1. Development of a prototype tool for measuring the context of care in intellectual disability settings in the UK Professor Bob Gates 1, Dr Kay Mafuba 2, Dr Stephen Roberts 3, Christian Sauer 4, Dr Nasser Matoorianpour 5, Maria Cozens 6 (bob.gates@uwl.ac.uk) This poster details the background and context to the development of a ‘prototype paper based tool’ to measure compliance with factors thought to be necessary for the delivery of safe and compassionate intellectual disability nursing care to people with intellectual disabilities in inpatient and community settings. It also details the origins, development, and testing of this tool, along with reporting on its initial psychometric properties leading to the development of a ‘demonstrator prototype web based tool’. http://buildhost.uwl.ac.uk:8080//staffingtool/ A previous systematic review of literature failed to locate any specific papers that addressed safe nursing staff levels in intellectual disability services (Mafuba, Gates, and Shanley, 2014). However, numerous papers were identified that explored factors that directly or indirectly impacted on the delivery of safe and compassionate intellectual disability nursing care. These papers were organised into eight themes that included; level of client need, staff attributes, staff perception of challenging behaviour, job satisfaction, working as a team, stress, burnout and work overload, and organisational support that includes staff feedback, and finally working in the community. Collectively these have been referred to as the ‘context of care’, and is based upon a relatively new concept in the field of learning disabilities, and it relates to; ‘a concept that integrates the totality of circumstances that comprise the milieu of human life and human functioning. Context can be viewed as an independent and intervening variable. As an independent variable, context includes personal and environment al characteristics that are not usually manipulated such as age, language, culture and ethnicity, gender and family. As an intervening variable, context includes organisations, systems and societal policies and practices that can be manipulated to enhance functioning’ (Shogren, et al., 2014, 110) Firstly the themes were operationalised into a number of trial statements that were presented to a national intellectual disability nursing task and finish group [T and F]. Each statement was written in order that it could be rated by a clinician as a component of the context in which they worked. These were approved by the T and F group. Subsequently all of the themes were developed into a paper-based prototype tool to measure context of care in a range of learning disabilities settings. In all 7 statements were carefully constructed for each of the 8 themes; some 56 separate statements in total. Next a national expert reference group was convened in London, UK where the tool was evaluated though group discussion. Also at this meeting opportunity was afforded to discuss ‘end user ‘ requirements for a possible electronic version. Based on comments gathered from this expert reference group the tool was amended. The tool was next sent to N = 22 individuals and organisations in England, who expressed interest in helping the research team undertake initial psychometric calculations. The tool has been designed specifically with clinicians in mind who are required to rate each of the statements, drawing on a range of evidence to support their clinical judgment, as to the extent of compliance with the statements, and this appears to have been well received. The tool has now been subjected to extensive testing and evaluation by an expert national reference group for construct validity. In addition the tool has good internal consistency reliability. Cronbach’s Alpha coefficient for the tool is.921, and based on standardized items, is.912. Using a confidence level of 95%, a reliability coefficient of between.89 and.97 would be expected; thus the tool has good internal consistency reliability. Subsequently the paper based tool has been developed into an on-line prototype demonstrator that is now being evaluated by a national group for additional financial support for further development and testing from NHS England. References Mafuba, K; Gates, B; Shanley, O. (2014) Final report of a systematic review of literature on intellectual disability nursing staffing levels, and its relation to the safety, quality and the delivery of compassionate nursing care. London. University of West London. Shogren, KA, Luckasson, R and Schalock, RL (2014) The definition of ‘context’ and its application in the field of intellectual disability. Journal of Policy and Practice in Intellectual Disability. 11. (2). 109-116. Author affiliations 1 - INSPIRE, University of West London, UK; 2, 6 - London College of Nursing, Midwifery & Healthcare, University of West London, UK; 3, 4, 5 - School of Computing and Technology, University of West London, UK. For the demonstrator prototype web based tool Java Server Pages were chosen to implement the web-based questionnaire, and subsequently the necessary software elements of the demonstrator were implemented in Java. The database format used in the demonstrator is MySQL. However, for a later development of the full online audit tool we can also choose different approaches, such as a PHP based website, and different database formats. The final choice of the tools will depend on the user requirements elicited, to best match these. The main components of the demonstrator are at the current time as follows; A web server, providing the webpages and script/java functionalities to serve the questionnaire pages, A MySQL database to store basic ward information and the answers from the wards/institutions, and A basic data mining, data evaluation interface to inspect the data provided The basic outline of the demonstrator is currently configured as shown in figure 1. Figure 1 Basic layout of the demonstrator The following screenshots figures 2 - 5 are taken from the demonstrator, showing a selection of the webpages in a Windows7/Firefox 31.0 context, however the prototype is also compatible with IE, Chrome and other browsers. Figure 2 - Welcome page Figure 3, Section 5 - Working as a team page from the tool Figure 4 - A simple data overview for a single ward Figure 5 - A selection of tabs from the demonstrator Firstly, relevant research reviewed during this project has shown that a range of factors; level of client need, staff attributes, staff perception of challenging behaviour, job satisfaction, working as a team, stress, burnout and work overload, and organisational support that includes staff feedback, and working in the community collectively provide a context for the delivery of safe and compassionate care in intellectual disability settings. From this it has been shown that a ‘context of care’ tool that offers both reliability and validity has been developed. Firstly as a paper based tool and then and developed into a demonstrator prototype web based tool’. Finally, feedback on the a recent online demonstrator prototype of the paper based tool is believed to have significant potential as a computer based application. Further work be undertaken to develop the demonstrator tool into a fully operational online tool. Following further development, further work be undertaken to evaluate the effectiveness of the tool, particularly its psychometric properties. Explore in the longer term the integration and alignment of the context of care tool to other sets of NHS data, platforms and systems. Background Method Findings Conclusion Recommendations