Construct validity in instrument development: a vital link between nursing practice, research, and theory

The relationship between the nurses' work environment and the quality and safe nursing care: Slovenian study using the RN4CAST questionnaire

Introduction

The safety and quality of patient care are basic guidelines in finding new and improved solutions in nursing. Important and influential factors shape the nurses’ work environment in hospitals.

Purpose

With the study, we intended to investigate whether the perception of nurses’ work environment is related to the safety culture and the quality of patient care and whether it differs according to nurses’ level of education.

Methods of work

The study with a quantitative research method was conducted at the six clinical departments of the University Medical Centre, Ljubljana in 2019. We used a survey questionnaire from the European survey Nurse forecasting in Europe (RN4CAST).

Results

270 nurses were included in the study. The response rate was 54%. The study confirmed that there is a correlation between the assessment of the nurses’ work environment and the general assessment of patient safety (r = 0.36; p <0.001), the general assessment of the quality of nursing care (r = 0.32; p <0.001), the confidence in patient self-care at discharge (r = 0.29; p <0.001) and the quality of patient care in the previous year (r = 0.27; p = 0.001). The results showed frequent verbal abuse of nurses, in 44.9% by patients and their relatives and in 35.4% by staff. Graduate nurses rated the work environment more negatively than healthcare technicians (p = 0.003).

Discussion and conclusion

We confirmed the correlation between the assessment of nurses’ work environment and patient safety and the quality of health care, and that employees’ education influences the assessment and perception of the work environment.

A psychometric assessment of the H & H Lactation scale in a sample of thai mothers using a repeated measurement design

BACKGROUND

The H & H Lactation (H & H) scale is a useful instrument for understanding mothers' perceptions of insufficient milk supply, which is the common reason given for premature cessation of breastfeeding. This instrument may be used to intervene in postbirth dropoff in breastfeeding among mothers.

OBJECTIVES

To examine construct and nomological validity and related psychometric evidence for the translated H & H scale using a repeated measurement design in a sample of Thai mothers.

METHOD

A repeated measurement design with 196 mother-infant dyads. Data were collected at two time periods. At Time 1, data on the H & H and Index of Breastfeeding Status (IBS) scales were obtained between 36 and 48 hr postbirth. For Time 2, the same mothers completed the same instruments at 1 month postbirth. Psychometricproperties of the H & H scale were examined using convergent, discriminant, and nomological validity principles with instructural equation modeling.

RESULTS

Based on judgment/classification task, exploratory/confirmatory factor analysis, and cross-validation using multisample analysis, only nine items of the H & H scale measured at Time 1 and Time 2 were found to be psychometrically sound for measuring insufficient milk supply for Thai mothers. An analysis of the influence of the nine-item of the H & H scale measured at Time 1 and Time 2 on the IBS measured at Time 2 showed that (a) the direct effects of two subscales of the H & H scale measured at Time 2 on the IBS were significant and positive, providing support for the nomological validity of the H & H scale; (b) each H& H factor at Time 1 had a significant influence on its corresponding factor at Time 2, supporting convergent validity; and (c) the crossover effects for each H & H factor for Time 1 and Time 2 data were nonsignificant, indicating discriminant validity.

DISCUSSION

Overall, the 20-item H & H scale appears to be unreliable and invalid for measuring the concept of insufficient milk supply in cross-cultural studies. However, the short form of nine items is reliable and valid for Thai mothers. Further testing and development of the H & H scale and the proposed short form in other cultures and contexts is warranted.

Lang and Goulet Hardiness Scale: development and testing on bereaved parents following the death of their fetus/infant

The process of development and testing of the Lang and Goulet Hardiness Scale (LGHS), a self-report instrument designed to measure hardiness in bereaved parents following the death of their fetus/infant, is presented. Hardiness is a personal resource, composed of 3 interdependent components that are characterized by a sense of personal control over the outcome of life events and hardships such as the death of a fetus/infant, an active orientation toward meeting the challenges brought on by the loss, and a belief in the ability to make sense of one's own existence following such a tragedy. The concept of hardiness has been studied by various disciplines and in a multitude of settings to understand its ability to lessen potentially negative effects of life stress. However, it has never been studied within the context of parental bereavement. The LGHS was developed systematically, originating from a concept analysis. A panel of 15 experts was used to establish content validity.A pretest was conducted on 73 bereaved individuals to assess convergent and discriminant validity of the LGHS. Subsequently, a validation study on 220 bereaved parents who had experienced the death of their fetus/infant 2 months previously was conducted including a retest 6 months after the loss with 192 of the remaining participants. Analyses reveal that the LGHS is a valid and reliable instrument for measuring hardiness and that it is sensitive enough to detect changes in the construct over time.

Measuring constructs accurately: a prerequisite to theory testing

Accurate identification and measurement of constructs is particularly relevant to mental health nurses, who often have to work with clients that have intangible needs and problems. In this paper, the measurement of constructs, the relevance of construct validity to nursing research and, in particular, to theory testing will be discussed. Constructs within the health belief model are used to illustrate the discussion and procedure of factor analysis. Analysis of data based on a survey of health beliefs of 276 adults with the chronic condition of insulin-dependent diabetes is presented, interpreted and discussed. Whilst the paper focuses upon specific constructs and study population in order to provide a worked example, the issues raised and principles outlined relate to an analytical model that can be applied to other research problems and settings.

Testing validity and reliability of an instrument which measures maternal evaluation of breastfeeding

Breastfeeding satisfaction is usually measured by how long a mother breastfeeds. Lack of another method to measure the mother's evaluation of breastfeeding has been a barrier to breastfeeding research. This study tested validity and reliability of the Maternal Breastfeeding Evaluation Scale (MBFES), a new tool which measures mothers' satisfaction with breastfeeding. The sample consisted of 73 women who attended breastfeeding classes in a midwestern hospital. MBFES scores were significantly correlated with the length of time mothers intended to breastfeed (r = .31) and the length of time they breastfed (r = .49), which supports validity. Correlation coefficients for the scale and subscales, .83, .73, .76, and .78, respectively, indicated acceptable internal consistency among items in the scale. These findings support reliability and validity of the MBFES for clinical use.

Instrument development and the measurement of unitary constructs

This article initiates needed dialogue on the development of instruments to measure unitary constructs. The concept of measurement is explored and current measurement in Rogerian research is considered in light of the issues raised in the discussion. The human field - environmental field relationship is presented as the clinical practice area serving as the basis for the development of a unitary instrument that purports to measure field pattern. The instrument entitled Mutual Exploration of the Healing Human Field - Environmental Field Relationship is offered as a beginning effort in constructing an instrument that measures a unitary phenomenon. Rogerian scholars are provided with the challenge to continue the debate regarding the whole field of measurement and the development of unitary tools.

Beyond Campbell and Fiske: assessment of convergent and discriminant validity

While it is not an innovation in the more established social sciences, the multitrait multimethod (MTMM) technique (Campbell & Fiske, 1959) and additional, more powerful statistical methods of interpreting a MTMM matrix of correlations, have not been used extensively in nursing to assess construct validity of new instruments. This article reviews the Campbell and Fiske method for the assessment of convergent and discriminant validity, reviews the application of the method in the nursing literature, and describes the limitations of the original method. In addition, the procedures, strengths, and limitations of the analysis of variance and confirmatory factor analytic approaches to the quantification of Campbell and Fiske's criteria are described.