The development and psychometric assessment of a scale to measure patient’s perceptions of patient-centered care from nurses and providers in primary care settings

Contributor: Laurel E. Radwin

October 23, 2018

Quality Improvement/Theory Exemplar

Location – Boston Veteran Administration Healthcare System (Formerly)

Project dates – June 20 2016 to June 2017

Key nurse involved

Laurel E. Radwin, RN, PhD

Funding

VA QUERI and OPCC&CT PEC13-001 Evaluating Patient-centered Care: Patient, Provider and Organizational Views (Bokhour=Evaluation Center Director).

Theoretical framework

The guiding framework for this study was congruent with two middle-range nursing theories: “knowing the patient” and “patient-centered nursing care.” These theories’ conceptualizations assert that knowing the patient enhances patient-centered care, and that patient-centered care is positively related to desired patient outcomes.

These theories were operationalized through the development and rigorous psychometric assessment of a scale to measure patient-centered nursing care from the patient’s perspective. Although this scale was originally designed to measure oncology patients’ perceptions, it has since been found valid and reliable in other patient populations. Furthermore, theory-testing studies verified the relationships among the process of patient-centered nursing care and patient outcomes.More information here. and in the publications below.

Project Description

Transformations in the US health care system require team-oriented, value-based primary care. However, not all contributors are included in measurement efforts. Most notably, nursing care is missing from publicly reported primary care quality scales used by the federal government for bench marking. Determining which team members best achieve high quality, cost-effective care supports care transformations and accurate attribution of patient outcomes.

In order to address this measurement gap, a scale is needed that measures the distinct contributions of nurses and of providers. Thus, the purpose of this pilot study was to develop and psychometrically assess a scale to measure patient’s perceptions of patient-centered care from nurses and providers in primary care settings. See –

Radwin, L. E., Cabral, H. J., Seibert, M. N., Stolzmann, K., Meterko, M., Evans, L., Barker, A., et al. (2018). Patient-Centered Care in Primary Care Scale*: Pilot Development and Psychometric Assessment. Journal of nursing care quality. DOI: 10.1097/NCQ.0000000000000341

Evaluation Methods

A survey was fielded online between June and November 2016 with Veteran Administration patients who had a primary care clinic appointment within the most recent 5 months. The non-random analytic pilot sample comprised 221 patients who had seen both a nurse and a provider at their visit. Exploratory factor analysis was used to examine the structure of the data.

Outcomes

The resultant pilot scale was titled the “Patient-Centered Care in Primary Care Scale: Nurses and Providers.” The short-form included 21 items that comprised four subscales. Two of the four subscales focused exclusively on nursing care: “Nurse Knowing the Person,” (5 items; alpha=.92); “Nurse Individualized Care” (5 items; alpha= .92). One subscale focused on provider care, being “Provider Knowing the Person and Individualized Care” (8 items; alpha=95). One subscale included both nurses and providers and measured care continuity (3 items, alpha not calculated due to categorical items).

The nursing contributions of knowing the person and individualized care have not been routinely measured in quality of primary care scales. Our pilot scale supports this measurement because patients in our study could distinguish nursing patient-centered care from provider care. Also, patients responded to items that measured nursing contributions specifically.

Theoretical Implications

Patient-centered nursing care, a core value of the profession, is conceived of as concepts and their definitions, theories, and frameworks. The operationalization of key concepts of patient-centered care serves nursing knowledge development because empiric data analysis allows theories to be refined and enriched.

Publications

Radwin, L. E. (1995). Knowing the patient: a process model for individualized interventions. Nursing research, 44(6), 364–370. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/7501491

Radwin, L. (2000).Oncology patients’ perceptions of quality nursing care. Research in Nursing and Health, 23, 179-190.

Radwin, L., & Fawcett, J. (2002). A conceptual model-based programme of nursing research: retrospective and prospective applications. Journal of advanced nursing, 40(3), 355–360. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12383187

Radwin, L., Alster, K., & Rubin, K.(2003).The development and testing of the Oncology Patients’ Perceptions of the Quality of Nursing Care Scale (OPPQNCS). Oncology Nursing Forum, 30, 283-290. DOI: 10.1188/03.ONF.283-290

Radwin, L., Cabral, H., & Wilkes, G. (2009).Relationships between patient-centered cancer nursing interventions and desired health outcomes in the context of the health care system. Research in Nursing and Health, 32, 4-17. DOI: 10.1002/nur.20302