Development and Validation of a Measurement to Assess Person-centered Critical Care Nursing

Jiyeon Kang; Young Shin Cho; Yeon Jin Jeong; Soo Gyeong Kim; Seonyoung Yun; Miyoung Shim

doi:10.4040/jkan.2018.48.3.323

Journal List > J Korean Acad Nurs > v.48(3) > 1108869

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kang, Cho, Jeong, Kim, Yun, and Shim: Development and Validation of a Measurement to Assess Person-centered Critical Care Nursing

Original Article

J Korean Acad Nurs 2018;48(3):323-334.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.3.323

Development and Validation of a Measurement to Assess Person-centered Critical Care Nursing

Jiyeon Kang¹, Young Shin Cho^2,, Yeon Jin Jeong¹, Soo Gyeong Kim², Seonyoung Yun³, Miyoung Shim⁴

¹Department of Nursing, Dong-A University, Busan

²Surgical Intensive Care Unit, Kosin University Gospel Hospital, Busan

³Department of Nursing, Youngsan University, Yangsan

⁴Nursing Department, Seoul National University Hospital, Seoul, Korea

Address reprint requests to : Cho, Young Shin Surgical Intensive Care Unit, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea Tel: +82-51-990-3271 Fax: +82-51-990-3005 E-mail: skystorysky@naver.com

Received 5 March 2018 Revised 30 May 2018 Accepted 30 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to develop a scale to measure person-centered critical care nursing and verify its reliability and validity.

Methods

A total of 38 preliminary items on person-centered critical care nursing were selected using content validity analysis of and expert opinion on 72 candidate items derived through literature review and qualitative interviews. We conducted a questionnaire survey with 477 nurses who worked in intensive care units. The collected data were analyzed using exploratory factor analysis (EFA) and confirmative factor analysis (CFA) with SPSS and AMOS 24.0 program.

Results

EFA was performed with principal axis factor analysis and Varimax rotation. The 15 items in 4 factors that accounted for 50.8% of the total variance were identified by deleting the items that were not meet the condition that the commonality should be .30 or more and the factor loading over .40. We named the factors as compassion, individuality, respect, and comfort, respectively. The correlation coefficient between this scale and the Caring Perception Scale was r=.57 (p<.001), which determined concurrent validity. The item-total correlation values ranged from .39 to .63, and the internal consistency for the scale was Cronbach's α=.84.

Conclusion

The reliability and validity of the 15 item person-centered critical care nursing scale were verified. It is expected that the use of this scale would expand person-centered care in critical care nursing.

Keywords: Critical Care Nursing, Patient-Centered Care, Factor Analysis, Statistical, Reproducibility of Results

References

1. World Health Organization. The world health report 2000: Health systems: Improving performance. Geneva: World Health Organization;2000. p. xi–xix.

2. Seoul University R&DB Foundation. A study on the development of patient-centered medicine evaluation model. Wonju: Health Insurance Review & Association Services;2015. May. Report No.: G000E70-2015-87.

3. Lusk JM, Fater K. A concept analysis of patient-centered care. Nursing Forum. 2013; 48(2):89–98. https://doi.org/10.1111/nuf.12019.

4. Morgan S, Yoder LH. A concept analysis of person-centered care. Journal of Holistic Nursing. 2012; 30(1):6–15. https://doi.org/10.1177/0898010111412189.

5. Sidani S, Collins L, Harbman P, MacMillan K, Reeves S, Hurlock-Chorostecki C, et al. Development of a measure to assess healthcare providers’ implementation of patient-centered care. Worldviews on Evidence-Based Nursing. 2014; 11(4):248–257. https://doi.org/10.1111/wvn.12047.

6. Charmel PA, Frampton SB. Building the business case for patient-centered care. Healthcare Financial Management. 2008; 62(3):80–85.

7. Suhonen R, Välimäki M, Katajisto J. Developing and testing an instrument for the measurement of individual care. Journal of Advanced Nursing. 2000; 32(5):1253–1263. https://doi.org/10.1046/j.1365-2648.2000.01596.x.

8. Edvardsson D, Fetherstonhaugh D, Nay R, Gibson S. Development and initial testing of the Person-centered Care Assessment Tool (P-CAT). International Psychogeriatrics. 2010; 22(1):101–108. https://doi.org/10.1017/S1041610209990688.

9. Tak YR, Woo HY, You SY, Kim JH. Validity and reliability of the person-centered care assessment tool in long-term care facilities in Korea. Journal of Korean Academy of Nursing. 2015; 45(3):412–419. https://doi.org/10.4040/jkan.2015.45.3.412.

10. Jakimowicz S, Perry L. A concept analysis of patient-centred nursing in the intensive care unit. Journal of Advanced Nursing. 2015; 71(7):1499–1517. https://doi.org/10.1111/jan.12644.

11. O’Connell E. Therapeutic relationships in critical care nursing: A reflection on practice. Nursing in Critical Care. 2008; 13(3):138–143. https://doi.org/10.1111/j.1478-5153.2008.00273.x.

12. Petty J. Learning from narrative to understand the person-centred experience in neonatal nursing: A literature review. Journal of Neonatal Nursing. 2016; 22(6):297–308. https://doi.org/10.1016/j.jnn.2016.08.005.

13. Ranse K, Bloomer M, Coombs M, Endacott R. Family centred care before and during life-sustaining treatment withdrawal in intensive care: A survey of information provided to families by Australasian critical care nurses. Australian Critical Care. 2016; 29(4):210–216. https://doi.org/10.1016/j.aucc.2016.08.006.

14. Mitchell ML, Coyer F, Kean S, Stone R, Murfield J, Dwan T. Patient, family-centred care interventions within the adult ICU setting: An integrative review. Australian Critical Care. 2016; 29(4):179–193. https://doi.org/10.1016/j.aucc.2016.08.002.

15. Kitson A, Marshall A, Bassett K, Zeitz K. What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing. 2013; 69(1):4–15. https://doi.org/10.1111/j.1365-2648.2012.06064.x.

16. Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: Its role in physical and psychological recovery. Journal of Intensive Care Medicine. 2012; 27(2):97–111. https://doi.org/10.1177/0885066610394322.

17. Hinkin TR. A brief tutorial on the development of measures for use in survey questionnaires. Organizational Research Methods. 1998; 1(1):104–121. https://doi.org/10.1177/109442819800100106.

18. Costello AB, Osborne JW. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research & Evaluation. 2005; 10(7):1–9.

19. Myers ND, Ahn S, Jin Y. Sample size and power estimates for a confirmatory factor analytic model in exercise and sport: A Monte Carlo approach. Research Quarterly for Exercise and Sport. 2011; 82(3):412–423. https://doi.org/10.1080/02701367.2011.10599773.

20. Suh EH. Statistical analysis using SPSS.

21. Paju: Freeacade-my. 2013. 357–381.

21. Arthur D, Pang S, Wong T, Alexander MF, Drury J, Eastwood H, et al. Caring attributes, professional self concept and technological influences in a sample of Registered Nurses in eleven countries. International Journal of Nursing Studies. 1999; 36(5):387–396. https://doi.org/10.1016/S0020-7489(99)00035-8.

22. Song HR. Comparative study of professional self-concept and caring perception in nurses and nursing student. [master’s thesis]. Daejeon: Eulji University;2010. p. 1–89.

23. Yu JP. The concept and understanding of structural equation modeling. Seoul: Hannare Publishing Co.;2012. p. 160–370.

24. Ji EG, Kim MJ. Development and practice of social welfare measurement. Seoul: Hakjisa;2015. p. 231–247.

25. Cohen J. A power primer. Psychological Bulletin. 1992; 112(1):155–159. https://doi.org/10.1037/0033-2909.112.1.155.

26. Schilling LS, Dixon JK, Knafl KA, Grey M, Ives B, Lynn MR. Determining content validity of a self-report instrument for adolescents using a heterogeneous expert panel. Nursing Research. 2007; 56(5):361–366. https://doi.org/10.1097/01.NNR.0000289505.30037.91.

27. Kim K, Kim S, Hong S, Kim J. The evaluation of the Korean Advance Directives (K-AD). Korean Journal of Hospice and Palliative Care. 2016; 19(2):109–118. https://doi.org/10.14475/kjhpc.2016.19.2.109.

28. Tembo AC, Higgins I, Parker V. The experience of communication difficulties in critically ill patients in and beyond intensive care: Findings from a larger phenomenological study. Intensive and Critical Care Nursing. 2015; 31(3):171–178. https://doi.org/10.1016/j.iccn.2014.10.004.

29. Jakimowicz S, Perry L, Lewis J. An integrative review of supports, facilitators and barriers to patient-centred nursing in the intensive care unit. Journal of Clinical Nursing. 2017; 26(23-24):4153–4171. https://doi.org/10.1111/jocn.13957.

30. Jakimowicz S, Perry L, Lewis J. Insights on compassion and patient-centred nursing in intensive care: A constructivist grounded theory. Journal of Clinical Nursing. 2018; 27(7-8):1599–1611. https://doi.org/10.1111/jocn.14231.

Table 1.

The Difference of PCCN according to the General Characteristics (N=477)

Characteristics	Categories	EFA (n=239)	CFA (n=238)	t or χ² (p)	Total	PCCN (total)
Characteristics	Categories	n (%)	n (%)	t or χ² (p)	) n (%) or M±SD	M±SD	t or F (p)
Gender	Male	12 (5.0)	10 (4.2)	0.18	22 (4.6)	3.88±0.40	0.98
	Female	227 (95.0)	228 (95.8)	(.670)	455 (95.4)	3.80±0.56	(.329)
Age (yr)^†				3.05	29.8±6.7		0.81
	<25	43 (18.0)	44 (18.6)	(.384)	87 (18.3)	3.87±0.40	(.491)
	25~29	106 (44.4)	96 (40.5)		202 (42.4)	3.85±0.39
	30~34	48 (20.0)	41 (17.3)		89 (18.7)	3.88±0.43
	≥35	42 (17.6)	56 (23.6)		98 (20.6)	3.93±0.41
Marital status	Single	173 (72.4)	174 (73.1)	0.03	347 (72.7)	3.85±0.38	1.95
	Married	66 (27.6)	64 (26.9)	(.859)	130 (27.3)	3.93±0.47	(.052)
Religion	Yes	123 (51.5)	128 (53.8)	0.26	251 (52.6)	3.92±0.41	2.76
	No	116 (48.5)	110 (46.2)	(.612)	226 (47.4)	3.82±0.40	(.006)
Highest degree held	Diploma	26 (10.9)	22 (9.2)	2.78	48 (10.1)	3.90±0.36	5.45
	Bachelor^a	192 (80.3)	184 (77.3)	(.249)	376 (78.8)	3.84±0.40	(.005)
	≥Master^b	21 (8.8)	32 (13.5)		53 (11.1)	4.04±0.46	a<b
Hospital size (number of bed)^†	General hospital	31 (13.0)	29 (12.2)	1.06	60 (12.6)	3.85±0.31	-0.48
	Advanced general hospital	208 (87.0)	208 (87.8)	(.588)	416 (87.4)	3.55±0.42	(.635)
ICU experience(yr)^†				0.45	5.43±5.10		1.29
	<1	19 (8.0)	18 (7.7)	(.931)	37 (7.9)	3.90±0.41	(.276)
	1~5	125 (52.8)	120 (51.0)		245 (51.9)	3.84±0.37
	6~10	56 (23.6)	55 (23.4)		111 (23.5)	3.90±0.43
	≥11	37 (15.6)	42 (17.9)		79 (16.7)	3.92±0.41
Position	Staff nurse	217 (90.8)	203 (85.3)	3.43	420 (88.1)	3.84±0.40	-4.22
	≥Charge nurse	22 (9.2)	35 (14.7)	(.064)	57 (11.9)	4.08±0.05	(<.001)
ICU type	Mixed^a	41 (17.1)	39 (16.4)	0.39	80 (16.8)	3.74±0.40	4.98
	Surgical^b Medical	44 (18.4) 53 (22.2)	44 (18.5) 57 (23.9)	(.984)	88 (18.4) 110 (23.0)	3.98±0.34 3.82±0.43	(.001) a<b,c
	Neurological	25 (10.5)	22 (9.3)		47 (9.9)	3.82±0.48
	Others^††	76 (31.8)	76 (31.9)		152 (31.9)	3.93±0.39
Number of patients per nurse				0.11	2.78±0.84		1.53
	≤2	78 (32.6)	81 (34.0)	(.746)	159 (33.3)	3.91±0.39	(.127)
	>2	161 (67.4)	157 (66.0)		318 (66.7)	3.86±0.42
Number of beds in ICU	≤10^b	59 (24.7)	56 (23.5)	0.09	115 (24.1)	3.94±0.38	4.67
	11~20	102 (42.7)	103 (43.3)	(.957)	205 (43.0)	3.89±0.39	(.010)
	≥21^a	78 (32.6)	79 (33.2)		157 (32.9)	3.80±0.44	a<b

EFA=Exploratory factor analysis; CFA=Confirmatory factor analysis; PCCN=Person-centered critical care nursing; ICU=Intensive care unit.

^† Missing included;

^†† Cardiac intensive care unit & Emergency intensive care unit.

Table 2.

Rotated Factor Pattern Matrix (N=239)

Item	Factor
Item	1	2	3	4
23. Condole patient and family with words and actions	.874	.092	.171	.162
22. Try to empathize with the situation of the patient and family	.733	.199	.278	.145
24. Try to make therapeutic contact with the patient and family (e.g., holding hands)	.575	.117	.388	.030
21. Talk to the patient and family about everyday topics (e.g., news, hobbies, interests)	.442	.285	.253	.103
4. Allow the patient to bring in the desired item (e.g., doll, religious article, photo, pillow)	.100	.725	.002	.097
3. Allow the patient to enjoy desired entertainment activities (e.g., listening to music, watching videos, reading)	.049	.689	.142	.080
20. In addition to the scheduled time, allow family visits if necessary	.278	.502	-.039	.190
17. Allow the family to participate in patient care (e.g., personal hygiene, feeding)	.088	.445	.041	.383
28. Talk to the unconscious patient as if he/she can listen to you	.263	-.008	.652	.244
29. Try non-verbal communication with the patient who can not speak	.241	.011	.627	.058
12. Allow the patient to urinate or defecate in the way he/she wants, to the extent possible	.073	.274	.488	.216
25. Consider other patients in the vicinity when CPR or death is ongoing	.324	-.051	.467	.224
8. Avoid unnecessary noise (e.g., chattering of medical staff, alarms)	.104	.194	.325	.774
9. Try to reduce unpleasant odor in the intensive care unit	.205	.085	.338	.571
7. Adjust lighting according to patients’ preference at night	.101	.413	.063	.559
Eigen value	2.23	1.89	1.84	1.66
Explained variance (%)	14.8	12.6	12.3 1	11.0
Total explained variances (%)	14.8	27.4	39.7 5	50.8

Table 3.

Confirmatory Factor of Analysis Finding (N=238)

Factors	Item S	Standardized estimate (β)	SE	C.R.	Factors			AVE	CR
Factors	Item S	Standardized estimate (β)	SE	C.R.	1 (r)	2 (r)	3 (r)	AVE	CR
1. Compassion	21	.60	.10	9.18	1			.64	.88
	22	.86	.07	13.63
	23	.88	.07	13.94
	24	.76	-	-
2. Individuality	3	.57	.20	6.33	.62	1		.42	.74
	4	.70	.20	7.14
	17	.64	.16	6.80
	20	.56	-	-
3. Respect	12	.37	.14	4.98	.80	.44	1	.46	.76
	25	.71	.12	9.01
	28	.70	.12	8.86
	29	.68	-	-
4. Comfort	7	.71	.12	9.33	.51	.65	.57	.67	.86
	8	.82	.13	10.09
	9	.71	-	-
Fitness index	χ² (p)		df	CMIN/DF	GFI	SRMR	RMSEA (90% CI)	TU	CFI
Criteria	(>.05)		≤	≤3.0	≥.90	≤.05	.05~.08	≥.90	≥.90
Model	205.13		84	2.68	.90	.05	.08	.90	.91
	(<.001)

PCCN=Person-centered critical care nursing; SE=Standard error; C.R.=Critical ratio; AVE=Average variance extracted; CR=Construct reliability; CMIN/DF=Chi square minimum/degree of freedom; GFI=Goodness of fit index; SRMR=Standardized root mean residual; RMSEA=Root mean square error of approximation; CI=Confidence interval; TLI=Turker lewis index; CFI=Comparative fit index.

Table 4.

Reliability Coefficients (N=238

Factors	Item	ITC (r)	Alpha if item	Cronbach's
Factors	Item	ITC (r)	deleted	alpha
Compassion	21	.52	.84	.81
	22	.63	.84
	23	.58	.84
	24	.52	.84
Individuality	3	.42	.85	.72
	4	.39	.85
	17	.42	.85
	20	.43	.85
Respect	12	.44	.85	.71
	25	.52	.84
	28	.42	.85
	29	.49	.85
Comfort	7	.50	.85	.76
	8	.60	.84
	9	.53	.84
Total				.84

ITC=Item-total correlation.

TOOLS

Similar articles