Souraya Sidani

Nurse staffing models as predictors of patient outcomes.

Background. Little research has been conducted that examined the intended effects of nursing care on clinical outcomes. Objective. The objective of this study was to evaluate the impact of different nurse staffing models on the patient outcomes of functional status, pain control, and patient satisfaction with nursing care. Research Design. A repeated-measures study was conducted in all 19 teaching hospitals in Ontario, Canada. Subjects. The sample comprised hospitals and adult medical–surgical and obstetric inpatients within those hospitals. Measures. The patient’s functional health outcomes were assessed with the Functional Independence Measure (FIM) and the Medical Outcome Study SF-36. Pain was assessed with the Brief Pain Inventory and patient perceptions of nursing care were measured with the nursing care quality subscale of the Patient Judgment of Hospital Quality Questionnaire. Results. The proportion of regulated nursing staff on the unit was associated with better FIM scores and better social function scores at hospital discharge. In addition, a mix of staff that included RNs and unregulated workers was associated with better pain outcomes at discharge than a mix that involved RNs/RPNs and unregulated workers. Finally, patients were more satisfied with their obstetric nursing care on units where there was a higher proportion of regulated staff. Conclusions. The results of this study suggest that a higher proportion of RNs/RPNs on inpatient units in Ontario teaching hospitals is associated with better clinical outcomes at the time of hospital discharge.

Effects of an abilities-focused program of morning care on residents who have dementia and on caregivers.

OBJECTIVE: To conduct a controlled investigation to examine the effects of an abilities‐focused program of morning care on the interaction behaviors and functioning of residents with dementia and on caregivers interaction behaviors and perceptions of caregiving.

Special featureQuantitative and qualitative methods:: Is There an Alternative?☆

Abstract The social sciences are particularly self-concious about their methodologies, and the distinction between quantitative and qualitative methods is more distinctly drawn than it should be. To some extent, proponents of both approaches have exaggerated the differences. Arguments opposed to quantitative methods are refutable, and methodological pluralism is needed and should be encouraged. Clinical and formulaic approaches to inquiry may be distinguished, but the two approaches may be used within the same line of inquiry but at different stages in the process leading from data collection, through analysis and interpretation, to utilization of information. In fact, both approaches may be used at the same points with the additional benefit of permitting triangulation on a closer approximation to the truth.

Understanding and Measuring Patients' Assessment of the Quality of Nursing Care

Background: Traditionally, patients have been considered incapable of evaluating the quality of care they receive, leading to their minimal involvement. Objective: To develop the Patients Assessment of Quality Scale-Acute Care Version (PAQS-ACV) to provide a mechanism through which patients can evaluate meaningfully the nursing care they receive. Methods: Developed from qualitative interviews with patients, the original 90-item PAQS-ACV was tested with 1,470 medical surgical patients in 43 units across seven hospitals. The typical patient was a married, 50-year-old, high school-educated patient hospitalized for the fourth time. Every 10th patient was asked to complete the PAQS-ACV 2 weeks later. Results: After exploratory factor analysis, 45 items remained in five factors, accounting for 54% of the variance. Internal consistency estimates were above.83 for four of the five factors, with the fifth factor being.68. Test-retest reliability ranged from .58 to .71. Content validity was established and construct validity has been explored preliminarily by examining the relationship between the PAQS-ACV scores and patients compliance. Discussion: Although the PAQS-ACV is a relatively new measure of quality nursing care, it has met many criteria for an adequate measure of quality care. The instrument fills a void in the assessment of quality by including patients in the direct evaluation of the care received.

Putting Program Theory into Operation

The emphasis on understanding how a program works and what makes a program work led to the development of the theory-driven approach to program evaluation. Theory plays a major role in guiding a program design and evaluation. The theory defines the presenting problem and the target population for whom the program is designed, specifies the causal processes underlying the program effects, and identifies its expected outcomes as well as factors that affect treatment processes. In this article, a conceptual framework is presented as a tool for putting the program theory into operation. The framework incorporates variables that reflect theoretical concepts and implementation issues addressed in program evaluation. The framework organizes the variables into three categories: input, process, and output, and proposes direct and indirect relationships among them. Implications of the framework for program evaluation are discussed.

The reliability and validity of two health status measures for evaluating outcomes of home care nursing

The reliability, validity, and sensitivity of the Medical Outcome Study Short Form (SF-36) and the Quality of Life Profile: Senior Version (QOLPSV) for measuring outcomes of home care nursing were evaluated. Data were collected from 50 clients receiving home care nursing services. Twenty-two registered nurses and six registered practical nurses collected client and nursing data on each home visit. Client baseline and outcome measures were collected by two independent evaluators at admission and discharge from the home care service. Internal consistency reliability ranged from.76 to.94 for the eight subscales of the SF-36. Internal consistency reliability ranged from.47 to.82 for the nine subscales of the QOLPSV. The subscales of both instruments had minimal problems with missing responses. The SF-36 was found to be more sensitive than the QOLPSV to change over time. In addition, the subscales of the SF-36 were found to be more sensitive than the subscales of the QOLPSV to several of the nursing variables, such as intensity of the clients nursing condition and skill mix.

The Therapeutic Use of Music for Dyspnea and Anxiety in Patients with COPD who Live at Home

The purposes of this repeated measures study were to examine the feasibility of using music as an intervention for dyspnea and anxiety in patients with chronic obstructive pulminary disease (COPD) who live in their homes and to examine the effect of music on anxiety and dyspnea. Twenty-four participants who experienced dyspnea at least once a week were studied over a 5-week period. Baseline data were collected on Week 1. Measures of anxiety and dyspnea were taken on Week 2, prior to and immediately following the use of music. These measures were repeated on Week 5. There was a significant decrease in dyspnea following the use of music as reported in the music diary (p < .001). There was a significant decline in anxiety (p < .05) and dyspnea (p < .01) following the use of music on Week 2. There was no significant change in anxiety or dyspnea over the 5-week period.

Including the Provider in the Assessment of Quality Care: Development and Testing of the Nursesʼ Assessment of Quality Scale—Acute Care Version

This study was designed to develop a psychometrically sound measure of nurses evaluation of patient care delivered. The Nurses Assessment of Quality Scale—Acute Care Version (NAQS-ACV), derived from the qualitative interviews of acute care nurses, was initially 138 items formatted as a Likert-type scale and administered to 1272 nurses from 7 acute care hospitals. After analysis, the scale was reduced to 77 items contained in 8 factors. Reliability estimates for the factors ranged from 74 to 94.

Use of the Multitrait Multimethod (MTMM) to Analyze Family Relational Data

In this article, the authors propose the logic of the multitrait multimethod (MTMM) approach for analysis of data as an alternative solution for examining family relational data. Application of the MTMM logic permits the assessment of commonperspectives shared byallfamily members and of the unique perspectives of individuals. The advantages of using this approach in family research include the ability to (a) maintain consistency between systems theory views of familyas-a-unit, and (b) delineate patterns of agreement, disagreement, or both amongfamily members.

An abilities assessment instrument for elderly persons with cognitive impairment: psychometric properties and clinical utility.

In this article the psychometric properties of an Abilities Assessment Instrument (AAI), developed to assess the self-care, social, interactional and interpretive abilities of older people with cognitive impairment (CI) related to dementia, are described. The sample consisted of 112 institutionalized older men with CI and 60 institutionalized older men without CI. The psychometric evaluation of the AAI indicated that: (a) it is reliable in terms of test-retest (Pearson’s r range .93-.99), interrater (Pearson’s r range .95-.99), and internal consistency evaluations (Cronbach’s alpha .90-.98), as well as through confirmatory factor analysis; and (b) that it is valid with respect to content validity (CVI 87.3%), concurrent validity (Pearson’s r correlations ranging from -.67-.80 on the London Psychogeriatric Rating Scale [LPRS], and from -.76-.85 on the Functional Assessment Stages Scale [FAST]), and construct validity with significant differences between subjects with and without CI (t values ranging from 5.13 -9.30). The AAI is a reliable and valid instrument that can be used to provide assessment data.