Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study.

INTRODUCTION: The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization. METHODS: This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed. RESULTS: The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit. CONCLUSION: Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.

Hospital nurses' knowledge about older patients in Turkey: a validation and comparison study.

BACKGROUND: In Turkey, nursing care in hospitals has gradually included more older patients, resulting in a need for knowledgeable geriatric nurses. It is unknown, however, whether the nursing workforce is ready for this increase. Therefore, the aim of this study is to validate the Knowledge about Older Patients Quiz (KOPQ) in the Turkish language and culture, to describe Turkish hospital nurses' knowledge about older patients, and to compare levels of knowledge between Turkish and Dutch hospital nurses. METHOD: First, the KOPQ was translated, resulting in the KOPQ-TR. Then, content validity was assessed by 10 geriatric experts using the Lynn method, a pilot test among 10 nurses was conducted, and a Rasch analysis was performed using data from 135 nurses working in two Turkish hospitals. Finally, a comparison between Turkish and Dutch nurses' levels of knowledge was performed. RESULTS: The results of the qualitative validation (i.e., content validity by experts and nurses), model fit, item reliability and the item separation index of the KOPQ-TR proved excellent, indicating good content and construct validity. However, the Person Separation Index and Person Reliability of the Rash analysis did not meet the criteria for adequate scale and psychometric validation. The levels of knowledge among Turkish nurses were significantly lower than those of Dutch nurses. CONCLUSIONS: The KOPQ-TR is promising for use in Turkey, although psychometric validation should be repeated using a better targeted sample with a larger ability variance to adequately assess the Person Separation Index and Person Reliability. Currently, education regarding care for older patients is not sufficiently represented in Turkish nursing curricula. However, the need to do so is evident, as the results demonstrate that knowledge deficits and an increase in older patients admitted to the hospital will eventually occur. International comparison and cooperation provides an opportunity to learn from other countries that currently face the challenge of an aging (hospital) population.

Characteristics of surfers as bystander rescuers in Europe.

INTRODUCTION: Coastal locations contribute significantly to global drowning, with surfers frequently conducting rescues. This study explored the characteristics of surfers as bystander rescuers in Europe. METHODS: A cross-sectional online survey collected demographics (age, sex, geographical location), surfing experience, ability, lifesaving and cardiopulmonary resuscitation (CPR) training, information seeking behaviors and previous performance of a rescue. Analyses comprised descriptive frequencies, binomial logistic regression with adjusted odds ratio (AOR) (95% confidence interval [CI]) and chi-squares (p < .05). RESULTS: Europe-dwelling respondents totaled 1705 (76% male; 43% 25-34 years). Thirty-nine percent (39.2%; n = 668) had previously performed a rescue. Likelihood of having conducted a rescue significantly increased with 6 or more years of surfing experience (6-10 years [AOR = 1.96; 95%CI: 1.20-3.22]; 11-15 years [AOR = 3.26; 95%CI: 1.56-6.79]; 16 years or more [AOR = 4.27; 95%CI: 2.00-9.11]) when compared to surfers with <1 year experience. Expert/professional ability surfers were 10.89 times (95%CI: 4.72-25.15) more likely to have conducted a rescue than novice/beginners. Respondents who had received both a certified lifeguard and CPR course were significantly more likely to have conducted a rescue (AOR = 3.34; 95%CI: 2.43-4.60). CONCLUSION: Surfers who had previously conducted rescues commonly had more years of experience, higher self-rated surf ability and greater likelihood of having received certified training. However, not all surfers who have performed rescues had received training. Findings suggest surfers should receive rescue and CPR training before they start surfing at locations without trained supervision and refresh training regularly. Surfers are amenable to injury prevention information, especially online and via apps.

Minimizing the knowledge-to-action gap; identification of interventions to change nurses' behavior regarding fall prevention, a mixed method study.

BACKGROUND: The need for effective continuing education is especially high in in-hospital geriatric care, as older patients have a higher risk of complications, such as falls. It is important that nurses are able to prevent them. However, it remains unknown which interventions change the behavior of nurses. Therefore, the aim of this study is to identify intervention options to change the behavior of hospital nurses regarding fall prevention among older hospitalized patients. METHODS: This study used a mixed method design. The Behavior Change Wheel (BCW) was used to identify intervention functions and policy categories to change the behavior of nurses regarding fall prevention. This study followed the eight steps of the BCW and two methods of data collection were used: five focus groups and three Delphi rounds. The focus groups were held with hospital nurses (n = 26). Geriatric experts (n = 11), managers (n = 13) and educators (n = 13) were included in the Delphi rounds. All data were collected within ten tertiary teaching hospitals in the Netherlands. All participants were included based on predefined in- and exclusion criteria and availability. RESULTS: In Geriatric experts' opinions interventions targeting behavior change of nurses regarding fall prevention should aim at 'after-care', 'estimating fall risk' and 'providing information'. However, in nurses' opinions it should target; 'providing information', 'fall prevention' and 'multifactorial fall risk assessment'. Nurses experience a diversity of limitations relating to capability, opportunity and motivation to prevent fall incidents among older patients. Based on these limitations educational experts identified three intervention functions: Incentivisation, modelling and enablement. Managers selected the following policy categories; communication/marketing, regulation and environmental/social planning. CONCLUSIONS: The results of this study show there is a discrepancy in opinions of nurses, geriatric experts, managers and educators. Further insight in the role and collaboration of managers, educators and nurses is necessary for the development of education programs strengthening change at the workplace that enable excellence in nursing practice.

Hospital nurses' knowledge regarding older patients: a multicenter study.

BACKGROUND: Nursing care in hospitals increasingly involves older adults. A nursing workforce able to care for the ageing population is therefore critical for ensuring quality older adult care. Gaining insight in the knowledge and attitudes of nurses regarding older patients in the Netherlands is needed to develop and increase the impact of education- and quality improvement programs which can positively influence nurses' knowledge and attitudes regarding older patients. METHODS: A cross-sectional multicenter study was performed. Data was collected in ten tertiary medical teaching hospitals well spread across the Netherlands (89 wards, 2902 nurses). Knowledge levels were measured using the Knowledge about Older Patient-Quiz (KOP-Q), consisting of 30 true-false questions. Knowledge levels of registered nurses are compared with knowledge levels known from literature of first year nursing students; last year nursing students; nurses; and nurse specialist. Potential associated factors considered were: age; sex; education; experience; opinions and preferences. Opinion and preferences regarding working with older patients were measured by three questions: 1) which patient group nurses preferred to work with; 2) how nurses feel about the increase of older patients in the hospital; and 3) whether nurses find it difficult to care for older patients. RESULTS: From all wards, a representative sample of 1743 registered hospital nurses working on all 89 wards participated. On all wards, a large range in knowledge levels is observed between nurses, with 37% of nurses presenting knowledge levels comparable with nursing student and 31% of nurses presenting knowledge levels comparable with nurse specialists. Knowledge is related to age (p < .001), work experiences (p < .001), preparatory secondary education (p < .001) and nurses education level (p = .012). A minority (12.5%) prefers working with older patients and most nurses do not find it difficult. CONCLUSIONS: This study shows that there is a large diversity in knowledge levels of Dutch hospital nurses in every hospital, on every ward. A majority of nurses demonstrate negative opinions and preferences. This implies that older patients admitted can receive different levels of quality of care on the same day as nurses with different knowledge levels provide care during the various shifts. Findings demonstrate an urgent need for education programs with themes regarding essential care for older patients in the Netherlands.

Measurement of nurses' attitudes and knowledge regarding acute care older patients: Psychometrics of the OPACS-US combined with the KOP-Q.

In clinical practice, identifying positive and negative attitudes toward older patients is very important to improve quality of care provided to them. The Older People in Acute Care Survey - United States (OPACS-US) is an instrument measuring hospital nurses attitudes regarding older patients. However, psychometrics have never been assessed. Furthermore, knowledge being related to attitude and behavior should also be measured complementing the OPACS-US. The purpose of this study was to assess structural validity and reliability of the OPACS-US and assess whether the OPACS-US can be complemented with the Knowledge about Older Patients-Quiz (KOP-Q). A multicenter cross sectional design was conducted. Registered nurses (n = 130, mean age 39,9 years; working experience 14,6 years) working in four general hospitals were included in the study. Nurses completed the OPACS-US section A: practice experiences, B: general opinion and the KOP-Q online. Findings demonstrated that the OPACS-US is a valid and reliable survey instrument that measures practice experiences and general opinion. Furthermore, the OPACS-US can be combined with the KOP-Q adding a knowledge construct, and is ready for use within education and/or quality improvement programs in the USA.

A multi-year quantitative study of the experienced age-friendliness in The Hague: A tale of four personas.

As an active member of the Global Network for Age-Friendly Cities and Communities, The Hague has been monitoring the progress over the years. In 2022, a second cross-sectional survey based on the Age Friendly Cities and Communities Questionnaire (AFCCQ) was conducted among 396 community-dwelling older citizens in the municipality. During times of the pandemic, scores for Social Participation went notably down, and scores for Respect and Social Inclusion increased. For the first time, based on survey data, four personas were found through cluster analysis. These personas ranged from the precariat and people with personal health issues with lower scores, to the silent majority without the limitations of health problems, and the upper echelon who score positively in all domains. Age-friendly policies in The Hague should focus particularly on the first two clusters through dedicated action plans, which would help steer efforts towards those most in need for support. This would help The Hague to become an age-friendly city for all, and not only for those living in good health and with sufficient financial means.

How older adults experience the age-friendliness of Skopje: Results of the validation of the AFCCQ for use in North Macedonia and a representative survey.

Hundreds of cities and communities in the world have joined the WHO's Global Network for Age-Friendly Cities and Communities since 2010. In order to do quantitative assessments of the age-friendliness of cities, the Age-Friendly Cities and Communities Questionnaire (AFCCQ) was developed for the Dutch municipality of The Hague. The purpose of this study was first to translate and test the validity and reliability of the AFCCQ for use in North Macedonia and second to explore perceptions on age-friendliness of the bicultural and bilingual City of Skopje. The AFCCQ proved valid for use in North Macedonia. Overall, older adults in Skopje experience the age-friendliness of the city as neutral (in seven out of nine domains). The best score ("slightly satisfied") was found in the domain of Housing domain, which was rated positive in all ten municipalities. The lowest total score ("slightly dissatisfied") was found in the domain of Outdoor spaces and buildings scoring, which received negative scores in eight out ten municipalities. In five out of nine domains differences were observed between the Albanian and Macedonian communities. The Albanian sample has slightly higher scores in two domains: 1) Housing and 2) Civic Participation and Employment, while the Macedonian sample scored higher in three domains: 1) Communication and Information; 2) Outdoor Spaces and Buildings and 3) Transportation. A hierarchical cluster analysis further revealed the presence of six distinct age-friendly typologies that can be used for a better understanding of subpopulations in the city and draft policies and action programs on the city level.

Development of a microlearning intervention regarding nursing nutritional care for older adults: A multi-methods study.

BACKGROUND: Nutritional care for older adults provided by hospital and home care nurses and nursing assistants is suboptimal. This is due to several factors including professionals' lack of knowledge and low prioritisation. Affecting these factors may promote nurses' and nursing assistants' behavioral change and eventually improve nutritional care. To increase the likelihood of successfully targeting these factors, an evidence-based educational intervention is needed. OBJECTIVES: To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults. In this paper, we describe the intervention development process. DESIGN: A multi-methods approach using literature and expert input. SETTINGS: Hospital and home care. PARTICIPANTS: Older adults, nurses, nursing assistants, experts, and other professionals involved in nutritional care. METHODS: The educational intervention was based on five principles: 1) interaction between intervention and users, 2) targeting users on both individual and team level, 3) supporting direct and easy transfer to the workplace, and continuous learning, 4) facilitating learning within an appropriate period, and 5) fitting with the context. Consistent with these principles, the research team focussed on developing a microlearning intervention and they established consensus on seven features of the intervention: content, provider, mode of delivery, setting, recipient, intensity, and duration. RESULTS: The intervention consisted of 30 statements about nursing nutritional care for older adults, which nurses and nursing assistants were asked to confirm or reject, followed by corresponding explanations. These can be presented in a snack-sized way, this means one statement per day, five times a week over a period of six weeks through an online platform. CONCLUSIONS: Based on a well-founded and comprehensive procedure, the microlearning intervention was developed. This intervention has the potential to contribute to nursing nutritional care for older adults.

The Impact of Community Learning During a Participatory Nursing Research Project.

BACKGROUND: Community learning is one approach to promote research competencies and to involve nurses and nursing students in research. This study examines the impact of community learning according to participants-both those inside and outside the community-in a joint nursing research project at a hospital. METHOD: A qualitative design was selected using a participatory approach. Data were collected through semistructured interviews, reflections, conversations, and patient input during 2 academic years. RESULTS: Thematic analysis showed 11 themes, which were organized into three clusters: realization, transformation, and influencing factors. Participants perceived changes in practice and described how their perspectives have changed on care, education, and research. Reconsiderations led to some new or revised strategies, and influencing factors were associated with the contemporary context, degree of involvement, and design/facilitation. CONCLUSION: The impact of community learning emerged and extended beyond community boundaries, and the indicated influencing factors must be taken into account. [J Contin Educ Nurs. 2023;54(3):131-144.].

Factors that influence continuing professional development over a nursing career: A scoping review.

AIMS: Systematically synthesize research about factors that influence CPD over a nursing career. BACKGROUND: Continuing professional development (CPD) in nursing is defined as 'a life-long process of active participation in learning activities that assist in developing and maintaining continuing competences, enhancing professional practice and supporting achievement of career goals'. Research has shown that inability to access resources and activities for CPD influences quality of care and adversely affects nurses' satisfaction, recruitment and retention. Although more and more research regarding CPD is done, a comprehensive overview about the needs of nurses for successful CPD is missing. DESIGN: Scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews ensuring all quality standards are met. METHODS: Between February and April 2020 the electronic databases CINAHL, PubMed, Scopus, Psychinfo and Eric were searched as well as reference lists of included papers. Papers published in peer-reviewed journals were included without restrictions on publication date, design or setting. Thematic analysis was done to synthesize the data. RESULTS: The search yielded 2673 papers of which 60 papers were included. Analyses showed that factors that influence CPD differ over a nursing career, which led to the identification of three groups: newly graduated nurses; experienced nurses; and experienced nurses with ambitions for advanced roles. Furthermore, analyses showed that factors for all three groups are related to personal and contextual facilitators and barriers. Newly graduated nurses find it important to be an accepted member of the team. They experience barriers when integrating into the nursing profession, where they for instance experience workplace incivility. Experienced nurses experience contextual barriers related to a lack of supportive structures and inaccessibility of CPD resources. There is limited time and availability of role models and a lack of support from managers and other colleagues. Moreover, the clinical care dynamics influence their ability to pursue CPD. For the experienced nurses with ambitions for advanced roles, an important barrier is that nursing culture emphasizes direct patient care. Often it is unclear what the value is of new nursing roles which makes it difficult for them to develop these. CONCLUSIONS: All nurses strive for CPD. However, organizations need to recognize nurses' personal goals and unique strategies as this leads to different needs in CPD. In addition, resources must be made available and accessible before CPD can be successfully pursued by all nurses.

Towards a Better Understanding of the Sense of Safety and Security of Community-Dwelling Older Adults. The Case of the Age-Friendly City of The Hague.

The sense of safety and security of older people is a widely acknowledged action domain for policy and practice in age-friendly cities. Despite an extensive body of knowledge on the matter, the theory is fragmented, and a classification is lacking. Therefore, this study investigated how older people experience the sense of safety and security in an age-friendly city. A total of four focus group sessions were organised in The Hague comprising 38 older people. Based on the outcomes of the sessions, the sense of safety and security was classified into two main domains: a sense of safety and security impacted by intentional acts and negligence (for instance, burglary and violence), and a sense of safety and security impacted by non-intentional acts (for instance, incidents, making mistakes online). Both domains manifest into three separate contexts, namely the home environment, the outdoor environment and traffic and the digital environment. In the discussions with older people on these derived domains, ideas for potential improvements and priorities were also explored, which included access to information on what older people can do themselves to improve their sense of safety and security, the enforcement of rules, and continuous efforts to develop digital skills to improve safety online.

Implementation of an interprofessional collaboration in practice program: a feasibility study using social network analysis.

BACKGROUND: Due to multimorbidity and geriatric problems, older people often require both psychosocial and medical care. Collaboration between medical and social professionals is a prerequisite to deliver high-quality care for community-living older people. Effective, safe, and person-centered care relies on skilled interprofessional collaboration and practice. Little is known about interprofessional education to increase interprofessional collaboration in practice (IPCP) in the context of community care for older people. This study examines the feasibility of the implementation of an IPCP program in three community districts and determines its potential to increase interprofessional collaboration between primary healthcare professionals caring for older people. METHOD: A feasibility study was conducted to determine the acceptability and feasibility of data collection and analysis regarding interprofessional collaboration in network development. A questionnaire was used to measure the learning experience and the acquisition of knowledge and skills regarding the program. Network development was assessed by distributing a social network survey among professionals attending the program as well as professionals not attending the program at baseline and 5.5 months after. Network development was determined by calculating the number, reciprocity, value, and diversity of contacts between professionals using social network analysis. RESULTS: The IPCP program was found to be instructive and the knowledge and skills gained were applicable in practice. Social network analysis was feasible to conduct and revealed a spill-over effect regarding network development. Program participants, as well as non-program participants, had larger, more reciprocal, and more diverse interprofessional networks than they did before the program. CONCLUSIONS: This study showed the feasibility of implementing an IPCP program in terms of acceptability, feasibility of data collection, and social network analysis to measure network development, and indicated potential to increase interprofessional collaboration between primary healthcare professionals. Both program participants and non-program participants developed a larger, more collaborative, and diverse interprofessional network.

The Participation of Older People in the Concept and Design Phases of Housing in The Netherlands: A Theoretical Overview.

In the Netherlands, there is a growing need for collective housing for older people to bridge the gap between ageing-in-place and institutional care facilities. Participation of older people in the concept and design phases is important to tune the market supply to the needs of (future) residents, yet social entrepreneurs find it challenging to involve older people. This commentary explores various ways older people can participate in the development of new housing initiatives. The ladder of citizen participation is applied to explore different roles that (future) residents could play with levels of influence varying from non-participation to citizen power. Considerations for meaningful participation are discussed, in order to show how collaborations can be formed between (future) residents and decision makers.

Value of social network analysis for developing and evaluating complex healthcare interventions: a scoping review.

OBJECTIVES: Most complex healthcare interventions target a network of healthcare professionals. Social network analysis (SNA) is a powerful technique to study how social relationships within a network are established and evolve. We identified in which phases of complex healthcare intervention research SNA is used and the value of SNA for developing and evaluating complex healthcare interventions. METHODS: A scoping review was conducted using the Arksey and O'Malley methodological framework. We included complex healthcare intervention studies using SNA to identify the study characteristics, level of complexity of the healthcare interventions, reported strengths and limitations, and reported implications of SNA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews 2018 was used to guide the reporting. RESULTS: Among 2466 identified studies, 40 studies were selected for analysis. At first, the results showed that SNA seems underused in evaluating complex intervention research. Second, SNA was not used in the development phase of the included studies. Third, the reported implications in the evaluation and implementation phase reflect the value of SNA in addressing the implementation and population complexity. Fourth, pathway complexity and contextual complexity of the included interventions were unclear or unable to access. Fifth, the use of a mixed methods approach was reported as a strength, as the combination and integration of a quantitative and qualitative method clearly establishes the results. CONCLUSION: SNA is a widely applicable method that can be used in different phases of complex intervention research. SNA can be of value to disentangle and address the level of complexity of complex healthcare interventions. Furthermore, the routine use of SNA within a mixed method approach could yield actionable insights that would be useful in the transactional context of complex interventions.

How Older People Experience the Age-Friendliness of Their City: Development of the Age-Friendly Cities and Communities Questionnaire.

The World Health Organization engages cities and communities all over the world in becoming age-friendly. There is a need for assessing the age-friendliness of cities and communities by means of a transparently constructed and validated tool which measures the construct as a whole. The aim of this study was to develop a questionnaire measuring age-friendliness, providing full transparency and reproducibility. The development and validation of the Age Friendly Cities and Communities Questionnaire (AFCCQ) followed the criteria of the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN). Four phases were followed: (1) development of the conceptual model, themes and items; (2) initial (qualitative) validation; (3) psychometric validation, and (4) translating the instrument using the forward-backward translation method. This rigorous process of development and validation resulted in a valid, psychometrically sound, comprehensive 23-item questionnaire. This questionnaire can be used to measure older people's experiences regarding the eight domains of the WHO Age-Friendly Cities model, and an additional financial domain. The AFCCQ allows practitioners and researchers to capture the age-friendliness of a city or community in a numerical fashion, which helps monitor the age-friendliness and the potential impact of policies or social programmes. The AFCCQ was created in Dutch and translated into British-English.

Comparisons of Knowledge of Dutch Nursing Students and Hospital Nurses on Aging.

BACKGROUND: Although there is a growing population of older adults admitted to hospitals, the literature demonstrates knowledge deficits of nurses regarding older patients. This study investigated knowledge levels of both nursing students and RNs about older hospitalized patients in relation to their educational level and work experience. METHOD: First- and final-year vocational and bachelor nursing students, and associate degree and bachelor degree nurses working in the hospital setting with 0 to 5 years, 6 to 15 years, and more than 15 years of experience, have completed the Knowledge about Older Patients-Quiz (KOP-Q). The KOP-Q has a clearly described theoretical base finding its origin in knowledge regarding nursing care for older patients and shows good content and construct validity. RESULTS: A substantial proportion of participants in all groups demonstrated insufficient knowledge about older patients. A difference in knowledge exists among nurses with different educational qualifications, and a link between years of experience and higher knowledge levels of nurses is found. CONCLUSION: Throughout the nursing career, basic care topics in relation to care for older patients should play a key role in basic nursing education programs, as well as for continuing education programs provided in hospitals for nurses. J Contin Educ Nurs. 2018;49(2):84-90.

The Knowledge-about-Older-Patients - Quiz (KOP-Q) for nurses: Cross-cultural validation between the Netherlands and United States of America.

BACKGROUND: The Knowledge about Older Patients-Quiz (KOP-Q) is designed as a unidimensional scale measuring knowledge of hospital nurses about older patients. Furthermore, the KOP-Q measures a second unidimensional construct, certainty of hospital nurses about their knowledge. The KOP-Q is developed and validated in the Netherlands. Whether the KOP-Q can be used in other countries is unknown given the cultural and language differences. OBJECTIVES: Investigate the level of measurement invariance of the KOP-Q between the Netherlands and United States of America (USA). DESIGN: A multicenter international cross-sectional design. SETTINGS: Four general hospitals in the Netherlands and four general hospitals in the USA. PARTICIPANTS: Nurses from the Netherlands (n=201) and the USA (n=130) were invited to participate by email from the ward manager, distributing flyers and present messages on the online hospital communication boards. Questions of the KOP-Q were completed online. METHOD: The level of measurement invariance (configural, metric or scalar invariance) across countries was tested by running increasingly constrained structural equation models, and testing whether these models fitted the data. RESULTS: Both the knowledge and certainty construct of the KOP-Q proved unidimensional in the Netherlands and USA sample. Test results of the measurement invariance across the Netherlands and USA indicated a stable, partial scalar invariance (15 items full scalar invariance) for the knowledge items and full scalar invariance for the certainty items. CONCLUSIONS: The KOP-Q shows to function uniformly across both language groups and can therefore be used to assess nurses' knowledge and their certainty about this knowledge which can be important for educational and/or quality improvement programs in the USA. Furthermore, the KOP-Q is suitable to make comparisons between the Netherlands and the USA using latent variable models. Before the KOP-Q can be used in other countries, cross-cultural tests should again be performed.

Content Validity and Psychometric Characteristics of the "Knowledge about Older Patients Quiz" for Nurses Using Item Response Theory.

OBJECTIVES: To assess the content validity and psychometric characteristics of the Knowledge about Older Patients Quiz (KOP-Q), which measures nurses' knowledge regarding older hospitalized adults and their certainty regarding this knowledge. DESIGN: Cross-sectional. SETTING: Content validity: general hospitals. Psychometric characteristics: nursing school and general hospitals in the Netherlands. PARTICIPANTS: Content validity: 12 nurse specialists in geriatrics. Psychometric characteristics: 107 first-year and 78 final-year bachelor of nursing students, 148 registered nurses, and 20 nurse specialists in geriatrics. MEASUREMENTS: Content validity: The nurse specialists rated each item of the initial KOP-Q (52 items) on relevance. Ratings were used to calculate Item-Content Validity Index and average Scale-Content Validity Index (S-CVI/ave) scores. Items with insufficient content validity were removed. Psychometric characteristics: Ratings of students, nurses, and nurse specialists were used to test for different item functioning (DIF) and unidimensionality before item characteristics (discrimination and difficulty) were examined using Item Response Theory. Finally, norm references were calculated and nomological validity was assessed. RESULTS: Content validity: Forty-three items remained after assessing content validity (S-CVI/ave = 0.90). Psychometric characteristics: Of the 43 items, two demonstrating ceiling effects and 11 distorting ability estimates (DIF) were subsequently excluded. Item characteristics were assessed for the remaining 30 items, all of which demonstrated good discrimination and difficulty parameters. Knowledge was positively correlated with certainty about this knowledge. CONCLUSION: The final 30-item KOP-Q is a valid, psychometrically sound, comprehensive instrument that can be used to assess the knowledge of nursing students, hospital nurses, and nurse specialists in geriatrics regarding older hospitalized adults. It can identify knowledge and certainty deficits for research purposes or serve as a tool in educational or quality improvement programs.