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Posts from the ‘Instrument Development’ Category

Jul 20

Professional Governance


The current featured article in ANS is titled “Professional Governance Scale: Instrument Development and Content Validity Testing” by Marla J. Weston, PhD, RN, FAAN; Joyce A. Verran, PhD, RN, FAAN; Joanne T. Clavelle, DNP, RN, NEA-BC, FACHE and Tim Porter-O’Grady, DM, EdD, APRN, NEA-BC, FAAN. The article is available at no cost from the ANS website while it is featured.  Dr. Weston shared this message for ANS readers about this work:

The Professional Governance Scale research team began meeting over four years ago with the goal of developing and refining a new instrument to measure shared governance that could be used by aspiring and current Magnet® organizations. After more than thirty years of experience and maturation with shared governance, the team recognized that the context and concept had evolved and so there was a need to examine the concept with a fresh, contemporary perspective. One of the most insightful observations was that the term shared governance was originally selected in order to limit management resistance to legitimate nurse power over their practice and that it often created more confusion than clarity by leaving the content of what was shared in governance undefined. With deep analysis of excellence in nursing practice, the term professional governance was recognized as more accurately describing the practice of legitimate autonomy and control over the structures and processes of nursing care.

A concept analysis enabled the clarification of attributes and characteristics of professional governance, and subsequently guided item development. The second most interesting discovery of this work was during content validity testing of the instrument. Two groups of subject matter experts were used – those with expertise in instrument development and those with expertise in professional governance. Unexpectedly, relevancy ratings differed between the two groups of subject matter experts indicating that the unique perspective and expertise offered by each set of experts provided valuable input into the items and instrument development. This finding reinforces the importance of thoughtfully selecting content validity experts.

Upon reflection, this discovery also highlights one advantage of the composition of the research team. The combination of expertise in both instrument development and content on shared/professional governance facilitated a rich analysis and contribution to understanding an important facet of the professional practice of nursing.

 

Jul 22

Measurement of Holistic Nursing Values


In the current ANS featured article, author Elizabeth Kinchen, PhD, RN, AHN-BC, addresses the challenges facing nursing to address the primary care needs of populations now served because of access to the U.S. Patient Protection and Affordable Care Act.  The article, titled “Development and Testing of an Instrument to Measure Holistic Nursing Values in Nurse Practitioner Care” provides evidence of the effectiveness of nurse practitioner care.  Dr. Kinchen provided this description of her work:

Elizabeth-Kinchen

Dr. Elizabeth Kinchen

With the expansion of health care accessibility in the United States, nurse practitioners (NPs) are projected to assume increased responsibility for a large portion of primary care delivery. This article derives from my dissertation research, in which I explored the patient’s perception of the nature of the nurse practitioner’s care, specifically the preservation of holistic nursing values. I think this topic has special importance in describing the unique contribution which NPs make to primary care delivery.

The impetus for this research came from my experiences in working with and being cared for by nurse practitioners in acute care, academic, and clinic settings. Many of the patients I came in contact with confided that they preferred the nurse practitioner’s care because NPs take time to listen to them and consider all aspects of their circumstances when providing care. These qualities are hallmarks of nursing care, which, I contend, is by tradition and definition holistic in nature. Furthermore, the incorporation of holistic nursing values in NP care exemplifies the value of the NP role for patients.

The majority of research into NP care has hitherto focused on satisfaction and practice style, and has been mainly qualitative in design, so this study, using a newly-developed instrument, represents a contribution to quantitative research on NPs that does not address provider-driven indices such as satisfaction, but rather patients’ perceptions of the preservation of nursing values in NP care.

My dissertation research, guided and supported by Dr. Bernadette Lange and Dr. Ruth McCaffrey, was undertaken to develop and test the Nurse Practitioner Holistic Caring Instrument (NPHCI), a new instrument designed to gauge the extent to which nurse practitioners preserve holistic nursing values in their care. Results from this study support previous research findings regarding the holistic qualities of NP care, wherein NPs report incorporating holistic nursing values in practice; namely, patient advocacy, listening, non-judgmental acceptance of patient choices, and viewing patient conditions from a comprehensive, whole-person perspective. These are attributes which define holistic nursing care, and which the IOM1 cites as defining primary care delivery.

Nurse practitioner care is posited to differ in essential ways from purely medical practice, most importantly in its attention to a relationship-centered, coordinated and comprehensive mode of care delivery. Exploring a care model which highlights the incorporation of nursing values in NP practice therefore has great significance for patients, practitioners, and educators in guiding care, improving practice, and planning academic curricula. In addition, it is hoped that studies documenting the nature and value of NP care will also inform policy creation and reform, especially in matters such as reimbursement, scope of practice, and collaborative regulation.

Therefore, as next steps in this research, I hope to explore how holistic nursing values are incorporated in nurse practitioner care in larger, more diverse patient samples, and in NP program curricula, by revising the NPHCI for use in nursing faculty populations.

1. Institute of Medicine. The future of nursing: Leading change, advancing health. http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Report%20Brief.pdf. Published October 2010. Accessed October 18, 2014.

Download this important article now at now cost, while it is featured!  Then return here to participate in discussion of your ideas based on Dr. Kinchen’s article!