Multiplicative rating scales do not enable measurement of vision‐related quality of life

Purpose: Many questionnaires for the measurement of visual impairment exist. One, the Houston Vision Assessment Test (HVAT), takes a different approach: the patient is asked to rate overall impairment and the proportion attributed to vision, then through multiplication the visual and non‐visual (physical) impairments are calculated. The purpose of this study was to determine whether the scores derived from this approach can be considered to be measures. Methods: The participants were 193 cataract patients awaiting surgery (mean age 74.1 ± 9.8 years, 54 per cent female and 53.6 per cent were awaiting first eye surgery), who self‐administered the HVAT, which consists of 10 questions, whereby impairment on each activity and the proportion attributable to vision is rated. Therefore, total, visual and physical impairments are calculated. For each question, multiplying the impairment (five response categories) by the proportion due to eyesight (five categories) gives 10 possible levels of visual impairment. Assessment of the multiplicative rating scales included frequency of category use and hierarchical ordering of response categories using category thresholds. Summary statistics of Rasch analysis were generated for the rating scale and overall questionnaire performance. Results: In the multiplicative scale, higher response categories were under‐utilised and thresholds were disordered, indicating that the categories did not function as intended. Some of the dysfunction arose from disordered thresholds in the ‘proportion due to eyesight scale’, but repairing this gave little improvement to the multiplicative scale. The ill‐defined nature of the disordered categories precluded further repair by combining categories. Measurement precision, as indicated by person separation reliability, was poor (0.70). Conclusion: Rasch analysis demonstrated that the categories of the multiplied rating scale of the HVAT were not ordered, as the user would expect; this precludes measurement. This provides evidence against the use of multiplicative rating scales in quality‐of‐life questionnaires. It would be better to use a single rating scale for each construct of interest.     

Fluid management for children presenting to the emergency department: Guidelines for clinical practice

Acute illness in children is frequently accompanied by fluid balance disturbances with many children experiencing hypovolaemia and/or dehydration of varying severity. Much of the evidence supporting fluid choice and management regimens stems from studies conducted on adults and well children. However, it is clear from more recent work concentrating on infants and children that physiological immaturity and the effects of acute illness impact significantly on their fluid requirements and responses to treatment. Guidelines exist for fluid resuscitation, fluid replacement and maintenance therapy, which are suitable in most circumstances for infants and children presenting to the ED with hypovolaemia and dehydration secondary to acute illness.Small numbers of children presenting to the ED will have unique fluid requirements (e.g. children with cardiac disease, DKA, etc.) and these circumstances along with blood loss and other trauma-related fluid management issues (e.g. burns) is outside the scope of this paper and will not be discussed.     

Impact of adjusting for inter‐rater variability in conference abstract ranking and selection processes

Background/aim

Scientific conferences provide a forum for clinicians, educators, students and researchers to share research findings. To be selected to present at a scientific conference, authors must submit a short abstract which is then rated on its scientific quality and professional merit and is accepted or rejected based on these ratings. Previous research has indicated that inter‐rater variability can have a substantial impact on abstract selection decisions. For their 2015 conference, the Occupational Therapy Australia National Conference introduced a system to identify and adjust for inter‐rater variability in the abstract ranking and selection process.

Method

Ratings for 1340 abstracts submitted for the 2015 and 2017 conferences were analysed using many‐faceted Rasch analysis to identify and adjust for inter‐rater variability. Analyses of the construct validity of the abstract rating instrument and rater consistency were completed. To quantify the influence of inter‐rater variability of abstract selection decisions, comparisons were made between decisions made using Rasch‐calibrated measure scores and decisions that would have been made based purely on raw average scores derived from the abstract ratings.

Results

Construct validity and measurement properties of the abstract rating tool were good to excellent (item fit MnSq scores ranged from 0.8 to 1.2; item reliability index = 1.0). Most raters (24 of 27, 89%) were consistent in their use of the rating instrument. When comparing abstract allocations under the two conditions, 25% of abstracts (n = 341) would have been allocated differently if inter‐rater variability was not accounted for.

Conclusion

This study demonstrates that, even with a strong abstract rating instrument and a small rater pool, inter‐rater variability still exerts a substantial influence on abstract selection decisions. It is recommended that all occupational therapy conferences internationally, and scientific conferences more generally, adopt systems to identify and adjust for the impact of inter‐rater variability in abstract selection processes.     

A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes

Tran DT, Johnson M, Fernandez R, Jones S. International Journal of Nursing Practice 2010; 16 : 148–158
A shared care model vs. a patient allocation model of nursing care delivery: Comparing nursing staff satisfaction and stress outcomes This study compared nurse outcomes between the shared care in nursing (SCN) and patient allocation (PA) models of care. A quasi‐experimental design was used. Job satisfaction, stress and aspects of role were measured at baseline and 6 months after the implementation of the SCN model using validated instruments. Nurses in the PA (n = 51) and SCN (n = 74) units were comparable at baseline. Nurses from both groups were satisfied with their job and experienced clarity in their role despite some levels of pressure. ‘Satisfaction with co‐workers’ in the SCN group decreased, emphasizing the challenges of supervising staff. Matched pair sample sizes at follow‐up were small. The SCN represents an innovative model of care delivery that is responsive to increasing proportions of enrolled nurses and assistants in nursing within wards. Both models have been found to be supportive of nursing staff. Although difficulties with follow‐up data were experienced, this study represents the first Australian quasi‐experimental research, comparing two models with validated measures. New tasks such as negotiating with co‐workers might create some new challenges for nurses. Hospital administrators should consider the repertoire of care delivery models available.     

Interdisciplinary communication in general medical and surgical wards using two different models of nursing care delivery

fernandez r., tran d.t., johnson m. & jones s . (2010) Journal of Nursing Management 18, 265–274
Interdisciplinary communication in general medical and surgical wards using two different models of nursing care delivery Aim To compare two models of care on nurses’ perception of interdisciplinary communication in general medical and surgical wards. Background Effective interdisciplinary collaboration remains the cornerstone of efficient and successful functioning of health care teams and contributes substantially to patient safety. Methods  In May 2007, participants were recruited from a tertiary teaching hospital in Australia. The multifaceted Shared Care in Nursing (SCN) model of nursing care involved team work, leadership and professional development. In the Patient Allocation (PA) model one nurse was responsible for the care of a discrete group of patients. Differences in interdisciplinary communication were assessed at the 6-month follow-up. Results Completed questionnaires were returned by 125 participants. At the 6-month follow-up, there was a significant reduction in scores in the SCN group in the subscales relating to communication openness (P = 0.03) and communication accuracy (P = 0.02) when compared with baseline values. There were no significant differences in the two groups at the 6-month follow-up in any of the other subscales. Conclusions There is a need for effective training programmes to assist nurses in working together within a nursing team and an interdisciplinary ward team. The SCN and the PA models of care have been found by nurses to support most aspects of interdisciplinary and intradisciplinary communication. The applicability of both models of care to wards with a varying skill mix of nurses is suggested. Further studies of larger samples with varying compositions of skill mix and varying models of care are required. Implications for nursing management Nurse managers can use varying models of care to support interdisciplinary communication and enhance patient safety.