Modified Delphi Study on Nursing Practice and Science in Fetal Care.

OBJECTIVE: To identify essential structures, processes, outcomes, and challenges of nursing practice in fetal care and to identify research priorities for nurses in fetal care. DESIGN: We used a modified Delphi method to achieve consensus. SETTING: A secure online survey platform. PARTICIPANTS: The expert panel included nurses from the Fetal Therapy Nurse Network. In addition, a multidisciplinary research jury included members of the North American Fetal Therapy Network (NAFTNet). METHODS: We collected data in three consecutive rounds with online questionnaires that were e-mailed to panelists. We used content analysis to generate statements from an initial round of open-ended questions. Statements met consensus if 75% of the panelists ranked it as greater than or equal to 6 on a 1-to-7 Likert scale. RESULTS: The 48 nurse panelists and 11 multidisciplinary jury members described a range of nursing processes. Consensus was reached on 96 statements related to the structure, processes, outcomes, and research priorities of nurses in fetal care. CONCLUSION: The participants agreed that an expert fetal care nursing team is necessary to provide care to women and families during fetal diagnosis and treatment. Ideally, these nurses should coordinate care and provide direct clinical care (e.g., patient counseling) in outpatient prenatal settings and inpatient settings when fetal surgery is involved. Nurses should be supported to take on leadership roles in program development, research, quality improvement, and professional development with relevant professional organizations.

Psychometric properties of the Danish Hospital Anxiety and Depression Scale in patients with cardiac disease: results from the DenHeart survey.

BACKGROUND: Anxiety and depression symptoms are common among cardiac patients. The Hospital Anxiety and Depression Scale (HADS) is frequently used to measure symptoms of anxiety and depression; however, no study on the validity and reliability of the scale in Danish cardiac patients has been done. The aim, therefore, was to evaluate the psychometric properties of HADS in a large sample of Danish patients with the four most common cardiac diagnoses: ischemic heart disease, arrhythmias, heart failure and heart valve disease. METHODS: The DenHeart study was designed as a national cross-sectional survey including the HADS, SF-12 and HeartQoL and combined with data from national registers. Psychometric evaluation included analyses of floor and ceiling effects, structural validity using both exploratory and confirmatory factor analysis and hypotheses testing of convergent and divergent validity by relating the HADS scores to the SF-12 and HeartQoL. Internal consistency reliability was evaluated by Cronbach's alpha, and differential item functioning by gender was examined using ordinal logistic regression. RESULTS: A total of 12,806 patients (response rate 51%) answered the HADS. Exploratory factor analysis supported the original two-factor structure of the HADS, while confirmatory factor analysis supported a three-factor structure consisting of the original depression subscale and two anxiety subscales as suggested in a previous study. There were floor effects on all items and ceiling effect on item 8. The hypotheses regarding convergent validity were confirmed but those regarding divergent validity for HADS-D were not. Internal consistency was good with a Cronbach's alpha of 0.87 for HADS-A and 0.82 for HADS-D. There were no indications of noticeable differential item functioning by gender for any items. CONCLUSIONS: The present study supported the evidence of convergent validity and high internal consistency for both HADS outcomes in a large sample of Danish patients with cardiac disease. There are, however, conflicting results regarding the factor structure of the scale consistent with previous research. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01926145.

Four Approaches for Determining Composite Scores for the Measurement of Transition in Cancer Scale.

BACKGROUND: We created the Measurement of Transitions in Cancer Scale to assess patients' perceptions of the extent of change they experience with cancer-related transitions and how well they feel they are managing these transitions. For some transitions, we found that the more change that was reported, the worse management was reported; however, the benchmark by which patients assess how well they have managed may vary with the extent of change. OBJECTIVES: The aim of the study was to identify approaches to combine reports of extent and management of change. METHODS: Among women with breast cancer, we explored relationships of composite measures (arithmetic and geometric means, subtractive and proportional need for improvement) with other indicators of well-being (symptoms, anxiety, depression, uncertainty, self-efficacy, knowledge of care options, medical communication competence). We examined statistical significance using false rate discovery for multiple tests on correlations with clinical outcomes. RESULTS: Greater extent and less management were significantly associated with higher total symptoms, anxiety, depression, uncertainty, and less self-efficacy in Personal Transitions, but not in Care Transitions. The arithmetic and geometric means had weak correlations with clinical outcomes, whereas the subtractive and proportional need for improvement had significant correlations with most clinical outcomes both in Personal and Care Transitions. The combined proportional need for improvement in Personal Transitions was significantly associated with total symptoms, anxiety, depression, uncertainty, and self-efficacy. The Care Transitions score was also significantly associated with total symptoms, anxiety, uncertainty, and self-efficacy. DISCUSSION: These approaches can be applied to other aspects of self-management that require assessment of the extent and management of an experience. The four approaches yield different results. We recommend the need for improvement composites to capture correlations with the clinical outcomes.

Essential evidence-based introductory bioterrorism content for practicing nurses.

Bioterrorism content is too often absent from nursing education post-licensure. According to the Centers for Disease Control and Prevention (CDC), bioterrorism is defined as "the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants." The purpose of this scholarly work was to develop and pilot a curriculum on introductory bioterrorism concepts for practicing nurses. A literature search and a review of available resources elucidated pertinent content items on bioterrorism and its associated precautions for nurses. Next, two rounds of expert panel consisting of five members rated the identified content and provided comments to validate the curriculum's content. Based on the results, content items were expanded into a curriculum that was piloted as a four hour in person educational session and nurses in attendance were invited to participate in pre-test and post-test questions. They were also asked for their perceptions of the educational session's usefulness and influence on patient care in case of a bioterrorism event. All respondents strongly agreed that the information presented would be useful to them and would influence their patient care in a bioterrorism event. Further refinement, evaluation, and implementation of the developed curriculum are recommended.

Adapting an Evidence-Based Pediatric Acute Asthma Exacerbation Severity Assessment Tool for Pediatric Primary Care.

INTRODUCTION: The purposes of this project were (a) to examine criteria derived from evidence-based pediatric acute asthma exacerbation assessment tools, asthma scores, and the acute asthma prediction rule validated and used in the emergency department and (b) to adapt these criteria for pediatric primary care. METHOD: The three stages of the project included (a) identification of criteria in a literature review, (b) validation of the criteria by an expert panel, and (c) adaptation of the criteria in the design of an assessment tool. RESULTS: The criteria were validated and adapted in the design of The Pediatric Acute Asthma Exacerbation Severity Assessment and Disposition Decision-Making Tool for Pediatric Primary Care. DISCUSSION: The adaptation of criteria derived from the evidence and validated by an expert panel will inform and guide clinicians in assessing severity and support decision making in determining disposition of pediatric patients presenting with an acute asthma exacerbation in primary care.

Translation and validation of the Canadian diabetes risk assessment questionnaire in China.

OBJECTIVES: To adapt the Canadian Diabetes Risk Assessment Questionnaire for the Chinese population and to evaluate its psychometric properties. DESIGN AND SAMPLE: A cross-sectional study was conducted with a convenience sample of 194 individuals aged 35-74 years from October 2014 to April 2015. METHODS: The Canadian Diabetes Risk Assessment Questionnaire was adapted and translated for the Chinese population. Test-retest reliability was conducted to measure stability. Criterion and convergent validity of the adapted questionnaire were assessed using 2-hr 75 g oral glucose tolerance tests and the Finnish Diabetes Risk Scores, respectively. Sensitivity and specificity were evaluated to establish its predictive validity. RESULTS: The test-retest reliability was 0.988. Adequate validity of the adapted questionnaire was demonstrated by positive correlations found between the scores and 2-hr 75 g oral glucose tolerance tests (r = .343, p < .001) and with the Finnish Diabetes Risk Scores (r = .738, p < .001). The area under receiver operating characteristic curve was 0.705 (95% CI .632, .778), demonstrating moderate diagnostic value at a cutoff score of 30. The sensitivity was 73%, with a positive predictive value of 57% and negative predictive value of 78%. CONCLUSIONS: Our results provided evidence supporting the translation consistency, content validity, convergent validity, criterion validity, sensitivity, and specificity of the translated Canadian Diabetes Risk Assessment Questionnaire with minor modifications. This paper provides clinical, practical, and methodological information on how to adapt a diabetes risk calculator between cultures for public health nurses.

Nutrition and Other Protective Behaviors Motivated by Environmental Health Risk Awareness.

BACKGROUND: Research findings have suggested that exposure to environmental pollutants contributes to increased health risks, which may be modulated by certain nutrition and other protective health behaviors. Nutrition professionals play an important role in effectively disseminating this information and in devising specific community-based nutrition education programs for audiences located in areas with environmental health issues. OBJECTIVE: To assess awareness of environmental health problems and motivation to adopt protective health behaviors for use in planning nutrition education programs for communities exposed to environmental pollutants. METHOD: Data were collected from a modified, validated Environmental Health Engagement Profile (EHEP) survey instrument administered to adults (n=774) participating in community events in Kentucky based on location relative to hazardous waste sites. RESULTS: The modified EHEP survey instrument showed good internal consistency reliability, and demographic characteristics were evaluated. Correlation analyses revealed significant positive correlations in all groups, separately and combined, between awareness of environmental pollution in an individual's surroundings and the extent of concern that pollutants cause adverse health effects (P < 0.01) and between concern that pollutants cause adverse health effects and taking personal actions to protect against such environmental insults (P < 0.01). The groups having the highest level of awareness posed by pollution are those residing near federally designated hazardous waste sites. CONCLUSION: These results suggest that determining and expanding an audience's knowledge and perceptions of environmental health risks will enhance effective nutrition education program planning.

Exploratory factor analysis of the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale in people newly diagnosed with advanced cancer.

BACKGROUND AND PURPOSE: The purpose of this study was to reexamine the factor pattern of the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) using exploratory factor analysis in people newly diagnosed with advanced cancer. METHODS: Principal components analysis (PCA) and 3 common factor analysis methods were used to explore the factor pattern of the FACIT-Sp-12. Factorial validity was assessed in association with quality of life (QOL). RESULTS: Principal factor analysis (PFA), iterative PFA, and maximum likelihood suggested retrieving 3 factors: Peace, Meaning, and Faith. Both Peace and Meaning positively related to QOL, whereas only Peace uniquely contributed to QOL. CONCLUSION: This study supported the 3-factor model of the FACIT-Sp-12. Suggestions for revision of items and further validation of the identified factor pattern were provided.

Predictors of diminished levels of social integration in older adults.

The purpose of this secondary analysis of prospective longitudinal data was to determine the variables predictive of diminished social integration in older adults over time. Using generalized estimating equations to model diminished levels of social integration over the 12-year study period, the following variables were predictive of diminished levels of social integration over time: bad overall health (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.39, 3.83), depressive symptoms (OR = 1.36, 95% CI 1.13, 1.65), positive smoking status (OR = 1.40, 95% CI 1.15, 1.71), and decreased religious engagement (OR = 1.81, 95% CI 1.04, 2.19). A better understanding of predictive factors could positively impact resource allocation, prioritization, and case management for older adults.

Cultural influences on causal beliefs about depression among Latino immigrants.

PURPOSE: This study describes causal beliefs about depression among Dominican, Colombian, and Ecuadorian immigrants. The authors describe participants' narratives about how particular supernatural or religious beliefs may contribute to or alleviate depression. METHOD: Latino primary care patients (n = 177) were interviewed with the Beliefs About Causes of Depression Scale, a list of 35 items rated from not at all important to extremely important. Participants had the option of expanding on responses using an informal conversational approach. Underlying themes of these explanatory comments were derived from narrative and content analysis. RESULTS: Major themes that emerged were Psychosocial and Religious and Supernatural causal beliefs. A third theme emerged that represented the integration of these categories in the context of the immigrant experience. DISCUSSION AND CONCLUSIONS: This article adds to the understanding of cross-cultural beliefs about depression. Psychosocial stressors related to the immigrant experience and adverse life events were highly endorsed, but the meaning of these stressors was construed in terms of religious and cultural values. To provide culturally appropriate services, nurses should be aware of and discuss the patient's belief systems, illness interpretations, and expectations of treatment.

Instrument translation and initial psychometric evaluation of the Chinese version of the Self-Management of Type 1 Diabetes for Adolescents scale.

AIM: To translate the validated measure, Self-Management of Type 1 Diabetes in Adolescents, into the Mandarin Chinese language and to test the psychometric properties of the Chinese version. BACKGROUND: Although research on self-management of Type 1 diabetes has been increasing over the past 20 years, few health-related instruments have been available in the Chinese language for youth with Type 1 diabetes. DESIGN: A two-phase design was used in this study, including instrument translation and psychometric testing. METHODS: The instrument translation, from October 2008-April 2009, included three steps: forward translation, back translation, and comparison of versions via Translation Validity Index - with multiple rounds, group discussion, and achievement of consensus at each step. Psychometric properties of the Chinese version Schilling's Self-Management of Type 1 Diabetes for Adolescents scale was assessed in a convenience sample of 136 Chinese youth (ages 8-19) with Type 1 diabetes between June 2009-August 2009. RESULTS: The internal consistency and test-retest reliabilities indicated generally good consistency and temporal stability of the Chinese version. Evidence of construct validity and criterion-related validity was obtained via correlations of subscales with established measures of diabetes adherence and quality of life and also with haemoglobin A1c. Results from hypothesis testing also supported construct validity. CONCLUSION: The Chinese version of Self-Management of Type 1 Diabetes for Adolescents scale is sound and will facilitate cross-cultural studies, while also enabling nurses to monitor and enhance the diabetes self-management of Chinese youth with Type 1 diabetes.

Scale development based on likelihood cross-validation.

The use of likelihood cross-validation for guiding the scale development process is formulated and demonstrated, including choosing the number of factors, assessing item-factor allocations suggested by rotations, adjusting those allocations, reducing the number of factors, removing items, and assessing the applicability of scales to subjects other than those for whom it was originally developed. An example analysis is presented on the development of scales to measure how parents caring for a child with a chronic condition view their family's management of that condition.

Psychometric testing of the Health Quotient questionnaire: a measure of self-reported holistic health.

AIM: This paper is a report of a test of the psychometric properties of the Health Quotient questionnaire. BACKGROUND: The Health Quotient questionnaire is an existing self-reported holistic health measure developed by integrating Western and Eastern perspectives, but limited psychometric properties have been reported. METHODS: Content validity was estimated by five experts. A pilot study allowed for feasibility testing and examination of reliability and validity. A total of 1874 Chinese college undergraduates took part in the study in 2007-2008. Internal consistency reliability of the five dimensions (Self-Care, Health Knowledge, Lifestyle, Mind Health and Life Skills) of the Health Quotient questionnaire was examined and item-to-dimension score correlation analysis was also completed. Construct validity was determined using the convergent validity, hypothesis testing approach and factor analysis. The single-item self-rated health status assessment by the American College Health Association-National Council was used to measure health status. RESULTS: Strong content validity and internal consistency reliability correlations were demonstrated. Test-retest reliability was acceptable, ranging from 0.72 to 0.82 for the five dimensions. Statistically significant relationships between the Health Quotient's total and dimension scores with self-rated health status (P < 0.001) provided evidence of convergent validity. In exploration of the factor structure by dimensions, four of five dimensions were consistent with the theoretical framework, with only the Life Skills dimension demonstrating lack of theoretical fit. CONCLUSION: The results provide some evidence for the reliability and validity of the Health Quotient questionnaire, as well as several recommendations for further research on the questionnaire.

Subjective versus objective: an exploratory analysis of latino primary care patients with self-perceived depression who do not fulfill primary care evaluation of mental disorders patient health questionnaire criteria for depression.

OBJECTIVE: Identification and treatment of depression may be difficult for primary care providers when there is a mismatch between the patient's subjective experiences of illness and objective criteria. Cultural differences in presentation of symptoms among Latino immigrants may hinder access to care for treatment of depression. This article seeks to describe the self-perceptions and symptoms of Latino primary care patients who identify themselves as depressed but do not meet screening criteria for depression. METHOD: A convenience sample of Latino immigrants (N = 177) in Corona, Queens, New York, was obtained from a primary care practice from August 2008 to December 2008. The sample was divided into 3 groups according to whether participants met Patient Health Questionnaire diagnostic criteria for depression and whether or not participants had a self-perceived mental health problem and self-identified their problem as "depression" from a checklist of cultural idioms of distress. Psychosocial, demographic, and treatment variables were compared between the 3 groups. RESULTS: Participants' descriptions of symptoms had a predominantly somatic component. The most common complaints were ánimo bajo (low energy) and decaimiento (weakness). Participants with "subjective" depression had mean scores of somatic symptoms and depression severity that were significantly lower than the participants with "objective" depression and significantly higher than the group with no depression (P < .0001). CONCLUSIONS: Latino immigrants who perceive that they need help with depression, but do not meet screening criteria for depression, still have significant distress and impairment. To avoid having these patients "fall through the cracks," it is important to take into account culturally accepted expressions of distress and the meaning of illness for the individual.

The environmental health engagement profile: what people think and do about environmental health.

OBJECTIVES: To develop and validate the Environmental Health Engagement Profile (EHEP)-an instrument for assessing the way people engage with environmental health issues, including people's experience of environmental health hazards, the assumptions concerning the risks involved, and the actions taken either individually or collectively in their communities. DESIGN AND SAMPLE: This instrument development study was conducted in an urban area with varying levels of health-related environmental concerns. First, qualitative interviews with 41 residents informed development of items. Next, the items were evaluated by 28 expert reviewers. Finally, validity was assessed from responses of 433 residents who completed the instrument and other measures by telephone interview. MEASURES: For assessing validity of EHEP, data were also collected concerning demographic characteristics, social involvements, goodness of life, and self-ratings of health. RESULTS: Through factor analysis, 5 subscales were identified-named Pollution Sensitivity Scale (alpha=.91), Pollution-Causes-Illness Scale (alpha=.84), Pollution Acceptance Scale (alpha=.67), Community Environment Action Scale (alpha=.79), and Personal Environmental Action Scale (alpha=.63). Patterns of correlations of these scales with age, and measures of odor sensitivity, social involvement, and goodness of life provided evidence of construct validity. CONCLUSIONS: These results provide beginning evidence for the reliability and validity of the EHEP. Thus, public health nurses and others may use this instrument to assess people's concerns about environmental health, and resulting actions-and to support strategies for advising people and communities on protecting their health.

A new self-report measure of self-management of type 1 diabetes for adolescents.

BACKGROUND: The development of instruments to measure self-management in youth with type 1 diabetes has not kept up with current understanding of the concept. OBJECTIVE: This study aimed to report the development and the testing of a new self-report measure to assess the Self-Management of Type 1 Diabetes in Adolescents (SMOD-A). METHODS: Following a qualitative study, items were identified and reviewed by experts for content validity. A total of 515 adolescents, 13 to 21 years old, participated in a field study by completing the SMOD-A (either once or twice) and additional measures of diabetes-related self-efficacy (Self-Efficacy for Diabetes Scale), quality of life (Diabetes Quality of Life for Youth Questionnaire), self-management (Diabetes Self-Management Profile), and adherence (Self-Care Inventory). Data were collected also on metabolic control (glycosylated hemoglobin [HbA1c]). RESULTS: The content validity index was .93. Exploratory alpha factor analyses revealed five subscales: Collaboration With Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication, and Goals (alpha = .71 to .85). The stability of the SMOD-A ranged from .60 to .88 at 2 weeks (test-retest) to .59 to .85 at 3 months. Correlations of SMOD-A subscales with Self-Efficacy for Diabetes Scale-Diabetes; Diabetes Quality of Life for Youth Questionnaire satisfaction, impact, and worry; Diabetes Self-Management Profile; and Self-Care Inventory were generally significant and in the expected direction. Collaboration with parents and HbA1c values were related significantly and positively (r = .11); all other SMOD-A subscales were related significantly and negatively to HbA1c (r = -.10 to -.26), demonstrating that better self-management is associated somewhat with better metabolic control and supporting construct validity of the new measure. DISCUSSION: The SMOD-A has been found to be a reliable, stable, and valid measure of SMOD-A.

Analysis of cross-sectional univariate measurements for family dyads using linear mixed modeling.

Outcome measurements from members of the same family are likely correlated. Such intrafamilial correlation (IFC) is an important dimension of the family as a unit but is not always accounted for in analyses of family data. This article demonstrates the use of linear mixed modeling to account for IFC in the important special case of univariate measurements for family dyads collected at a single point in time. Example analyses of data from partnered parents having a child with a chronic condition on their child's adaptation to the condition and on the family's general functioning and management of the condition are provided. Analyses of this kind are reasonably straightforward to generate with popular statistical tools. Thus, it is recommended that IFC be reported as standard practice reflecting the fact that a family dyad is more than just the aggregate of two individuals. Moreover, not accounting for IFC can affect the conclusions.

Determining content validity of a self-report instrument for adolescents using a heterogeneous expert panel.

BACKGROUND: The use of experiential experts, especially children and adolescents, in content validity evaluations of new instruments has not been described well. OBJECTIVE: To describe the use of experiential experts in a content validity evaluation of a new instrument. METHODS: Experiential (adolescents and parents, n = 11) and professional (diabetes clinicians and researchers, n = 17) expert judges evaluated the content validity of a new instrument that measures self-management of Type 1 diabetes in adolescents. The content validity index for each of 99 items (I-CVIs) for the total group of experts (n = 28; I-CVI-ALL) and for the experiential experts only (I-CVI-EXPERIENTIAL) were calculated, respectively, and both were used to inform decisions about whether to retain, eliminate, or revise each item. RESULTS: There were 20 items where the I-CVI-ALL was >/=.80 and the I-CVI-EXPERIENTIAL was <.80. Each of these 20 items was evaluated critically. Some were retained (n = 3), some were eliminated (n = 7), and some were revised as suggested by the experts (n = 10). DISCUSSION: Using experiential content validity experts (adolescents and parents) and critically evaluating their recommendations regarding items can result in further elimination and revision of items beyond what is suggested by content validity assessment done by professional experts. The result may be a more thorough content validity assessment of the instrument, leading to an instrument with greater relevance for the target population.

Instrument translation process: a methods review.

BACKGROUND: Cross-cultural and international collaborative studies are needed in nursing research. Therefore, it is necessary to translate research instruments into the language of the culture being studied. In this methods review, different processes of instrument translation and evaluation of translation adequacy in published nursing research are described and classified into a hierarchy. METHODS: Studies including translation of quantitative research instruments were reviewed. Forty-seven studies were included. These were classified into six categories. RESULTS: Studies were classified into categories as follows: forward-only translation (2), forward-only translation with testing (7), back-translation (13), back-translation with monolingual test (18), back-translation with bilingual test (3), and back-translation with both monolingual and bilingual test (4). Strengths and weaknesses are analysed. CONCLUSION: The studies reviewed used diverse methods of varying quality. There is need for consensus among researchers in how to achieve quality of instrument translation in cross-cultural research. Researchers should carefully attend to achieving and reporting evidence of the accuracy and validity of instrument translation. When back-translation fails to achieve semantic equivalence, the instrument development process should be replicated in the target language.