Monday, November 3, 2003

This presentation is part of : Advanced Practice Nursing

Validation of Instruments to Measure Clinical Nurse Specialists' Patterns of Practice

Anna Omery, RN, DNSc1, Ann M. Mayo, RN, CNS, DNSc2, Hannah Dean, PhD3, Fatemah Khaghani, EdD4, Zanaida Lara, MN, CNS4, Patricia Meckes, MN5, Nora Moti, BSN4, Jacqueline B. Redeemer, RN, MN4, Lynne Scott, MN, CNS4, and Marguerite Voorhees, MN1. (1) Patient Care Services, Kaiser Permanente, Pasadena, CA, USA, (2) Patient Care Services/Nursing Research, Kaiser Permanente, San Diego, CA, USA, (3) Sisters of Providence St. Joseph's Hospital, Burbank, CA, USA, (4) Nursing Administration, Kaiser Permanente, West Los Angeles, CA, USA, (5) Nursing Education, Kaiser Permanente, Bellflower, CA, USA
Learning Objective #1: Identify issues related to using existing instruments to measure clinical nurse specialists' patterns of practice
Learning Objective #2: Describe the psychometric properties of two instruments that measure clinical nurse specialists' activities, outcomes, and barriers to practice

Objective. To determine the psychometric properties of the Advanced Practice Survey (APN) and the Clinical Nurse Specialists Outcomes/Barrier Analysis (CNS-SOBA).

Design. Instrument explication study using classical psychometric techniques.

Population, Sample, Setting. The population is currently practicing CNSs. The sample included 547 BRN certified CNSs.

Concepts. Clinical nurse specialists' activities, perceived outcomes, and barriers to practice.

Methods. Data were collected via a mailed survey to all Board certified CNSs in one western state. 947 (62%) of the surveys were returned. The data from the 547 (60%) CNSs in current practice were used in the analysis. Data analysis included item analysis (item to total correlations and alphas if items deleted), reliability (Cronbach's alphas), and validity (exploratory factor analysis) techniques.

Findings. All items were retained for the APN. The APN's alpha was .80. The factor analysis resulted in ten factors (Staff Development, Patient Education, Clinical Practice, Expert Clinical Practice, Interdisciplinary Clinical Practice, Consultation, Leadership, Management, and Research activities) that explained 59% of the variance. Three items were deleted from the CNS-SOBA. The alpha for the outcomes subscale was 0.95 and 0.85 for the barriers subscale. The factors analysis of outcomes subscale resulted in nine factors (Clinical Practice, Support Group, Leadership, Educational, Advocacy, Utilization, Consultation, Research, Product Evaluation outcomes ) that explained 67% of the variance. The factor analysis of the barriers subscale resulted in 4 factors (Functional, Interpersonal, Physical Environment, Organizational Cultural barriers) that explained 66% of the variance.

Conclusions. The APN and CNS-SOBA have acceptable psychometric properties. These properties indicate more discrete categories of activities, outcomes, and barriers than those that are generally identified in the theoretical and clinical literature associated with the CNS.

Implications. An assessment of the impact of the CNS should move beyond the five traditionally accepted five role components to include more specificity.

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