The Algase Wandering Scale: initial psychometrics of a new caregiver reporting tool.

This paper reports on the Algase wandering scale (AWS), a 28-item questionnaire, based on five dimensions of wandering. With factor analysis, an eight-factor solution explained nearly 70 percent of the variance in ratings for 151 long-term care subjects and confirmed three of the structuring dimensions. Reliability of the AWS was examined for internal consistency and for inter-rater reliability. The AWS had an alpha of .86; subscale alphas ranged between .88 (persistent walking) and .57 (routinized walking). Inter-rater reliabilities, estimated through cross-rater comparisons of the AWS and subscales with a four-point judgement of wandering status, were moderately strong and no significant differences existed between two sets of raters. Validity of the AWS and its subscales was supported by examining their ability to differentiate wanderers and nonwanderers, by positive correlation with measures of cognitive impairment and with multiple parameters of observed wandering, and by negative or no correlations with nonwandering locomotion. Although the AWS may be a useful measure of wandering in long-term care settings, validation of its factor structure and evaluation in cross-cultural samples is needed.

Inpatient and ambulatory patient satisfaction with nursing care.

This study reports on the development and psychometric testing of inpatient and ambulatory patient satisfaction scales designed to measure patient satisfaction using the standards of nursing practice within a medical center. The surveys were administered to patients 4-6 weeks after discharge from the hospital or following a clinic visit. A total of 619 inpatient and 955 ambulatory patient questionnaires were analyzed. Factor analyses suggest there exist four scales for inpatient satisfaction anf five scales for outpatient satisfaction with high reliability and reasonable validity.

Strategic dislocation: reconsidering the role of benchmarking in the development of core competencies.

American healthcare is under tremendous pressure to make difficult choices to stay even with patient and payer expectations. The answer lies not in benchmarking incremental improvement alone but in benchmarking the processes to nurture core competencies.

Quality of condom use as reported by female clients of a family planning clinic.

OBJECTIVES: This study analyzed the prevalence and determinants of the quality of condom use after a woman's first visit to a family planning clinic. METHODS: This report presents data from 360 female family planning clients who reported using condoms as their primary method of contraception for at least 1 sexually active month during the study's follow-up period after their first clinic visit. RESULTS: Only 1% always engaged in all five use behaviors studied: using a condom for each sexual intercourse, putting the condom on before first entry, withdrawal after intercourse while there is still an erection, holding on to the condom's rim during withdrawal, and using foam. Multiple linear regression indicated that more effective condom use was reported by women who had not had an induced abortion, were not using condoms just because they were starting oral contraceptive pill regimens, had more knowledge about birth control in general, had received a nursing intervention, and had more communication with their partner. CONCLUSIONS: Increasing attention needs to be devoted to understanding determinants of the specific actions that differentiate between more and less effective contraceptive use.

Oral contraceptive pill use after an initial visit to a family planning clinic.

A retrospective study of 1,311 women making initial family planning visits to metropolitan-area health department clinics found that many women switch methods or discontinue use in the first year following the clinic visits. Among a subgroup of women, most of whom selected the pill as their primary method and who used the pill for at least one of the months in the study period, almost half either changed methods or used no method at some point during a follow-up period averaging eight months. This includes 13 percent of women who made two or more changes. In addition, only 42 percent said they took a pill every day, and only half of these said they always took their pill at about the same time every day. Despite such irregularities, pill users were approximately one-third as likely to get pregnant during the study period as women making an initial family planning visit to a health department clinic who did not use the pill at all.

PIP: A retrospective study of 1311 women making initial family planning visits to metropolitan area health department clinics found that many women switch methods or discontinue use in the 1st year following clinic visits. Among a subgroup of women, most of whom selected the pill as their method of choice and who used it for at least 1 of the months in the study, almost 1/2 either changed methods or used no method at some time during a followup period averaging 8 months. This includes 13% of women who made 2 or more changes. In addition, only 42% said they took a pill every day and 1/2 of these women always took their pill at the same time each day. Despite such irregularities, pill users were approximately 1/3 as likely to get pregnant during the study period as women making an initial family planning visit to a health department clinic who did not use the pill at all.