Developing An Instrument To Asess Home-based Older Adults’ Expectation About Community Nurses’ Role Characteristics In Geriatric Care

ObjectivesTo develop an instrument to assess’ Home-based older adults’ expectation about community nurses’ role characteristics in geriatric care.This will pave the way for better geriatric nursing services for community-dwelled older adults.It will also indicate the directions for recruiting and developing community geriatric nurses.MethodsThis is a mixed-methods study design combining qualitative and quantitative approaches following the principles for the development of instruments.The first phase is to adopt the qualitative approach to generate the questionnaire:Purposive sampling strategy was used.Key stakeholders(including older adults and community doctors,nurses,and therapists together with managers involved in geriatric nursing service)were recruited and interviewed with the aid of pre-designed interview guide to know their expectations about the characteristics of community nurses in the role of providing geriatric nursing care at home.Transcripts of the audio-recorded interviews were analyzed using the method of content analysis to identify categories,subcategories,and representative words.The commonly used words were selected to compose the items of the proposed questionnaire assessing older adults’ expectations of community nurses’characteristics in geriatric care at home(called as ’role characteristics questionnaire’ in short).These items were combined with a 5-point Likert scale,ranging from "1=very unimportant" to "5=very important",to formulate the initial version of the questionnaire.The sum of item scores was the role characteristics questionnaire score and a higher score indicates higher expectation.The expert panel evaluated its content validity which reached content validity index(CVI)of 100%,suggesting the appropriateness for further tests.Phase two was a quantitative questionnaire survey.A convenience sampling strategy was used to recruit older adults registered in the target community health center in the city of Jinan.The first test and two-week retest were conducted to examine the internal consistency/reliability(assessed by Cronbach’s alpha,α)and test-retest reliability(evaluated by intraclass correlation coefficient,ICC)of the role characteristics questionnaire in the same sample.The principal component analysis with varimax rotation was performed for exploratory factor analysis(EFA).The items with low factor loading(<0.4)and/or low corrected item-total correlation coefficient(<0.04)were removed from the questionnaire,while the remaining items and their 5-point Likert scale constituted the revised version of the role characteristics questionnaire.This version was combined with basic information sheet for the use in the main/formal test so to further shorten the role characteristics questionnaire and evaluate its construct validity through Spearman correlation analysis.ResultsTwenty key stakeholders were interviewed,while the content analysis of transcribed interview recording generated 31 representative words under three categories(i.e.,personal characteristics,working attitudes and conducts,and nursing service capability).Five experts assessed the role characteristic questionnaire regarding the relevancy.CVI reached 100%,and the interrater agreement on the adequacy,appropriateness and comprehensibility of the questionnaire was 100%.In total,710 eligible older adults were recruited,of whom,110 participated the first test but only 100 returned the valid questionnaire(valid response rate 90.9%).Those with valid responses were retested two weeks later.Another 600 participants were involved in the main test,but only 502 returned valid questionnaire(valid response rate=83.7%).EFAs helped remove three and eight items from the initial 31-item and revised 28-item version of the questionnaire,respectively,resulting in the final 20-item role characteristics questionnaire.The final version of the questionnaire had sound internal reliability(α=0.895)and two-week test-retest reliability(ICC=0.944).ConclusionThe 20-item role characteristics questionnaire had satisfactory validity and reliability,which could be used to select and develop the characteristics of community nurses in geriatric care from care receivers’ perspective.In this way,older adults can participate in the continuous quality improvement in community nursing and home-based care.s and geriatric nursing services.Community-dwelling home-based older adults had high expectation of community nurses’ characteristics in geriatric nursing care in terms of strong nursing competencies,good working style,and excellent personality.