Research Objective: Develop and test the psychometric properties of the Oncology Patients’ Perceptions of the Quality of Nursing Care Scale (OPPQNCS), which was designed to measure patients’ perceptions of cancer nursing care quality.
Design: Instrument development.
Population, Sample, Setting, Years Studied: The study participants were drawn from patients in active treatment for cancer at the hematology-oncology clinic of a designated NCI comprehensive center in a New England tertiary medical center over a period of 5 months from 2000 to 2001.
Responses from 436 participants were included in the analysis. Two-thirds were female. The mean age was 54.8 years (SD=13.0). Most participants (92.6%) were White; 4.3% were African-American/Black; 0.8%, Asian; 0.8% indicated more than one race; 1.6% indicated “other.” Seventeen (3.8%) identified themselves as Hispanic/Latino. Most (80.5%) had more than a high school education. Fifty-eight percent indicated a household income of > or=$59,001. Two hundred and seventy-one participants had been hospitalized; the average number of hospitalizations was 2.6 (SD=2.3). Of the 40 types of cancer identified by 381 of the participants, breast was the most frequent (39.6%), followed by melanoma (9.4%), lung (6.3%), renal cell (3.9%), squamous cell (3.7%) and prostate (3.1%).
Concept Studied: Patients’ perceptions of cancer nursing care quality
Methods: A qualitative study of cancer patients’ perceptions of nursing care yielded a middle-range theory of eight attributes of excellent cancer nursing care: professional knowledge, continuity, attentiveness, coordination, partnership, individualization, rapport, and caring. Conceptual definitions, theoretical descriptions, and verbatim data from the qualitative study were used to generate 122 items describing nurse activities that were arranged in 8 subscales reflecting the attributes of excellent cancer nursing care. Eighty-five items remained after critique by an expert methodologist. Fifty-nine items that met the criterion content validity index (CVI) of > or=.78 remained after a nine-member expert panel review.
The 436 participants rated each the 59 items on a 6-point Likert scale reflecting the frequency of the nursing activity (1=never to 6=always). “Didn’t matter” and “don’t know” responses were two additional rating points.
Construct validity was assessed using exploratory factor analysis. Internal consistency reliability was determined using coefficient alpha.
Findings: Principal component factor analysis (PCA) indicated that four components explained 80.5% of the variance. A forced four-factor solution was conducted using PCA and a promax (oblique) rotation. Items that did not meet criteria (> or=.4 factor loading, unambiguous loading) were eliminated. The PCA and promax rotation were conducted twice more.
The final version of the OPPQNCS contains 40 items (alpha=.99), arranged in 4 subscales: a 22-item responsiveness subscale (alpha=.99), defined as the nurse meets patient needs in a caring and attentive manner; a 10-item individualization subscale (alpha=.97), defined as the nurse personalizes care according to the patient’s feelings, preferences, and desired level of involvement; a 3-item coordination subscale (alpha=.87), defined as the nurse promotes communication among other nurses and the patient; and a 5-item proficiency subscale (alpha=.95), defined as the nurse provides knowledgeable and skillful care. Correlations among the four subscales ranged from .61 to .79.
A short form of the OPPQNCS was created using stepwise regression to reduce the number of items in the responsiveness and individualization subscales. Items in these two subscales were removed as long as the underlying four factor structure of the 40 item scale was maintained. The short form contains 18 items (alpha=.97). The responsiveness and individualization subscales were reduced to 5 items each (alpha=.95 for responsiveness; .93 for individualization). The 3-item coordination (alpha=.87) and 5-item proficiency subscales remained intact (alpha=.95). Correlations among the OPPQNCS short form subscales ranged from .69 to .81.
Conclusions: The psychometric data indicated that both the long (40 items) and short (18 items) forms of the OPPQNCS adequately measure cancer nursing care quality from the patient’s perspective. The long form may be especially useful for quality improvement purposes; the short form may be useful when respondent burden is a concern.
Implications: The OPPQNCS is distinctive in that few if any measures of the quality of cancer nursing care are based so extensively on patients’ perceptions of being cared for well. The OPPQNCS can be used in studies designed to examine relations among cancer patients’ perceptions of care quality, health care system characteristics (e.g., nurse staffing), patient characteristics (e.g., race, gender), and nurse sensitive patient outcomes (e.g., health related quality of life; psychological sense of well-being). Also, the OPPQNCS can be used in quality improvement programs to measure attributes that distinguish nursing care.
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