Using clinical simulation to assess a new paediatric ESCALATION system education package: Empirical research mixed methods.

AIM: The aim of the study was to assess the suitability of an online education package to prepare health professionals to use a new paediatric early warning system. DESIGN: Quasi-experimental mixed methods using co-production. METHODS: Participants completed the Package and participated in up to four clinical scenarios. Data were collected using self-report surveys, and during clinical scenarios; escalation of care, documentation, family involvement, communication handovers were assessed, and recorded debriefings were thematically analysed. Data were integrated using tabulated joint displays. RESULTS: Eleven nurses and three doctors were recruited from three mixed adult and paediatric hospitals. Following completion of the Package and clinical scenarios 13/14 (93%) participants agreed preparedness and confidence to use the ESCALATION System had increased. For 53% handovers, the communication framework was followed, for 79% charts, documentation was complete. Participants engaged with the parent (actor) for 97% scenario interactions. The Package was effective and participation in clinical scenarios appeared to enhance learning. PATIENT OR PUBLIC CONTRIBUTION: Consumers participated in the steering group overseeing the study and in the expert panel who reviewed the education package and clinical scenarios.

Perceived diversity norms, cultural identity styles and bicultural identity consolidation in two bicultural groups in Australia.

In this study, we investigate the relationships among contextual variables of perceived diversity norms- multiculturalism, assimilation and polyculturalism, identity styles and identity consolidation in bicultural Australians. The Multicultural Identity Styles Scale proposes two identity strategies, hybrid identity style (HIS) and alternating identity style (AIS) as processes through which individuals negotiate their bicultural identities. We test a model whereby perceived diversity norms predict bicultural identity consolidation directly and indirectly via HIS in samples of British (n = 195) and non-British (n = 181) Australians. Participants (56.9% females, mean age = 41.52) completed an online survey on perceived diversity norms, the MISS and bicultural identity consolidation. Results showed that for non-British Australians, there was a positive indirect effect of perceived multiculturalism norms on bicultural identity consolidation via HIS. Perceived assimilation was directly (and negatively) linked to bicultural identity consolidation but indirectly via HIS. In British Australians only perceived polyculturalism was directly and indirectly associated to bicultural identity consolidation via HIS, whereas perceived multiculturalism and assimilation norms were negatively associated to bicultural identity consolidation. The results are discussed in terms of the differential roles of perceived diversity norms on bicultural identity processes and consolidation relative to the nature of the cultural group.

Instrument validation process: a case study using the Paediatric Pain Knowledge and Attitudes Questionnaire.

AIMS AND OBJECTIVES: To compare two methods of calculating interrater agreement while determining content validity of the Paediatric Pain Knowledge and Attitudes Questionnaire for use with Australian nurses. BACKGROUND: Paediatric pain assessment and management documentation was found to be suboptimal revealing a need to assess paediatric nurses' knowledge and attitude to pain. The Paediatric Pain Knowledge and Attitudes Questionnaire was selected as it had been reported as valid and reliable in the United Kingdom with student nurses. The questionnaire required content validity determination prior to use in the Australian context. DESIGN: A two phase process of expert review. METHODS: Ten paediatric nurses completed a relevancy rating of all 68 questionnaire items. In phase two, five pain experts reviewed the items of the questionnaire that scored an unacceptable item level content validity. Item and scale level content validity indices and intraclass correlation coefficients were calculated. RESULTS: In phase one, 31 items received an item level content validity index <0·78 and the scale level content validity index average was 0·80 which were below levels required for acceptable validity. The intraclass correlation coefficient was 0·47. In phase two, 10 items were amended and four items deleted. The revised questionnaire provided a scale level content validity index average >0·90 and an intraclass correlation coefficient of 0·94 demonstrating excellent agreement between raters therefore acceptable content validity. CONCLUSION: Equivalent outcomes were achieved using the content validity index and the intraclass correlation coefficient. RELEVANCE TO CLINICAL PRACTICE: To assess content validity the content validity index has the advantage of providing an item level score and is a simple calculation. The intraclass correlation coefficient requires statistical knowledge, or support, and has the advantage of accounting for the possibility of chance agreement.