Trust in Nurses Scale: validation of the core elements.

BACKGROUND: The Trust in Nurses Scale (TNS) was developed and psychometrically assessed so that patients' trust could be accurately and reliably measured. The TNS has been translated, assessed and administered to patients in Europe, Asia and North America. AIM: This descriptive, cross-sectional, correlational study aimed to assess the psychometric characteristics of the Italian version of the Trust in Nurses Scale. METHODS: An Italian version of the TNS was developed. We used a forward-backward translation methodology to establish semantic and conceptual equivalence within the Italian context. The scale was then administered to a convenience sample of 200 hospitalised patients in medical, surgical or oncology units. Internal consistency and construct validity were assessed performing Cronbach's alpha and confirmatory factor analysis (CFA). Both a 4-item and a 5-item TNS were assessed. RESULTS: The 4-item TNS demonstrated better construct validity than the 5-item version. Similarly, the internal consistency reliability was better with 4 items than 5 (0.83 and 0.79, respectively). CONCLUSION: The Italian version of the scale has acceptable reliability and validity and may be used to assess this aspect of the nurse-patient relationship. Being tested in different settings, it may be used with all patients admitted to hospital. Trust in nurses is critically important to patient outcomes; however, it is rarely measured quantitatively on a wide scale. The use of the Italian validated scale could be useful to increase evidences on this important topic, as it represents a core component of nursing care.

How Resiliency and Hope Can Predict Stress of Covid-19 by Mediating Role of Spiritual Well-being Based on Machine Learning.

Nowadays, artificial intelligence (AI) and machine learning (ML) are playing a tremendous role in all aspects of human life and they have the remarkable potential to solve many problems that classic sciences are unable to solve appropriately. Neuroscience and especially psychiatry is one of the most important fields that can use the potential of AI and ML. This study aims to develop an ML-based model to detect the relationship between resiliency and hope with the stress of COVID-19 by mediating the role of spiritual well-being. An online survey is conducted to assess the psychological responses of Iranian people during the Covid-19 outbreak in the period between March 15 and May 20, 2020, in Iran. The Iranian public was encouraged to take part in an online survey promoted by Internet ads, e-mails, forums, social networks, and short message service (SMS) programs. As a whole, 755 people participated in this study. Sociodemographic characteristics of the participants, The Resilience Scale, The Adult Hope Scale, Paloutzian & Ellison's Spiritual Wellbeing Scale, and Stress of Covid-19 Scale were used to gather data. The findings showed that spiritual well-being itself cannot predict stress of Covid-19 alone, and in fact, someone who has high spiritual well-being does not necessarily have a small amount of stress, and this variable, along with hope and resiliency, can be a good predictor of stress. Our extensive research indicated that traditional analytical and statistical methods are unable to correctly predict related Covid-19 outbreak factors, especially stress when benchmarked with our proposed ML-based model which can accurately capture the nonlinear relationships between the collected data variables.

Patient-Centered Care in Primary Care Scale: Pilot Development and Psychometric Assessment.

BACKGROUND: Nurse contributions to patient-centered care in primary care clinics are all but ignored in standard patient experience surveys. PURPOSE: The purpose was to conduct a pilot study to develop and psychometrically assess a scale measuring nurses' and other providers' patient-centered care in Veteran Affairs primary care clinics. METHOD: We developed a patient experience survey composed of original items and previous studies' items and scales. The survey was field tested online with patients who had a recent clinic appointment. The nonrandom analytic sample comprised 221 patients. RESULTS: Exploratory factor analyses yielded a 36-item, 4-factor solution explaining 76% of the variance. The factors were: (1) Provider Knowing the Person/Individualizing Care (18 items; α = 0.98); (2) Nurse Knowing the Person (8; 0.95); (3) Nurse Individualizing Care (7; 0.94); and (4) Continuity of Care (3; not calculated). A short form with 23 items was created using stepwise regression. It had the same 4 factors as the long form with 76% of the variance explained. CONCLUSIONS: Patients reported distinctive nurse contributions that have not been routinely measured.

An Expanded Theoretical Framework of Care Coordination Across Transitions in Care Settings.

For many patients, high-quality, patient-centered, and cost-effective health care requires coordination among multiple clinicians and settings. Ensuring optimal care coordination requires a clear understanding of how clinician activities and continuity during transitions affect patient-centeredness and quality outcomes. This article describes an expanded theoretical framework to better understand care coordination. The framework provides clear articulation of concepts. Examples are provided of ways to measure the concepts.

Validation of Persian Version of Mindful Attention Awareness Scale (MAAS) in Iranian Women with Breast Cancer.

BACKGROUND: Breast cancer is now the most significant health issue in women, threatening diverse aspects of human health, including mental health and cognitive function. This research aimed to validate the Persian version of Mindful Attention Awareness Scale (MAAS) in Iranian women with breast cancer. METHODS: We gathered data on 229 women with breast cancer in Tehran through convenience sampling. They completed a demographic questionnaire, the Persian version of MAAS, the General Self-Efficacy Scale, and DASS-21. SPSS-22 analyzed the Pearson correlation between the Persian version of MAAS, general self-efficacy, and DASS-21. Also, LISREL 8.8 was used to analyze the internal structure of the MAAS. RESULTS: Findings from the confirmatory factor analysis (CFA) showed that the model with one factor fits well with the data (sbχ2=4.29 (P=0.36); SRMR=0.058; CFI=1.0; NFI=0.91; IFI=0.95; RFI=0.97; GFI=0.90; RMSEA=0.069). Significant negative correlations were found between MAAS and DASS-21 scores for anxiety (r=-0.51), depression (r=-0.48) and stress (r=-0.49), indicating an acceptable divergent validity. There was also a positive relationship between MAAS and general self-efficacy (r=0.37; P<0.01). CONCLUSION: The Persian version of MAAS seems to be a valid scale for evaluating the extent of mindfulness of Iranian women with breast cancer.

Effects of a patient/family-centered practice change on the quality and cost of intensive care: research protocol.

AIM: This paper is a description of a protocol for studying the impact of a patient/family-centered, evidence-based practice change on the quality, cost and use of services for critically ill patients at the end of life. BACKGROUND: International attention currently is focused on the quality and cost/use of intensive care services. Empirical literature and expert opinion suggest that early, enhanced communication among the clinical team and the patient and family results in higher quality and less costly care at the end of life. DESIGN: Our Medical Intensive Care Unit practice change involves three components: teaching sessions for all Registered Nurses and physicians assigned to the unit; patient/family meetings held in 72 hours of the patient's admission to the unit; and formal documentation to support communication among clinicians. Ethical approval was obtained in April 2009. A two-group post-test design is used, with one group comprising patients hospitalized before the practice change and their families, and the second group of patients/families after the practice change. Data comprise medical record information and families' responses to surveys. Final analytic models will result from multivariable regression techniques. DISCUSSION: The study represents translational research in that interventions are brought to the bedside to reach the people for whom the interventions were designed. The practice change is likely to endure after the study because our research team is composed of both clinicians and scientists. Also, direct care clinicians endorse and are responsible for the practice change.

Trust in Nurses Scale: construct validity and internal reliability evaluation.

AIM: This paper is a report of the continued psychometric evaluation of the Trust in Nurses Scale. BACKGROUND: Qualitative analyses indicate that trust in nurses is critically important to adult patients. Instruments that distinctively measure this concept are lacking. A middle-range theory of patient-centred nursing care provided the theoretical basis for the Trust in Nurses Scale. Content validity was assessed by an expert panel and patient interviews. Construct validity and reliability were found acceptable using multi-trait/multi-item analysis techniques. These findings were previously reported. METHODS: Construct validity and reliability of the Trust in Nurses Scale was assessed in 2007 using data collected during 2004-2005 from 187 hospitalized patients in a haematology-oncology setting. Trust in nurses (the latent factor) was operationalized by five items (manifest variables) using confirmatory factor analyses. Fit statistics included comparative fit index, Tucker-Lewis Index, root mean square error of approximation and the standardized root mean square residual. Internal consistency reliability was assessed using coefficient alpha. FINDINGS: Both a five-item and a four-item version demonstrate acceptable psychometric properties. The five-item version met three fit statistics criteria. Fifty-nine per cent of the variance was explained. A four-item version met all fit statistics criteria. Sixty-six per cent of the variance was explained. Acceptable internal consistency reliability was found for both versions. CONCLUSION: Previous psychometric testing of the Trust in Nurses Scale provided evidence of the instrument's reliability, content validity and construct validity. The presented analyses further support construct validity. Thus, cumulative findings indicate that the instrument measures with a few items the underlying concept of trust.

A protocol for capturing daily variability in nursing care.

To meet current and future patient safety and quality requirements, traditional analyses based on data aggregated to the hospital or unit level over months or years may need to change. Nine customized databases were developed, five with patient data (e.g., age, illness severity, perceptions of nursing care quality, desired health outcomes) and four with nurse data (e.g., education, experience). These were merged to create a Patient-Nurse database. Nurse managers, clinicians, and researchers could use the protocol to conduct a more robust analysis of the relationships between nursing system characteristics and patient care processes and outcomes. The protocol described here could be used by nurse managers, clinicians, and researchers to better understand temporal phenomena and patient level data. Through information derived from applying this protocol, staffing decisions can be made to assure the right mix of nurses is available, not just the right number.

Factors Associated With Patient Ratings of Timeliness of Primary Care Appointments.

As access is the lowest rated dimension in surveys of outpatient experience, we sought to identify patient, practice, and provider factors associated with positive ratings of timeliness of primary care appointments. A cross-sectional study with multivariable, multilevel logistic regression was performed using survey responses from 236 695 individuals receiving care in the Veterans Health Administration (VA). Top box ratings (response of "always") for whether the patient reported receiving an appointment as soon as they needed in primary care for routine care and for care needed right away were the main outcomes. Independent variables capturing patient, practice, and provider factors were obtained from survey responses and VA databases. Degree of continuity with primary care provider and duration of relationship were strongly associated with higher ratings. Shorter primary care appointment wait times for both new and returning patients were associated with higher ratings. Independent wait times for mental health and specialty appointments had no effect. Older age, better self-reported physical and mental health, lower disease complexity, and rural residence were patient factors associated with higher ratings while gender, race, ethnicity, and education had little effect. Measures of continuity with primary care provider as well as appointment wait times have strong association with positive patient ratings of appointment timeliness. Patients treated in Veterans Affairs clinics may value continuity with their primary care provider over longer times. Initiatives to improve access could focus on improving continuity and ensuring efforts to improve access do not impact continuity.

Relationships between patient-centered cancer nursing interventions and desired health outcomes in the context of the health care system.

A non-experimental longitudinal prospective study was conducted to examine the relationships between patient-centered nursing interventions (PCNIs), system characteristics, patient characteristics, and desired health outcomes (DHOs) for 173 hematology-oncology patients. Forty-nine nurse participants provided system characteristics data. Confirmatory factor analyses yielded parsimonious scales to operationalize the variables. In the path model, one PCNI-individualization-was positively related to three subsequent DHOs: authentic self-representation, optimism, and sense of well-being. Two additional PCNIs-responsiveness and proficiency-were positively related to subsequent trust in nurses. PCNIs did not vary with patient race, ethnicity, age, gender, or educational level. Patient-centeredness of care for cancer patients may be enhanced by quality improvement activities that measure and monitor these PCNIs and resultant outcomes.

A scale to measure nurses' and providers' patient centered care in primary care settings.

OBJECTIVES: 1) Refine pilot scale measuring patients' experiences of outpatient nurses' and providers' care; 2) Determine variance explained by (a) pilot scale items and (b) "Survey of Health Experiences of Patients" (SHEP)/"Consumer Assessment of Health Care Providers and Systems" (CAHPS) scale items. METHODS: Randomly selected Veteran patients with recent visits with primary care outpatient nurses and providers (n = 1192) completed scales: pilot "PCC in Primary Care: Nurses and Providers Scale" and SHEP/CAHPS scale items. Factor analyses conducted using structural equation modeling (SEM), variance measurement using regression strategies. RESULTS: SEM generated scale comprised 17 items in 3 factors; 2 operationalized nurses' care; 1 providers' care. Fit statistics were acceptable. Variance explained for total PCC: nurses = 42%, providers = 56%. Combined pilot and SHEP/CAHPS item analyses yielded similarly structured scale. 70% of provider care variance explained by single item. CONCLUSION: Appraisal of team, value-based care requires accrediting care to the appropriate clinician. The "PCC in Primary Care: Nurses and Providers Scale (PC2:NaPS)" provides a psychometrically sound measure for this purpose. PRACTICE IMPLICATIONS: PC2:NaPS use would improve primary care leaders' and clinicians' analyses of patient centered care and associated outcomes in their settings, and thus enhance success of quality improvement and organizational projects.

Effects of race and language on patient-centered cancer nursing care and patient outcomes.

Nursing prides itself on the ability to advocate for patients. However, questions are raised in the National Health Care Disparities Reports from the Agency for Healthcare Research and Quality about how well nurses communicate with African Americans, Hispanics, and people who speak languages other than English. Our secondary analysis of patient data collected at an urban safety-net hospital oncology unit examined the relationships among race, language, patient-centered nursing care, and patient outcomes. Using path modeling techniques, findings indicate that patient-centered care and associated outcomes for African American/Black and Others differ from those for Whites. For the African American/Black and Others group, individualization played a more significant role in achieving a sense of well-being, optimism, and authentic self-representation. Patients who spoke a language other than English at home had different perceptions of their nurses' responsiveness; nurses' responsiveness in turn affected patients' trust in nurses. Future testing is recommended for relationships between patient-centered nursing care and patient outcomes in underserved populations.

Cancer patients' descriptions of their nursing care.

AIM: This paper reports a study of cancer patients' descriptions of nurses and nursing care. BACKGROUND: Nurses lament their poor representation in the media, and campaigns to improve their portrayal have been initiated. Media portrayal of nurses might be more realistic if patients' descriptions of nursing care were incorporated. METHOD: Qualitative data from an instrument development study were analysed. A total of 461 patients answered the question, 'In general, how do you feel about nurses?' The data were analysed by the constant comparative method and grounded theory coding techniques. FINDINGS: A typology of four concepts reflecting cancer patients' descriptions of their nursing care emerged from the data. The concepts were: laudable, caring, professional and outcomes. The concept laudable refers to commendable qualities of the nurse and nursing care. Caring refers to the nurse showing compassion, concern and kindness. Professional refers to the nurse as meeting expected standards of knowledge, skill and demeanour. Outcomes refer to the affective, cognitive, or physical effects attributed to nursing care. Both positive and negative instances of the concepts were included in the analysis. Examples of each concept using patients' own words are given. CONCLUSIONS: These cancer patients held nurses in relatively high esteem. These findings could be disseminated to the public press as an example of what patients' value about nurses and nursing care. They also could be used in media efforts to recruit and retain nurses.

Development and pilot testing of four desired health outcomes scales.

PURPOSE/OBJECTIVES: To develop and pilot test scales to measure desired health outcomes hypothesized to result from high-quality cancer nursing care: Fortitude Scale, Trust in Nurses Scale, Cancer Patient Optimism Scale, and Authentic Self-Representation Scale. DESIGN: Instrument development. SETTING: Community cancer support organization. SAMPLE: 66 recently treated patients with cancer who attended a cancer support organization workshop. The sample was predominately white, middle-aged, well-educated females. METHODS: Items for each scale were generated from qualitative data and the literature. The scales properties were evaluated using expert panel assessment of content validity, cognitive interviews of patients with cancer, and reliability and validity testing of each scale with the Multitrait/Multi-Item Analysis Program Revised (MAP-R) statistical program. FINDINGS: Participant responses to the four scales did not include the lowest possible score. Responses yielded evidence of adequate Cronbachs alpha internal consistency reliability for each scale: 0.81 for the Fortitude Scale; 0.81 for Trust in Nurses Scale, 0.75 for Cancer Patient Optimism Scale, and 0.71 for Authentic Self-Representation Scale. The MAP-R statistics yielded evidence of acceptable convergent validity and discriminant validity. CONCLUSIONS: The data provided preliminary evidence of acceptable psychometric properties for four scales designed to measure desired outcomes of cancer nursing care. Support was found for careful use of scales. Further psychometric testing with large samples is recommended. IMPLICATIONS FOR NURSING: These scales represent an initial effort toward providing measures of the desired health outcomes that patients with cancer attributed to high-quality cancer nursing care.

Cancer patients' demographic characteristics and ratings of patient-centered nursing care.

PURPOSE: To examine relationships between patients' demographic characteristics and patients' reports of patient-centered care. DESIGN: Secondary analysis of data (N = 423) from a study in the northeastern United States focused on the psychometric properties of the Oncology Patients' Perceptions of the Quality of Nursing Care Scale (OPPQNCS). METHODS: The quality of four interpersonal nursing interventions, representing patient-centered nursing care, was measured with the OPPQNCS subscales. Patients' characteristics included race (White or non-White), sex, age, education, income, and hospitalization for cancer. Four separate ordinary least squares regression models were constructed. FINDINGS: Hospitalization was inversely related to intervention quality in each model. Income was the only statistically significant characteristic for nonhospitalized patients, and only in the coordination model. For hospitalized patients, education was statistically significant in the coordination model, and income in the proficiency model. An interaction term for education and income was statistically significant in the responsiveness model, and a term for gender and education in the individualization model. CONCLUSIONS: Hospitalized patients' exposure to nursing care may indicate a wider range of care quality than for nonhospitalized patients, possibly accounting for the inverse relationship between hospitalization and patient-centered care. Groups identified at risk for lower quality care--minorities, women, elders, and people in low-income groups--did not report a lower level of patient-centered nursing care. Nurses' contributions to patient-centered care and care equity are important components of care quality, particularly for hospitalized cancer patients.