The development and validation of the hospital organizational environment scale for medical staff in China

Objectives

There is currently no measure of the hospital organizational environment targeting both clinicians and nurses in China. This study was conducted with the aim of developing and testing an instrument to assess the properties of the hospital organizational environment that is applicable to Chinese medical staff.

Methods

Items were developed based on a literature review, semi-structured interviews and an expert review and finalized based on corrected item-total correlation, content validity, construct validity, convergent validity, discriminant validity and reliability. The two samples for testing the first and final version of the Hospital Organizational Environment Scale (HOES) included 447 and 424 participants, respectively.

Results

The primary test, which comprised 18 items, contained four factors: hospital culture, work situation, organizational support and scientific research situation. The Cronbach's alphas were 0.935, 0.824, 0.943, and 0.920, respectively. The results of the validation test showed that the questionnaire had good validity and reliability.

Conclusion

The HOES is a comprehensive instrument with demonstrated validity and reliability that can be adopted among medical staff to assess the organizational environment in hospitals.

Development of Content for a Virtual Reality Simulation to Understand and Mitigate Moral Distress in Healthcare Workers

Background In high-stakes situations, healthcare workers are prone to suffer moral injury, the psychological, social, and spiritual impact of events involving betrayal or transgression of one's own deeply held moral beliefs and values. As a result, this may negatively impact their capacity to provide adequate levels of care to patients. There is a lack of educational resources catered to help healthcare workers navigate ethical situations in clinical settings that may lead to or worsen moral distress. The aim of this report is to describe the methodology of development and resulting outcomes in the form of an educational resource that includes a virtual reality (VR) simulation to help healthcare workers understand and mitigate moral distress as a result of internal and external constraints at their workplaces. Methodology A study using a method outlining a set of constraint parameters, followed by ideation utilizing design thinking (DT), and concluding with a consensus-building exercise using Delphi methodology (DM) with a group of 13 experts in healthcare simulation, VR, psychiatry, psychology, and nursing. The constraints parameters included technology use (VR), use of experiential learning theory, and duration of the intervention (15 minutes). A DT process was performed to generate and expand on ideas on the scenario and intervention of a possible VR simulation which were funneled into a three-round DM to define the foundations of the VR simulation. Average, standard deviations, and free-text comments in the DM were used to assess the inclusion of the produced requirements. Finally, a focus group interview was conducted with the same experts to draft the VR simulation. Results Within the specified constraints, the DT process produced 33 ideas for the VR simulation scenario and intervention that served as a starting point to short-list the requirements in Round 1. In Rounds 1 to 2, 25 items were removed, needed revising, and/or were retained for the subsequent rounds, which resulted in eight items at the end of Round 2. Round 2 also required specialists to provide descriptions of potential scenarios and interventions, in which five were submitted. In Round 3, experts rated the descriptions as somewhat candidate to use in the final VR simulation, and the open feedback in this round proposed combining the elements from each of the descriptions. Using this data, a prototype of the VR simulation was developed by the project team together with VR designers. Conclusions This development demonstrated the feasibility of using the constraints-ideation-consensus approach to define the content of a possible VR simulation to serve as an educational resource for healthcare workers on how to understand and mitigate moral distress in the workplace. The methodology described in this development may be applied to the design of simulation training for other skills, thereby advancing healthcare training and the quality of care delivered to the greater society.

Development of Thai Sensory Patterns Assessment Tool for Children Aged 3-12 Years: Caregiver-Version

Most existing tools for measuring sensory patterns of children have been developed in Western countries. These tools are complex and may not be culturally appropriate for other contexts that require specific knowledge in the clinical perspective. The aim of this study was to develop a simplified tool called the Thai Sensory Patterns Assessment (TSPA) tool for children. It is designed for children ages 3–12 years old to be completed by their caregiver. The process of creating the tool consisted of drafting a questionnaire and interpreting the result. Partial psychometrics were completed during item development, content validity of items was assessed by five expert ratings. Construct validity and internal consistency were assessed using data from 414 caregivers and intra-rater reliability was assessed with 40 caregivers. The two parts of the TSPA tool for children results, sensory preference, and sensory arousal, were designed to be presented as a sensory pattern in a radar chart/plot. The data analysis showed that both parts of the TSPA tool for children had acceptable psychometric properties with the retained 65 items. Only proprioceptive sensory arousal had a low Cronbach’s α coefficient, suggesting more information sharing between caregivers and professionals is needed. This research is an initial study and must be continuously developed. Future development of this tool in technology platforms is recommended to support use within healthcare services.

Translation, cross-cultural adaptation and psychometric properties of Urdu version of upper limb functional index; a validity and reliability study

BACKGROUND

The upper limb functional index is broadly used outcome measure for musculoskeletal disorders of the upper limb. The main objective of the study was to translate and validate the upper limb functional index (ULFI) outcome measure in the Urdu language.

METHODS

Upper limb functional index was translated into Urdu language using Beaton et al. guidelines through forward and backward translation along with the expert committee reviews. Two fifty (n = 250) Urdu-speaking patients with sub-acute or chronic conditions of upper limb musculoskeletal disorders were included in the study. The mean age was 32.33 ± 4.67 years. The data were collected from the physical therapy department of The University of Lahore Teaching hospital. All participants completed the upper limb functional index-Urdu (ULFI-U), Numeric pain rating scale (NPRS), Quick Disability of arm, shoulder, and hand (QuickDash), and (health survey) SF-12 at baseline while only ULFI-U at day three. Reliability was assessed through internal consistency by Cronbach's alpha and test-retest reliability by intra-class correlation (ICC). Content validity was measured by Lynn and Lawshee method. Spearman's correlation has been used to measure criterion validity. The construct validity was measured through hypothesis testing. The structural validity has been explained through factor analysis by exploratory factor analysis (EFA) using Maximum likelihood extraction (MLE) with Promax rotation.

RESULTS

The English version of ULFI was translated into the Urdu language with minor alterations. The Urdu version ULFI has demonstrated high levels of reliability with intra-class correlation (ICC2,1= 0.91) and Cronbach's alpha (α = 0.94). The content validity index found as 0.808, the criterion validity for ULFI-U correlating with quick Dash was found excellent (r = 0.845) and ULFI-U established strong correlation with 6 domains of SF-12(r = 0.697 to 0.767) and weak correlation with its 2 domains and NPRS(r = 0.520). A two-factor structure was obtained using EFA.

CONCLUSIONS

The ULFI-U is a valid and reliable patient-reported outcome (PRO) that can be used to assess upper limb musculoskeletal disorders in Urdu-speaking patients.

TRIAL REGISTRATION

This study was registered in the U. S National Library on clinicaltrial.gov under registration no. NCT05088096 . (Date: 21/10/2021).

Investigation of challenges in academic institutional repositories

Purpose

The purpose of this paper is to explore the breadth of the challenges and issues facing institutional repositories in academic libraries, based on a survey of academic librarians. Particularly, this study covers the challenges and barriers related to data management facing institutional repositories.

Design/methodology/approach

The study uses a survey method to identify the relative significance of major challenges facing institutional repositories across six dimensions, including: data, metadata, technological requirements, user needs, ethical concerns and administrative challenges.

Findings

The results of the survey reveal that academic librarians identify limited resources, including insufficient budget and staff, as the major factor preventing the development and/or deployment of services in institutional repositories. The study also highlights crucial challenges in different dimensions of institutional repositories, including the sheer amount of data, institutional support for metadata creation and the sensitivity of data.

Originality/value

This study is one of a few studies that comprehensively identified the variety of challenges that institutional repositories face in operating academic libraries with a focus on data management in institutional repositories. In this study, 37 types of challenges were identified in six dimensions of institutional repositories. More importantly, the significance of those challenges was assessed from the perspective of academic librarians involved in institutional repository services.

Content Validity of an Assessment Tool to Identify Home Fall Hazards: The Westmead Home Safety Assessment

Identifying hazards in the homes of elderly people adequately is of central importance to reducing the risk of falls; however, no assessment tool has demonstrated validity in the area of, or focuses specifically on, home fall hazards. Content validity was undertaken to develop further and refine the Westmead Home Safety Assessment (WeHSA).

A list of stimulus attributes was generated from an extensive literature review and contributed to an expert review by providing a descriptive scheme of the tool's domain of interest. A content analysis of the literature and the expert review process established the tool as having a high degree of content validity and an overall content validity index of 0.80. The rigorous process ensured that the items in the tool were complete and relevant to the focus of the assessment and helped to guide manual development. The WeHSA provides a meaningful tool to enhance therapists' ability to observe and judge hazards.

Content Validity of the Relative Mastery Measurement Scale: A Measure of Occupational Adaptation

This research addressed the need for a clinically practical and psychometrically sound measure of a central construct of Occupational Adaptation theory. As an indicator of Occupational Adaptation, the Relative Mastery Measurement Scale (RMMS) was developed and evaluated for content and construct validity. The RMMS assesses individuals' perceptions of their effectiveness, efficiency, and satisfaction regarding their responses to occupational challenges. In the first phase, the content validity of the RMMS was statistically evaluated using the ratings of five experts in Occupational Adaptation. Lu's Coefficient of Agreement among the experts for the final 12-item RMMS was an acceptable .95. In phase two, construct validity and reliability were examined using a combination of Rasch analysis and traditional measurement statistics. Participants were 150 rehabilitation clients. Reliability and validity was supported through the unidimensionality of 11 of 12 RMMS items by the ordering of item difficulty, goodness-of-fit statistics, factor analysis, and point-biserial correlations.

A conceptual framework of outcomes for caregivers of assistive technology users

OBJECTIVE

To develop and validate the content of a conceptual framework concerning outcomes for caregivers whose recipients are assistive technology users.

DESIGN

The study was designed in four stages. First, a list of potential key variables relevant to the caregivers of assistive technology users was generated from a review of the existing literature and semistructured interviews with caregivers. Second, the variables were analyzed, regrouped, and partitioned, using a conceptual mapping approach. Third, the key areas were anchored in a general stress model of caregiving. Finally, the judgments of rehabilitation experts were used to evaluate the conceptual framework.

RESULTS

An important result of this study is the identification of a complex set of variables that need to be considered when examining the experience of caregivers of assistive technology users. Stressors, such as types of assistance, number of tasks, and physical effort, are predominant contributors to caregiver outcomes along with caregivers' personal resources acting as mediating factors (intervening variables) and assistive technology acting as a key moderating factor (effect modifier variable).

CONCLUSIONS

Recipients' use of assistive technology can enhance caregivers' well being because of its potential for alleviating a number of stressors associated with caregiving. Viewed as a whole, this work demonstrates that the assistive technology experience of caregivers has many facets that merit the attention of outcomes researchers.

Basis for a functional capacity evaluation methodology for patients with work-related neck disorders

BACKGROUND

Neck pain is a common musculoskeletal complaint and a relationship with reduced work-related functional capacity is assumed. A validated instrument to test functional capacity of patients with neck pain is unavailable. The objective of this study was to develop a Functional Capacity Evaluation (FCE), which is content valid for determining functional capacity in patients with work related neck disorders (WRND).

METHODS

A review of epidemiological review literature was conducted to identify physical risk factors for WRND.

RESULTS

Evidence was found that physical risk factors contribute in development of WRND. Physical risk factors were related to repetitive movements, forceful movements, awkward positions and static contractions of the neck or the neck/shoulder region. An FCE was designed based on the risk factors identified. Eight tests were selected to cover all risk factors: repetitive side reaching, repetitive reaching overhead, static overhead work, front carry, forward static bend neck, overhead lift and the neck strength test. Content validity of this FCE was established by providing the rationale, specific objectives and operational definitions of the FCE.

CONCLUSIONS

Further research is needed to establish reliability and other aspects of validity of the neck-FCE.

Reliability and validity study of Silver's test for Hong Kong-Chinese with dementia

There has been great concern regarding the functional and cognitive abilities of elderly people in performing activities of daily living. 'Silver's test' has been widely used to assess the abilities and mental functions of the aging population in Hong Kong. The purpose of this study was to establish the validity and reliability of a Chinese version of Silver's test (CVST) for Hong Kong-Chinese with dementia. A sample of 78 (21 male and 57 female) elderly subjects was recruited through two-stage cluster sampling. They were administered both the CVST and the Chinese Mini-Mental Status Examination (MMSE). Spearman rank-order correlation coefficient (rs) and intra-class correlation coefficient (ICC) showed that the CVST had a very good inter-rater reliability (rs=0.9573, P=0.000; ICC=0.9966) and test-retest reliability (rs=0.9693, P<0.001; ICC=0.9769). The internal consistency of the test was satisfactory (Cronbach's alpha=0.8396). The Mann-Whitney U-test showed that the CVST could discriminate the demented elderly subjects from the non-demented subjects, suggesting the best cut-off score to be 34, yielding a high sensitivity of 96.4% and equally good specificity of 96.7%. There was also a high positive correlation (rs=0.9218, P<0.001) between the total scores of the CVST and the MMSE. Suggestions for the modification of Silver's test were also made. In conclusion, the initial reliability and validity of the CVST has been established for Hong Kong-Chinese with dementia. It appears to be a sensitive and practical cognitive assessment acceptable to this population.

Functional capacity evaluation as a performance measure: evidence for a new approach for clients with chronic back pain

OBJECTIVES

To report the research and development of a new approach to Functional Capacity Evaluation, the Gibson Approach to Functional Capacity Evaluation (GAPP FCE) for chronic back pain clients.

METHODS

Four studies, including pilot and feasibility testing, expert review, and preliminary interrater reliability examination, are described here. Participants included 7 healthy young adults and 19 rehabilitation clients with back pain who underwent assessment using the GAPP FCE. Thirteen therapists were trained in the approach and were silently observed administering the Functional Capacity Evaluations by at least 1 other trained therapists or the first investigator or both. An expert review using 5 expert occupational therapists was also conducted.

RESULTS

Study 1, the pilot with healthy individuals, indicated that the GAPP FCE was a feasible approach with good utility. Study 2, a pilot using 2 trained therapists assessing 5 back pain clients, supported the clinical feasibility of the approach. The expert review in Study 3 found support for GAPP FCE. Study 4, a trial of the approach with 14 rehabilitation clients, found support for the interrater reliability of recommendations for return to work based on performance in the GAPP FCE.

DISCUSSION

The evidence thus far available supports the GAPP FCE as an approach that provides a sound method for evaluating the performance of the physical demands of work with clients with chronic back pain. The tool has been shown to have good face and content validity, to meet acceptable test standards, and to have reasonable interrater reliability. Further research is occurring to look at a larger interrater reliability study, to further examine content validity, and to examine predictive validity.

Development of a conceptual framework for the assessment of geriatric rehabilitation outcomes

The objective of the study was to develop a conceptual framework of key assessment areas for the evaluation of rehabilitation outcomes in older persons. The study was designed in four stages. First, a review of the literature generated a list of 84 potential outcome variables. Second, semi-structured interviews were conducted with older adults informants (n = 19) to record their thoughts about important rehabilitation outcomes. From the analyses of the transcripts, 20 recurrent themes became apparent. Third, relevant assessment areas were determined based on the merged data from the literature and the interviews. Fourth, a focus group was held with a panel of eight interdisciplinary experts with strong involvement in geriatric rehabilitation to evaluate, improve, and validate the preliminary work. As a result of the study, the conceptual framework for the assessment of geriatric rehabilitation outcomes (FAGRO) is composed of four primary outcome domains related to important activities for community-living older persons: mobility activities, basic activities of daily living, activities of independent living, and leisure activities. The models also allows for four brief evaluations of underlying functioning components, including: physical functioning, psychological functioning, social functioning, and factors related to the caregiver status and available resources. The model has the potential to become a valuable additional tool for outcome assessment, researched and developed specifically for geriatric rehabilitation.

The psychometric properties of the Chinese Dialysis Quality of Life Scale for Hong Kong dialysis patients

AIMS

This paper describes the process by which the Chinese Dialysis Quality of Life Scale was developed, and the preliminary testing and psychometric evaluation of the scale in a sample of dialysis patients.

BACKGROUND

Quality of life as a specific outcome variable has not been systematically and satisfactorily studied in Chinese dialysis patients in Hong Kong. A single global quality of life measure that is both reliable and valid for dialysis patients has yet to be developed. Without measurement tools, it is impossible to judge progress towards this goal.

DESIGN

A list of key issues was first derived from an in-depth literature review, then verified by semi-structured interview on seven patients. The initial list of 87 items was then further refined through two rounds of content analysis. The remaining 50 items were finalized by pilot test on seven patients. Of the refined 40 items, face validity was assessed by a team including one professor and ten patients. The 40-item scale was further evaluated by stability, internal consistency and criterion validity with a convenience sample of 164 patients. The scale demonstrated high internal consistency and good test-retest reliability and criterion validity when used.

CONCLUSIONS

The psychometric evaluations suggest that the instrument is worthy of further development. Continued validation of this scale on larger sample and Chinese population living outside Hong Kong has the potential to provide nurses with a valid assessment and treatment guide, and researchers with a valid measurement tool.