1. Psychometric Testing of the Presence of Nursing Scale: Patient Perceptions of Nursing Presence Capability in an Academic Medical Center
Rebecca L. Turpin, PhD, MSN, RN, NEA-BC
Assistant Professor, Whitson-Hester School of Nursing
Problem Statement:
Conclusions:
FINDINGS:
Nursing Presence Capability may be declining due to environmental threats(technology, economic pressures, nurse workforce experiential level and generational differences).
Quantifiable research to measure this value of nursing care is limited.
Clear, identifiable models (preferably visual) and reliable and valid instrument measures to validate patient perception are needed to teach and evaluate nurses’ and nursing student’s capability.
PONS-R established as reliable instrument for measurement of nursing presence.
PONS-R established construct validity using various methods.
PONS-R positively correlated to concurrent HCAHPS(NS) and NOT to unit-specific historical HCAHPS(NS).
Concurrent HCAHPS(NS) NOT correlated to historical HCAHPS(NS).
Nursing Presence positively correlated with units with:
* Younger nurses
* Less experienced (statistically significant)
* Higher % Associate degree nurses (statistically significant)
Nursing presence was NOT correlated significantly with any patient demographic
category.
7. Exploratory Factor Analysis:
One strong factor identifying that PONS-R is measuring ONE concept.
Secondary, weak factor indicative of “Intimacy Factor”
(potentially the elusive factor of our art) .
Reliability & Validity:
Internal consistency reliability of the PONS-R (r = .974)
Test-retest reliability (Pearson’ r = .791, Spearman’s rho = .872) both statistically significant at the .01 level).
Construct validity (PONS-R to HCAHPS) (r = .736, significant at the .01 level.
Divergent validity: independent t-tests between divergent sample and remaining sample. (p=.002). The magnitude of the differences was moderate (eta squared = .08).
Exploratory factor analysis:
Varimax Rotation & Oblimin Rotation (2 factor forced)
One solid factor, Weak secondary factor (Intimacy items)
Correlation Analysis: Unit Workforce
Average RN experience level to PONS-R: r = (negative correlation significant at the .05 level).
Average RN age to PONS-R: r = (negative correlation).
Associate degree nurses to PONS-R: r = .213, positive correlation, statistically significant at the .05 level.
Bachelor’s degree nurses to PONS-R: r = -.212, negative correlation, statistically significant at the .05 level.
Annual RN turnover rate to PONS-R: r = -.048, minimal negative correlation.
Correlation Analysis: Patient Demographics
PONS-R versus patient demographics (age, race/ethnic background, gender, state of residence, NC region of residence, household annual income, or employment status) - No statistically significant correlations
PONS-R versus patient-specific variables (number of RN that provided care & length of stay on the units) - No statistically significant correlations.
Study Process/Method:
Non-experimental, correlational, quantitative research design with two aspects:
1) instrument psychometrics, and
2) inpatient study using a minimally revised version of the Presence of Nursing Scale (PONS-R) to explore correlations within the work environment.
Conducted over 4 months. (May 2015 – August 2015)
Sample/Setting:
Convenience sample of adult hospitalized, inpatients in non-intensive care units.
10 non-intensive, acute care nursing units including: Cardiology, general medicine (2 units), medical/renal, hematology/oncology (2 units), surgical oncology, cardiothoracic surgery, gynecology/gynecological oncology, and trauma surgery.
Sample Size: 122 subjects
Test-retest reliability - resampled after 2 days = 21 subjects
Divergent validity –sample of poorest HCAHPS unit = 13 subjects
Setting: Tertiary care, academic medical center in the Southeast, Wake Forest Baptist Medical Center in Winston-Salem, NC.
Future Research/ Recommendations:
Repeat study in community-based hospitals in Southeast (non-Magnet status) to evaluate for differences.
Conduct concept analysis & expert panel review for identified intimacy factor to determine additional instrument items, then conduct further psychometric testing with larger sample size to improve upon factor analysis of PONS-R.
Additional studies of concurrent HCAHPS(NS) versus historic HCAHPS(NS) to determine “effect” of in-hospital surveying.
Correlational studies focusing on PONS-R and
other patient quality outcomes measures.
expanded nursing demographics beyond unit workforce variables (explore for confounding variables).
Measurement of Presence Scale (MOPS)-nurse perception.
Measures:
Patient Demographic and Satisfaction form (designed by the PI) – contains four nursing-sensitive HCAHPS satisfaction items.
Presence of Nursing Scale (PONS) – Revised (minus the traditional patient satisfaction question.
From Hospital:
Historical data on four nursing-sensitive HCAHPS satisfaction items.
How often did nurses treat you with courtesy & respect?
How often did nurses listen carefully to you?
How often did nurses explain things in a way you could understand?
After pressing the call button, how often did you get help as soon as you wanted? (all scored as 1=Never, 2=Sometimes, 3=Usually, 4=Always)
Unit-Specific Nursing Workforce Data Collection Tool (Avg. RN experience level and age, % of RN educational level, & Annual RN turnover rate.
References:
Kostovich, C. (2002). Development of a scale to measure nursing presence. (Order No.
, Loyola University of Chicago). ProQuest Dissertations and Theses, 139 p.
Retrieved from
( ).
Kostovich, C. (2012). Development and psychometric assessment of the Presence of
Nursing Scale. Nursing Science Quarterly, 25(2),
Turpin, R. (2014). State of the science of nursing presence revisited: Knowledge for
preserving nursing presence capability. International Journal for Human Caring,
18(4),
Research Questions:
What is the internal consistency and construct validity of the Presence of Nursing Scale-Revised?
How does reliability and validity evidence of PONS-R in this sample compare to prior studies using the PONS instrument?
What factors will be identified by conducting exploratory factor analysis?
Were resultant subscales and factors congruent with the Mid-Range Theory of Nursing Presence?
How do unit-specific data from HCAHPS patient satisfaction compare to Presence of Nursing Scale-Revised data during the study period?
Do relationships exist between unit-specific nurse demographic data and patient perception of nursing presence capability?
Do relationships exist between patient-specific demographic data and patient perception of nursing presence capability?
Acknowledgements:
East Tennessee State University Dissertation Committee: Dr. Florence Weierbach, Dr. Patricia Hayes, Dr. Lee Glenn, & Dr. Carol Kostovich (at Loyola University)
Wake Forest Baptist Medical Center: Dr. Sally Bulla, Research Director
Contact Info:
Rebecca L. Turpin, Primary Investigate – (beginning 8/1/2016)