2.50
Hdl Handle:
http://hdl.handle.net/10755/163654
Category:
Abstract
Type:
Presentation
Title:
Development of survey measures of clinical nursing expertise
Author(s):
Lake, Eileen
Author Details:
Eileen V. Lake, Ph.D., RN, FAAN, Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA, email: elake@nursing.upenn.edu
Abstract:
Purpose: This study bridges two research traditions: Patricia Benner's groundbreaking qualitative work on clinical nursing expertise and Linda Aiken's multi-site studies of the organization and outcomes of hospital nursing care. The study objective was to develop survey measures of clinical nursing expertise. Valid, reliable survey measures would have great potential to show scientifically that nursing expertise is important to patient well-being and to identify work settings that cultivate nurses' expertise. Specific Aim: To develop valid, reliable survey measures of clinical nursing expertise. Framework: Clinical nursing expertise could be included in a theoretical framework linking the organization of hospital nursing to patient outcomes. This framework is based in the sociology of organizations and work. Two distinct aspects of the organization of nursing are posited: nurse staffing and the practice environment. It is theorized that both the human resources available (i.e., staffing) and the social organization of work (the practice environment) influence patient outcomes directly, and indirectly through nurse job outcomes. A growing body of literature shows that nurse staffing levels are important to patient outcomes. The focus on numbers of nurses, however, can obscure what may be a key component of the nurse staffing dimension that has yet to be factored into outcomes research: clinical nursing expertise. Expertise may be the single, most powerful influence on the technical quality of nurses' clinical interventions. Moreover, expertise is critical to nurses' non-clinical functions, such as coordination within a therapeutic team of providers. The concept of nursing expertise could be added to the theoretical framework to help delineate the effect of hospital nursing organization on patient outcomes. Methods: Two survey measures of clinical expertise were developed from Benner's From Novice to Expert (1984). A single "global" expertise question was crafted to describe the differences in a nurse's approach to patient care from being guided by clinical standards and orders to responding intuitively to unique patient situations. The five response categories described "novice" to "expert" practice, without using those labels explicitly. The question was evaluated using staff nurse survey responses from the U.S. (n = 745) and Germany (n = 176). A multi-item instrument comprising 35 nursing roles or functions was developed. For each item, respondents reported their level of ability using a five-point scale. Sample items are "Establishing trust and good communication with patients and families," "Creating and implementing wound care strategies that foster healing and comfort," and "Setting priorities to effectively coordinate and meet multiple patient needs and requests." The instrument was pretested by 95 staff nurses from all clinical areas and levels of care in one teaching hospital. Descriptive analyses were used to assess whether responses to both the global question and the multi-item instrument varied sufficiently across nurses to identify differences in level of expertise. A scale created of all 35 items was assessed for internal consistency using Cronbach's alpha. The validity of both measures was evaluated using seven indicators of clinical advancement and professional activity by correlation analysis, chi-square analysis, and analysis of variance. The concurrent validity indicators were years of staff nurse experience, nursing specialty certification, membership in a professional organization, subscription to a professional journal, and participation in nursing committees and projects. The construct validity indicators focused on the supervisor's and peers' views of the respondent's expertise. Results and Conclusions: For the global question, nearly no respondents chose the implicit "novice" category. Most nurses (44%) described themselves as "proficient" (implicit label). The U.S. and German samples exhibited similar percent distributions for level of expertise. The multi-item instrument was highly reliable (alpha = .97) and demonstrated a good range in responses across items. Although the scale scores ranged from 2.25 (advanced beginner) to 5 (expert), most nurses' (60%) scores corresponded to a proficient level of practice. Construct and concurrent validity of both survey measures were supported. The evidence supporting the validity of the multi-item scale is more consistent and stronger than the evidence for the global question. Implications for Nursing Practice and Knowledge Development in Nursing: The new survey measures show promise for use in research on clinical expertise and its association with the quality of patient care and patient outcomes. Refinements in the measures and additional psychometric testing are recommended.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
14th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
University Park, Pennsylvania, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleDevelopment of survey measures of clinical nursing expertiseen_GB
dc.contributor.authorLake, Eileenen_US
dc.author.detailsEileen V. Lake, Ph.D., RN, FAAN, Associate Professor, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA, email: elake@nursing.upenn.eduen_US
dc.identifier.urihttp://hdl.handle.net/10755/163654-
dc.description.abstractPurpose: This study bridges two research traditions: Patricia Benner's groundbreaking qualitative work on clinical nursing expertise and Linda Aiken's multi-site studies of the organization and outcomes of hospital nursing care. The study objective was to develop survey measures of clinical nursing expertise. Valid, reliable survey measures would have great potential to show scientifically that nursing expertise is important to patient well-being and to identify work settings that cultivate nurses' expertise. Specific Aim: To develop valid, reliable survey measures of clinical nursing expertise. Framework: Clinical nursing expertise could be included in a theoretical framework linking the organization of hospital nursing to patient outcomes. This framework is based in the sociology of organizations and work. Two distinct aspects of the organization of nursing are posited: nurse staffing and the practice environment. It is theorized that both the human resources available (i.e., staffing) and the social organization of work (the practice environment) influence patient outcomes directly, and indirectly through nurse job outcomes. A growing body of literature shows that nurse staffing levels are important to patient outcomes. The focus on numbers of nurses, however, can obscure what may be a key component of the nurse staffing dimension that has yet to be factored into outcomes research: clinical nursing expertise. Expertise may be the single, most powerful influence on the technical quality of nurses' clinical interventions. Moreover, expertise is critical to nurses' non-clinical functions, such as coordination within a therapeutic team of providers. The concept of nursing expertise could be added to the theoretical framework to help delineate the effect of hospital nursing organization on patient outcomes. Methods: Two survey measures of clinical expertise were developed from Benner's From Novice to Expert (1984). A single "global" expertise question was crafted to describe the differences in a nurse's approach to patient care from being guided by clinical standards and orders to responding intuitively to unique patient situations. The five response categories described "novice" to "expert" practice, without using those labels explicitly. The question was evaluated using staff nurse survey responses from the U.S. (n = 745) and Germany (n = 176). A multi-item instrument comprising 35 nursing roles or functions was developed. For each item, respondents reported their level of ability using a five-point scale. Sample items are "Establishing trust and good communication with patients and families," "Creating and implementing wound care strategies that foster healing and comfort," and "Setting priorities to effectively coordinate and meet multiple patient needs and requests." The instrument was pretested by 95 staff nurses from all clinical areas and levels of care in one teaching hospital. Descriptive analyses were used to assess whether responses to both the global question and the multi-item instrument varied sufficiently across nurses to identify differences in level of expertise. A scale created of all 35 items was assessed for internal consistency using Cronbach's alpha. The validity of both measures was evaluated using seven indicators of clinical advancement and professional activity by correlation analysis, chi-square analysis, and analysis of variance. The concurrent validity indicators were years of staff nurse experience, nursing specialty certification, membership in a professional organization, subscription to a professional journal, and participation in nursing committees and projects. The construct validity indicators focused on the supervisor's and peers' views of the respondent's expertise. Results and Conclusions: For the global question, nearly no respondents chose the implicit "novice" category. Most nurses (44%) described themselves as "proficient" (implicit label). The U.S. and German samples exhibited similar percent distributions for level of expertise. The multi-item instrument was highly reliable (alpha = .97) and demonstrated a good range in responses across items. Although the scale scores ranged from 2.25 (advanced beginner) to 5 (expert), most nurses' (60%) scores corresponded to a proficient level of practice. Construct and concurrent validity of both survey measures were supported. The evidence supporting the validity of the multi-item scale is more consistent and stronger than the evidence for the global question. Implications for Nursing Practice and Knowledge Development in Nursing: The new survey measures show promise for use in research on clinical expertise and its association with the quality of patient care and patient outcomes. Refinements in the measures and additional psychometric testing are recommended.en_GB
dc.date.available2011-10-27T11:11:25Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:11:25Z-
dc.conference.date2002en_US
dc.conference.name14th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationUniversity Park, Pennsylvania, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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