Development and testing of the Hogan Inventory of Bereavement short form for children and adolescents.

To reduce response burden for bereaved children and adolescents, we provide data on the development and psychometric testing of a short form of the Hogan Sibling Inventory of Bereavement (HSIB). The resulting measure of grief symptoms and personal growth was renamed the Hogan Inventory of Bereavement - Short Form (Children and Adolescents; HIB-SF-CA). Psychometric properties were evaluated in a sample of 86 bereaved siblings. Instrument development and validation research design methods were used. Evidence of strong reliability and convergent validity indicates that the 21-item HIB-SF-CA is comparable to the original 46-item HSIB in measuring grief and personal growth in this population.

A Rasch Rating Scale Analysis of the Presence of Nursing Scale-RN.

The phenomenon of nursing presence encompasses the emotional connection between nurse and patient, and technical skills performed by the nurse. The Presence of Nursing Scale-RN version (PONS-RN) was developed to measure nurses' perceptions of their ability to be present to their patients. This study summarizes the process of re-evaluation of the psychometric properties of the PONS-RN instrument. A sample of 76 registered nurses providing direct patient care responded to the 31-item questionnaire. The Rasch rating scale model was used for assessing construct validity of PONS-RN data. A principal component analysis (PCA) of residuals supported appropriateness of the subscales defined by a 2-dimensional structure. The results of item and person fit analysis, rating scale functioning analysis and reliability analysis have demonstrated that the thirty-one item Presence of Nursing Scale-RN instrument yielded measures with high validity and reliability as two sub-scales.

Making meaning in the legacy of tissue donation for donor families.

CONTEXT-Individuals needing lifesaving (heart valves, skin grafts for repair of critical burn injuries) and life-enhancing (corneas, bone and tendon grafts, skin, and veins) tissue donations outnumber the tissues available for transplant. OBJECTIVE-To describe the grief family members experienced 6 months after donation and to learn how family decision makers gained meaning from the decision to donate a loved one's tissues. This is phase 1 of a longitudinal study in which family decision makers will be surveyed again at 13 and 25 months after donation. DESIGN-Qualitative descriptive.Participants-One hundred seven family decision makers whose family member died a traumatic sudden death and who authorized donating tissues for transplant. DATA COLLECTION AND ANALYSIS-Data were written responses to the questions, "If you could ask or tell your dead family member something, what would it be?" and "What meaning does donating tissue to others have for you?" Data were analyzed by using content analysis procedures. RESULTS-Concepts derived from the first question represent the context of family members grieving the sudden death of a loved one. Concepts were (1) feeling empty, (2) missing and loving, (3) being grateful, and (4) having regrets. The concepts derived from the second question were (1) fulfilling their family member's wish, (2) doing the right thing, (3) believing something good came from the death, (4) helping others, and (5) living on. Reasons for donating were based, in part, on honoring the legacy of their loved ones who had given of themselves to others in life and now continued to give to others after death. CONCLUSION-The results of this study provide a basis for health professionals and donation staffs to better understand the context within which families grieve and give meaning to tissue donation.

Cross-cultural validity of the Individualised Care Scale - a Rasch model analysis.

AIMS AND OBJECTIVES: The aim of this study was to investigate, using Rasch model analysis, the measurement invariance of the item ratings of the Individualised Care Scale. BACKGROUND: Evidence of reliability is needed in cross-cultural comparative studies. To be used in different cultures and languages, the items must function the same way. DESIGN: A methodological and comparative design. METHODS: Secondary analysis of data, gathered in 2005-2006 from a cross-cultural survey using the Individualised Care Scale from Finnish, Greek, Swedish and English predischarge hospitalised orthopaedic and trauma patients (n = 1093), was used. The Rasch model, which produces calibrations (item locations and rank) and item fit statistics, was computed using the Winstep program. RESULTS: The rank of average Individualised Care Scale item calibrations (-2·26-1·52) followed a generally similar trend (Infit ≤ 1·3), but slight differences in the item rank by country were found and some item misfit was identified within the same items. There was some variation in the order and location of some Individualised Care Scale items for individual countries, but the overall pattern of item calibration was generally corresponding. CONCLUSIONS: The Rasch model provided information about the appropriateness, sensitivity and item function in different cultures providing more in-depth information about the psychometric properties of the Individualised Care Scale instrument. Comparison of the four versions of the Individualised Care Scale - patient revealed general correspondence in the item calibration patterns although slight differences in the rank order of the items were found. Some items showed also a slight misfit. Based on these results, the phrasing and targeting of some items should be considered. RELEVANCE TO CLINICAL PRACTICE: The Individualised Care Scale - Patient version can be used in cross-cultural studies for the measurement of patients' perceptions of individualised care. Information obtained with the use of the Individualised Care Scale in clinical nursing practice is important, and valid measures are needed in evaluating patients' assessment of individualised care, one indicator of care quality.

Making sure: registered nurses watching over their patients.

BACKGROUND: Surveillance has been identified as an important patient quality and safety intervention, but the process used by registered nurses as they perform this function with their hospitalized patients on a single work shift has not been conceptualized or studied. OBJECTIVE: The purpose of this study was to generate a substantive theory of the process used by hospital registered nurses as they watch over their assigned patients during a work shift. METHODS: Classical grounded theory was used to generate the substantive theory. Fifteen registered nurses from a variety of hospital patient care settings were interviewed to determine the process they used to watch over their assigned patients during a work shift and the conditions that facilitated or hindered their abilities to watch over their patients. RESULTS: Making Sure emerged as the basic social process used by registered nurses as they watch over their assigned patients during a single work shift. Making Sure was conceptualized as a process involving six categories: (a) knowing what's going on and (b) being close set conditions for (c) watching in which the nurse is (d) not taking anything for granted. As necessary, (e) taking action occurs to achieve the outcome of this process, (f) protecting patients from harm and negative events to the extent possible. As more information about the patient is obtained through the process, this information is incorporated into the knowing what's going on category. CONCLUSIONS: The results of this study provide the theoretical basis for the process used by registered nurses as they watch over their patients on a work shift and provide insight into one of the key nursing care processes that may impact patient outcomes. Measures should be developed to operationalize the concepts of the theory and to conduct quantitative testing of the theory.

Adapting the Individualized Care Scale for cross-cultural comparison.

RATIONALE: Cross-cultural comparative studies using reliable and valid instruments can increase awareness of the differences and similarities between health worker's ability to respond to patients' individual needs within different health systems. This will enable a better understanding of cultural perspectives in individualized nursing care. AIM: To describe the translation and adaptation process of the Individualized Care Scale (ICS) and examine its reliability and validity in a cross-cultural study. DESIGN: A cross-sectional comparative study. SETTINGS: Twenty-seven orthopaedic and trauma in-patient units at 14 hospitals in 5 countries. PARTICIPANTS: A total of 1126 patients were included in the study: Finland (n = 425), Greece (n = 315), Sweden (n = 218), UK (n = 135) and USA (n = 33). METHODS: A systematic forward- and back-translation procedure using bilingual techniques, a committee approach, pretest techniques and pilot testing were used with a convenience sample to produce a valid ICS for each participating group. Psychometric evaluation of the adapted ICS was based on means, SD, missing data analysis, Cronbach's alpha coefficients and average inter-item correlations. Construct validity was examined using sub-scale correlations to total scales and principal components analysis. RESULTS: The use of the range of options and the sub-scale mean scores ranging from 2.72 to 4.30 demonstrated the sensitivity of the scale. Cronbach's alpha coefficients (0.77-0.97) and average inter-item correlations (0.37-0.77) were acceptable. The sub-scale correlations to total scales were high (0.83-0.97). The underlying theoretical construct of the ICS was demonstrated by the explained variances ranging from 58% to 79%. CONCLUSIONS: The ICS shows promise as a tool for evaluating individualized care in European cultures. The international expansion of an existing instrument developed for one country facilitates comparative studies across countries. There is a need to further test the construct validity and appropriateness of the ICS in different settings in European and nonwestern cultures.

European orthopaedic and trauma patients' perceptions of nursing care: a comparative study.

AIM: To compare English, Finnish, Greek and Swedish orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. BACKGROUND: Patient perceptions are important when evaluating nursing care delivery. Evaluations usually take place sub-nationally though European citizens may be treated throughout the European Union. International comparative studies are possible because of the universal nature and philosophical roots of quality in nursing care. They are needed to assist in improving care outcomes. DESIGN: A cross-sectional, comparative study design was used. METHOD: The Schmidt Perception of Nursing Care Survey was used to obtain data from orthopaedic and trauma patients in acute hospitals in four countries: Finland (n = 425, response rate 85%), Greece (n = 315, 86%), Sweden (n = 218, 73%) and UK (n = 135, 85%). Data were first analysed using descriptive statistics, then between-country comparisons were computed inferentially using a one-way analysis of variance and a univariate analysis of covariance. RESULTS: Between-country differences were found in patients' perceptions of the nursing care received. Over the whole Schmidt Perception of Nursing Care Survey the Swedish and Finnish patients gave their care the highest assessments and the Greek patients the lowest. The same trend was seen in each of the four sub-scales: Seeing The Individual Patient, Explaining, Responding and Watching. Responding was given the highest assessments in each participating country and Seeing the Individual Patient the lowest except in Greece. CONCLUSIONS: Further research is needed to consider whether the between-country differences found are caused by differences between cultures, nursing practices, roles of healthcare personnel or patients in the different countries. The Schmidt Perception of Nursing Care Survey is suitable for the assessment of European orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. RELEVANCE TO CLINICAL PRACTICE: The results are useful in evaluating and developing nursing care in hospitals from different European countries.

Lowering stress while teaching research: a creative arts intervention in the classroom.

Undergraduate students often request "hands-on" research experience but seldom have the time and opportunity during a one-semester introductory course to participate in such a project. The purposes of this educational approach, implemented during a beginning research class for baccalaureate nursing students, were to provide an opportunity for students to participate in an experimental research study, and test the effect of a creative arts intervention on students' stress, anxiety, and emotions. Students designed, participated in, and analyzed the results of the project. The intervention significantly reduced stress and anxiety and increased positive emotions in this student population, while providing a creative research experience. For future use, the intervention may be helpful with a variety of vulnerable groups.

Telephone support for caregivers of patients with cancer.

Caregivers have complex needs as they care for a loved one with cancer at the end of life. The objective of this pilot study was to determine the feasibility of conducting a brief telephone intervention, Tele-Care II, for caregivers of hospice patients. Guided by Hogan's Model of Bereavement, nurse interventionists implemented Tele-Care II via teleconference calls with caregivers. Although 14 caregivers were recruited for the study, only 5 were able to complete the intervention before the patient's death. Those completing the intervention experienced decreased depression, despair, and disorganization although the patient's condition became more serious. Late enrollment in hospice continues to be problematic for patients, family caregivers, and hospice staff because it allows little time for completion of interventions with family caregivers before the patient's death.

Psychometric evaluation of the Writing-To-Learn Attitude Survey.

The Writing-To-Learn Attitude Survey (WTLAS) was developed to measure the effects of using writing-to-learn activities in the classroom, but adequate psychometric data have not been reported for the measure. Using the pretest scores from 149 basic and RN-to-BSN nursing students enrolled in a Nursing Management and Leadership course, the reliability and validity of the WTLAS were evaluated. The initial 30-item measure demonstrated acceptable reliability, but the item intercorrelations suggested revision of the subscales was appropriate. After exploratory factor analyses, the WTLAS was revised to 21 items and consists of two factors: Apprehensions about Writing Abilities and Perceived Benefits of Writing-To-Learn Activities. Both subscales possess acceptable internal consistency reliability and conceptually sound, significant correlations with a separate measure of writing apprehension. The revised WTLAS appears to have adequate psychometric properties for further use in the evaluation of students' perceptions of writing-to-learn activities.

Evaluating the Writing-to-Learn strategy with undergraduate nursing students.

The writing-to-learn (WTL) instructional strategy has not received sufficient empirical investigation. Using a pretest-posttest, quasi-experimental, non-equivalent, control group design, the WTL strategy was evaluated with 87 undergraduate basic and RN-to-BSN nursing students enrolled in a Nursing Leadership and Management course. Students participating in the course perceived significant benefits of the WTL approach. A significant decrease in writing apprehension was found in the experimental group on two separate measures of writing apprehension. These findings are congruent with the theoretical WTL literature and anecdotal reports of the benefits of using the WTL strategy.

Patients' perceptions of nurse staffing, nursing care, adverse events, and overall satisfaction with the hospital experience.

Noticeably absent in the discussions surrounding nurse staffing and adverse events is the patients' perspective, except for their satisfaction with various aspects of their hospitalization experience. The results of a study undertaken to test a theoretical model of patients' perceptions of nurse staffing, the nursing care they receive, self-reported adverse events, and overall satisfaction with the hospital experience are presented. Perception of nurse staffing only weakly predicted the number of adverse events reported by patients, but was a strong predictor of the perception of nursing care received, and the perception of nursing care received was the only significant predictor of overall satisfaction with the hospital experience.

Impact of patient characteristics on orthopaedic and trauma patients' perceptions of individualised nursing care.

RATIONALE AND OBJECTIVES: Relatively few studies have investigated the relationship between patient characteristics and individualised care, in relation to the improvement of care efficiency, efficacy and quality. Individualised care is a key concept in health strategy and policy in Western countries. The aim of this exploratory study was to identify orthopaedic and trauma patients' characteristics relating to their perceptions of individualised nursing care in Western hospital settings. METHODS: A cross-sectional questionnaire survey was conducted among orthopaedic and trauma patients (n=1126) from acute care in hospitals from five countries: Finland, Greece, Sweden, the UK and the USA, in 2005-06. The data were analysed using descriptive statistics, one-way analysis of variance and a multivariate analysis of variance (manova) of the main effects. RESULTS: The separate examination of each background factor showed statistically significant differences between patients' perceptions of individualised care. In the multivariate analysis the statistically significant main effects, associated with patients' perceptions, were age, gender, education and type of admission. These explained 13% of the variance in the support of patient individuality in care and 19% in perceived individuality in care received. CONCLUSIONS: These results can be used in individualising care to different patient groups and in prioritising and focusing quality programs to improve care. Detailed questions about specific aspects of patients' experiences are likely to be more useful in monitoring hospital performance from the patients' perspective.

Measuring individualized nursing care: assessment of reliability and validity of three scales.

AIM: This paper is a report of a study to assess the reliability and convergent validity of three measures of nursing care individualization. BACKGROUND: Individualized care is a key element of nursing care quality, yet little is known about the extent to which it is implemented, its effects, and the factors that help or hinder nurses in giving individualized care. Therefore reliable and valid instruments are needed to measure individualized nursing care. METHOD: A cross-sectional correlational survey design was used. The purposive sample consisted of 861 patients from six hospitals in Finland (response rate 82%). Data were collected in 2004. The Individualized Care Scale was administered simultaneously with translated versions of the Schmidt's Perceptions of Nursing Care Survey and the Oncology Patients' Perceptions of the Quality of Nursing Care Scale. Internal consistency reliability and convergent validity were assessed for each scale. FINDINGS: Evidence for convergent validity was identified between the Individualized Care Scale (part A/B), the Individualization subscale (r = 0.64 with Part A, r = 0.66 with part B) and the Seeing the Individual Patient subscale (r = 0.68 with part A, r = 0.71 with part B). Cronbach alpha coefficient was 0.97 for the Individualized Care Scale, 0.82 for Seeing the Individual Patient and 0.87 for the Individualization subscale. CONCLUSION: Data provided preliminary evidence for the convergent validity of the individualized care scales, as well as acceptable internal consistency reliability for each scale. These scales represent useful measures for assessing patients' perceptions of the individualization of nursing care received.

Patients' perceptions of nursing care in the hospital setting.

BACKGROUND: Patient satisfaction and patient satisfaction with nursing care data are routinely collected as an indicator of the quality of services delivered. Despite the widespread collection and reporting of these data, the theoretical basis of patient satisfaction and patient satisfaction with nursing care remains unclear. Without a clear theoretical base, interpretation of patient satisfaction findings is hampered and the entire line of patient satisfaction research is of questionable validity. It has been suggested that, to understand patient satisfaction, patient perceptions of their care must first be understood. AIM: The aim of this study was to discover patients' perceptions of the nursing care they receive in the hospital setting. METHOD: Grounded theory method was used in this study of eight medical-surgical patients recently discharged from an academic medical centre in the south-eastern United States of America (USA). Participants were interviewed and the verbatim transcripts analysed using the constant comparative method. FINDINGS: Four categories of patient perceptions of their nursing care emerged from the data. 'Seeing the individual patient' captures the unique nature of the nursing care experience for each patient. 'Explaining' represents the informal explanations given by nursing staff as they provide care. 'Responding' refers to both the character and timeliness of nursing staff's responses to patient requests or symptoms. 'Watching over' represents the surveillance activities of nursing staff. CONCLUSIONS: The categories identified in this study may be used in efforts to further develop a formal theory of patient satisfaction with nursing care. These categories should also be tested with patients possessing a wider range of characteristics, to assess the transferability of the findings.

Testing the grief to personal growth model using structural equation modeling.

The belief that loss can result in growth has been hypothesized for centuries.Yet, traditional grief theories have viewed grief work as a process of resolving grief and returning to normal. Formal conceptualizations of grief to growth models have been recently delineated by several grief theorists. The Grief to Personal Growth model represents one emergent perspective of the qualitative changes resulting from the loss of a loved one. The model delineates a pathway through grief that indicates the bereft experience despair and detachment followed by intrusive thoughts and later avoidance of intense preoccupation with grief. Social support is shown to facilitate the bereft as they reconstruct their lives and find new meaning in life. A second path indicates that some bereaved individuals become mired in grief and need help to proceed toward personal growth. The model was tested in a sample of bereaved parents using structural equation modeling as a method of theory testing. The results of testing this model are presented within a framework of theory testing as a mechanism to bridge the gaps between theory, practice, and research. Implications for practice are considered.

Testing the efficacy of a creative-arts intervention with family caregivers of patients with cancer.

PURPOSE: To test the efficacy of a creative arts intervention (CAI) with family caregivers of patients with cancer. DESIGN: A pre-posttest quasi-experimental design, with participation in the CAI as the independent variable and stress, anxiety, and emotions as the dependent variables. METHOD: The 6-month study was implemented at a regional cancer treatment center with family caregivers. The CAI consisted of several creative arts activities designed for delivery at the bedside. FINDINGS: Forty family caregivers reported significantly reduced stress, lowered anxiety, and increased positive emotions following CAI participation. CONCLUSIONS: The CAI promoted short-term well being in this family caregiver sample. Caregivers also increased positive communication with cancer patients and health care providers while expressing delight over their handmade pieces of art.

A clinical ladder program based on Carper's Fundamental Patterns of Knowing in Nursing.

Clinical and career ladder programs were popular adjuncts to recruitment and retention during the nursing shortage of the 1980s. Programs commonly used Benner's work as an organizing framework and typically used activities such as continuing education credit, committee participation, work experience, certifications, academic degrees, community service, and performance appraisal scores as criteria for advancement. The authors present a unique clinical ladder program based on Carper's Fundamental Patterns of Knowing in Nursing. This philosophical work has been debated in the literature for many years, yet to the authors' knowledge, this work has never been used as the conceptual basis for program development. The four patterns of knowing in nursing were found to be consistent with the definition of professional nursing, and provided a meaningful organizing framework that was well received by staff registered nurses. An overall history of clinical ladders is presented, followed by the organization's prior experience with these programs, and finally the details of development and implementation of the program with plans for evaluation.