Methods: Experts from across the U.S. agreed to participate on an expert panel for this instrument development research. The experts included nurses from several states, a physician medical director of a transfusion service, a transfusion medical technology director, and a national director of a hemovigilance quality reporting group. Interviews with the experts along with a review of the literature identified the broad scope of nurses’ involvement with blood transfusions. Key information was also obtained from the National Healthcare Safety Network (NHSN) Hemovigilance Module of the Centers for Disease Control and Prevention (CDC), the American Red Cross Practice Guidelines, the AABB Circular of Information, and U.K. SHOT. The instrument was developed in two phases with content validity determined for questions during each phase. The first phase identified content to represent the scope of transfusions practices of nurses’ as well as their in-hospital training and preparation and comprehensive set of questions were developed. The second phase refined the questions for clarity and grouped them into the following content areas, hospital demographics, transfusion orders and policy, technology and safety measures, bedside transfusion practices, and nurses and nursing staff preparation for blood transfusions, patient and family instructions, and nursing and the transfusion service (blood bank). Content validity and test-retest reliability were determined for each question and for the instrument as a whole. The final instrument, Nurses Practices with Blood Transfusion, Medical-Surgical Acute Care, is a 72 questions survey that could be administered via a robust online survey software system.
Results:
Validity: Content validity was evaluated twice during the instrument development by a convenience sample of experts. Fourteen blood transfusion experts from across the U.S. comprised the first panel of judges. The panel of experts was robust with a wide diversity in clinical focus, roles, and geographic representation that provided nationwide perspective regarding validating content for nurses’ practices and blood transfusions. Seven of the first panel of experts comprised the second content validation panel. This panel retained the diversity in clinical focus and roles however all seven experts worked in large Texas hospitals with inpatient beds of 500 or more. The panel of experts evaluated the instrument and assigned a relevancy score to each question using a 4-point ordinal rating scale. The 72 question instrument had I-CVI scores of 0.8 to 1 and retained an S-CVI/Ave of 0.962 which confirmed the instrument, Nurses’ Practices with Blood Transfusion: Medical-Surgical Acute Care, as a robust representation of nurses’ involvement and practices with blood transfusions.
Reliability: Stability reliability of the instrument was established via intrarater test-retest. Fourteen nurse experts completed the web-based survey for test-retest evaluation; two of the experts were also content validators. Six experts also completed a second round of test-retest which included selected revised or new questions. The sample of experts was robust in representation of the diversity of hospitals, including geographic locale and hospital characteristics, and therefore was an excellent sample to pilot the web-based survey on nursing transfusion practices in acute medical-surgical hospitals throughout the U.S. Reliability statistics for Cohen’s kappa and for raw agreement were calculated. Raw agreement was added so that the 14 survey pairs with 100% agreement could be incorporated into the evaluation of reliability. The instruments reliability was established as high with a Cohen’s kappa of 0.797 and a raw agreement of 0.855.
Conclusion: Nurses’ Practices with Blood Transfusions: Medical-Surgical Acute Care is a robust and comprehensive representation of nurses’ practices with blood transfusions with a scale content validity index (S-CVI) of 0.963. Cohen’s kappa of 0.797 and raw agreement of 0.855 establish that the instrument is a very stable and reliable tool.