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Biomedical subjects

S J Redfern

Publications and source records attributed to S J Redfern.

At least 19 recordsLinked to original sources
PubMed1997

Evaluation of a new night nursing service for elderly people suffering from dementia.

A new night hospital nursing service was developed for older people with dementia. A case study approach to evaluation was adopted using a structure-process-outcome quality assurance cycle. The effects and attendance of patients are reported and discussed. Discussion relating to care provision for the future is presented. The effects on carers of patients' attendance are briefly discussed.

Activities of Daily Living↗
PubMed1996

The validity of two quality assessment instruments: Monitor and Senior Monitor.

This paper is concerned with validity of Monitor and Senior Monitor. The study carried out, which was funded by the Department of Health, attempted to establish the validity of the instruments through a multiple triangulation research design. Monitor and Senior Monitor were compared to another instrument, Qualpacs, and also to other methods that focused on quality of nursing care--observation of patients' activities and interactions with nurses, and interviews with patients and nurses on their perceptions of quality. The results did not reveal a clear picture. Convergent validity was relatively strong for Senior Monitor and the Monitor DG3 schedule, but not the DG1, DG2 and DG4 schedules, when compared to Qualpacs. The comparison with observation of nurse-patient activities and interactions supported Monitor rather more than Senior Monitor, particularly with respect to frequency of omitted activities. Both instruments showed considerable construct validity in that congruence emerged between their items and the views of patients and nurses on what constitutes quality.

Aged↗
PubMed1996

Clinical audit, related cycles and types of health care quality: a preliminary model.

This paper is drawn from a study carried out in England, funded by the Department of Health. The aims of the study were to explore clinical audit in the four health professions of clinical psychology, occupational therapy, physiotherapy and speech and language therapy and to develop a model of clinical audit and guidelines for use by practitioners and managers. The focus in this paper is the model development. Included are examples of audits relevant to different types of health care quality that illustrate the process of clinical audit using the model. The modelling process involved interrogating the clinical audit cycle and related cycles against the data and identifying their inter-connecting links. The model was refined and reformulated to include guidelines for the professions on what is needed to make clinical audit work. The position of the professional service manager is crucial. A mandate that includes creating machinery at provider unit level, mobilizing the principal working groups and promoting internalization of audit by practitioners, is essential for audit to be effective.

England↗
PubMed1995

Quality assessment instruments in nursing: towards validation.

The aim of this study was to explore the validity of the nursing quality assessment instruments, Monitor, Senior Monitor and Qualpacs. This follows recommendations in the literature for the need for more comprehensive validation of instruments than has been the case hitherto. A multiple triangulation research design was used which included observation of and interviews with nurses and patients as well as administration of the instruments with the same patients and a questionnaire completed by the nurses in charge on ward organisation and their approach to nursing care. Results reported here focus on our experiences of using the instruments, their inter-rater reliability and comparisons of instrument scores within medical, surgical and elderly care wards. Difficulties were encountered in using the instruments but most of these can be overcome given sufficient time for preliminary discussions. Inter-rater reliability of all three instruments taken as a whole reached acceptable levels, although some of the section score correlation coefficients were low, especially for Qualpacs. Convergent validity was achieved for the Senior Monitor-Qualpacs comparisons in four elderly care wards. The results were less clear for the Monitor-Qualpacs comparisons in seven medical and surgical wards. Explanations for the equivocal results are suggested and subsequent hypotheses were tested which supported these explanations.

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PubMed1995

The validity of Qualpacs.

The validity of the quality assessment instrument Qualpacs is discussed. The literature reviewed addresses the sensitivity, scoring and scope of the instrument, operational decisions and cost and policy implications. Specific attention is given to the reliability and validity of Qualpacs and methodological challenges of convergent validity testing. The study, which was funded by the Department of Health, England, employed a multiple triangulation research design to assess the validity of the instrument. Qualpacs was compared to two other instruments (Monitor and Senior Monitor) and to other quality of nursing care data derived from: observation of patients' activities and nurse-patient interaction, and interviews with patients and nurses on their perceptions of quality of care. The results support Qualpacs as a relatively valid instrument in that it displayed greater convergent validity than Monitor or Senior Monitor. Convergent validity was stronger when compared to Senior Monitor and the Monitor DG3 schedule than the other Monitor schedules. Comparison with the observation of nurse and patient activities and interactions supported Qualpacs for medical and surgical wards but not for elderly care wards. Congruence between Qualpacs' items and the views of patients and nurses provides evidence in support of construct validity of the instrument.

Data Collection↗
PubMed1994

Kitson's Therapeutic Nursing Function Indicator as a predictor of the quality of nursing care in hospital wards.

This study examines the value of Kitson's (1991) Therapeutic Nursing Function Indicator (TNFI) as a predictor of the quality of nursing care in hospital wards. The TNFI was updated and modified for use in medical and surgical as well as elderly care wards, and was administered to the sister and deputy of 11 wards. Kitson's Therapeutic Nursing Function Matrix (TNFM), which assesses the quality of self-care activities (more precisely, the level of therapeutic nursing), was administered to patients in the first nine wards and was tested for inter-rater reliability. Acceptable reliability was achieved for identification of activities. However, correlations between activity scores were low, although statistically significant. Scores from the modified TNFI were compared with mean TNFM ward scores to test Kitson's finding that the TNFI is a predictor of the quality of nursing; our results did not support this hypothesis. Differences in the design of our study with Kitson's might be responsible for this result. Our analysis, however, suggests that the TNFI has become out of date because of changes in the organisation of nursing work, and that it is no longer a sensitive predictor of the quality of nursing care.

Activities of Daily Living↗
PubMed1994

A comparison of two quality assessment instruments: Monitor and Senior Monitor.

Similarities and differences between the two U.K. generic quality assessment instruments, Monitor and Senior Monitor, are outlined. The relative merits of each are explored to determine the most valid instrument for assessing the quality of care of elderly patients. Both instruments were simultaneously administered to 46 patients aged 70 years or over in three medical, three surgical and three elderly care wards. Senior Monitor scores were significantly lower than Monitor scores for the nine wards overall. This remained the case when the sections in Senior Monitor that do not feature in Monitor were removed from the analysis. Factors to be taken into account when selecting which instrument to use with elderly patients are outlined.

Aged↗
PubMed1994

Evaluation of Kitson's therapeutic nursing function matrix in the assessment of quality of nursing care in hospital.

This paper describes our test of Kitson's structured observation and scoring technique (the Therapeutic Nursing Function Matrix--TNFM) and our development of her technique (referred to as the Quality Assessment Project scheme--QAP scheme) as methods of assessing the quality of patient care in hospital wards. Both techniques were tested for inter-observer reliability and for validity against continuous observation. Kitson's technique and the QAP scheme reached acceptable levels of inter-observer agreement for identification of patients' activities, but not for scoring of those activities. Overall, the QAP scheme was found to be more reliable than the Kitson technique. Validity testing against continuous observation again revealed acceptable levels of inter-observer agreement for identification of activities, but not for scoring of those activities. For the Kitson technique there was virtually no agreement in scoring between observers. The QAP scheme achieved higher agreement but needs further work to iron out problems of detail. The conclusion reached is that the QAP scheme is a promising method for assessing the quality of nursing care in hospital wards.

Activities of Daily Living↗
PubMed1993

Inter-rater reliability of Monitor, Senior Monitor and Qualpacs.

This paper describes inter-rater reliability of three quality assessment instruments: Monitor, Senior Monitor and Qualpacs. The work forms part of a Department of Health funded study examining the reliability and validity of these three instruments. Inter-rater reliability is not a fixed entity and therefore should be tested every time raters or the setting change. In this instance, testing was carried out in three wards (one elderly and two surgical). Two methods of analysis were used: percent agreement and intra-class correlation coefficient. Results and some of the techniques that were found to be useful in enhancing reliability are described. Acceptable levels of inter-rater reliability with all three instruments were reached.

Geriatric Nursing↗
PubMed1993

Quality assurance in nursing care: from inspection to opportunity.

Describes alternative approaches to quality assurance in nursing and traces the historical shift from one approach to the other; quality as inspection to quality as opportunity. Early proselytizing approaches were superseded by an emphasis on quantitative measurement and attempts at "objective" evaluation which involved the development of the generic audit. More recently, the move has been towards locally developed audit and standard setting.

Health Services Research↗
PubMed1992

Monitor and Senior Monitor: problems of administration and some proposed solutions.

This paper describes the content and administration of Monitor and Senior Monitor and the difficulties encountered, together with suggestions for avoiding or overcoming these difficulties. This work forms part of a study, funded by the Department of Health, which is examining the reliability and validity of the quality assessment instruments, Monitor, Senior Monitor and QualPacs. The instruments were administered in care of the elderly, medical and surgical wards in two Health Authorities in London. Difficulties encountered with the administration of Monitor and Senior Monitor were to do with the structure of the instruments, accessing required information, interpreting questions and answers, disrupting ward staff, the time required to carry out the procedure and frustrations experienced by the assessors. Although the number of difficulties encountered was considerable, they were not insurmountable. The authors are confident that awareness of these difficulties, and taking steps beforehand to avoid or overcome them, contributes to the reliability and validity of these instruments.

Humans↗
PubMed1992

Developing Flanagan's critical incident technique to elicit indicators of high and low quality nursing care from patients and their nurses.

This paper discusses a development of Flanagan's critical incident technique (CIT) to elicit indicators of high and low quality nursing from patients and their nurses on medical, surgical and elderly care wards. Stages in undertaking the CIT are identified and presuppositions held by most researchers about the nature of the technique are identified. The paper describes how the authors moved to a different set of presuppositions during the course of the study. Preliminary analysis of interview transcripts revealed that critical incidents need not always be demarcated scenes with a clear beginning and end, but may arise from respondents summarizing their overall experience within their description of one incident. Characteristically respondents were unable to give a detailed account of such incidents but validity may be established by the fact that respondents appear to recount what actually happened as they saw it, and what they said was clearly important to them. The researchers found that the most appropriate basic unit of analysis was not the incident itself but 'happenings' revealed by incidents that are 'critical' by virtue of being important to respondents with respect to the quality of nursing care. The importance of CIT researchers achieving an understanding of the 'meaning' of critical happenings to respondents is emphasized. Analysis of the interview transcripts is facilitated by the use of INGRES, a relational database computer program which should enable a 'personal theory' of quality nursing for each respondent, both patients and nurses, to be described. The study suggests that the CIT is a flexible technique which may be adapted to meet the demands of nursing research. If carefully applied, the CIT seems capable of capitalizing on respondents' own stories and avoids the loss of information which occurs when complex narratives are reduced to simple descriptive categories. Patients and nurses have unique perspectives on nursing and their views are of primary importance in understanding what quality means with respect to the interpersonal processes that are integral to nursing care. This paper discusses the identification of indicators of quality nursing from interviews with patients and nurses using the authors' development of Flanagan's critical incident technique.

Data Collection↗
PubMed1991

Interpersonal communication between nurses and elderly patients: refinement of an observation schedule.

The aim of the study was to refine and improve the inter-observer reliability of an observation schedule, developed by Le May & Redfern, designed to record the amount and type of nurse-patient interpersonal communication. The new technique involved observation of non-verbal interactions using a portable computer programmed as an event recorder and a tape recorder to record conversation. The observation schedule was employed in an acute/rehabilitation care of the elderly ward and inter-observer reliability was tested on two occasions. The second observer used a handwritten version of the schedule. Reliability coefficients were acceptable (greater than or equal to 0.60 or greater than or equal to 70% agreement) for all the schedule components although the recording of non-verbal response was inadequate. Use of the portable computer produced no additional benefits over the handwritten schedule. The observation confirmed previous research which found that relatively little expressive touch takes place between nurses and elderly patients. A simplified version of the handwritten schedule together with tape-recording of verbal communication is likely to increase reliability.

Aged↗
PubMed1990

Measuring the quality of nursing care: a consideration of different approaches.

This paper argues that a preoccupation with cost-effectiveness threatens to swamp nurses' traditional concern with quality of care, and underlines the importance of clinical nurses becoming familiar with the complexities of quality measurement. Terminology widely used in the nursing literature is clarified and research studies that address the quality of nursing care are reviewed. It is suggested that whilst some of these have provided important theoretical insights into quality issues, the qualitative research methods employed have so far failed to provide a practical alternative to the more 'objective' measures of quality currently adopted by clinical nurses and their managers. Generic measures of quality are identified and categorized and it is suggested that most of these are in need of extensive validity testing in relation to the concepts of quality that they purport to measure. The measures of quality themselves may be less important than the content in and process by which they are applied. 'Top-down' and 'bottom-up' approaches to measurement are discussed in relation to the notion of facilitative leadership. The value of top-down approaches is questioned on the grounds that they may violate the integrity of the quality-assurance cycle and prevent clinical nurses from making the commitment that is necessary in order to assess and improve the quality of their nursing practice.

Humans↗
PubMed1980

Hospital sisters: work attitudes, perceptions and wastage.

This study attempts to describe the attitudes and perceptions that hospital sisters have towards their work and the relationship, if any, of these attitudes and perceptions to absence, leaving intent and wastage. The theoretical approach adopted was based on the Minnesota Theory of Work Adjustment and the role stress theory originally developed at the University of Michigan, and the measures used included rating scales developed in these centres. The results indicated that most of the sisters were, in general, satisfied with their jobs, although a substantial minority were dissatisfied with and experienced role conflict and ambiguity from certain features of their working environment. Comparison of the leavers with the stayers revealed no difference between the groups on intrinsic satisfaction, absence and role ambiguity, but the leavers were less satisfied with extrinsic features of the job, and experienced more tension and role conflict than the stayers. The fairly strong 'mobility culture' reported by other research was supported and it was tentatively concluded that after a year or two, the job fails to provide the sister with sufficient challenge, and her propensity is to leave for more stimulating work. The implications of this conclusion are discussed.

Attitude of Health Personnel↗