The validity and reliability of the Turkish version of short‐form McGill Pain Questionnaire in patients with leukemia

Aims and objectives. To assess reliability and validity of the Turkish version of the Short‐form McGill Pain Questionnaire. Background. Pain is one of the most frequent and significant problems encountered by nurses practice across the world. The Short‐form McGill Pain Questionnaire was widely translated and used to assess the pain experience of several types of patients because it combines the properties of the standard McGill Pain Questionnaire but takes substantially less time to administer. Design. The study used psychometric testing to establish reliability and validity of the Turkish version of Short‐form McGill Pain Questionnaire. Methods. A convenience sample of 160 patients with leukaemia in Turkey was used to collect data regarding pain evaluation. The original version of the Short‐form McGill Pain Questionnaire, adapted into Turkish, was tested for internal consistency, content validity, construct validity and concurrent validity. Results. Internal consistency was found adequate at both assessments with Cronbach’s α 0·88 for test and 0·91 for retest. For reliability of the total, sensory, affective and evaluative total pain intensity, high intraclass correlations were demonstrated (0·85, 0·84, 0·82 and 0·70, respectively). Correlation of total, sensory and affective score with the numerical rating scale was tested for construct validity demonstrating r = 0·61 (p < 0·01) for test and r = 0·68 (p < 0·01) for retest. Correlation with blood pressure values for concurrent validity was found to be r = 0·78 (p < 0·001) for test and r = 0·73 (p < 0·001) for retest. Conclusion. Turkish version of the Short‐form McGill Pain Questionnaire has shown statistically acceptable levels of reliability and validity for pain evaluation in patients with leukaemia. Relevance to clinical practice. This study provided evidence that the Turkish version of the Short‐form McGill Pain Questionnaire is a reliable and valid instrument for assessing pain. This scale can be used to assess nursing interventions aimed at decreasing pain and efficacy of the treatment.     

Development and psychometric testing of the Cancer Knowledge Scale for Elders

Aim. To develop the Cancer Knowledge Scale for Elders and test its validity and reliability. Background. The number of elders suffering from cancer is increasing. To facilitate cancer prevention behaviours among elders, they shall be educated about cancer‐related knowledge. Prior to designing a programme that would respond to the special needs of elders, understanding the cancer‐related knowledge within this population was necessary. However, extensive review of the literature revealed a lack of appropriate instruments for measuring cancer‐related knowledge. A valid and reliable cancer knowledge scale for elders is necessary. Design. A non‐experimental methodological design was used to test the psychometric properties of the Cancer Knowledge Scale for Elders. Methods. Item analysis was first performed to screen out items that had low corrected item‐total correlation coefficients. Construct validity was examined with a principle component method of exploratory factor analysis. Cancer‐related health behaviour was used as the criterion variable to evaluate criterion‐related validity. Internal consistency reliability was assessed by the KR‐20. Stability was determined by two‐week test–retest reliability. Results. The factor analysis yielded a four‐factor solution accounting for 49·5% of the variance. For criterion‐related validity, cancer knowledge was positively correlated with cancer‐related health behaviour (r = 0·78, p < 0·001). The KR‐20 coefficients of each factor were 0·85, 0·76, 0·79 and 0·67 and 0·87 for the total scale. Test–retest reliability over a two‐week period was 0·83 (p < 0·001). Conclusion. This study provides evidence for content validity, construct validity, criterion‐related validity, internal consistency and stability of the Cancer Knowledge Scale for Elders. The results show that this scale is an easy‐to‐use instrument for elders and has adequate validity and reliability. Relevance to clinical practice. The scale can be used as an assessment instrument when implementing cancer education programmes for elders. It can also be used to evaluate the effects of education programmes.     

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.     

Reliability and validity of the 4-item perceived stress scale among pregnant women: results from the OTIS antidepressants study

We aimed to estimate the reliability of the 4‐item Perceived Stress Scale (PSS) and its validity in predicting maternal depression and quality of life (QoL). Data regarding stress, depression and QoL were collected during pregnancy among a sub‐sample from the Organization of Teratology Information Specialists Antidepressants in Pregnancy Cohort. The 4‐item PSS demonstrated acceptable internal consistency (Cronbach's alpha coefficient = .79), alternate forms stability reliability with the 10‐item PSS (Pearson correlation coefficient r = .63; p < .001), convergent validity with the Edinburgh Postnatal Depression Scale (r = .67; p < .001), and concurrent validity with the mental health component of the Short‐Form‐12 (r = ?.62; p < .001) as a measure of QoL. The 4‐item PSS is a valid and useful tool for assessing maternal stress during pregnancy. © 2012 Wiley Periodicals, Inc. Res Nurs Health 35:363–375, 2012     

Nurse–Physician Collaboration Scale: development and psychometric testing

Title. Nurse‐Physician Collaboration Scale: development and psychometric testing. Aim. This paper is a report of a study conducted to develop and test the psychometric properties of the Nurse–Physician Collaboration Scale. Background. The importance of cooperation between healthcare professionals is widely acknowledged in Europe and the United States of America, but there have been no specific studies of interactions between healthcare professionals or of nurse–physician cooperation in Japan. Methods. The 51‐item Nurse–Physician Collaboration Scale was developed using a process of item design, item refinement, and testing for reliability and validity. Random sampling was used to identify potential respondents from 27 of the 87 acute care hospitals in one city in Japan in 2006. Valid responses were obtained from 446 physicians and 1217 nurses (response rate 78·7% for nurses, and 54·4% for physicians). Construct validity was first confirmed by an exploratory factor analysis and then by a confirmatory factor analysis. Finally, a simultaneous analysis of several groups was performed. The test–retest method and Cronbach’s α coefficients were used to assess reliability. Findings. Exploratory factor analysis yielded three factors. The three‐factor models were confirmed by a confirmatory factor analysis (CFI >0·9, RMSEA <0·08). Simultaneous analysis of several groups (RMSEA = 0·046, AIC = 3115·888) showed the same factor structure for both nurses and physicians. The r values of the test–retest reliability correlations were all 0·7 or above. Internal consistency was demonstrated by a Cronbach’s α = 0·8 or above. Conclusion. The Nurse–Physician Collaboration Scale can be used to establish standards for nurse–physician collaboration, to measure the frequency of collaborative activity, and to verify unit‐specific relationships between collaboration and quality of care.     

Assessing the reliability and validity of a urinary incontinence scale after radical prostatectomy

Urinary incontinence (UI) is a major complication after a radical prostatectomy and this problem can last for over a year after surgery. There is a need for valid research instruments to assess the extent of this problem. The purpose of this study was to assess the reliability and validity of a urinary incontinence scale after radical prostatectomy (UISRP). Psychometric testing of the UISRP using a sample of 124 patients who had been diagnosed with prostate cancer and undergone radical prostatectomy was conducted to determine the quality of items, internal consistency reliability, test–retest reliability, construct validity and criterion-related validity. The final sample consisted of 102 patients (92·7%) in the data analysis. The results indicated that one factor was identified that accounted for 60·28% of the explained variance. The Cronbach's alpha coefficient was 0·90. Two-week test–retest reliability (ICC = 0·56; 95% CI = 0·26–0·72) was provided. Criterion-related validity was supported by correlation with the University of California, Los Angeles Prostate Cancer Index urinary function subscale (r = 0·74, p < 0·001) and a criterion variable measuring a 1-h pad test (r = 0·58, p < 0·001. The UISRP displays satisfactory reliability and validity for radical prostatectomy patients. The UISRP is a valuable research measure and can identify priority areas for nursing interventions designed to improve prostatectomy patients' outcomes.     

Validation of the NOSCA – nurses’ observation scale of cognitive abilities

Aims and objectives. To examine the psychometric properties of the Nurses’ Observation Scale for Cognitive Abilities. Background. Nurses’ Observation Scale for Cognitive Abilities is a behavioural rating scale comprising eight subscales that represent different cognitive domains. It is based on observations during contact between nurse and patient. Design. Observational study. Methods. A total of 50 patients from two geriatric wards in acute care hospitals participated in this study. Reliability was examined via internal consistency and inter‐rater reliability. Construct validity of the Nurses’ Observation Scale for Cognitive Abilities and its subscales were explored by means of convergent and divergent validity and post hoc analyses for group differences. Results. Cronbach’s αs of the total Nurses’ Observation Scale for Cognitive Abilities and its subscales were 0·98 and 0·66–0·93, respectively. The item–total correlations were satisfactory (overall > 0·4). The intra‐class coefficients were good (37 of 39 items > 0·4). The convergent validity of the Nurses’ Observation Scale for Cognitive Abilities against cognitive ratings (MMSE, NOSGER) and severity of dementia (Clinical Dementia Rating) demonstrated satisfactory correlations (0·59–0·70, p < 0·01), except for IQCODE (0·30, p > 0·05). The divergent validity of the Nurses’ Observation Scale for Cognitive Abilities against depressive symptoms was low (0·12, p > 0·05). The construct validity of the Nurses’ Observation Scale for Cognitive Abilities subscales against 13 specific neuropsychological tests showed correlations varying from poor to fair (0·18–0·74; 10 of 13 correlations p < 0·05). Conclusions. Validity and reliability of the total Nurses’ Observation Scale for Cognitive Abilities are excellent. The correlations between the Nurses’ Observation Scale for Cognitive Abilities subscales and standard neuropsychological tests were moderate. More conclusive results may be found if the Nurses’ Observation Scale for Cognitive Abilities subscales were to be validated using more ecologically valid tests and in a patient population with less cognitive impairment. Relevance to clinical practice. Use of the Nurses’ Observation Scale for Cognitive Abilities yields standardised, reliable and valid information about patient’s cognitive behaviour in daily practice. The Nurses’ Observation Scale for Cognitive Abilities aids in tailoring nursing interventions to patients’ specific cognitive needs. We advocate the implementation of the Nurses’ Observation Scale for Cognitive Abilities both in research and at geriatric units in acute care hospitals.     

Falls and fall risk among nursing home residents

Aim and objectives. The aim of this study was to identify risk factors for falls in older people living in nursing homes. Background. Impaired cognitive function and a poor sense of orientation could lead to an increase in falls among those with impaired freedom of movement. Many accidents occur while an older person is walking or being moved. Method. The study was carried out over four years (2000–2003) and 21 nursing home units in five municipal homes for older people in Stockholm, Sweden, participated. A questionnaire was sent to staff nurses, including questions on fall risk assessments, falls, fractures, medication and freedom‐restricting measures, such as wheelchairs with belts and bed rails. The data were aggregated and not patient‐bound. The study covered 2343 reported incidents. Results. There was a significant correlation between falls and fractures (r = 0·365, p = 0·004), fall risk and use of wheelchairs (r = 0·406, p = 0·001, safety belts (r = 0·403, p = 0·001 and bed rails (r = 0·446, p = 0·000) and between the occurrence of fractures and the use of sleeping pills with benzodiazepines (r = 0·352, p = 0·005). Associations were also found between fall risk and the use of anti‐depressants (r = 0·412, p = 0·001). Conclusion. In clinical practice, patient safety is very important. Preventative measures should focus on risk factors associated with individuals, including their environment. Wheelchairs with safety belts and bed rails did not eliminate falls but our results support the hypothesis that they might be protective when used selectively with less anti‐depressants and sleeping pills, especially benzodiazepines.     

Effect of an evidence-based education programme on ED discharge advice for febrile children

Aims. This study aimed to examine the effect of an educational intervention on discharge advice given to parents leaving the emergency department with a febrile child. Background. Childhood fever is a common reason to seek emergency care. Many children are discharged from the emergency department with fever as a significant component of their illness; therefore, it is vital that emergency department medical and nursing staff provide accurate and reliable information about childhood fever management. Design. A pre/post‐test design was used. The outcome measure was parental advice regarding paediatric fever management and the intervention for the study was an educational intervention for emergency department nursing staff that consisted of two tutorials. Data were collected using structured telephone interviews. Results. Data were collected from 22 families during the pretest period and 18 families during the post‐test period. The number of parents leaving the emergency department with no advice decreased by 48% (p = 0·002). Reports of written advice increased by 69·7% (p < 0·001) and there was a 38·4% increase in reports of verbal advice (p = 0·014). Parents leaving the emergency department with both written and verbal advice increased from 0 to 55·6% (p < 0·001). Reports of advice by nursing staff increased by 52% (p < 0·001) and there were significant increases in specific instructions related to oral fluid administration (22·7 vs. 77·8, p = 0·001) and use of antipyretic medications (27·2 vs. 77·8, p = 0·001). Conclusion. Evidence‐based education of emergency nurses improved both the amount and quality of discharge advice for parents of febrile children. Relevance to clinical practice. Parents and health care professionals alike need to better understand the physiological benefits of fever and the potential harmful effects of aggressive and often unwarranted treatment of fever.     

The comparison of effectiveness of two modalities of mental health nurse follow-up programmes for female outpatients with depression in Taipei, Taiwan

Aims and objectives. This study compares the effectiveness of two modalities of mental health nurse three‐month follow‐up programmes: telephone counselling programme and group therapy programme for female outpatients with depression. Background. The lifetime prevalence of major depression is 15% and is about twice as common in women as in men. Outpatients with depression often discontinue their treatment after the initial visits to their physicians. Methods. This study used a quasi‐experimental, pre–post‐test comparison group design. Twenty‐six female outpatients with depression were assigned to one of follow‐up programmes: telephone counselling programme or group therapy programme. To qualify for group therapy programme, potential participants were required to come to group sessions weekly. To be accepted into telephone counselling programme, potential participants had to be able to be contacted by phone regularly. Mental health nurse three‐month follow‐up programmes included care management and structured psychotherapy. Patients in telephone counselling programme received 10 regular telephone calls of 30–60 minutes each. Patients in group therapy programme received 12 sessions of weekly group meetings of 90–120 minutes each. Results. Wilcoxon signed ranks tests provided evidence that the group therapy programme (S = −52·5, p < 0·001; S = 31·5, p = 0·046) and telephone counselling programme (S = −36, p = 0·002; S = 25, p = 0·050) follow‐up programmes were effective in terms of relieving depressed symptoms and improving quality of life. According to Quade's analysis of covariance, telephone counselling programme and group therapy programme appeared to have similar effects of relieving depressed symptoms (F_(1,24) = 0·06, p = 0·813) and increasing quality of life (F_(1,24) = 0·07, p = 0·792). While there was no significant difference in using emergency services ( = 0·89, p = 0·539) between telephone counselling programme and group therapy programme, the rate of adherence to scheduled outpatient appointments with psychiatrists was higher among patients in group therapy programme than patients in telephone counselling programme ( = 8·67, p = 0·034). Conclusions. Establishing two modalities of mental health nurse follow‐up programmes in Taiwan could benefit patients with different needs. Relevance to clinical practice. Mental health nurses specialized in management of depression could provide not only care management but also structured psychotherapy.     

Disease knowledge and treatment adherence among patients with thalassemia major and their mothers in Taiwan

Aims. The current study had three aims: (i) to examine disease knowledge in both thalassemia major patients and their mothers; (ii) to understand the relationships between disease knowledge and treatment adherence in thalassemia major patients; and (iii) to explore the importance of selected factors in predicting patients’ knowledge about thalassemia major. Background. Patients with thalassemia major must be treated with life‐long blood transfusions. Evidence suggests that patients with more knowledge/information about their illnesses adhere more readily to treatment schedules. However, there has been little evaluation of knowledge and treatment adherence in thalassemia major patients. Design and methods. A cross‐sectional correlational survey design and purposive sampling were used. Thirty‐two thalassemia major patients (mean age 17·5 years) and 32 mothers (mean age 40·5 years) were recruited. Results. On a scale ranging from 0–20, the average of the patients’ disease knowledge about thalassemia major was 15·19 and the average of their mothers’ disease knowledge was 16·44. The scores for the patients’ disease knowledge about thalassemia major were positively correlated with follow‐up visit adherence (r = 0·690, p < 0·001) and with desferrioxamine infusion adherence (r = 0·791, p < 0·001). 95.6% of variance in patients’ knowledge was explained by a model that included mothers’ knowledge (β = 0·901, p < 0·001), follow‐up visit adherence (β = 0·084, p = 0·140) and annual household income (β = 0·042, p < 0·387). Conclusions. The positive association between knowledge and treatment adherence and factors of patients’ knowledge indicate the need for systematic education for patients and caregivers to improve adherence to treatment. Relevance to clinical practice. Improvement of the quality of patient care, reinforcement of medical education and enhanced efforts by clinical staff to provide practical knowledge to patients with thalassemia major should significantly improve patient adherence to treatment.     

Effects of the culturally-sensitive comprehensive sex education programme among Thai secondary school students

Title. Effects of the culturally‐sensitive comprehensive sex education programme among Thai secondary school students. Aim. This paper reports on a study to evaluate the effectiveness of a culturally‐sensitive comprehensive sex education programme among Thai secondary school students. Background. Increasing number of adolescents in Thailand have been engaging in premarital sex. No theory‐based, abstinence‐oriented models of sex education have been evaluated in this population. Method. A quasi‐experimental study was conducted in 2006–2007. Outcome measures included sexual behaviour, condom use, intention to refuse sex, intention to use condoms, and knowledge regarding sexually transmitted infections/human immunodeficiency virus/acquired immunodeficiency syndrome and pregnancy. Findings. Students in the experimental group had lower levels of reported sexual intercourse at 3‐ and 6‐month follow‐ups, compared with those in control group (P < 0·01). Students participating in the programme had significantly greater intention to refuse sex in the future across time than controls (P < 0·05). Sexually active adolescents participating in the programme reported significantly lower frequencies of sexual intercourse across time than controls (P < 0·01). However, the programme did not influence consistent condom use (P > 0·05), although the intervention was associated with increased intention to use condoms (P < 0·01). Knowledge about sexually transmitted infections/human immunodeficiency virus/acquired immunodeficiency syndrome and pregnancy among students in the intervention group was significantly greater than that of the controls (P < 0·05). Conclusion. School nurses can play a major role by applying this kind of sex education programme. For nurse researchers, it would be useful to extend this research by considering alternative ways to foster condom use in the non‐commercial partnerships that have become common among adolescents.     

Psychometric testing of the Chinese version of nursing practice environment scale

Aims. To test the reliability and validity of the Chinese version of the Nursing Practice Environment Scale (C‐NPES) translated from the Lake’s Practice Environment Scale of the Nursing Work Index and to explore nurses’ perceptions of the nursing work environments in Taiwan Background. Magnet hospitals are characterised by professional autonomy, control over nursing practice, adequacy of staffing, supportive management and effective interdisciplinary relationships, which are successful in attracting and retaining nurses. In Taiwan, this concept has gained importance since the SARS crisis of 2003. However, there have been limited Chinese instruments based on magnet hospital traits to explore Taiwan’s nursing work environment. Design. This study was designed as a cross‐sectional survey. Purposive convenience samples of 842 nurses were recruited from five acute hospitals in Taiwan. Internal consistency reliability, content validity using expert review, construct validity using factor analysis and criterion‐related validity were examined. Results. The Cronbach’s alphas were 0·90 for the total scale and 0·87–0·65 for the subscales. The validity was obtained using a content validity index and principal component analysis of five‐factor structure (variance explained 47·89%). The criterion‐related validity was supportive of the turnover rate (t = 7·84, p < 0·001). The participants disagreed on staffing and resource adequacy and participation in hospital affairs but agreed on professional development. Conclusion. The preliminary psychometric properties of C‐NPES have been established. Considering cultural appropriateness, the subscales of staffing and participation in hospital affairs need advanced modification. Relevance to clinical practice. The C‐NPES will provide hospital administrators with an overview of magnet hospital settings for nursing practice. It is beneficial for the stabilisation of the nursing workforce as well as for the optimisation of nursing work environments. Additionally, the use of professional development programs to enhance nurses’ knowledge of SARS prevention is favorable.     

Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care

Aims. One aim was to compare the quality and comprehensiveness in nursing documentation of pressure ulcers before and after implementation of an electronic health record in a hospital setting. Another aim was to investigate the use of preformulated templates for pressure ulcer recording in the electronic health record. Background. With the possibilities of the electronic health record to provide information and give accurate and reliable feedback to the healthcare organisation, it is of high priority to develop standardised documentation practices for various areas of care (e.g. such as pressure ulcer care). Design. A cross‐sectional retrospective review of health records. Methods. Three departments in a Swedish university hospital participated. In 2002, there were 413 patients, including 59 paper‐based records identified with notes on pressure ulcers and in 2006, 343 patients, including 71 electronic health records with pressure ulcer recording. Recorded data on pressure ulcers were retrospectively reviewed. Results. Significantly more patient records showed notes of pressure ulcer grade (p < 0·001), size (p = 0·004), risk assessment (p = 0·002), nursing history (p = 0·040), nursing diagnoses (p < 0·001), nursing goals (p < 0·001) and nursing outcomes (p = 0·016) in 2006 than in 2002. One third of the recordings used preformulated templates. Conclusions. Although there were significant improvements in pressure ulcer recording after the change to the electronic health record, several deficiencies remained. Due to the short time of our follow‐up after implementation of the electronic health record, we suspect that the quality of recording will improve when nurses become more familiar with the new system. Relevance to clinical practice. Education related to the use of the electronic health record and evidence‐based pressure ulcer prevention should be provided to the nurses. To facilitate documentation, the templates need to be refined to be more user‐friendly.     

The effects of a nerve‐sparing procedure on urinary incontinence and sexual function among radical prostatectomy patients

Urinary incontinence (UI) and sexual dysfunction are common complications among patients after radical prostatectomy (RP). Although a nerve‐sparing procedure has been recommended to reduce these two complications, the benefits of this procedure still need to be examined in Taiwan. The purposes of this study were to describe and compare the changes over time in the urinary and sexual function of prostate cancer patients treated with or without nerve‐sparing RP. In this study, a longitudinal pre‐test and four post‐test study designs were employed. In all, 62 prostate cancer patients who had undergone an RP were recruited from two hospitals in southern Taiwan. Structure questionnaires and one‐hour pad tests were administered to the patients upon their first visit to the urological clinic (as baseline data) and at follow‐up visits at the clinic 3, 6, 9 and 12 months after RP. All of the patients experienced UI and sexual dysfunction from the first month after undergoing an RP to 12 months. A two‐way multivariate analysis of variance with repeated measurements indicated that the nerve‐sparing procedure (F = 4·41, p < 0·01) and time (F = 12·47, p < 0·001) significantly affected the combined dependent of UI and sexual function. The results of a univariate analysis of variance indicated that the International Index of Erectile Function (IIEF) scores were significantly different for patients who underwent the nerve‐sparing procedure (F = 7·72, p = 0·001), but pad weights were not altered by the effects of the nerve‐sparing procedure. Regarding the effects of time, the results demonstrated that both pad weights and IIEF scores changed significantly over time (F = 12·47, p < 0·001). This study demonstrates that nerve‐sparing positively affects sexual dysfunction, but that it exhibits limited benefit for UI in RP patients. These results can assist health care providers in providing patients with pre‐operation information.     

A study on development of a scale to assess nursing students’ performance in clinical settings

Aims. To develop a valid and reliable scale to assess nursing student performance in clinical settings. Background. In nursing education, clinical evaluation is important for students, teachers and patients and there is a need to evaluate with valid and reliable scales. Design. Instrument development. Methods. Data were collected at 2002–2003 and 2003–2004 academic years and 350 evaluations of third and fourth year students formed the study population. In the light of the literature and our experiences, we determined clinical responsibilities of nursing students and wrote 77 items accordingly. These items were discussed twice by 17 teachers at a University School of Nursing and then the items were decreased to 28. Each item was scored between 1 and 10. The structure validity of the scale was evaluated with factor analyses and reliability of the scale with Cronbach’s alpha and item‐to‐total correlation. Results. The item‐to‐total correlation coefficient was 0·40 and items were excluded with item‐to‐total correlation coefficient of lower than 0·40. Cronbach’s alpha was 0·97. Three factors with an eigenvalue greater than one were extracted. These factors were ‘nursing process’, ‘professionalism’ and ‘ethical principles’ and their Cronbach’s alpha values were 0·97, 0·94 and 0·87, respectively. Conclusion. This scale can be used to evaluate nursing students’ performance in clinical settings. Relevance to clinical practice. A valid and reliable tool may allow an objective evaluation of nursing students’ performance in clinical settings.     

The multidimensionality of caring: a confirmatory factor analysis of the Caring Nurse-Patient Interaction Short Scale

Title. The multidimensionality of caring: a confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale Aim. This paper is a report of a study to evaluate the construct validity of the four‐dimensional Caring Nurse–Patient Interaction–Short Scale using confirmatory factor analysis. Background. Validating theoretical structures of caring is an ongoing challenge in the discipline of nursing. Our previous work has contributed to this literature by the exploration of the dimensionality of the Caring Nurse–Patient Interaction Short Scale via an exploratory factor analysis. The Caring Nurse–Patient Interaction Short Scale comprises 23 items reflecting four caring domains: humanistic care, relational care, clinical care and comforting care. Method. A methodological study was conducted involving a convenience sample of 531 nursing students in a baccalaureate nursing programme (20% were already Registered Nurses). Data were collected in 2002 and 2004. Confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale was performed. Findings. As expected with large samples and models, the chi‐squared‐associated P‐value was statistically significant (χ² = 811·43, d.f. = 224, P < 0·01). However, the other indices reached acceptable levels with 0·054 for the standardized root mean‐squared residuals, 0·070 for the root mean‐square error of approximation, 0·88 for the goodness of fit index, 0·98 for the comparative fit index and 0·97 for the normal fit index. The factor loadings for all items with their hypothesized factor were ≥0·48 and statistically significant at the 0·01 level. Conclusion. The Caring Nurse–Patient Interaction Short Scale model was judged to fit the data adequately. Although further testing of the scale with different samples of patients is warranted, our model emerged as a middle‐range theory during the construct validity process and still reflects Watson’s theory while offering a structure that is testable in clinical research.     

Left ventricular diastolic function is enhanced after peak exercise in endurance‐trained adolescents as well as in their non‐trained controls

The aims of the study were to explore the temporal change of cardiac function after peak exercise in adolescents, and to investigate how these functional changes relate to maximal oxygen uptake (VO_2max). The cohort consisted of 27 endurance‐trained adolescents aged 13–19 years, and 27 controls individually matched by age and gender. Standard echocardiography and colour tissue Doppler were performed at rest, and immediately after as well as 15 min after a maximal cardio pulmonary exercise test (CPET) on a treadmill. The changes in systolic and diastolic parameters after exercise compared to baseline were similar in both groups. The septal E/e′‐ratio increased immediately after exercise in both the active and the control groups (from 9·2 to 11·0; P<0·001, and from 8·7 to 10·2; P = 0·008, respectively). In a comparison between the two groups after CPET, the septal E/e′‐ratio was higher in the active group both immediately after exercise and 15 min later compared to the control group (P = 0·007 and P = 0·006, respectively). We demonstrated a positive correlation between VO_2max and cardiac function including LVEF and E/e′ immediately after CPET, but the strongest correlation was found between VO_2max and LVEDV (r = 0·67, P<0·001) as well as septal E/e′ (r = 0·34, P = 0·013). Enhanced diastolic function was found in both groups, but this was more pronounced in active adolescents. The cardiac functional response to exercise, in terms of LVEF and E/e′, correlates with the increase in VO₂ uptake. These findings in trained as well as un‐trained teenagers have practical implications when assessing cardiac function.