Tests of Revisions to the Norbeck Social Support Questionnaire.

OBJECTIVES: To compare the accuracy of averaged scores from the original Norbeck Social Support Questionnaire (NSSQ)and averaged scores from each of three new NSSQ versions (NSSQ-R.aid, NSSQ-R.n/a, and NSSQ-R.format). These three new versions of the widely used NSSQ were developed to address three previously identified concerns regarding score accuracy: the Aid subscale's examples of aid, lack of an n/a response option, and the network nomination/rating procedure. Missing data rates were also assessed. METHODS: A convenience sample (N = 223) completed one of the four NSSQ versions. Score accuracy (restriction) was assessed by size of correlation between averaged scores (averaged score/network size) and network size, with low correlations indicating less score restriction and higher score accuracy. Fisher's r-to-z transformations assessed the significance of the difference between all correlations from the three versions. Missing data rates were assessed using chi-square tests of independence. RESULTS: The cumulative effects of removing the aid examples and use of the n/a response option improved score accuracy; averaged Aid scores from the NSSQ-R.n/a were statistically significantly less restricted than corresponding scores on the original NSSQ. The final version (NSSQ-R.format) actually resulted in statistically significant decreased score accuracy for averaged Affect scores. There were no statistically significant differences in missing data rates among versions. CONCLUSION: Averaged scores from the NSSQ-R.n/a should be used. Future research should focus on the use of situation-specific Aid items.

Peplau's Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data?

A confirmatory factor analysis of data from the responses of 12,436 patients to 16 items on the Consumer Assessment of Healthcare Providers and Systems-Hospital survey was used to test a latent factor structure based on Peplau's middle-range theory of interpersonal relations. A two-factor model based on Peplau's theory fit these data well, whereas a three-factor model also based on Peplau's theory fit them excellently and provided a suitable alternate factor structure for the data. Though neither the two- nor three-factor model fit as well as the original factor structure, these results support using Peplau's theory to demonstrate nursing's extensive contribution to the experiences of hospitalized patients.

Emotional Eating Mediates the Relationship Between Role Stress and Obesity in Clergy.

The purpose of this study was to investigate the relationships between role stress, emotional eating, and obesity in clergy. A random sample of United States Lutheran Church Missouri Synod clergy who met the study criteria (N = 430), response rate 38%, completed the Role Stress and Emotional Eating Behavior Scales, and self-reported height and weight for Body Mass Index (BMI) calculation. Obesity was high (81.4% overweight/obese, 36.7% obese), and emotional eating partially mediated the relationship between role stress and obesity. This study tested relations of the Neuman Systems Model.

Identifying and Addressing Sources of Measurement Error in the Norbeck Social Support Questionnaire.

BACKGROUND AND PURPOSE: The Norbeck Social Support Questionnaire (NSSQ) provides a rich portrait of one's perceived social support including network size/composition and quality of support. Analyses of quantitative research reports and critiques of the NSSQ revealed non-negligible measurement error. We document evidence of measurement error, report potential sources of this error, and present forthcoming psychometric testing. METHODS: Quantitative evidence of measurement error from the NSSQ literature provided the basis for initial hypotheses concerning sources of error in network nomination and support ratings. We then conducted cognitive interviews to investigate these hypotheses. RESULTS: Cognitive interviews revealed evidence of respondents' miscomprehension and response option bias. CONCLUSIONS: The current nomination process coupled with the lack of a "not applicable" response option and embedded examples in tangible Aid items reduces the accuracy of NSSQ subscores.

A beginner's guide to writing the nursing conceptual model-based theoretical rationale.

Writing the theoretical rationale for a study can be a daunting prospect for novice researchers. Nursing's conceptual models provide excellent frameworks for placement of study variables, but moving from the very abstract concepts of the nursing model to the less abstract concepts of the study variables is difficult. Similar to the five-paragraph essay used by writing teachers to assist beginning writers to construct a logical thesis, the authors of this column present guidelines that beginners can follow to construct their theoretical rationale. This guide can be used with any nursing conceptual model but Neuman's model was chosen here as the exemplar.

A medieval metaphor to aid use of the Neuman systems model in simulation debriefing.

Patient simulation is an effective clinical nursing experience and debriefing is recognized as the most crucial phase for students to internalize learning. The Neuman systems model is an excellent organizing framework for simulation debriefing to maximize learning. However, due to the model's complexity, metaphor may be useful to help students to link simulation events with the model's concepts. A medieval metaphorical adaptation of the Neuman systems model was created as an educational debriefing tool to help students bridge this gap. Neuman's concepts are represented as medieval figures encountering and dealing with stressor dragons, with assistance (nursing intervention) as necessary. The companion questionnaire allows recording of student insights and becomes an evaluation tool for student comprehension.

New advances in the use of Neuman's Lines of Defense and Resistance in Quantitative Research.

In 1997, Gigliotti proposed that certain conceptual and empirical considerations were necessary when using the Neuman systems model lines of defense and resistance in quantitative research. Since that time, a period of theoretical sharpening has resulted both from the iterative process of theory development through research and refinement of proposed relations, and from concept clarification efforts. These new advances prompt new empirical considerations. Specifically, the notion of the flexible line of defense strictly as a moderator has been reconsidered and new relations between the normal line of defense and the lines of resistance, as well as between the core, the lines of resistance and the normal line of defense are proposed.

Use of averaged norbeck social support questionnaire scores.

Background. Averaged Norbeck Social Support Questionnaire (NSSQ) support scores remove the influence of network size variability but may unduly lower scores for participants with large networks. Objectives. To evaluate the use of averaged NSSQ scores. Method. Pearson correlations determined if averaged scores decreased as network size increased across three samples. Then, Pearson correlations between a criterion variable and both averaged and raw support scores were computed along with the resultant power to detect a true effect. Results. Neither averaged total functional support nor averaged affect and affirmation scores decreased as sample size increased. However, averaged aid scores did decrease as network size increased. Power also increased markedly in all averaged versus raw scores except in averaged aid scores. Discussion and Conclusions. Use of averaged aid scores is not recommended. Use of all other averaged scores appears acceptable.

Conceptualization of burnout from the perspective of the Neuman systems model.

Due to an incomplete match between Neuman's definition of the core response and proposed examples, the core response has been interpreted as solely physiological in nature. As a result, the majority of Neuman systems model-based research has focused on either identification of stressors or the relations between stressors, the flexible line of defense, and normal line of defense invasion while the core response has been largely neglected. The purpose of this paper is to argue for a broader conceptualization of the core response as any and/or all of the person variables proposed by Neuman. The burnout process, which is both psychological and spiritual in nature, was developed as a core response exemplar.

Tool development for evaluation of clinical nurse specialist competencies in graduate students: a pilot study.

PURPOSE: The purpose of this study was psychometric testing of the tool, Self Evaluation of CNS Competency Development. METHODS: The tool was developed using the NACNS competencies, with some concepts added to reflect graduate program objectives. The student sample was 33 students who provided informed consent and completed the tool. The preceptor sample was 6 preceptors who clinically supervised 6 students. RESULTS: As expected, independent samples t tests with matched pairs of 6 students and preceptors showed that there were no mean differences in 9 of the 12 categories within the 3 spheres of influence. Using the contrasted groups approach, discriminant function analysis showed that 91.7% of beginning and ending students were correctly classified. Cronbach alpha was estimated as .96. CONCLUSION: Results show partial support for criterion-related validity and construct validity. Tool reliability is satisfactory. Further testing with larger samples of students and clinical nurse specialists is recommended.

Improving external and internal validity of a model of midlife women's maternal-student role stress.

This study's purpose was to improve both the external and internal validity of Gigliotti's model of maternal-student role stress in midlife women. It was found that the model is generalizeable to midlife women who are non-degreed undergraduate students of varied marital and immigration status and varied college major, thus improving external validity. It was also found that investigating particular types of children's situation-specific social support improved internal validity. These results support the propositions of the Neuman systems model as well as Meleis and others' transition framework. An interventional study is proposed as the next step in this program of research.

Stressors in five client populations: Neuman systems model-based literature review.

AIM: This paper reports a literature review identifying and categorizing client system stressors in Neuman systems model-based studies. BACKGROUND: To date, literature reviews related to the Neuman systems model have focused broadly on all concepts of the model. The concept of stressors has been selected by the Neuman Systems Model Research Institute as the focus for an initial collaborative research project. METHOD: Cooper's five-stage integrative review method was used: problem formulation, data collection, data evaluation, analysis and interpretation, and dissemination. The Neuman systems model research literature from 1983 to February 2005 was searched using Fawcett's Neuman systems model bibliography and a follow-up review of the CINAHL database using the keywords 'Neuman systems model' and 'stressors'. A total of 87 studies published as journal articles or book chapters between 1983 and 2005 were reviewed; 13 of the 87 studies met the definition of 'stressor studies'. FINDINGS: Stressors were identified in five client populations: caregivers, cancer survivors, ICU patients in intensive care units, care receivers, and parents whose children were undergoing day surgery. The most common data collection method was the interview, and investigator-developed interview guides were most often used. Evidence of categorization of intra-, inter- and extra-personal stressors was present. The following overall stressors were identified: burden of responsibility (caregivers); awareness of vulnerability (cancer survivors); being overwhelmed (patients in intensive care units); loss of control (parents); and frustration with role changes (care receivers). CONCLUSIONS: These data could form the basis for nursing practice as well as future research within a collaborative environment. Given the existing body of knowledge concerning Neuman system model-derived middle range theory concepts in the caregiver population, the middle-range theory of caregiver role strain could be tested empirically.

A confirmatory factor analysis of situation-specific Norbeck Social Support Questionnaire items.

BACKGROUND: Situation-specific social support, measured by comparably worded Norbeck Social Support Questionnaire (NSSQ) items, holds promise in the development of context-specific theories at the practice level. However, psychometric work on situation-specific NSSQ items is lacking. OBJECTIVE: The aim of this study was to explore the statistical parameters of situation-specific NSSQ items (affect, affirmation, and aid). METHODS: Using data (N = 154) collected for a larger study, the parameters of three LISREL models were estimated by the generally weighted least squares method using an asymptotic covariance matrix. RESULTS: The modified two-factor model was accepted (chi2 = 11.54, df = 7, p < or = .12). Overall, parameter estimates suggest that, in this research context, two situation-specific items (affirmation and aid) measure unique dimensions of social support. CONCLUSIONS: In this instance, situation-specific affirmation and aid items measure unique dimensions of support. Guided by strong theory, investigators should develop situation-specific items based on the original NSSQ items.

Types and sources of social support and maternal-student role stress in married associate degree nursing students.

This paper presents findings from a secondary data analysis designed to determine, specifically, which types and sources of social support are associated with Maternal Student Role Stress for women in two age groups. Participants in the study were students in an Associate Degree nursing program who were married and had at least one child living at home. Data were collected at 11 community colleges in New York and New Jersey. For women aged 37 years and older, all types of support from their husbands and children were associated with less Maternal Student Role Stress. For women under 37 years of age, affirmation and aid from their husbands; aid from their children; and affect, affirmation, and aid from their mothers-in-law were associated with less Maternal Student Role Stress. Findings are interpreted in light of the groups' varied developmental stages, and recommendations for future research and practice are offered.

Etiology of maternal-student role stress.

This paper details the refinement and testing of a proposition regarding the age-related effects of psychological involvement in both the maternal role and the student role, and total network support on maternal-student role stress. Results of hierarchical multiple regression analysis showed that the independent variables contribute to an explanation of maternal-student role stress only for women aged 37 years and older. The proposition was further refined. It supports the propositions of both Neuman's systems model and Meleis et al.'s transition framework. Implications for research and practice are discussed.

The Neuman Systems Model Institute: testing middle-range theories.

The credibility of the Neuman systems model can only be established through the generation and testing of Neuman systems model-derived middle-range theories. However, due to the number and complexity of Neuman systems model concepts/concept interrelations and the diversity of middle-range theory concepts linked to these Neuman systems model concepts by researchers, no explicit middle-range theories have yet been derived from the Neuman systems model. This article describes the development of an organized program for the systematic study of the Neuman systems model. Preliminary work, already accomplished, is detailed, and a tentative plan for the completion of further preliminary work as well as beginning the actual research conduction phase is proposed.

A confirmation of the factor structure of the Norbeck Social Support Questionnaire.

BACKGROUND: The Norbeck Social Support Questionnaire was designed to measure three functional types of social support: (a) affect, (b) affirmation, and (c) aid. Due to high intercorrelations among factors, it has been impossible to empirically disentangle these three factors using exploratory factor analysis. OBJECTIVE; To confirm the originally hypothesized three-factor structure of the Norbeck Social Support Questionnaire by imposing theoretically motivated constraints upon the model. METHOD: With pooled data (N= 457) from two previous studies, the parameters of the hypothesized LISREL model were estimated by the Generally Weighted Least Squares Method using an asymptotic covariance matrix. RESULTS: The Norbeck Social Support Questionnaire measures three functional types of social support: (a) AFFECT, (b) AFFIRMATION, and (c) AID (chi2 = 8.42, df= 6, p=.208). These three factors are highly correlated and their unique error terms are uncorrelated. CONCLUSIONS: The Norbeck Social Support Questionnaire is a valid and reliable measure of total network support, as well as three functional types of social support. The three functional types of social support should be calculated and used in analyses, when appropriate. To support the development of context-specific theories, the efficacy of specific functional types of social support from specific network members should be investigated.