Different psychometric properties of the Emotional Reaction Instrument-English (ERI-E) between hospitalized African American and Caucasian children.

PURPOSE: To demonstrate the psychometric properties of the Emotional Reactions Instrument-English (ERI-E) between hospitalized African American and Caucasian children aged 7-12 years. DESIGN AND METHOD: A methodological study was conducted to examine validity and reliability of the ERI-E with 230 hospitalized African American and Caucasian children. Data were collected with sociodemographic and clinical forms, and using the ERI-E, and the Facial Affective Scale (FAS). RESULTS: Different factor structures were found between hospitalized African American and Caucasian children. In psychometric testing of the ERI-E with African American children, four items, alone, lonely, shy, and bored, were removed from the original 16-item ERI-E after exploratory factor analysis. Three factors, including Fear, Anxiety, and Distress, were identified explaining 60.71% of the total variance. Cronbach's alpha coefficient for the revised 12-item scale was 0.85. Six items, happy, sad, afraid, frightened, hurt, and uncomfortable, in the ERI-E were significantly correlated with the FAS (r = 0.20-0.59) as evidence of concurrent validity. In the sample with hospitalized Caucasian children, two items, bored and uncomfortable, were eliminated from the original ERI-E after exploratory factor analysis. Four factors including Fear, Anxiety, Distress, and Loneliness were extracted with 62.61% of total variance. Cronbach's alpha coefficient for the revised 14-item in the ERI-E was 0.84 for hospitalized Caucasian children. As evidence of concurrent validity, 10 items, happy, sad, afraid, frightened, bad, lonely, scary, bored, hurt, and uncomfortable, in the ERI-E were significantly correlated with the FAS (r = 0.20-0.69). PRACTICE IMPLICATION: Because children with different cultural backgrounds understand or use words differently, healthcare providers should assess the cultural norms of pediatric patients and ensure steps have been taken to ensure clear, effective communication with pediatric patients. In addition, healthcare providers should evaluate the meanings of faces in the FAS before using it in a clinical setting because faces have different cultural connotations. The explosive growth of ethnic minority children in the United States makes it paramount for healthcare providers and researchers to consider the measurement equivalence of any measure to better serve different racial and cultural groups.

Examining Validity and Reliability of the Emotional Reactions Checklist with Hospitalized Children.

Fear, anxiety, and emotional upset are common experiences for hospitalized children. To identify and treat children's emotional reactions, health care professionals must be able to differentiate emotional reactions from pain and other symptoms. Clinical assessment of emotions requires the use of valid and reliable instruments in acute care settings. This study examined internal consistency, construct, and concurrent validity of the Emotional Reactions Checklist (ERC). A descriptive correlational design guided the psychometric approach. Children answered a sociodemographic questionnaire and responded to self-generated scenarios of pleasant and unpleasant events using two self-report scales of emotions. The convenience sample comprised 59 children admitted to an inpatient unit in a large children's hospital or to a community hospital emergency department. Construct validity was supported by significantly different ERC mean responses to recalled pleasant prehospitalization experiences and unpleasant hospitalization experiences (p < .001) for both ERC item responses and total scale scores. Children's explanations for seemingly inconsistent item responses further supported their ability to use the ERC to convey their emotions. Concurrent validity was supported by moderate (r = 0.32) to strong (r = 0.70) correlations between the Facial Affective Scale and ERC items and scale scores. Internal consistency was better supported for the recalled unpleasant experience (α = 0.77) than for the pleasant experience (α = 0.60). Results supported construct and concurrent validity and beginning internal consistency reliability for the ERC in an acute care setting. Further research is required to establish feasibility of repeated use with ill children.

Psychometric validation of Emotional Reaction Instrument-English to measure American children's emotional responses to hospitalisation.

AIMS AND OBJECTIVES: The aim of this study was to test the initial psychometric properties of the Emotional Reactions Instrument-English with hospitalised American children, ages 7-12 years, in the USA. BACKGROUND: Children's negative emotional responses have been a subject of concern for paediatric clinicians and researchers, especially because negative emotional responses following or during hospitalisation are associated with adverse patient outcomes. Existing self-report paediatric instruments have a number of limitations including lack of clinical feasibility and psychometric evidence. DESIGN: A survey and psychometric approach was used to test initial reliability and validity of the Emotional Reactions Instrument-ENGLISH. METHODS: Two hundred hospitalised American children, 7-12 years of age, who were admitted to a Children's Hospital in the USA were recruited for this study. The children were administered the Emotional Reactions Instrument-English, the Facial Affective Scale, and a demographic form. RESULTS: Internal consistency was supported by a Cronbach's alpha of 0·83 for the total scale. Alpha coefficients for subscales ranged from 0·59-0·82. Construct validity was tested with exploratory factor analysis. Through principal component analysis, four factors were identified that explained 64% of the variance. Concurrent validity was supported by most items in the Emotional Reactions Instrument-English being significantly correlated with the Facial Affective Scale (r = 0·18-0·59). The instrument can be administered to hospitalised children in 5-10 minutes. CONCLUSIONS: The results of this exploratory study provide initial support for the psychometric adequacy of the Emotional Reactions Instrument-English with hospitalised American children ages 7-12 years. Further testing of the Emotional Reactions Instrument-English is required to validate the subscales and evaluate the instrument's use with children of different ages, race and ethnicity. RELEVANCE TO CLINICAL PRACTICE: This study introduces a new, clinically feasible instrument to measure children's diverse emotional responses to hospitalisation.

An integrative review of literature examining psychometric properties of instruments measuring anxiety or fear in hospitalized children.

Anxiety and fear are among the most frequently reported emotional responses to hospitalization and are known to be contributing factors to pain and other negative patient outcomes. The first step in confronting unnecessary anxiety and fear is to identify valid and clinically feasible assessment instruments. The purpose of this paper is to review and evaluate instruments that measure children's fear or anxiety associated with hospitalization or painful procedures. A search was conducted of published English-language literature from 1980 through 2010 with the use of Ovid Health and Psychosocial Instruments, Medline, Nursing/Academic Edition, Cinahl, and Google Scholar. Inclusion criteria specified that the self-report instrument: 1) was developed in English; 2) was developed for and/or widely used with hospitalized children or children undergoing medical procedures or treatment; and 3) had research evidence of psychometric properties from at least five different studies. A comprehensive review of the literature revealed only five fear or anxiety instruments with adequate testing for evaluation of reliability and validity. Although all instruments have beginning psychometric adequacy, no one tool stands out as superior to the others. Therefore, we recommend that researchers and clinicians exercise caution in choosing assessment instruments, balancing potential strengths with reported limitations. Using more than one tool (triangulating) may be one way to achieve more credible results. Knowledge of credible existing instruments alerts us to what is possible today and to the imperative for research that will improve communication with children tomorrow.

Psychometric assessment of the Emotional Reactions Instrument-Korean (ERI-K) to measure Korean children's emotional reaction to hospitalization.

The purpose of this study was to test psychometric properties of the Emotional Reactions Instrument-Korean (ERI-K). A convenience sample of 170 hospitalized Korean children was recruited. Each child was asked to describe how she or he felt during hospitalization, through the ERI-K and the Facial Affective Scale. Surprisingly, children reported lower levels of negative emotions and physical discomfort and a moderate level of positive emotion (Happy, Good). Internal consistency reliability of .88 for the 14-item scale provides strong support for reliability. Construct validity was supported by item-to-total correlations ranging between .42 and .65. Exploratory factor analysis identified two factors that explained 54% of the variance. Further testing of the ERI-K is recommended to provide additional evidence of psychometric adequacy across Korean populations.