Discharge Instrument as a Measure of Resource Use in Home Care

The dependency at discharge instrument, developed to evaluate the needs for care of hospitalized patients on the day of discharge, was tested for its usefulness in measuring resource consumption in home health care. The instrument evaluates dependency in relation to bathing/hygiene, activity, technical procedures, and monitoring signs and symptoms. The sample used in this study consisted of 150 subjects admitted to one of three types of home health care agencies. Interrater reliability and internal consistency of the instrument were high. Factor analysis produced results similar to those of the developers for three of the four scale items. The item concerning need for assistance with procedures had a much lower loading, indicating that it had little in common with the other items. Criterion-based validity was measured by testing the instrument's ability to predict the number of registered nurse and home health aide visits, and length of enrollment. Findings indicated that the instrument had a modest level of criterion-based validity in predicting the use of registered nurse and home health aide services for the hospital-affiliated agency, but was relatively ineffective for public health and for-profit agencies.     

A scale to measure satisfaction of bereaved family receiving inpatient palliative care

Although satisfaction is an important outcome of medical care, there are no validated tools to quantify family satisfaction with hospital-based palliative care. In this nationwide postal survey, an instrument to measure informal carer satisfaction with an inpatient palliative care service was validated. A 60-item questionnaire was mailed to 1344 bereaved people who had lost their family members at 50 palliative care units in Japan, and 850 responses were analysed (response rate = 64%). The reliability, construct validity, and convergent validity of the scale were examined after the responses were randomly divided into two groups: a training set used in the development phase (n = 500) and a testing set used in the validation phase (n = 350). The number of scale items was reduced from 50 to 34 through psychometric techniques in the development phase. In the testing sample, the overall Cronbach's coefficient alpha for the final 34-item scale was 0.98. A factor analysis revealed that the scale consisted of seven subcategories: Nursing Care, Facility, Information, Availability, Family Care, Cost, and Symptom Palliation. The total score of the scale was significantly correlated with the degree of global satisfaction of the bereaved (Spearman's rho = 0.78). In conclusion, this 34-item scale, the Satisfaction Scale for Family Members Receiving Inpatient Palliative Care (Sat-Fam-IPC), has acceptable psychometric properties and would be a useful tool to measure carer satisfaction with an inpatient palliative care service.     

Development of a consumer constructed scale to evaluate mental health service provision

Objective Most mental health outcome and satisfaction measures have been developed by academic researchers or service providers. Consumers have been limited to the role of participant or advisor. The validity and reliability of these satisfaction measures have been challenged. This paper reports the development of a consumer satisfaction questionnaire in which consumers work as collaborative researchers to increase its face validity and relevance. Method Eleven themes from a previous participatory study were used by consumer researchers and university‐based researchers to generate questionnaire items, with four items reflecting each theme. The internal consistency and factor structure were examined in public and non‐government mental health service centres based on data of 202 mental health consumers. Results Principal Components Analysis with oblique rotation yielded a two‐factor structure: Empowerment and Dehumanization. The two factors together explained 36.7% of the total variance. The scale demonstrated high internal consistency, with Cronbach's alpha for the total scale at 0.92, and for the two factors at 0.92 and 0.80. Conclusions The questionnaire was developed in accordance with an evaluation framework of consumer directed evaluation of mental health services. The final questionnaire consists of 26 items. It has satisfactory internal consistency and appeared to be useful with inpatients and outpatients. Further research will be performed to establish its test–retest reliability and criterion validity.     

Job satisfaction among health care workers in Serbia

According to literature review there seems to be a general agreement that job satisfaction among doctors is declining. This study's objective was to identify job satisfaction levels and their causes among health care workers, employed at the public health institutions. A job satisfaction survey of health care workers was therefore carried out in 197 public health centers in the Republic of Serbia, 157 primary health care centers and 40 general hospitals, in 2008. A satisfaction questionnaire, containing 24 items was used to investigate job satisfaction. Respondents (23.259), working in primary health care, indicated an average job satisfaction level of 3.08 +/- 0.67 on a 5-point scale. Respondents (11.302), working in general hospitals, indicated a lower average job satisfaction level of 2.96 +/- 0.63. The reported level of satisfaction was the highest for their opportunities to use their abilities, cooperation with colleagues and fellow workers, and freedom to choose their own methods of work. Doctors, working in primary health care centers, reported higher level of job satisfaction than hospital doctors. Overall, job satisfaction of doctors and nurses is relatively low. Increased pay rate and more adequate equipment, as well as possibilities for education and career improvement, would enhance their job satisfaction.     

Psychometrics of the computer-based Relationships with Health Care Provider Scale in older adults

The type and quality of the provider-patient health care relationship impacts patient adherence. The study purpose was to convert the 5-item paper and pencil Relationships With Health Care Provider Scale (RHCPS) to a reliable and valid computer-based scale for use with older adults. Outpatient adults (N = 121) older than 59 years were recruited. The RHCPS underwent several iterations documenting internal consistency reliability, content and factorial validity, and scale usability in a computer tablet format. A total of 5 expert judges rated all 5 items as valid, which resulted in a scale content validity index of 1. Cronbach's standardized alpha was .81. Principal components analysis extracted 1 factor (eigenvalue > 1; confirmed by scree plot) as anticipated. Computer-based RHCPS has the potential to reveal valuable clinical and scientific data on patient-provider relationships among older adults.     

Stressors associated with coronary bypass surgery

The purpose of this study was to: design and test an instrument to evaluate the incidence and severity of stressors associated with coronary bypass surgery and assess the concordance between patient and nurse perceptions of such stressors. The patient sample consisted of 30 patients recovering without complications from coronary bypass surgery. Patients were white, primarily male and employed, one-third with graduate education, with a mean age of 54. The nurse sample consisted of 18 registered nurses with cardiosurgical nursing care experience. A 30-item stressor scale was developed: 27 items were derived from literature review and 3 from comments of cardiovascular clinical specialists. Stressfulness of each item was rated on a 5-point scale. A pilot study with seven patients provided information for initial scale refinement. Content validity of the scale has both theoretical and empirical support because of the varied sources used to obtain and validate relevant items for the tool. Homogeneity reliability of the scale was supported by high coefficient alphas. Based on severity of stress ratings, two-way analysis of variance indicated that the cardiothoracic nurses generally rated all items as significantly more stressful for coronary bypass patients than did the patients themselves. Comparisons used by the nurses and the patients in assigning stressfulness ratings are discussed.     

The Turkish version of the Newcastle Satisfaction with Nursing Care Scale used on medical and surgical patients

Aim and objectives. The aim of this study is to test the validity and reliability of the modified version of the Newcastle Satisfaction with Nursing Care Scale on medical and surgical patients. Background. Measuring patient satisfaction with nursing care is important in evaluating the extent to which patients’ needs are met and for determining the appropriate nursing care. In recent years there has been increasing interest in patient satisfaction with nursing care in Turkey, but there are no validated scales available to measure this. Design. It is an evaluative study. Methods. The data were collected using the Newcastle Satisfaction with Nursing Care Scale and by a demographic information questionnaire. After translinguistic study, the content validity of the scale was confirmed and tested on 200 patients who were recruited at Istanbul University Hospital on the day of discharge. Internal consistency of the scale was tested by Cronbach's alpha. Demographic variables related to the satisfaction scores were analysed using the Spearmen correlation, the Mann–Whitney U‐ and Kruskal–Wallis tests. Results. The Turkish version of the Satisfaction with Nursing Care Scale, with a total of 19 items, was determined to be suitable for measuring patient satisfaction with nursing care. Patients were generally satisfied with the nursing care received. The items with the most positive rating were respectively: the amount of freedom they were given on the ward, the amount of privacy they were given by nurses and how quickly nurses responded to their requests. The study found that female patients, older patients and those who had health insurance were the most satisfied. Conclusion. The Turkish version of the Satisfaction with Nursing Care Scale showed an adequate reliability and validity for its use on adult Turkish patients. Relevance to clinical practice. Nurses can use the Satisfaction with Nursing Care Scale of Newcastle Satisfaction with Nursing Scales in evaluating and improving the nursing care in clinical practice.     

Development of an instrument measuring family care

This study developed and evaluated an instrument to measure the quality of care given by family members to a patient in the home. The Family Care Measure consisted of 11 items, each of which was rated on a visual analogue scale. Fifteen registered nurses rated the care given by families of 72 eligible patients for whom the nurses had provided nursing care. Estimation of the reliability resulted in a high internal consistency. With deletion of five items from the measure, the internal consistency reliability resulted in a Cronbach's alpha coefficient of .93. The six-item instrument correlated moderately, as predicted, with a scale of family coping (r = .76). With acceptable reliability and evidence of construct validity, this measure may be used in research studies, but further testing to assess its usefulness in clinical situations is recommended.     

Nurses' satisfaction with shiftwork and associations with work,home and health characteristics: a survey in the Netherlands

Title. Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands. Aim. This paper is a report of a study conducted to determine if satisfaction with irregular working hours that are a form of shiftwork operates as a mediator between work and home characteristics and health problems. Background. Shiftwork contributes to health problems, decreased well‐being and poorer health habits. It also affects employees’ decisions to leave the healthcare sector. Although many nurses voluntarily work shifts, there have been few studies of their satisfaction with irregular working hours when these are a form of shiftwork. Methods. A survey was carried out with 144 nurses working in three nursing homes and one care home in the Netherlands. Questionnaires were distributed in 2003 to 233 nurses who worked shifts (response rate 60%). The questionnaire contained items on work and home characteristics, satisfaction with irregular working hours that are a form of shiftwork and health. A new scale to measure satisfaction with irregular working hours was constructed. Results. All work characteristics, but no home characteristics, were associated with satisfaction with irregular working hours. The work characteristics ‘job demands’ and the home characteristics ‘autonomy at home’ and ‘home demands’ were associated with health. Satisfaction with irregular working hours did not mediate between work/home characteristics and health. Those reporting more social support, lower job demands and more job autonomy were more satisfied with their irregular working times that were a form of shiftwork. Conclusions. Satisfaction with irregular working hours is a useful construct that requires further longitudinal study. The results also underline the importance of considering home characteristics when predicting health outcomes.     

Family evaluation of hospice care: results from voluntary submission of data via website

The Family Evaluation of Hospice Care (FEHC) survey is a 61-item questionnaire that surveys family members about care provided to the decedent by the hospice. Hospices submit their data to the National Hospice and Palliative Care Organization (NHPCO), where results are tabulated. For the first two quarters of 2004, a total of 29,292 surveys were tabulated. On average, respondents rated their overall satisfaction with care as 47.1 on a 50-point composite scale of five measures of satisfaction. Opportunities for improvement were identified for attending to family needs for support (18.2% of those surveyed reported at least one unmet need), attending to family needs for communication (10-29%), and coordination of care (22.1%). Surrogate reporting of unmet needs for pain, dyspnea, or emotional support ranged from 5.3% to 9.8%. The FEHC is a useful tool for measuring hospice performance and identifies a number of opportunities for improvement.