The purpose of this study was to develop and test the Verran and Snyder-Halpern (VSH) Sleep Scale, an instrument to subjectively measure sleep characteristics. Four major sleep factors and their associated characteristics were proposed for the Sleep Scale. Subjects completed three randomly ordered sleep questionnaires on three consecutive weekday mornings within the first two hours after arising. Scales included the VSH Sleep Scale, a sleep questionnaire and a sleep log. The VSH Sleep Scale had a reliability coefficient of .82 (theta). Construct validity was examined by factor analysis and correlations between Sleep Scale items and corresponding items on the two other study instruments. Scale validity also was assessed by the known groups method. Beginning support for the validity of the VSH Sleep Scale is provided.
Improvement of hospital unit work environments is key to quality patient care, productivity, nurse retention, and job satisfaction. Accurate measurement of such environments is necessary prior to introduction and evaluation of improvement structures and strategies. Characteristics and attributes of work environments are group level phenomena. Accurate assessment of these phenomena requires survey response rates of sufficient size to ensure sample representativeness and data that can reliably be aggregated to group level. What is the sufficient response rate? This question was answered through psychometric testing of five random samples from the population of 23 M.D. Anderson Cancer Center clinical units that had 100% response rates on an environmental survey. Response rates of 40% or more had acceptable psychometric properties for unit-specific scales.
Purpose To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager’s work domain. Methods Data for the WDA were obtained from semi-structured interviews with nurse managers, division directors, CNOs, and other managers (n = 20) on 10 patient care units in 3 Arizona hospitals. The WDA described the nurse manager’s environment in terms of the constraints it imposes on the nurse manager’s ability to achieve targeted outcomes through organizational goals and priorities, functions, processes, as well as work objects and resources (e.g., people, equipment, technology, and data). Constraints were identified and summarized through qualitative thematic analysis. Results The results highlight the competing priorities, and external and internal constraints that today’s nurse managers must satisfy as they try to improve quality and safety outcomes on their units. Nurse managers receive a great deal of data, much in electronic format. Although dashboards were perceived as helpful because they integrated some data elements, no decision support tools were available to help nurse managers with planning or answering “what if” questions. The results suggest both the need for additional decision support to manage the growing complexity of the environment, and the constraints the environment places on the design of that technology if it is to be effective. Limitations of the study include the small homogenous sample and the reliance on interview data targeting safety and quality.
Purpose We used Organization Risk Analyzer (ORA), a dynamic network analysis tool, to identify patient care unit communication patterns associated with patient safety and quality outcomes. Although ORA had previously had limited use in healthcare, we felt it could effectively model communication on patient care units. Methods Using a survey methodology, we collected communication network data from nursing staff on seven patient care units on two different days. Patient outcome data were collected via a separate survey. Results of the staff survey were used to represent the communication networks for each unit in ORA. We then used ORA's analysis capability to generate communication metrics for each unit. ORA's visualization capability was used to better understand the metrics. Results We identified communication patterns that correlated with two safety (falls and medication errors) and five quality (e.g., symptom management, complex self care, and patient satisfaction) outcome measures. Communication patterns differed substantially by shift. Conclusion The results demonstrate the utility of ORA for healthcare research and the relationship of nursing unit communication patterns to patient safety and quality outcomes.
Criteria for the examination of data collected at the individual level and aggregated to the group are proposed. These four empirical criteria relate to content validity, representativeness, reliability, and validity of the aggregated scores as indicators of group phenomena. An example of the use of the criteria is provided using data from a large research project on the implementation of a professional practice model on nine nursing units. The use of the criteria proposed provide a systematic approach to the evaluation of individual data for use at the group level.
The purpose of this article is to provide a brief review of guidelines for development of culturally appropriate measures of phenomena. The principles are illustrated by citing an example of their use in developing a survey instrument to be used with a rural Mexican American and Euro American population. Discussion focuses on practical issues of implementing the approaches suggested in the literature and adds to the literature about issues in formatting and administration of survey instruments used in cross-cultural research.
Aim:To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects.Background: Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research. Methods:A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety. A panel of 25 international experts in leadership and safety engaged a three-round modified Delphi study with Likert-scored surveys.Results: Eighty per cent of participating experts from six countries were retained to the final survey round. Consensus (>66% agreement) was achieved on 40 factors believed to influence safety climate in the acute care setting. Conclusions:Consensus regarding specific factors that play important roles in an organisation's climate of safety can be reached. Generally, the demonstration of leadership commitment to safety is key to cultivating a culture of patient safety. Implications for Nursing Management:Transformational nurse leaders should consider and employ all three categories of factors in daily leadership activities and decision-making to drive a strong climate of patient safety. K E Y W O R D SDelphi survey, nursing, patient safety, safety climate, transformational leadership | INTRODUCTIONHuman suffering caused by preventable medical error has taken a significant toll on patients, families and the second victims, health care organisations and clinicians (James, 2013). As care providers and consumers have become increasingly aware of the high rates of preventable patient deaths worldwide, the global health care community has called for transformational improvement in patient care quality and safety. To achieve this goal, an understanding of specifically how nurse leaders improve patient safety is essential. According to Wong (2015: p. 276), "the development and testing of robust conceptualisations of leadership that clearly describe leadership behaviours and identify the | BACKGROUNDTransformational leadership has a salient role in the safety chain by developing cultures of safety in the patient care environment (Buckner et al., 2014). This leadership style is associated with im- Despite a growing body of evidence related to TFL and its influence on patient safety outcomes (Merrill, 2015;Ross, 2011;Weng et al., 2015), further research is needed to explain how, why, or when these factors affect the safety chain by testing mediating and moderating effects (McFadden et al., 2014;Wong, 2015). A mediator specifies how the relationship between TFL and SC occurs, while a moderator interacts with TFL to vary the strength of the relationship with SC (Baron & Kenny, 1986). The framework validated by this study serves as an organising tool for this testing.The review of current evidence and prop...
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