Development of competency inventory for registered nurses in the People's Republic of China: scale development.

BACKGROUND: Literature review indicated there is no existing nursing competency framework or instrument for Chinese registered nurses. By virtue of its global leadership role in nursing, the International Council of Nurses (ICN) developed an ICN Framework of Competencies for the Generalist Nurses in 2003. On the basis of the ICN's framework, a qualitative study was conducted to explore the expectations of Chinese nurse professionals on nursing competency in the previous study. A competency framework for Chinese registered nurses was formed. This paper describes the development and testing of the Competency Inventory for Registered Nurses (CIRN). METHODS: A methodological study design was used, consisting of two phases with six steps. A review of literature generated 112 items, which were evaluated by six experts followed by field testing in a purposive sample of 815 Chinese clinical registered nurses. Factor analysis and item analysis were applied to establish the scale's construct validity and reliability. RESULTS: The final scale consists of seven dimensions with 58 items. The overall scale reliability had a Cronbach's alpha of 0.89; the dimensions Cronbach's alpha ranged from 0.79 to 0.86. In addition, evidence for two other kinds of validity was obtained, which included criterion-related validity (r=0.44, p=0.04) and contrasted-group validity (p<0.001). CONCLUSION: The CIRN has demonstrated evidence of internal consistency reliability, content validity, and construct validity, and it provides an objective tool for assessing registered nurse competencies in the various areas of clinical practice.

Assessing advance care planning readiness in individuals with kidney failure.

The purpose of this study was to initiate development of an instrument to assess readiness of patients to discuss advance care plans. The first step of the development of the instrument involved the generation of a 49-item pool representative of the grounded theory of personal preservation (Calvin, 2004). The second step was to assess the content validity of the items using both a professional panel of four experts in end-of-life care and a patient panel of five persons currently being treated with hemodialysis in an inpatient setting. The third step was to pilot test the resultant 30-item instrument with another sample of 10 patients on hemodialysis. The instrument showed preliminary evidence of content validity (overall content validity index = 0.90) and internal consistency reliability of the scale (Cronbach's alpha = 0.73).

Content validity of self-report measurement instruments: an illustration from the development of the Brain Tumor Module of the M.D. Anderson Symptom Inventory.

PURPOSE/OBJECTIVES: To illustrate one technique for establishing content validity of measurements using the initial development and testing of the M.D. Anderson Symptom Inventory Brain Tumor Module. DATA SOURCES: Published articles, book chapters, and subjective judgments of experts. DATA SYNTHESIS: Content validity is the essential first step in the development of items to be included in a measurement instrument. Content validity is a criterion-referenced process that is judged by how well each item in a newly developed instrument reflects its respective objective or content domain. The stages in addressing content validity include a developmental stage and a judgment-quantification stage. Steps involved in the developmental stage include domain identification, item generation, and instrument formation. The judgment-quantification stage is when experts review the items and either report validity of the items subjectively or with an empirically referenced method, such as calculation of the content validity index. The content validity of a set of questions designed to measure symptoms in a population of patients with primary brain tumors was ascertained by using the calculation of the content validity index. CONCLUSIONS: The final version of the M.D. Anderson Symptom Inventory Brain Tumor Module consists of the 13 core items and 18 additional items designated as valid by a panel of experts. The instrument will be administered to a group of patients to determine construct validity and reliability of the items. IMPLICATIONS FOR NURSING: Self-report instruments are used to measure various health outcomes in oncology. Oncology nurses are in a key position to develop such instruments to be used in clinical care and research of symptoms associated with cancer. Understanding the process of content validation is an essential first step in developing new instruments.

Symptom clusters in oncology patients and implications for symptom research in people with primary brain tumors.

PURPOSE: To provide a critical analysis of the state of the science of research on symptom clusters in the general oncology population, compared to symptom research in the primary brain tumor population. ORGANIZING CONSTRUCT: Symptoms are a multidimensional experience that include perceptions of the frequency, intensity, distress, and meaning as symptoms occur and are expressed. A symptom can influence the occurrence and meaning of other symptoms. METHODS: Literature pertaining to symptom presentation in people with primary brain tumors and the occurrence of multiple symptoms and symptom clusters in patients with cancer was reviewed and analyzed. FINDINGS: Symptoms occur in clusters in general oncology patients, and these clusters have been shown to influence functional status. The potential effect of tumor biology on symptom clusters is shown by the cluster of symptoms theorized to be associated with proinflammatory cytokine production. In patients with primary brain tumors, few researchers have examined the occurrence of symptoms at the time of diagnosis. Studies to date are retrospective and descriptive and were conducted before the use of modern imaging techniques. Studies of symptom clusters have not been reported for patients with primary brain tumors. CONCLUSIONS: Symptom clusters have recently been identified in the general oncology population and might provide a new strategy for assessment and intervention. Neurologic symptoms in patients with primary brain tumors are those related to increased intracranial pressure and those that are location-dependent within the brain. Therefore, application of the symptom cluster paradigm to guide research is warranted.

Comparison of mortality in mexican-american females and mexican american males following acute myocardial infarction

Acute myocardial infarction results in 7.2 million deaths per year world-wide. The treatment of AMI in the post-myocardial infarction period differs among the races and genders. This study investigated differences in mortality between Mexican American (MA) males and females, post-AMI who received BB therapy and those who did not receive BB therapy. Findings from this secondary analysis indicate that MA females experienced a higher mortality post-AMI compared to MA males. However, MA females taking BB therapy post-AMI had a reduced odds of mortality compared to MA males taking BB post-AMI. Interestingly, MA females were less likely to have received BB therapy post-AMI compared to MA males, despite its apparent benefit.

Screening for depression in a hepatitis C population: the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D).

RATIONALE: Depression is reported as a serious adverse event of antiviral therapy used to treat patients with hepatitis C (HCV); therefore, there is a need to identify a reliable and valid measure of depressive symptoms for this population. AIMS: To determine reliability, construct validity and predictive validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a hepatitis C (HCV) population. ETHICAL ISSUES: Study reviewed/approved by the University Institutional Review Board and informed consent obtained. METHODS: Longitudinal design testing psychometric properties of the CES-D prior to treatment and 4 and 24 weeks postinitiation of treatment. Reliability was tested using Cronbach's coefficient alpha. Construct validity was tested, prior to therapy, using principal components factoring with varimax rotation. Predictive validity was tested using repeated measures analysis of variance (anova) of CES-D scores at 4 and 24 weeks postinitiation of treatment. RESULTS: Non-probability sample, 116 adult HCV patients [62 (53%) males and 54 (47%) females]. Reliability (Cronbach's alpha) = 0.88 pretreatment, 0.89 week 4 and 0.90 week 24. Construct validity testing revealed four factors: negative affect; positive affect; somatic; and depressed affect/somatic. Exception for two items, 'felt sad' and 'couldn't get going', all items loaded distinctly with correlation coefficients in the range of 0.51-0.84. Predictive validity testing revealed a statistically significant effect over time (P < 0.001) in the direction predicted (pretreatment x = 13.97; post 4 weeks x = 19.54 and 24 weeks x = 19.97). CONCLUSIONS: The CES-D is a reliable and valid instrument to screen for depressive symptoms in HCV patients. The instrument detected the predicted increase in depression associated with HCV. Examination of the sensitivity and specificity is needed to determine the most accurate cut-off score.