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Audits of nursing care in Britain: a review and a critique of approaches to validating them.

The literature on audits of nursing care shows a strong link between the quality of nursing care and nursing labour force issues. Early attempts to develop a universally applicable formula to set nurse staffing levels on the basis of variations in patient dependency were shown to have been based on unrealistic assumptions about the ability of scientific methods to remove the influence of judgement from such areas of decision-making. The extent to which the validity of audit instruments has been established is reviewed, showing the number of studies to be small, almost exclusively in relation to American instruments, and with inconclusive results. An extension of the concept of validity is discussed, based on House's approach [House, E.R. (1980). Evaluating with Validity. Sage Publications, London, Beverly Hills] towards establishing validity in educational evaluation. This approach explicitly acknowledges the role of judgement in the evaluative enterprise, and widens the debate about how to settle questions of validity for audits of nursing care.

Clinical Protocols↗

Un lugar seguro para sus ninos: development and evaluation of a pesticide education video.

The need exists for culturally appropriate and effective educational interventions to reduce pesticide exposure in migrant and seasonal farm-worker (MSFW) communities. The development of one such intervention was part of a community-based research project which partnered the Oregon Health Sciences University and the Oregon Child Development Coalition (Migrant Head Start). The process involved identifying an optimal educational method and content, evaluating existing educational materials on pesticides, developing the selected educational tool (a video), and assessing the effectiveness of the video as an intervention. Focus groups were conducted with MSFWs to elicit their perceived need for education and desired content, method, and delivery. Four currently used educational tools were evaluated for satisfaction, preference, recall ability and knowledge change. Based on these findings, a pesticide exposure video directed at the protection of children was produced. To determine the effectiveness of the video, knowledge, satisfaction and self-reported behaviors were assessed with MSFWs. A sizeable increase in overall pesticide knowledge was measured after seeing the video (p < 0.0001). MSFWs overall were satisfied with the video and reported increased protective behaviors after seeing the video.

Journal Article↗

Evaluation of continuing education for long-term care personnel: impact upon attitudes and knowledge.

Nursing assistants (aides) and licensed practical nurses (LPNs) from three proprietary nursing homes participated in a continuing education program designed to enhance knowledge and attitudes about the elderly in long-term care. The program covered six weeks for the initial 115 aides and one full-day seminar for the 83 LPNs. The content covered knowledge and human anatomy, the physiology of normal aging, physical and psychosocial problems of the elderly and, for the nurses, problems associated with cardiovascular accidents. The final participants (29 aides and 52 LPNs) consisted of those who were tested before and after their training with respect to knowledge, life satisfaction, and attitudes toward the elderly. Results indicated overall favorable changes for both aides and LPNs, particularly in the areas of increased knowledge and more positive attitudes. The data suggest that continuing education is an effective means of influencing the knowledge and attitudes of personnel in long-term care facilities, and it should be a first step toward improving the quality of care for elderly residents.

Adult↗

Professional performance of physician's assistants: a comparison of physician's assistant and physician ratings.

Physician's assistant educational programs have used surveys of their graduates as one method of evaluating educational objectives and curricula. A concern is the validity of physician's assistant self-ratings as measures of job performance. Ratings by supervising physicians have been suggested as more valid measures. In the present study ratings of physician's assistants and their supervising physicians were compared. Physician's assistants and their supervising physicians were interviewed using an interview instrument developed to cover the performance of the physician's assistant in the major activities of primary care practice. While the physicians and physician's assistants disagreed on several measures, in all cases the ratings of the physician's assistants were more conservative. Thus, the physician's assistants did not show any tendency to inflate ratings of their own performance.

Analysis of Variance↗