Better understanding of this phenomenon along with methods of measurement is needed to be able to teach nurses and future nursing students this skill. Nursing presence has traditionally been deemed a phenomenon that is elusive to full understanding and measurement due to its mystical quality. Multiple concept analyses have illuminated pre-conditions, attributes and outcomes of nursing presence, however only three instruments have been developed to measure nursing presence.
The Measurement of Presence Scale (MOPS) (Hines, 1991) and its derivative visual analog scale (MOPVAS) (Foust, 1998) both measured nursing presence from a nurse perspective with no subsequent research. Initial factor analysis resulted in nine subscales for MOPS that varied when the MOPS was retested in the second study. The Presence of Nursing Scale (PONS) was recently developed to measure nursing presence from the patient’s perspective in three U.S. acute care institutions (Hansbrough, 2011; Kostovich, 2002; Kostovich, 2012). Psychometric testing of PONS using exploratory factor analysis had not been reported at the time of this study.
This report documents research conducted in a large southeastern academic medical center using the PONS-Revised. A sample of 122 hospitalized, adult inpatients from ten acute-care nursing units were surveyed to conduct the first psychometric testing of this revised instrument using exploratory factor analyses. Seven research questions were explored to evaluate potential correlations between the PONS-R, patient satisfaction, nursing unit-specific workforce factors and patient demographic factors. Historic and concurrent patient satisfaction data using four nursing sensitive measures of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) standardized instrument were compared with PONS-R. Nursing unit-specific workforce factors including average nurse experiential level, registered nurse age, academic preparation levels of unit nursing workforce, and registered nurse turnover were compared with PONS-R.
Results:
Internal consistency reliability of the PONS-R was established with the highest to date internal consistency rating (r = .974) for related instruments. Test-retest reliability was established with a sample of 21 patients 48 hours after initial test with both parametric and non-parametric analyses (Pearson’ r = .791, and Spearman’s rho = .872, both statistically significant at the .01 level). Construct validity was evaluated with comparison of PONS-R summed scores to nurse HCAHPS measures with Pearson’s r = .736 and correlation highly significant at the .01 level. Divergent validity was verified by evaluating a small sample of thirteen from the unit with historically poorest performance on nursing HCAHPS measures. A statistically significant negative difference was found in both HCAHPS historical average score and patient-specific average HCAHPS score based on independent t-tests between divergent sample and remaining sample. The magnitude of the differences was large (eta squared = .92) indicating a very large effect size (historical nurse HCAHPS) and between moderate and large effect size (eta squared = .11) for concurrent nurse HCAHPS. A statistically significant negative difference was likewise found on PONS-R summed scores between the divergent unit sample and the remaining sample with poor performance unit [M=93.75, SD=16.47] and remaining units [M=108.59, SD=15.46; t(112)= -3.12, p=.002]. The magnitude of the differences was moderate (eta squared = .08).
Exploratory factor analysis revealed one solid factor using eigenvalues over one following Varimax rotation and parallel analysis indicating the PONS-R instrument was measuring one concept. Using Oblimin rotation with two factors forced revealed a weak secondary factor in which items were centered on the concept of intimacy (physical and emotional closeness, and spirituality, suggesting the need for inclusion of additional items and a larger sample size to further psychometrically develop the instrument.
Correlations were found between PONS-R and unit-workforce factors which were not anticipated:: Average RN experience level to PONS-R: r= -.185 (negataive correlation significant at the .05 level). Average RN age to PONS-R: r = -.218 (negative correlation). Percentage of Associate degree nurses to PONS-R: r = -.212, positive correlation, statistically significant at the .05 level. Percentage of Bachelor's degree nurses to PONS-R: r = -.212, negative correlation, statistically significant at the .05 level. Percentable of Master's degree nurses to PONS-R: r = -.-77, minimal negative correlation, not significant. Annual RN turnover rate to PONS-R: r = -.048, minimal negative correlation. No statistically significant correlations were found for PONS-R in relation to patient demographics including age, race/ethnic background, gender, state of residence, state region, household annual income, or employment status. Finally, no statistically significant correlations were found between nursing presence and patient-specific variables such as estimated number of RN that provided care, nor the length of stay on the units.