Measurement and clinical decision making: focus on instrument development

Clinical Validation of the Nursing Outcome "Swallowing Status" in People with Stroke: Analysis According to the Classical and Item Response Theories

AIMS AND OBJECTIVES

To validate clinically the nursing outcome "Swallowing status".

METHODS

The adjustment of the nursing outcome was investigated according to the Classical and Item Response Theories. The models were compared regarding information loss, goodness-of-fit, and differential item functioning. Stability and internal consistency were examined.

RESULTS

The nursing outcome has the best fit in the generalized partial credit model with different discrimination parameters. Strong correlations among the scores of each indicator were observed. There was no differential item functioning of the outcome indicators. The scale presented high internal consistency (Cronbach's α = .954) and stability (and > .800).

CONCLUSIONS

This study presents a valid nursing outcome.

RELEVANCE TO CLINICAL PRACTICE

Most accurate monitoring of sensitivity to an intervention.

OBJETIVO

Validar clinicamente o resultado de enefermagem "Estado da Deglutição". MÉTODOS: O ajustamento do resultado foi investigado de acordo com as teorias Clássica e de Resposta ao Item. Os modelos foram comparados assumindo parâmetros de itens cruzados de igual discriminação. Investigaram-se as propriedades de bondade do ajuste, funcionamento diferencial dos itens, estabilidade e consistência interna.

RESULTADOS

O resultado se ajustou melhor a partir do Modelo de crédito parcial generalizado, o qual demonstrou unidimensionalidade do resultado e forte correlação entre os escores de cada indicador. Não houve funcionamento diferencial dos indicadores. A consistência interna para a escala global (Cronbach's α = .954) e a estabilidade (>.800) mantiveram-se elevadas. CONCLUSÃO: O estudo apresenta um resultado de enfermagem válido. RELEVÂNCIA PARA A PRÁTICA CLÍNICA: Maior acurácia para monitorar a sensibilidade da intervenção.

Expanding the comfort of postmastectomy patients using the Papilla Gown

PURPOSE

To determine whether the Papilla Gown designed specifically to meet the needs of postmastectomy patients with a closed drainage system in place is more comfortable than is a typical hospital gown.

BACKGROUND

The closed wound drainage system used for breast cancer patients immediately following mastectomy requires external drainage tubes that connect to a pouch. The pins that are usually used to attach the drains to a patient's gown create problems. The Papilla Gown (Papilla is the Latin term for breast) was designed with safety pouches for supporting the drains.

METHODS

A convenience sample of 13 postmastectomy patients participated in this preliminary study of the gown's use. Participants were taught how to properly wear the typical hospital gown and Papilla Gown before surgery. Patients were discharged with the gowns and two questionnaires that were to be returned approximately 1 week following surgery. Thirteen of the 38 (34%) who agreed to participate submitted usable forms. The Wilcoxon signed-ranks test was used for comparing the comfort scores of the Papilla with the hospital gown.

FINDINGS

Participants reported significantly higher scores (p<.003) for the Papilla Gown on all of Comfort Questionnaire's 10 items, except one (p=.337) related to fear of pulling out the drainage tubes. Specifically, patients felt more comfortable about their appearance in the gowns, their ability to move, and the support of the drainage tubes.

CONCLUSION

The newly designed Papilla Gown shows promise for meeting the purpose of increasing the comfort of postmastectomy patients with closed drainage systems.

CLINICAL RELEVANCE

The Papilla Gown was designed to address the comfort, mobility, and body image issues that patients face during the first week following a mastectomy, when they are dealing with such issues as the cancer diagnosis, loss of a breast, and managing drainage tubes. Preliminary results show that nurses can improve patient satisfaction by providing clothing that is comfortable, attractive, and supports the drainage system in place during this critical time.

Care dependency: testing the German version of the Care Dependency Scale in nursing homes and on geriatric wards

The purpose of this study was the psychometric evaluation of the German version of the dependency scale in nursing homes and on geriatric wards. The 15-item scale was originally developed in the Netherlands for assessing the care dependency of demented and mentally handicapped patients. Data of 81 nursing home residents and of 115 geriatric patients were collected. Residents and patients were assessed several time by professionals and nonprofessionals. Reliability was determined by Cronbach's alpha, showing very good results with values of 0.94 and 0.98. Inter-rater and intrarater reliability show moderate to substantial Kappa values. Criterion validity was examined by comparing the data of the scale with the German nursing personal regulation and the German statutory insurance. The results show that the scores of the Care Dependency Scale correlate to the scores of the two classifications. In general, the German version of the scale can be recommended for use in nursing homes and on geriatric wards.

The development of the Pain Management Inventory for patients with arthritis

The initial development of the Pain Management Inventory (PMI), a precise clinical index of pain management methods intended for use with patients with arthritis, is reported. The PMI differs from available instruments in its intent to assess specific methods that the individual is currently using for arthritis pain management and the perceived helpfulness of these methods, thus providing information to be used in combination with other clinical indicators for planning and evaluating ongoing pain self-management. Sixteen of 17 items, or methods, initially demonstrated content validity. Using methods appropriate for an index of independent items, psychometric testing with a sample of 82 persons having a primary diagnosis of osteoarthritis or rheumatoid arthritis then focused on estimating the construct validity and test-retest reliability of each item. Findings assist in better understanding how various methods relate to overall pain management when it is defined as successfully taking care of or handling the pain as viewed within a cognitive-behavioural framework. Findings suggest that there are eight items that represent valid and reliable pain management methods. These items should be used and evaluated with additional arthritis samples to determine whether the findings replicate.