Development and Content Validity of the Self-Care of Oral Anticancer Agents Index (SCOAAI)

ObjectiveTo develop and test the content validity of the Self-Care of Oral Anticancer Agents Index (SCOAAI).Data SourcesSCOAAI items were developed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. The Middle Range Theory of Self-Care of Chronic Illnesses informed item generation. A four-phase procedure was followed; Phase 1: items were created based on a previous systematic review and a qualitative study; Phase 2: the SCOAAI comprehensibility and comprehensiveness were established through qualitative interviews with clinical experts and with patients (Phase 3); and Phase 4: the SCOAAI was then administered through an online survey to a group of clinical experts for the Content Validity Index (CVI) calculation.ConclusionThe first version of the SCOAAI included 27 items. Five clinical experts and 10 patients tested the comprehensiveness and comprehensibility of instructions, items, and response options. Fifty-three experts (71.7% female, mean experience with patients on oral anticancer agents 5.8 years [standard deviation ± .2]; 66% nurses) participated in the online survey for content validity testing. The final version of the SCOAAI includes 32 items. Item CVI ranges between 0.79 and 1; the average Scale CVI is 0.95. Future studies will test the psychometric properties of the tool.Implications for Nursing PracticeThe SCOAAI showed excellent content validity, confirming its usefulness for assessing self-care behaviors for patients on oral anticancer agents. By implementing this instrument, nurses could define and implement targeted interventions for improving self-care and obtaining more positive outcomes (eg, better quality of life, reduced hospitalizations and emergency department visits).     

Evaluation of the clinical utility of the Home Falls and Accidents Screening Tool (HOME FAST)

Purpose: The HOME FAST was developed and trialled in Australia as a screening tool designed to be used by any health professional to identify older people at increased risk of falls and to facilitate referral for more detailed assessment and intervention. This study aimed to evaluate the clinical utility of the HOME FAST from the perspective of users.

Method: A mixed-methods approach using survey data (n?=?32), focus group data (n?=?46) and interview data (n?=?5) from occupational therapists, physiotherapists, community nurses and other health professionals working in hospitals, community services and private practice, located in the UK, Canada and Australia. Data were integrated using a matrix of quantitative and qualitative data that aligned the findings with established theoretical constructs of clinical utility.

Results: Findings across the data sources provide evidence of the clinical utility of the HOME FAST, and these findings align with theoretical constructs about how a tool such as the HOME FAST is adopted in practice.

Conclusion: The HOME FAST can be used in a variety of international setting in developed countries and by different health professionals as a screening tool. A manual would assist in the consistent application of the HOME FAST.

• Implications for Rehabilitation

• Hazards in the home environment are a key contributor to falls risk for older people

• The Home Falls and Accidents Screening Tool (HOME FAST) was designed for any health professional to screen older people at increased risk of falling because of home hazards.

• Even with psychometric evidence of the reliability and validity of a tool, it is critical that the tool can be easily adopted by clinicians (clinical utility), otherwise its applicability to practice and research is limited.

• An international mixed-method study has provided evidence of the clinical utility of the HOME FAST.

     

Mental health nursing and physical health care: A cross‐sectional study of nurses' attitudes,practice, and perceived training needs for the physical health care of people with severe mental illness

Mental health nurses have a key role in improving the physical health of people with a serious mental illness, however, there have been few studies of their attitudes or the extent of their involvement in this work. The aim of this study was to examine mental health nurses' attitudes to physical health care and explore associations with their practice and training. A postal questionnaire survey including the Physical Health Attitude Scale for mental health nurses (PHASe) was used within a UK mental health trust. The 52% (n = 585) of staff who responded reported varying levels of physical health practice; this most frequently involved providing dietary and exercise advice and less frequently included advice regarding cancer screening and smoking cessation. Having received post‐registration physical health‐care training and working in inpatient settings was associated with greater reported involvement. More positive attitudes were also evident for nurses who had attended post‐registration physical health training or had an additional adult/general nursing qualification. Overall, the attitudes of mental health nurses towards physical health care appear positive and the willingness of nurses to take on these roles needs to be recognized. However, there are areas where nurses in our sample were more ambivalent such as cancer screening and smoking cessation.     

Assessing catastrophic thinking associated with debilitating mental health conditions

Purpose: The present study examined the psychometric properties of the Symptom Catastrophizing Scale (SCS). The SCS items were drawn from the Pain Catastrophizing Scale but were modified to make them better suited to the context of debilitating mental health conditions that are not necessarily associated with pain. The number of items was reduced from 13 to 7, and the response scale was simplified.

Methods: The SCS was administered to individuals diagnosed with Major Depressive Disorder (MDD) (N?=?79) or with a chronic musculoskeletal (MSK) condition (N?=?88).

Results: Exploratory factor analyzes revealed single factor solutions of the SCS for both the MSK and MDD samples. The internal consistency of the SCS was good. The SCS was significantly correlated with measures of pain severity, depressive symptom severity and disability in both samples. Individuals with MDD scored higher on the SCS than individuals with MSK. The SCS was shown to be sensitive to treatment-related reductions in catastrophic thinking.

Conclusions: Preliminary analyzes suggest that the SCS is a reliable and valid measure of symptom-related catastrophic thinking associated with debilitating mental health conditions.

• Implications for Rehabilitation

• Although catastrophic thinking has been identified as a risk factor for disability, current assessment tools are not well suited for individuals with debilitating mental health conditions.

• This paper describes a brief assessment instrument that can be used to assess catastrophic thinking in individuals with debilitating mental health conditions.

• The results of this study suggest that targeting catastrophic thinking might yield reductions in symptom severity and disability in work-disabled individuals with major depressive disorder.

     

Implementing a Competence Framework for Administering Medication: Reporting the Experiences of Mental Health Nurses and Students in the UK

Medicine administration is a high risk activity that most nurses undertake frequently. In this paper, the views of registered mental health nurses and final year student nurses are evaluated about the usefulness of the Medicines with Respect Assessment of the Administration of Medicines Competency Framework. A questionnaire using 22 items with closed and open response questions was distributed to 827 practising mental health nurses and 44 final year mental health nursing students. This article presents a content analysis of written replies to the open response questions. Four overlapping themes were identified in response to the open questions posed in the survey: (1) reasons for undertaking the Medicines with Respect Framework; (2) positive aspects; (3) negative aspects; and (4) service user benefits.     

The HPV vaccine: knowledge and attitudes among public health nurses and general practitioners in Northern Norway after introduction of the vaccine in the school-based vaccination programme

Objective: To investigate knowledge of and attitudes to human papillomavirus (HPV) infection, HPV vaccination, cervical cancer, related sources of information and factors associated with willingness to vaccinate one’s own daughter among primary health care (PHC) personnel.

Design: Cross-sectional study.

Setting: PHC.

Subjects: All public health nurses (PHNs) and general practitioners (GPs) in Northern Norway were invited to answer a structured electronic questionnaire; 31% participated (N?=?220).

Main outcome measures: Self-reported and actual knowledge, information sources, attitudes and willingness to vaccinate their (tentative) daughter.

Results: 47% of respondents knew that HPV infection is a necessary cause of cervical cancer. PHNs had higher self-reported and actual knowledge about HPV vaccination and cervical cancer than GPs. PHNs used the Norwegian Institute of Public Health’s numerous information sources on HPV, while GPs had a low user rate. 88% of PHNs and 50% of GPs acquired information from the pharmaceutical industry. 93% PHNs and 68% of GPs would vaccinate their 12-year-old daughter. In a multivariate logistic regression analysis, willingness to vaccinate one’s daughter was positively associated with younger age, being PHN (OR?=?5.26, 95%CI 1.74–15.94), little concern about vaccine side effects (OR?=?3.61, 95%CI 1.10–11.81) and disagreement among experts (OR?=?7.31, 95%CI 2.73–19.60).

Conclusions: Increased knowledge about HPV infection and vaccination is needed, particularly among GPs. Those least concerned about side effects and disagreements among experts were most likely to vaccinate their daughter. These findings are of interest for public health authorities responsible for the Norwegian vaccination and cervix cancer screening programmes, and providers of training of PHC personnel.

• Key points

• One year after introduction of HPV vaccination among 12-year-old schoolgirls in Norway, a cross-sectional study in Northern Norway among general practitioners (GPs) and public health nurses (PHNs) showed that

• ??barely half of PHC professionals knew the causal relationship between HPV infection and cervical cancer

• ??PHNs and GPs had higher self-reported than actual knowledge about HPV vaccination and cervical cancer

• nearly all PHNs and two thirds of GPs wanted to vaccinate their 12-year-old daughter. Those most concerned about side effects and disagreement among experts were less likely to vaccinate.

     

Development,reliability, and piloting of a wheelchair caster failure inspection tool (C-FIT)

Abstract

Introduction: Wheelchair casters fail frequently in the field causing multiple user consequences and wheelchair breakdowns. To inform caster design improvement, there exists no validated tools that can collect caster failures. This need motivated the development of a user-reported, caster failure inspection tool (C-FIT).

Methods: To develop C-FIT, a multistep design and testing approach was used which included face validity testing, test-retest reliability testing and expert review. Reliability testing was conducted with two independent cohorts of wheelchair professionals who inspected caster failures physically and online through pictures. The tool was revised based on testing outcomes and expert feedback. For preliminary data collection and evaluating usability, C-FIT was piloted at wheelchair service centers in Scotland, Indonesia and Mexico.

Results: Caster failure items reported in the literature were screened to develop the initial list of C-FIT items. Face validity testing conducted through surveys with wheelchair experts (n?=?6) provided 14 items for C-FIT inclusion. The test-retest reliability was found to be high for 10 items with physical failure inspections (n?=?12). For each of these items, 75% or more participants had substantial to almost perfect agreement scores (κ?=?0.6–1.0). Lower reliability scores were found with online failure inspections (n?=?11). C-FIT received positive usability feedback from study participants and data collectors in the field. Pilot field data (n?=?31) included comprehensive details about failures useful for manufacturers, designers and researchers to improve caster designs.

Conclusions: The C-FIT tool developed in this study has substantial reliability and can be used for documenting caster failures at wheelchair service centers.

• Implications for rehabilitation

• Collecting data on caster failures is an important first step to inform design improvements and caster quality testing methods.

• The caster failure inspection tool is a reliable tool that can be used during wheelchair repair and servicing to collect caster failures in a standardized way.

• The failure data can be used by wheelchair manufacturers, designers, technicians and researchers to develop reliable caster designs. Wheelchair providers can select caster designs based on context of use.

     

A critical enquiry into the psychometric properties of the professional quality of life scale (ProQol-5) instrument

AimThis study had conducted a comprehensive analysis of the psychometric properties of Proqol 5, professional quality of work instrument among nurses and palliative care-workers on the basis of three independent datasets. The goal is to see the general applicability of this instrument across multiple populations.BackgroundAlthough the Proqol scale has been widely adopted, there are few attempts that have thoroughly analyzed this instrument across multiple datasets using multiple populations.MethodsA questionnaire was developed and distributed to palliative care-workers in Canada and Nurses at two hospitals in Australia and Canada, this resulted in 273 datasets from the Australian and 303 datasets from the Canadian nurses and 503 datasets from the Canadian palliative care-workers. A comprehensive psychometric property analysis was conducted including inter-item correlations, tests of reliability, and both convergent and discriminant validity as well as construct validity analyses. In addition, to test for the reverse coding artifacts in the BO scale, exploratory factor analysis was adopted.ResultsThe psychometric property analysis of Proqol 5 was satisfactory for the compassion satisfaction construct. However, there are concerns with respect to the burnout and secondary trauma stress scales and recommendations are made regarding the coding and specific items which should improve the reliability and validity of these scales.ConclusionThis research establishes the strengths and weaknesses of the Proqol instrument and demonstrates how it can be improved. Through specific recommendations, the academic community is invited to revise the burnout and secondary traumatic stress scales in an effort to improve Proqol 5 measures.     

Suicide,mental, and physical health condition stigma in medical students

Abstract

The current study aimed to compare the personal stigma of suicide with the personal stigma for other mental and physical health conditions. 116 Australian medical students (58% women), aged between 20 and 41?years (M?=?25.02, SD?=?3.80), completed an online survey. Suicide was more highly stigmatized than most of the other mental and physical health conditions in both attitudes toward suicide and willingness to disclose. The current study highlights the need for further medical student education in suicide, as ongoing negative attitudes could negatively affect patient care and disclosure.     

Use of a mental health guideline by occupational physicians and associations with return to work in workers sick-listed due to common mental disorders: a retrospective cohort study

Abstract

Purpose: The aim of this study was to evaluate (1) whether adherence to the Dutch occupational mental health guideline by occupational physicians was associated with time to return to work in workers sick-listed due to common mental disorders; and (2) whether adherence to specific guideline items was associated with time to return to work.

Methods: Twelve performance indicators were developed to assess occupational physicians’ guideline adherence. Medical records of 114 sick-listed workers were audited. Performance indicators were scored as indicating no (0), minimal (1) or adequate adherence (2). Cox regression analysis was used to assess the association between guideline adherence and first or full return to work.

Results: Guideline adherence was predominantly minimal on most performance indicators. This low overall adherence was not associated with first return to work (Hazard Ratio 1.07, p?=?0.747) or with full return to work (Hazard Ratio 1.25, p?=?0.301). Only one performance indicator (regular contact between occupational physician and employer) was significantly associated with earlier full return to work (Hazard Ratio 1.87, p?=?0.021).

Conclusions: Overall, the guideline adherence of occupational physicians was not related to earlier return to work. However, there was considerable room for improvement in guideline use. Whether this leads to earlier return to work is still an ununanswered question.

• Implications for Rehabilitation

• Adherence of occupational physicians to an evidence-based occupational mental health guideline was low.

• Regular contact between occupational physician and employer was associated with earlier full return to work in workers with common mental disorders.

• It is important to focus on how implementation problems and barriers for guideline use can be overcome, in order to improve the quality of occupational mental health care and to potentially reduce sickness absence duration in workers with common mental disorders.

     

Psychosocial issues need more attention in COPD self-management education

Abstract

Objective: To find out how regularly the contents of patient education regarded as essential for COPD patients’ self-management are provided by healthcare professionals in specialised healthcare (SHC) and primary healthcare (PHC) in Finland.

Design: A cross-sectional study based on an e-questionnaire with 42 items on the content of self-management education of COPD patients.

Setting: The study sample included all public SHC units with pulmonary outpatient clinics (n?=?29) and nine out of 160 health centres in Finland.

Subjects: 83 doctors and 162 nurses.

Main outcome measures: The respondents’ answers on how regularly they included the contents regarded as essential for COPD patients’ self-management in their education of COPD patients.

Results: COPD patients were educated regularly on medical issues regarding COPD treatment, such as smoking cessation, exercise and pharmacological treatment. However, issues vital for coping with the disease, such as psychological well-being, stress management or fatigue, were often ignored. Patient education in SHC seemed to be more systematic than education in PHC. The education provided by the asthma/COPD nurses (n?=?70) was more systematic than the education provided by the other nurses (n?=?84).

Conclusion: Healthcare professionals’ continuous education should cover not only the medical but also the psychosocial aspects of coping with COPD. The role of doctors and nurses should be considered to ensure that there is no gap in COPD patients’ education. Training asthma/COPD nurses and promoting specialised nurse-led asthma/COPD clinics in primary care could be beneficial while improving practices of patient education that enhance patients’ ability to cope with the disease.

• KEY POINTS

• Issues vital for coping with chronic obstructive pulmonary disease (COPD), such as psychological well-being, stress and fatigue, are irregularly included in self-management education both in primary and specialised healthcare.

• Patient education provided by asthma/COPD nurses is more regular than patient education provided by other nurses.

• The distribution of work between doctors and nurses should be considered to ensure that there is no gap in COPD patients’ education.

     

The Development and the Content Validation of the Oncology Nurses Health Behaviors Determinants Scale

ObjectiveChemotherapy exposure is an occupational hazard affecting oncology nurses. The adherence to chemotherapy-handling guidelines is essential to prevent exposure to these drugs. Oncology nurses’ health beliefs and the cues in the environment are factors influencing the adherence to these guidelines. There is a lack of instruments with evidence of reliability and validity in the literature that address these factors. The purpose of this article is to describe the development and the content validation of the Oncology Nurses’ Health Behaviors’ Determinants Scale relative to adherence to chemotherapy-handling guidelines.Data SourcesThis study was conducted in two phases: item development, then, content validation using a quantitative cross-sectional design with an exploratory part. A convenience sample of seven experts reviewed the items for relevance, wording, and comprehensiveness. The initial version of the scale that was sent to experts contained 65 items.ConclusionThe Oncology Nurses’ Health Behaviors Determinants’ Scale has evidence of content validity. Twenty-eight items in the final instrument met the required level of content validity (item content validity index = 0.83). Four additional items were retained due to conceptual significance. Two items were added. The final scale contains 34 items with a total scale content validity index = 0.90.Implications for Nursing PracticeThis newly developed instrument could be used to assess the factors that influence chemotherapy exposure among oncology nurses in the light of the Health Belief Model. Following that, interventions can be developed and implemented to foster greater adherence to safe chemotherapy handling guidelines.     

Self-Administered Instruments to Measure Cultural Competence of Health Professionals: A Systematic Review

Background: Tools that measure knowledge, attitudes, and skills reflecting cultural competence of health professionals have not been comprehensively identified, described, or critiqued.

Summary: We systematically reviewed English-language articles published from 1980 through June 2003 that evaluated the effectiveness of cultural competence curricula targeted at health professionals by using at least one self-administered tool. We abstracted information about targeted providers, evaluation methods, curricular content, and the psychometric properties of each tool. We included 45 articles in our review. A total of 45 unique instruments (32 learner self-assessments, 13 written exams) were used in the 45 articles. One third (15/45) of the tools had demonstrated either validity or reliability, and only 13% (6/45) had demonstrated both reliability and validity.

Conclusions: Most studies of cultural competence training used self-administered tools that have not been validated. The results of cultural competence training could be interpreted more accurately if validated tools were used.     

A mixed methods exploration of the team and organizational factors that may predict new graduate nurse engagement in collaborative practice

Abstract

Although engagement in collaborative practice is reported to support the role transition and retention of new graduate (NG) nurses, it is not known how to promote collaborative practice among these nurses. This mixed methods study explored the team and organizational factors that may predict NG nurse engagement in collaborative practice. A total of 514 NG nurses from Ontario, Canada completed the Collaborative Practice Assessment Tool. Sixteen NG nurses participated in follow-up interviews. The team and organizational predictors of NG engagement in collaborative practice were as follows: satisfaction with the team (β?=?0.278; p?=?0.000), number of team strategies (β?=?0.338; p?=?0.000), participation in a mentorship or preceptorship experience (β?=?0.137; p?=?0.000), accessibility of manager (β?=?0.123; p?=?0.001), and accessibility and proximity of educator or professional practice leader (β?=?0.126; p?=?0.001 and β?=?0.121; p?=?0.002, respectively). Qualitative analysis revealed the team facilitators to be respect, team support and face-to-face interprofessional interactions. Organizational facilitators included supportive leadership, participation in a preceptorship or mentorship experience and time. Interventions designed to facilitate NG engagement in collaborative practice should consider these factors.     

Contact between patients with suicidal ideation and nurses in mental health wards: Development and psychometric evaluation of a questionnaire

Suicide prevention and treatment opportunities often depend on interpersonal contact between patients and professionals. Presently, there is a lack of valid and reliable instruments to obtain the perspective of patients with suicidal ideation regarding their contact with professionals in mental health wards. This was a three‐stage study to develop and psychometrically evaluate a questionnaire: the Contact with Nurses from the perspective of Patients with Suicidal ideation (CoNuPaS). First, the construct was defined by a systematic review, qualitative study, and face validity among experts. Second, the content was validated through a Delphi procedure with professional experts (n = 14) and cognitive interviews with hospitalized patients (n = 12). Third, using a sample of adult patients with suicidal ideation in the past year (n = 405), the psychometric properties were assessed by an exploratory factor analysis, a test‐retest procedure, and the internal consistency. The CoNuPaS comprises 23 items and two subsections, to examine patients’ perceptions of contact experiences with nurses (CoNuPaS‐experience) and what they find important in that contact (CoNuPaS‐importance). The subsections comprise four components: encountering a space to express suicidal thoughts and explore needs, being recognized as a unique and self‐determining individual, encountering nurses’ availability/information‐sharing/transparency on expectations, and trusting nurses in communication about suicidality. Content validity scores were excellent (0.78–1.00); test‐retest intraclass correlation coefficient and internal consistency were >0.90. Thus, the CoNuPaS demonstrated good psychometric properties. The availability of a valid questionnaire to examine patient‐nurse contact in mental health wards is central to improving understanding of nurses’ contributions to suicide prevention and suicidal ideation treatment.     

Integrating Mental Health and Addictions Services to Improve Client Outcomes

Substance use disorders are highly prevalent among adults with mental health disorders. In many health service delivery areas, mental health and addictions services are delivered separately. However, current best practices indicate that integration of mental health and addictions services can lead to better outcomes for clients with co-occurring disorders, including fewer hospitalizations. Service integration in the community can occur in many ways, including full or partial program integration. While the delivery of mental health and addictions services must be responsive to the needs of the local community, fully integrated programs have the strongest evidence base for positive client outcomes.     

Sexuality and Consumers of Mental Health Services: The Impact of Gender and Boundary Issues

The importance of sexuality to humanity is clearly acknowledged. However, for consumers of mental health services, it tends to be a neglected topic. Although nurses are at the forefront of mental health service delivery, evidence suggests they are reluctant to include sexuality as part of their care. This article describes the findings from a qualitative exploratory research project that examined mental health nurses’ attitudes to discussing sexuality with consumers. Fourteen mental health nurses from a service in Queensland participated in this study. Data analysis revealed two main themes: the impact of gender, and professional boundary issues. In terms of gender, participants referred to the impact of sexual dysfunction experienced by young adult male consumers. For female consumers the discussion centred on vulnerability to sexual exploitation and the need to exercise protective measures to ensure safety. Participants indicated concerns about being professionally compromised when discussing sexuality with consumers of the opposite sex. These findings highlight the need for further exploration of mental health nurses’ attitudes towards discussing sexuality with consumers as part of their practice.