Academic journal article Journal of Nursing Measurement

Measuring Nursing Error: Psychometrics of MISSCARE and Practice and Professional Issues Items

Academic journal article Journal of Nursing Measurement

Measuring Nursing Error: Psychometrics of MISSCARE and Practice and Professional Issues Items

Article excerpt

Background and Purpose: Health care error causes inpatient morbidity and mortality. This study pooled the items from preexisting nursing error questionnaires and tested the psychometric properties of modified subscales from these item combinations. Methods: Items from MISSCARE Part A, Part B, and the Practice and Professional Issues were collected from 556 registered nurses. Principal component analyses were completed for items measuring (a) nursing error and (b) antecedents to error. Results: Acceptable factor loadings and internal consistency reliability (.70-.89) were found for subscales Acute Care Missed Nursing Care, Errors of Commission, Workload, Supplies Problems, and Communication Problems. Conclusions: The findings support the use of 5 subscales to measure nursing error and antecedents to error in various inpatient unit types with acceptable validity and reliability. The Activities of Daily Living (ADL) Omissions subscale is not appropriate for all inpatient unit types.

Keywords: nursing staff, hospital; medical errors; delivery of health care; questionnaires; psychometrics; missed nursing care

Health care error and omissions as root causes of aggregate patient morbidity and mortality has been documented for decades (Brennan et al., 2004; Mills, 1978; Schimmel, 1964). Contemporary hospital nurses face challenges in com- pleting all of their work to basic standards, without committing errors (Al-Kandari & Thomas, 2009; Kalisch, Landstrom, & Williams, 2009; Krishnagopalan, Johnson, Low, & Kaufman, 2002). In addition, nurses working in hospitals undergoing merger may face additional challenges in environments that are more prone to errors (Van Geest & Cummins, 2003; Weil, 2010). Measuring and studying error in challenging environments, such as during hospital merger, will add to patient safety science in various contexts.

The process of nursing care may involve two types of error: missed nursing care and commission errors. Missed nursing care is "any aspect of required patient care that is omitted (either in part or in whole) or delayed" (Kalisch, Landstrom, & Hinshaw, 2009, p. 1509). Coimnission errors occur when an inappropriate action is taken by the nurse and include near miss events when an error almost occurs because of an improper nursing action that is caught before the point of care delivery (Kalisch, Landstrom, & Hinshaw, 2009; World Health Organization, 2005).

Missed nursing care has been extensively studied in a body of work using MISSCARE survey items. The MISSCARE items have been developed and studied in only a limited subset of nursing unit types that provide 24-hour care in acute care hospitals: medical, surgical, rehabilitation, intensive, intermediate, renal, and oncology (Kalisch, Tschannen, Lee, & Friese, 2011; Kalisch & Williams, 2009). Nursing commission errors have been studied using observational and survey designs (Kalisch & Aebersold, 2010; Smith & Crawford, 2002, 2003, 2004). However, survey studies that include items of commission errors have focused on the newly licensed nurse.

To fully quantify and analyze the magnitude of, and relevant relationships relating to, nursing errors in all acute care settings at all levels of registered nurse (RN) experi- ence, measurement relevant to a greater breadth of specialty inpatient units and RNs is warranted. Therefore, the purpose of this study was to test the psychometric properties of items from existing nursing error and omissions questionnaires (MISSCARE Part A, Part B, and Practice and Professional Issues [PPI]) in a unique sample and setting of RNs.

BACKGROUND AND CONCEPTUAL FRAMEWORK

The conceptual model for testing is depicted in Figure 1. The structure, process, and outcome domains are derived from Donabedian's (2005) classic theory of quality care relationships. Empirical links have been demonstrated between nursing errors of omission (missed nursing care), errors of coimnission, and unit characteristics such as unit type, staffing ratios, material resources, coimnunication, and individual nurse characteristics (Kalisch, Landstrom, & Williams, 2009; Kalisch & Lee, 2010; Kalisch, Tschannen, & Lee, 2011a, 2011b, 2012; Smith & Crawford, 2002, 2003, 2004; Tschannen, Kalisch, & Lee, 2010). …

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