The validation of nursing measures for patients with unpredictable outcomes
Date
2013-05-06
Authors
Loubser, Hendrik Johannes
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Abstract
The sciences of restorative nursing are unknown in South Africa, leaving patients with restorative needs with rather unpredictable outcomes. This study investigated the validity of four prospective nursing scales to be used for patients requiring nursing where the focus is to improve their functionality. Such patients are usually found in sub- and non-acute nursing units and suffering with chronic debilitating diseases, mental illness or recovering from trauma. Typically they are in need of rehabilitation, palliative care, geriatric services or long-term care to restore or maintain their functional independence.
Inspired by the theories of nursing pioneers such as Florence Nightingale, the definitive nurse who was also an astute healthcare reform statistician, as well as Ida Jean Orlando, better known as the originator of the nursing process, the researcher, a general medical practitioner, has explored the intuitive knowledge of experienced nurses to document the links between their observations, interpretations and predictions of patient functioning. This information was used to develop four interrelated nursing scales to be used routinely by nurses to provide raw patient scores on patient functional changes. As nursing intuition was used to develop the measures, the working hypothesis was that the scales are considered valid. Therefore, the approach towards the study was deductive in nature, seeking the evidence to confirm this assumption.
As the purpose of the study was to offer nurses useful scales to provide validated empirical evidence of human functional status, the research question was how scientific evidence can be used to conclude that these four scales have indeed the integrity to deliver a measurement function to the nurses. The researcher’s hypothesis of validating routine nursing measures is supported by two concepts: nursing utility and constructs validity. If nursing utility fail, construct validity is of no value to the nursing profession. With this in mind, the
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study objectives were to first validate nursing utility using a qualitative design to collect descriptive data from nurses who have implemented the scales. Once positive findings were reported on the usefulness of the scales to the nursing profession, then construct validity was explored using the Rasch measurement model to qualitatively analyse the scale’s raw data collected in various sub- and non-acute nursing facilities.
One scale was discarded, and three showed good to excellent results on both utility and construct validity. It has provided the restorative nursing sciences with a methodology to routinely collect patient-based empirical evidence for parametric analysis. In so doing, it delivered the missing link in Orlando’s nursing process theory; it also confirmed Nightingale’s theory that healthcare evidence provided routinely by nurse is the stepping stone for healthcare reform, provided it is useful, meaningful and valid. The ultimate beneficiaries of this new knowledge are patients who previously would have had unpredictable outcomes resulting in a poor prognosis.
Description
Ph.D. (Nursing Education)--University of the Witwatersrand, Faculty of Health Sciences, 2012