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At least 1,117 records · Page 62Linked to original sources

PubMed2001

Adaptation of an instrument to measure the informational needs of men with prostate cancer.

AIM OF THE STUDY: The aim of this study is to adapt an instrument suitable for assessment of the informational needs of men with prostate cancer. BACKGROUND: In recent years prostate cancer has become an important public health problem world-wide with considerable social and economic consequences. It is reported that it is the most common cancer affecting British men, with an average lifetime risk of occurrence of one in twelve. DESIGN/METHODS: Methodological research was conducted to develop an instrument to assess the informational needs of men with prostate cancer on hormonal manipulation therapy (HMT) regarding their disease and treatment. The Toronto Informational Needs Questionnaire (TINQ-BC) (Galloway et al. 1997) was modified for use with this client group and was applied to a sample of 90 men generated from three urology centres in Northern Ireland. RESULTS/FINDINGS: Construct and content validity of the instrument was established. Internal consistency reliability using Cronbach's alpha was calculated and found to be satisfactory (0.92). Using confirmatory factor analysis, factor loadings ranging from 0.37 to 0.90 were obtained and considered satisfactory. The subsections of the TINQ-BC categorized as Disease, Investigative tests, Treatment, Psychosocial and Physical needs were confirmed as individual factors. These results indicate that this instrument can be validly applied to this client group. As the instrument was initially developed in Canada and successfully used in the United Kingdom (UK), it is suggested that this instrument also has the potential for cross-cultural application. It has the potential to be used as a clinical reference instrument to assess the informational needs of this patient group. Health care professionals must be aware of the domains of information that these men perceive important so that educational interventions can be accurately and appropriately planned.

Activities of Daily Living↗

PubMed2001

Development and testing of the parental coping strategy inventory (PCSI) with children with cancer in Taiwan.

RATIONALE: This study describes the development and psychometric testing of the parental coping strategy inventory (PCSI). METHODS: The PCSI was developed on the basis of previous qualitative study on the Taiwanese parental adaptation process, when caring for children with cancer. In order to develop the measure of parental coping strategy inventory (PCSI), relevant parameters or items for the assessment subscales were then identified and tested in a three-stage process: item development, content validity testing and reliability testing. The PCSI consisted of 48 items in 12 scales after item selection, and the internal consistency of the scales were acceptable. In order to test the psychometric characteristics of the PCSI, data were collected from 183 mothers with children with cancer. RESULTS: Confirmatory factor analysis supported a good overall model fit of the construct validity of PCSI. In order to test the generalizability of the factor structure, mothers with children with epilepsy were used. The factorial validity of PCSI was supported from the population of those mothers with children with epilepsy. CONCLUSIONS: This version of the PCSI was developed with an explicit prior conceptual model based on grounded qualitative study findings. The PCSI is a specified coping behaviour measure with the conceptual framework that adaptation problems can be solved through specific coping strategies. It can be administered in 20 minutes and is the first documented measure of the adaptation process administered directly to Taiwanese parents. It demonstrates acceptable psychometric properties and could be used as a quick screening instrument in evaluating parental problems when caring for children with cancer as well as chronic illness (such as epilepsy, as tested). It could also be used as a predictor of parental adaptation outcome. This report presents preliminary data on the initial instrument development and psychometric properties of PCSI.

Adaptation, Psychological↗

PubMed2003

Thai nurses' beliefs about breastfeeding and postpartum practices.

Cultural beliefs are important determinants of health care behaviours. Nurses have an important influence on infant feeding decisions and maternal postpartum care, but little is known about the extent to which their practice is influenced by traditional beliefs and/or recent innovations driven by evidence-based research. The aim of this study was to investigate Thai nurses' traditional beliefs about breastfeeding and related postpartum care, and their impact on nursing practice. A survey of 372 nurses working in hospitals and health services in Ubon Ratchathani, Thailand was undertaken. Questionnaire items were developed from a review of the literature and exploratory interviews with Thai women. Descriptive statistics were used to represent the incidence of particular beliefs and behaviours. Chi-square analyses were conducted to determine relationships between demographic characteristics and traditional beliefs and practices. There were discrepancies between nurses' beliefs and contemporary evidence-based practices. Many nurses supported traditional Thai postpartum practices such as food restrictions and encouraging hot baths. Some traditional beliefs supported by nurses may be detrimental to women and babies such as "lying by fire", discarding of colostrum, and giving boiled water to neonates. Only half the nurses reported that they encouraged mothers to breastfeed immediately following birth. The study was undertaken in the North-East of Thailand, where the population is known to have strong belief systems. Reliability and content validity of the tool would be enhanced through replication studies and qualitative investigations of other breastfeeding issues. There is a need for professional development strategies such as peer review and mentoring to address inadequate knowledge and outdated practices of some health professionals, as well as continuity of care models to assess quality care outcomes that are culturally appropriate.

Adult↗

PubMed1998

The development of general practice standards in Australia. Royal Australian College of General Practitioners.

The Royal Australian College of General Practitioners has spent 4 years developing a set of entry standards which define the minimum features of general practices expected for the mid-1990s. The project design followed a slow, iterative process, with several opportunities for wide consultation with professional, consumer and Government groups. The draft standards were piloted in 25 volunteer practices, modified and then field-tested in 200 randomly selected practices representing urban and rural practices. Results of this field testing showed that the standards had content validity and that reliable measures were possible using triangulation from several data sources. The current version of the standards has been distributed widely for voluntary application in Australian general practices from early 1997.

Australia↗

PubMed1999

'Hello, my name is Gabriel, I am the house officer, may I examine you?' or the Objective Santa Christmas Examination (OSCE).

OBJECTIVE: To design a clinical examination of high content validity suitable for use as a formative assessment tool with pre-registration house officers (PRHO'S) towards the end of their first house officer post. DESIGN: A multicentre collaboration between four UK medical schools who offer undergraduate curricula which are problem-based, systems-based, patient-orientated, student-centred, jargon-laden and utterly staff-bewildering. MAIN OUTCOME: An objective structured clinical examination (OSCE) which is suitable for use with graduates of UK medical schools. It assesses the knowledge, skills and attitudes essential for future careers in a hierarchical system where protecting the senior staff from all forms of irritation is paramount. RESULTS: PRHO'S who excel in this examination get better references. CONCLUSION: The OSCE format can be used to provide 'real-life' scenarios appropriate to the season.

Career Choice↗

PubMed2000

The management of patient encounter time in a high-stakes assessment using standardized patients.

OBJECTIVES: The purpose of this study was to gather information regarding the appropriateness of the length of time allotted for candidates to complete the history taking and physical examination tasks in a high-stakes standardized patient (SP) assessment. DESIGN: Data were collected on actual time used by 1548 examinees for each of their 10 standardized patient encounters, for which a maximum of 15 minutes was allotted, but not required. SETTING: The Clinical Skills Assessment Center of the Educational Commission for Foreign Medical Graduates (ECFMG), Philadelphia, Pennsylvania, USA. SUBJECTS: Graduates of foreign medical schools who are seeking ECFMG certification. RESULTS: The average time spent with the standardized patient was 13.3 minutes, suggesting that the 15-minute time limit was sufficient. A positive correlation was found between data-gathering scores and patient interview times. Candidates did tend to spend more time with SPs presenting with cases involving complex histories, as well as with cases of chronic conditions. CONCLUSIONS: Candidate time use varied as a function of type of clinical encounter, providing additional evidence of the content validity of the Clinical Skills Assessment.

Clinical Competence↗

PubMed2001

Composite undergraduate clinical examinations: how should the components be combined to maximize reliability?

BACKGROUND: Clinical examinations increasingly consist of composite tests to assess all aspects of the curriculum recommended by the General Medical Council. SETTING: A final undergraduate medical school examination for 214 students. AIM: To estimate the overall reliability of a composite examination, the correlations between the tests, and the effect of differences in test length, number of items and weighting of the results on the reliability. METHOD: The examination consisted of four written and two clinical tests: multiple-choice questions (MCQ) test, extended matching questions (EMQ), short-answer questions (SAQ), essays, an objective structured clinical examination (OSCE) and history-taking long cases. Multivariate generalizability theory was used to estimate the composite reliability of the examination and the effects of item weighting and test length. RESULTS: The composite reliability of the examination was 0.77, if all tests contributed equally. Correlations between examination components varied, suggesting that different theoretically interpretable parameters of competence were being tested. Weighting tests according to items per test or total test time gave improved reliabilities of 0.93 and 0.81, respectively. Double weighting of the clinical component marginally affected the reliability (0.76). CONCLUSION: This composite final examination achieved an overall reliability sufficient for high-stakes decisions on student clinical competence. However, examination structure must be carefully planned and results combined with caution. Weighting according to number of items or test length significantly affected reliability. The components testing different aspects of knowledge and clinical skills must be carefully balanced to ensure both content validity and parity between items and test length.

Clinical Competence↗

PubMedDate not supplied

Description and measurement of handicap caused by vision impairment.

To develop an instrument to describe and quantify handicap caused by vision impairment an item pool was derived from focus groups and from a review of vision-related quality-of-life questionnaires. Only items related to handicap were included and grouped into five subscales. The 76-item 'Impact of Vision Impairment' was administered to 95 people who were vision impaired. Content validity was established by consultation with professionals and with people with impaired vision. Forty-six items remained after the elimination of those found to be irrelevant and others with inter-item correlation coefficients of > or = 0.7. Univariate and multivariate analyses revealed an association between visual acuity and type and degree of handicap on subscales, except emotional reaction to vision loss, which is related to cause of vision impairment. The instrument is responsive to the level of vision loss and discriminates the different performances of people with different causes of vision loss.

Activities of Daily Living↗

PubMed2000

Psychosocial morbidity in prostate cancer: I. Design of a new questionnaire.

OBJECTIVE: To design a questionnaire capable of measuring psychosocial morbidity in patients with prostate cancer and in their partners. METHODS: Issues to be covered in the questionnaire were determined by discussion among professionals, a literature review and semi-structured interviews with a group of seven patients and their partners. The potential issues were analysed and condensed, then re-presented to a further group of professionals, and to 10 patients and partners for comment and amendment. This process aimed to confirm the completeness and relevance of the list of issues. Questions were then constructed around the final list of issues and the questionnaire adjusted continually while testing on patients, until it was completed easily. RESULTS: The questionnaire consisted of 10 items; three items related to the general threat of cancer (concern about the diagnosis itself, fear of the future and difficulty dealing with the emotional response to the disease). Two items covered social and role functioning and there were five items to determine the severity of psychological morbidity caused by pain, urinary symptoms, treatment, physical limitation and sexual dysfunction. The questionnaire appeared to cover those areas of morbidity most consistently raised by patients and partners; it was also rapidly and easily completed by most respondents. CONCLUSION: The questionnaire constructed may be easily applied as part of routine clinical practice; it addresses aspects of psychosocial morbidity related to prostate cancer in patients and their partners. Although it appears to have content validity, further psychometric testing is required.

Aged↗

PubMed1999

Predictors of health promotion lifestyle among three ethnic groups of elderly rural women in Taiwan.

The purpose of this study was to examine the predictors of health promotion lifestyle (HPL) and examine the similarities and differences among three ethnic groups of elderly rural women in Taiwan. Pender's Health Promotion Model was used as the conceptual framework of this study. A convenience sample of 599 elderly rural women was recruited from three rural areas: Kao-Shu, San-Di-Men, and Ma-Chia. Ho-Lo, Hakka, and aboriginal people are the three main ethnic groups in these areas. Of the 599 elderly women, 391 completed all of the interview questions. Subjects ranged from 65 to 91 years old. All instruments used in this study have been evaluated for their content validity. The interrater reliability and alpha coefficient reliability of all instruments were greater than 0.70. A survey-interview method was used to collect data. Findings showed that the predictors of HPL have differences and similarities among elderly rural women from different ethnicities. In the group of elderly Ho-Lo women, age, education, living arrangements, and perceived barriers to health promotion lifestyle (PBaHPL) were significant predictors and they explained 41.9% of total variance in HPL. In the group of elderly Hakka women, education, number of chronic health problems, PBaHPL, and perceived benefits of health promotion lifestyle (PBeHPL) were significant predictors in explaining 53.9% of total variance in HPL. Finally, in the group of elderly aboriginal women, living arrangements, PBaHPL, and PBeHPL were significant predictors in explaining 70.0% of total variance in HPL. Community nurses can use their understanding of different ethnic groups to assess, identify, and use effective health promotion interventions for elderly rural women.

Aged↗

PubMedDate not supplied

Development and evaluation of an instrument to measure seniors' attitudes toward the use of bathroom grab bars.

Bath grab bars can minimize the effects of many age-related deficits that may contribute to bath-related falls. Despite their potential value, bathroom safety devices remain largely underutilized by many community-living older adults and knowledge concerning attitudinal factors that influence the use of grab bars is sparse. This void of knowledge is due, at least in part, to the lack of instruments to measure the psychosocial constructs influencing bathroom safety device use. This study examined the psychometric properties of a newly developed Grab Bar Use Attitude scale (GUAS). Instrument formation, including item generation, evaluation by a panel of experts, and pilot testing of the draft instrument to establish its face and content validity, was followed by instrument validation using 546 community-living seniors. Results of principal components analysis of the GUAS revealed a two-factor solution, explaining 56% of the variance. The two constructs may best be described as functional/safety and psychosocial consequences of using grab bars. Psychometric analyses of the 9-item scale provided empirical evidence of the internal consistency of the total scale and each subscale. Finally, the GUAS distinguished between regular grab bar users and nonregular users. Implications for use are discussed.

Aged↗

PubMed2001

Measuring parental uncertainty during the diagnosis phase of serious illness in a child.

The purpose of this study was to revise and evaluate the Parental Perception of Uncertainty Scale (PPUS) for use in measuring parental uncertainty during the diagnosis of serious illness in a child. The concept of parental uncertainty during diagnosis was elaborated and original PPUS items were revised based on a review of the literature. Content validity of the revision was judged by nurse and parent experts. Preliminary psychometric evaluation of the measure was conducted in a sample of 25 biological mothers of infants who are HIV seropositive. The results offer initial support for the reliability and validity of the revised instrument.

Adult↗

PubMedDate not supplied

Practice management skills for the nurse practitioner.

The faculties of three schools of nursing involved in a collaborative family nurse practitioner (FNP) program designed a study to address issues involved in preparing the nurse practitioner for the challenges of practice management in the clinical environment. The purposes of the study were to (1) identify business concepts necessary to successfully manage a primary care practice; (2) determine which of these concepts should be incorporated into an FNP curriculum; and (3) clarify information to be taught regarding each identified concept. Fifty-four business concepts related to primary care were identified from a literature review. A survey was then developed to assess the extent to which the identified concepts were necessary for an FNP to effectively manage a practice. Seven experts and five FNP faculty responded to the survey. The Content Validity Index (CVI) defined by Lynn (1986) was applied and 20 concepts necessary for an FNP to effectively manage a practice were identified. A focus group that included nurse practitioners (both faculty and nonfaculty) from the three collaborative sites connected by interactive telecommunications determined that all 20 of the identified concepts should be included in an FNP curriculum. Additionally, the focus group clarified relevant information to be taught regarding each identified concept.

Curriculum↗

PubMed2001

The Derriford Appearance Scale (DAS59): a new psychometric scale for the evaluation of patients with disfigurements and aesthetic problems of appearance.

The DAS59 has been designed and developed to meet the need for an objective measure of the spectrum of psychological distress and dysfunction that is characteristic of disfigurements, deformities and aesthetic problems of appearance. Content validity has been assured by basing the scale's items on a detailed autobiographical study of representative patients. Internal consistency is high (0.98) and test-retest reliabilities are good (general population: 0.75; clinical population: 0.86). Correlations with other appropriate standardised tests show good criterion validity and good construct validity. Factor analysis of 2741 data sets (general population and clinical population) identified three factors that are not feature specific and two that are (bodily and sexual features, facial features). The DAS59 thus generates a full-scale score and five factorial sub-scale scores. The DAS59 has been standardised on the clinical population across a range of patient groups and on the general population subdivided into those concerned and those not concerned about appearance. The DAS59 is highly sensitive as a measure of change following treatment with large and significant preoperative-postoperative reductions in full-scale and factorial scores of patients treated for facial features or bodily/sexual features. The DAS59 offers benefits for patient selection in both cosmetic and reconstructive plastic surgery and in the evaluation of outcome. It provides valid and reliable data for clinical audit and governance and for evaluating the merits of one treatment protocol against another.

Adult↗

PubMed1980

On the readability of surgical consent forms.

A great deal of attention has been paid to ensuring that surgical consent forms have valid content, but little effort has been made to ensure that the average patient can read and understand them. Five representative surgical consent forms were analyzed with two standardized readability tests. The readability of all five was approximately equivalent to that of material intended for upper-division undergraduates or graduate students. Four of the five forms were written at the level of a scientific journal, and the fifth at the level of a specialized academic magazine. I suggest that few consent forms currently in use could pass readability tests. The implication of these findings is that thousands of persons may be undergoing surgery each year on the basis of inadequate consent. The problem has a reasonably simple solution: analysis of all consent forms for readability, and rewriting of those found excessively difficult.

California↗

PubMed2001

Factors influencing patient satisfaction with GI endoscopy.

BACKGROUND: A modified Group Health Association of America-9 survey (mGHAA-9) was recently proposed for measurement of patient satisfaction with endoscopy. It is unknown whether the mGHAA-9 addresses the issues most important to this outcome. METHODS: A 15-item survey of factors potentially important to patient satisfaction with endoscopy was developed, including the 6 core mGHAA-9 items. Respondents were asked to rank the factors from 1 to 15 (1 = most important to l5 = least important to satisfaction). Two groups were surveyed: (1) patients with prior endoscopy experience and (2) physician endoscopists. Item rank distributions overall and by patient age, gender, and procedure experience were examined. RESULTS: Of 559 outpatients surveyed, 437 (78%) provided complete responses. The mean patient age was 59 years (48.7% female, 45.3% male, 6% not stated). The number 1 ranked factor was the endoscopist's technical skills (median ranking (mr) = 1), an item included in the mGHAA-9. Pain control, a factor not assessed by the mGHAA-9, was second (mr = 4), and ranked number 1 by 16% of patients. Item rankings were consistent across patient subgroups. Relative to patients, endoscopists underprioritized preprocedure and postprocedure communication. CONCLUSIONS: The mGHAA-9 has inadequate content validity for measurement of patient satisfaction with endoscopy because it does not assess pain control. However, endoscopy satisfaction measurement with a single, universally applied instrument appears feasible.

Adult↗

PubMedDate not supplied

Advanced practice nursing role delineation in acute and critical care: application of the strong model of advanced practice.

PURPOSE: This purpose of this study was to differentiate between the roles of clinical nurse specialists and acute care nurse practitioners. BACKGROUND AND SIGNIFICANCE: Hypothesized blending of the clinical nurse specialist and acute care nurse practitioner roles is thought to result in an acute care clinician who integrates the clinical skills of the nurse practitioner with the systems knowledge, educational commitment, and leadership ability of the clinical nurse specialist. Ideally, this role blending would facilitate excellence in both direct and indirect patient care. The Strong Model of Advanced Practice, which incorporates practice domains of direct comprehensive care, support of systems, education, research, and publication and professional leadership, was tested to search for practical evidence of role blending. METHODS: This descriptive, exploratory, pilot study included subjects (N = 18) solicited from an academic medical center and from an Internet advanced practice listserv. Questionnaires included self-ranking of expertise in practice domains, as well as valuing of role-related tasks. Content validity was judged by an expert panel of advanced practice nurses. RESULTS: Analyses of descriptive statistics revealed that clinical nurse specialists, who had more experience both as registered nurses and in the advanced practice nurse role, self-ranked their expertise higher in all practice domains. Acute care nurse practitioners placed higher importance on tasks related to direct comprehensive care, including conducting histories and physicals, diagnosing, and performing diagnostic procedures, whereas clinical nurse specialists assigned greater importance to tasks related to education, research, and leadership. CONCLUSIONS: Levels of self-assessed clinical expertise as well as valuing of role-related tasks differed among this sample of clinical nurse specialists and acute care nurse practitioners. Groundwork has been laid for continuing exploration into differentiation in advanced practice nursing roles. IMPLICATIONS: As the clinical nurse specialist role changes and the acute care nurse practitioner role emerges, it is imperative that advanced practice nurses describe their contribution to health care. Associating advanced practice nursing activities with outcomes will help further characterize these 2 advanced practice roles.

Adult↗

PubMed1996

A simple polynomial that predicts low-back compression during complex 3-D tasks.

While most existing models that predict loads on the low back for occupational risk analysis are restricted to assessing moments in the sagittal plan, a few have the ability to determine spine compression from three-dimensional (3-D) loading. The objective of this work was to find a method to estimate low-back compression forces during 3-D loading tasks from a model that contains as much biological content validity as the authors could incorporate, such as the effects of muscle co-contraction, but was simple enough to be implemented into a model appropriate for industrial use. The problem that had to be solved was how to represent the anatomical reality that a given muscle force vector contributes simultaneously to all three moments, flexion or extension, lateral bend and axial twist. Simply summing the compression components of independent equivalent muscles in each plane unrealistically assumes that muscles are uncoupled (i.e. each one works independently to support only one moment). In this study, loads in the various tissues of the low back that resulted from the simultaneous generation of moments about the three orthopaedic axes during 3-D tasks were estimated by an anatomically detailed 90 muscle model. A four-dimensional regression equation was developed to predict low-back compression from the three moments generated about the three axes (R2 = 0.94). Comparison of compression estimates from an uncoupled model showed that accounting for muscle coupling reduces compression by 22% on average. The predictive equation is presented to simplify analysis of complex 3-D industrial tasks for those who would like to incorporate it into their own models that produce moments of force in three plans of the L4/L5 level of the lumbar spine.

Adult↗