Laurel E. Radwin

Development and pilot testing of four desired health outcomes scales.

PURPOSE/OBJECTIVES To develop and pilot test scales to measure desired health outcomes hypothesized to result from high-quality cancer nursing care: Fortitude Scale, Trust in Nurses Scale, Cancer Patient Optimism Scale, and Authentic Self-Representation Scale. DESIGN Instrument development. SETTING Community cancer support organization. SAMPLE 66 recently treated patients with cancer who attended a cancer support organization workshop. The sample was predominately white, middle-aged, well-educated females. METHODS Items for each scale were generated from qualitative data and the literature. The scales properties were evaluated using expert panel assessment of content validity, cognitive interviews of patients with cancer, and reliability and validity testing of each scale with the Multitrait/Multi-Item Analysis Program Revised (MAP-R) statistical program. FINDINGS Participant responses to the four scales did not include the lowest possible score. Responses yielded evidence of adequate Cronbachs alpha internal consistency reliability for each scale: 0.81 for the Fortitude Scale; 0.81 for Trust in Nurses Scale, 0.75 for Cancer Patient Optimism Scale, and 0.71 for Authentic Self-Representation Scale. The MAP-R statistics yielded evidence of acceptable convergent validity and discriminant validity. CONCLUSIONS The data provided preliminary evidence of acceptable psychometric properties for four scales designed to measure desired outcomes of cancer nursing care. Support was found for careful use of scales. Further psychometric testing with large samples is recommended. IMPLICATIONS FOR NURSING These scales represent an initial effort toward providing measures of the desired health outcomes that patients with cancer attributed to high-quality cancer nursing care.

An Expanded Theoretical Framework of Care Coordination Across Transitions in Care Settings.

For many patients, high-quality, patient-centered, and cost-effective health care requires coordination among multiple clinicians and settings. Ensuring optimal care coordination requires a clear understanding of how clinician activities and continuity during transitions affect patient-centeredness and quality outcomes. This article describes an expanded theoretical framework to better understand care coordination. The framework provides clear articulation of concepts. Examples are provided of ways to measure the concepts.

The Deserved Care Framework for Evaluating Health Care Quality

Excessively narrow definitions of health care quality do not identify certain important components of health care for clinicians, providers, or patients. Excessively broad definitions drive up health care costs and encourage unjustified interventions. This article proposes a framework for examining health care quality that distinguishes between what patients need, want, and deserve, and it advances the idea that deserved care is the relevant concept of care to inform health policy debates.

The Clinical Nurse Specialist in the Faculty Role

Often, contributions by the clinical nurse specialist (CNS) are seen as exclusive to CNSs employed in the service setting. Yet, this may be too narrow a view of the possibilities of the specialist role. This paper examines how a faculty member in a school of nursing who does not hold a joint appointment can fulfill the mission and intent of the CNS role. Citations from the literature and examples from practice describe how the CNS who is a faculty member can enhance nursing as a direct care provider, consultant, researcher and educator.

Gate keeping and legitimisation were central in the interactions between informal carers of older people and healthcare workers

Participants 19 English speaking carers who attended the ward and 25 healthcare workers. Informal carers were those who provided physical or social care or assistance for another person. Without this help, the recipient would need health, social, or voluntary sector service intervention. Healthcare workers were nurses, physiotherapists, occupational therapists, dieticians, ambulance personnel, nursing auxiliaries, agency carers, and housekeepers.