Preferences for care near the end of life: scale development and validation.

The purpose of this study was to develop and validate an instrument, the Preferences for Care near the End of Life (PCEOL) scale. Following a literature review and using the domain-referenced approach and a test grid, a large pool of items was generated to reflect five dimensions of preferences for care near the end of life. These were reviewed for relevance and clarity by an expert panel. A convenience sample of 198 adults was secured to provide data for the study of the psychometric properties of the scale. Data screening and item analysis resulted in a final sample of 43 items. A principal factor analysis (PFA) resulted in an interpretable, meaningful five-factor solution. Reliability estimates (internal consistency) for the factors on the multidimensional instrument ranged from.68 to.91. Retest stability estimates for the PCEOL showed correlations of.80 to.94 for factor scores over a 2-week interval.

Measuring attitudes toward persons with AIDS: the AAS-G as an alternate form of the AAS.

For most of the score of years that the Acquired Immune Deficiency Syndrome (AIDS) has been with us, we have been concerned with the care of and attitudes toward AIDS patients. As the treatment and face of AIDS changes, not all of those suffering with the disease are considered patients. Many are active community members, young and old, male and female. The AIDS Attitude Scale (AAS) is a widely used measure of health professionals' attitudes toward persons with AIDS who are patients. That scale was developed with the intended audience of respondents being nurses or others dealing directly with AIDS patients. This research details the development and validation of an alternate form of the AAS, the AAS-G, intended for use with the general public. The AAS-G may be completed by lay members of the community and is not limited to assessing attitudes toward patients alone. Reliability and validity information, Classical Test Theory estimates and Generalizability Theory estimates for psychometrics on the AAS-G are reported. These estimates are compared to the same estimates available for the AAS in order to make informed decisions about the utility of the new AAS-G. The AAS-G appears to be a promising, efficient instrument for measuring the attitudes of lay individuals toward persons with AIDS.

Assessing the credibility of a clinical ladder review process: an interrater reliability study.

Clinical ladders are common means of establishing and maintaining practice-based systems that differentiate levels of professional nursing practice. The implementation of an effective clinical ladder review system assumes the process is objective, replicable, and fair. This project describes the assessment of one clinical ladder review system.

Rethinking the use of the Hogan Empathy Scale: a critical psychometric analysis.

OBJECTIVE: The purpose of this research was to study the stability internal consistency factor structure, and convergent and discriminate validity of the Hogan Empathy Scale (EM) when used longitudinally with occupational therapy students. METHOD: More than 300 occupational therapy students completed the EM once; 192 completed it twice over a 12-month interval; and 56 completed a third administration at intervals ranging from 3 years to 6 years. The Fieldwork Performance Evaluation (FWPE) was rated twice for students after fieldwork rotations in the occupational therapy program. Data on grade-point average, gender, and age were collected. RESULTS: Stability was estimated at .41 over a 12-month interval and from .30 to .38 over longer intervals. Internal consistency was estimated at .57, and factor structures hypothesized previously were not replicable. Students' biographical variables explained only trivial amounts of variance in EM scores in regression equations (R = .08 and .21). Correlations between EM and FWPE scores did not support convergent validity (r = -. 01-.18). CONCLUSION: The reliability estimates for the EM as a measure of a trait-like construct are not encouraging and do not replicate previous estimates. Validity evidence was equally disappointing, raising questions about what the EM is measuring and cautioning against its continued, uncritical use as a measure of empathy.

The Female Sexuality Questionnaire: instrument development.

The purpose of this study was to develop and validate a measure of female sexuality, the Female Sexuality Questionnaire (FSQ). A survey design was employed for the study. The sample included 262 adult women ages 18 to 81 (M = 32). Five hundred questionnaires were distributed to a diverse female population representing multiple geographic areas in the U.S. and Canada. Participants were healthy (as per self-report), sexually active and engaged in an intimate relationship. The majority of the sample was premenopausal. Item stems for the FSQ were developed based on the literature and the domain-referenced approach for item generation. A pool of 70 items generated to represent 6 theoretical domains of female sexuality: Reproduction, Beliefs, Intimacy, Body Image, Physical Responsiveness, and Satisfaction were subjected to systematic review by a panel of experts. A 5-point self-report response scale was appended to the 54 items surviving judges' reviews (criterion validity index of 91.3 for the pool of retained items). Data screening and item analysis was performed and yielded 13 items which were removed prior to principal factor analysis (PFA) resulting in a sample of 218 subjects and 41 items. The PFA with quartrimax rotation resulted in a 5-factor solution. Four of the five were consistent with the hypothesized domains of Satisfaction, Physical Responsiveness, Beliefs, and Body Image. The fifth factor suggested an association with Intimacy, and was renamed Relationships. The hypothesized domain of Reproduction was not supported. Twelve items failed to load on any of the factors. Recommendations for alternations of the final version of the FSQ are based upon the empirical results of the item analysis and PFA.

American and Korean adolescents' physical and mental health self-efficacy.

Self-efficacy beliefs are thought to have causal influence on behavior, helping to explain what tasks people approach, persevere at, or abandon. Few cross-cultural studies of adolescents' self-efficacy beliefs have been conducted or reported. We compared physical and mental health self-efficacy beliefs of Korean and American high school students. A Korean translation of the English language School Health Efficacy Questionnaire (SHEQ) was used in data collection. The translated version of the SHEQ showed psychometric estimates similar to the original English language version. Sizable age and culturally related differences were found on both physical and emotional health self-efficacy perceptions between the two groups of adolescents.

Uses and abuses of the analysis of covariance.

The analysis of covariance (ANCOVA) is a powerful analytic tool, but there continue to be abuses of the method. We review assumptions and illustrate legitimate uses of ANCOVA, and summarize statistical packages' approach to the method. Finally, we consider how ANCOVA is used in contemporary nursing research.

Measurement characteristics of the levels of institutionalization scales: examining reliability and validity.

The Level of Institutionalization (LoIn) scales were developed to assess the extent to which a health promotion program has become integrated into a health care organization. The instrument was designed specifically to measure the amount of routinization and niche saturation of four subsystems (production, maintenance, supportive, and managerial) believed to make up an organization. In this study, the LoIn scales were completed for diabetes programs in 102 general hospitals and 30 home health agencies in Maryland and Pennsylvania. Reliability estimates across the four subsystems for routines (alpha = .61) and for niche saturation (alpha = .44) were substandard. Average correlation among the four subsystems for routines was .67, and among the four subsystems for niche saturation was .38, indicating moderate to large amounts of shared variance among subsystems and challenging claims of discriminant validity. Given these large correlations and a poor fit when testing the eight-factor model, higher-order confirmatory factor analyses were carried out. Results supported the existence of two second-order factors. When collapsed into two factors, the reliabilities were adequate (routines alpha = .90; niche saturation alpha = .80). Criterion-related validity also was found between length of program existence and the routine factor.

Development and evaluation of the Osteoporosis Self-Efficacy Scale.

The Osteoporosis Self-Efficacy Scale was developed as a measure of self-efficacy, or confidence, for behaviors related to physical activity and calcium intake. An item pool of 21 statements, responded to on a visual analog self-report format, was reviewed by a panel of expert judges. The revised item stems were tested with a sample of 201 women, ages 35 to 95. Concurrent data on sport, leisure, and exercise activity and calcium in diet and dietary supplements were collected from the respondents. Factor analysis of responses to the self-efficacy items revealed a logical, theoretically meaningful two-factor structure, one for physical activity and one for calcium intake. Internal consistency estimates for each of the two factors were in the .90s. Convergent and discriminant validity analyses as well as hierarchical regression analyses to explain self-reports of physical activity and calcium intake were supportive. The final version of the brief, psychometrically sound scale contains items reflecting initiation, maintenance, and persistence at osteoporosis preventive behaviors; thus, the Osteoporosis Self-Efficacy Scale is a potentially beneficial research instrument.

Isopropyl pad use in neonatal intensive care units.

OBJECTIVES: Isopropyl pads (IPs) are commonly used to cleanse skin. This traditional practice is benign when applied to adults, however, its efficacy and safety when used for health-compromised neonates is questionable. This research explores the extent of IP use in 114 infants in neonatal intensive care units and identifies characteristics associated with IP use. STUDY DESIGN: A descriptive design, with data collected at two different sites over multiple observation periods, was used. RESULTS: Generally low IP to skin use was found, with most babies being exposed to one to two pads per 8 hours. Some babies, most frequently the lowest weight, most premature, and health compromised babies, had exposure to as many as eight pads per 8 hours. CONCLUSIONS: Because the smallest, most vulnerable neonates are those most exposed to the highest levels of isopropyl alcohol on the skin, conscious attention needs be paid to IP use to avoid or eliminate unnecessary exposure to the potentially toxic substance.

Predictors of referral to cardiac rehabilitation and cardiac exercise self-efficacy.

Cardiac rehabilitation (CR) has known benefits after myocardial infarction (MI) or coronary artery bypass surgery (CABG). Yet, only a small percentage of patients are referred for outpatient CR after hospital discharge. This study investigates patient characteristics related to referral to CR and cardiac exercise self-efficacy, a salient predictor of health behavior change and maintenance. Two hundred nineteen patients enrolled in the study. Of the 185 patients who were CR candidates, 74 were referred to CR. Logistic regression analysis was used to identify variables related to CR referral. Results indicate that patient characteristics of having had fewer MIs or CABGs, having attended CR in the past, and being less physically active during leisure time are related to an increased likelihood of being referred to CR. Multiple regression analysis indicates that leisure physical activity is a predictor of cardiac exercise self-efficacy. Implications for nurses who recruit patients for CR are discussed.

Refinement of the Habitual Physical Activity Index for use with American adults.

The relationship between physical activity and health outcomes makes the assessment of physical activity important to many health professionals. Numerous physical activity questionnaires exist but none is tailored to the assessment of physical activity in cardiac patients. Ideally, a questionnaire should be appropriate for both healthy individuals and those with cardiac disease to allow comparison of epidemiologic and intervention research. The purpose of this research is to adapt and validate an existing physical activity questionnaire for use with healthy individuals and those with coronary artery disease. The Habitual Physical Activity Index (HPAI) is an easy to administer questionnaire developed in the Netherlands by Baecke, Burema, and Frijters (1982). The factorial validity and alpha internal consistency of the HPAI were examined to evaluate its potential for use in assessing physical activity of hospitalized cardiac patients in the U.S. The sample was 213 cardiac patients. A factor analysis produced a meaningful two-factor solution that differed from the original Dutch results. This suggested the HPAI should be modified for use with American adults with cardiac disease. New items were generated and added to the HPAI. The modified HPAI was tested using classical testing theory and generalizability theory. Stability estimates are high and relative generalizability acceptable. However, the absolute generalizability estimates indicate that the addition of new items to the HPAI could improve its use for absolute decision making.

Further validation of the AIDS Attitude Scale.

The AIDS Attitude Scale (AAS) is a self-report measure of attitude toward persons with AIDS. Since its introduction in 1992, the AAS has been used in over 30 research studies. Initial psychometric estimates of reliability and validity for the scale were supportive. This report summarizes emerging psychometric data from a broad range of samples. These data offer additional support for the internal consistency and stability of the two dimensions underlying the scale, as well as documenting the factorial and construct validity of the AAS.

Blood pressure measurement during pregnancy: auscultatory versus oscillatory methods.

OBJECTIVE: To determine the equivalence of auscultatory and oscillatory blood pressure measurements. SETTING: Inner-city prenatal clinic. PARTICIPANTS: Eighty-one women in their 2nd to 9th month of pregnancy. DESIGN: Participants were assessed for systolic and diastolic blood pressures on left and right arms using auscultatory (manual) and oscillatory (electronic) methods. A correlational study design was used. MAIN OUTCOME MEASURES: Differences in pressures related to arm and method of measurement. RESULTS: The oscillatory method produced consistently higher readings for both systolic (F[1,80] = 45.9, p < 0.001) and diastolic (F[1,80] = 25.79, p < 0.001) pressure readings. Correlations between estimates generally treated as substitutable all fell below the recommended level of 0.80 for measurement equivalence. CONCLUSIONS: Results suggest the need for caution when interpreting blood pressure estimates as interchangeable. This is particularly important when patients move from clinic settings, where auscultatory methods predominate, to inpatient settings, where oscillatory methods of measurement are used.

Preliminary validation of a measure of life support preferences.

A rapid, easy to use instrument that provides illustrations of life support choices can enhance discussion of life support measures with patients. The goal of this preliminary study was to develop and validate an instrument, the Life Support Preferences Questionnaire (LSPQ). In a convenience sample of 116 healthy adults, the LSPQ showed a sturdy degree of internal consistency for a short measure. The 2-week stability evidence was supportive of respondents' consistent attitudes over time at both the item and scale level. Principal factor analyses give evidence there is one dominant theme underlying the items. Use of the LSPQ with hospitalized patients is being explored as a response to policy changes resulting from the 1991 Patient Self-Determination Act.

A national survey of neonatal intensive-care units: criteria used to determine readiness for oral feedings.

OBJECTIVE: To describe criteria used to determine readiness for oral feedings in stable, preterm infants. DESIGN: A 25-item survey questionnaire was mailed to hospitals having level II or level III NICUs. SETTING: Nurseries identified in the 1987 National Perinatal Directory (576 in all) as level II or level III NICUs. PARTICIPANTS: Head nurses (HN) and staff nurses (SN) at 420 hospitals comprised 73% of the sample surveyed. PROCEDURES: Survey items were predominantly multiple choice and included an "other" option to encourage comments. MAIN OUTCOME MEASURES: Respondents described clinical practice in their nurseries relative to feeding policies, use of traditional decision criteria, or behavioral cues and related interventions. RESULTS/CONCLUSIONS: Fewer than 50% of nurseries identified a specific feeding policy for the initiation of oral feedings. Seventy-five percent used either gestational age or weight criteria in deciding when to start oral feedings. Eighty-six percent considered infant behavior as well when determining feeding readiness. Findings suggest an emerging emphasis on infant behavioral cues in addition to gestational age and weight criteria when making feeding decisions.

Culture, stress and substance use in Cambodian refugee women.

Initial data were generated on the use of alcohol and other drugs by Cambodian refugee women and their families (N = 120) in two sites: Massachusetts and California. Information on frequency and situations surrounding use, and culturally specific use, was elicited. In those families where alcohol was perceived as a problem, the majority of problem drinkers were husbands. About 45% of the East Coast women, however, said they used alcohol for nervousness, stress, headaches, insomnia and pain. In addition, about 15% of the East Coast women reported that a family member used street drugs and was having dependency problems. While use of alcohol or street drugs was not perceived as problematic on the West Coast, over 58% reported using prescription drugs for self-treatment of illnesses other than those targeted by the prescription. When prescription drugs were misused by women, it was most frequently to get an altered state, or "street drug effect". Numerous stressors influence Cambodian women during the pressures of acculturation to the U.S. lifestyle. Some may turn to self-medication in the form of alcohol, prescription sleeping pills, or other drugs. A better understanding of how and why these women make coping choices is needed.