Marjorie J. Powers

Quality of life index: development and psychometric properties.

The purpose of the study on which this article is based was to assess the validity and reliability of an instrument designed to measure quality of life. Sixty-four items applicable to both healthy subjects and dialysis patients were tested with graduate students (n = 88); six items relative to dialysis were added, and the instrument was administered to dialysis patients (n = 37). Items were based on literature review, which supported content validity. Correlations between the instrument and an overall satisfaction with life question of 0.75 (graduate students) and 0.65 (dialysis patients) supported criterion-related validity. Support for reliability was provided by test-retest correlations of 0.87 (graduate students) and 0.81 (dialysis patients) and Cronbachs alphas of 0.93 (graduate students) and 0.90 (dialysis patients).

Development of an instrument to measure hope.

The purpose of this study was to develop an instrument to measure hope in adults and to evaluate its psychometric properties. A 40-item Miller Hope Scale (MHS) was developed based on critical elements of hope revealed in a comprehensive review of the literature and on an exploratory study of hope in persons who survived a critical illness. The instrument was critiqued by measurement and content experts, and content validity was established. The MHS was pretested on 75 subjects. The refined instrument was next evaluated using 522 healthy adults. The intent was to establish norms on the instrument before using it on ill subjects. The range of scores on the MHS is 40 to 200, with high scores indicating high hope. Mean hope score for this healthy sample was 164.46 (SD = 16.31). A leptokurtic curve, skewed to the left, was noted in these responses. As expected, the instrument detected high hope in individuals who were screened to have no physical or mental health problems. The internal consistency alpha coefficient was .93 with a 2-week test-retest reliability of .82. Criterion-related construct validity was established by correlating the MHS to the Psychological Well-Being Scale, r = .71, the Existential Well-Being Scale, r = .82, and a 1-item hope self-assessment, r = .69. Divergent validity with the Hopelessness Scale was established, r = -.54. Maximum likelihood factor analysis with oblimin rotation resulted in a three-factor solution: I, Satisfaction with Self, Others, and Life; II, Avoidance of Hope Threats; and III, Anticipation of a Future.

Psychometric assessment of the Jalowiec Coping Scale.

The Jalowiec Coping Scale consists of 40 coping behaviors culled from a comprehensive literature review, which are rated on a 1− to 5-point scale to indicate degree of use. Twenty judges classified the items to permit analysis of the coping behaviors according to a problem-oriented/affective-oriented dichotomy; 15 problem and 25 affective items resulted. Overall agreement by the judges was 85%, with greater consensus on problem items. Evaluation of stability using a two-week retest interval (N=28) yielded significant rhos of .79 for total coping scores, .85 for problem, and .86 for affective. With a one-month interval (N=30) coefficients were .78, .84, and .83, respectively. Alpha reliability coefficients of .86 (N= 141) and .85 (N= 150) supported instrument homogeneity. Content validity is substantiated by the systematic manner of tool development, by the large number of items used, and by the inclusion of diverse coping behaviors. Factor analysis (N=141) was used to investigate construct validity. A two-factor solution to evaluate the validity of the dichotomous classification showed that 80 % of the problem items loaded on Factor I, but only 56% of the affective items loaded on Factor II. To examine this multidimensional aspect, several other factor solutions were explored. Ultimately, the four-factor solution provided the most intelligible conceptual pattern with the least loss of information. Conceptual composition of these factors is discussed, and several tentative labels for each factor are suggested.

Stress and coping in hypertensive and emergency room patients.

Stressful life events (SLEs) and coping behavior were compared in 25 emergency room patients with nonserious acute illness and 25 newly diagnosed hypertensive patients. Stress was evaluated with a modified Rahes SLE questionnaire and coping with a rating scale developed by the primary investigator. Results showed that: ER patients reported significantly more (p<.05) SLEs for the one year preceding illness onset, although more hypertensives subjectively rated their stress level as high; ER patients experienced significantly more SLEs in personal and social, home and family, and financial categories; hypertensives experienced significantly more health-related SLEs; age was seen as influencing SLEs; hypertensive patients used significantly more problem-oriented coping methods than did ER patients; hypertensives relied more on religion and physical activity in coping than did the ER group; ER patients more often day-dreamed or used their past experience as a guide for coping with stress; each group rated use of drugs as least important in coping; and educational level proved to be a salient variable affecting coping.

Stressors associated with coronary bypass surgery.

The purpose of this study was to: (a) design and test an instrument to evaluate the incidence and severity of stressors associated with coronary bypass surgery and (b) assess the concordance between patient and nurse perceptions of such stressors. The patient sample consisted of 30 patients recovering without complications from coronary bypass surgery. Patients were white, primarily male and employed, one-third with graduate education, with a mean age of 54. The nurse sample consisted of 18 registered nurses with cardiosurgical nursing care experience. A 30-item stressor scale was developed: 27 items were derived from literature review and 3 from comments of cardiovascular clinical specialists. Stressfulness of each item was rated on a 5-point scale. A pilot study with seven patients provided information for initial scale refinement. Content validity of the scale has both theoretical and empirical support because of the varied sources used to obtain and validate relevant items for the tool. Homogeneity reliability of the scale was supported by high coefficient alphas. Based on severity of stress ratings, two-way analysis of variance indicated that the cardiothoracic nurses generally rated all items as significantly more stressful for coronary bypass patients than did the patients themselves. Comparisons used by the nurses and the patients in assigning stressfulness ratings are discussed.

Nurse practitioner and physician care compared for nonurgent emergency room patients.

This experimental field study compared knowledge, satisfaction and compliance in 62 nonurgent emergency room (ER) patients based on whether they were cared for by a nurse practitioner (experimental group) or a physician (control). Data were collected via structured interviews in the ER, two weeks later by phone and three months later by phone, mail and chart review. No significant differences were found between groups in overall short- and long-term compliance scores, appointment-keeping scores for the three-month study period, number of health recommendations recalled, resolution of health problem or satisfaction ratings of ER care. It was also found that: referrals were the recommendation least complied with; 60 percent of appointments were kept; frequent reasons for non-compliance were inconvenience and lack of perceived need; experimental subjects showed greater comprehension of diagnostic recommendations and therapeutic applications, while controls had better knowledge of medications; 77 percent of experimentals were completely satisfied with NP care, as compared to only 48 percent of the controls with MD care; and reasons for satisfaction centered on the quality of care, while reasons for dissatisfaction focused on unresolved problems and slow care.

The employment potential of hemodialysis patients.

This study examined variables that may influence the employment potential of hemodialysis patients. The study group consisted of currently employed (n = 20) and currently unemployed (n = 20) hemodialysis patients. All subjects had been employed before starting dialysis and were currently judged physically able to work by their physicians. No significant differences were found in job satisfaction or job importance before starting dialysis. The groups did not differ on biophysiological status or perception of health. However, a greater number of the unemployed had held jobs requiring heavier physical labor and reported that uremic symptoms prevented them from working. They also encountered more job discrimination due to illness and had a greater loss of career and life goals. No significant differences were found between the two groups in life satisfaction or dependence. In both groups the more independent subjects reported greater satisfaction with life.

Psychometric evaluation of the hemodialysis stressor scale.

This report updates the psychometric information available on the Hemodialysis Stressor Scale. The tool is a 29-item scale that rates the incidence and severity of stressors associated with hemodialysis treatment of end-stage renal disease. Six items are classified as physiologic stressors and 23 as psychosocial stressors. Alpha homogeneity coefficients achieved acceptable standards for reliability. Content validity is demonstrated by the varied sources used to ascertain pertinent items for the scale. Construct validity of the scale was investigated by factor analysis (N = 174). A two-factor solution to evaluate the validity of the physiological-psychosocial dichotomy showed insufficient support for this simplistic dichotomous classification of hemodialysis stressors. A subsequent unrestricted factor solution to explore the multidimensionality of the scale yielded eight factors, but only three were significant, so a three-factor solution was subjected to rotation. The content of the 6 physiological and 9 psychosocial items loading significantly on Factor I characterized this factor as psychobiological; Factor II consisted of 12 psychological and social stressors; Factor III pertained to 8 dependency and restriction stressors. The three-factor solution was seen as the best-fitting solution with this particular data set because it was conceptually clear, informative, and parsimonious.