Instrument Measures Nurse Practice in a Hospital Essay

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Instrument Measures Nurse Practice

In a hospital or any medical care setting, nurses make up the majority of the environment, and are the backbone of facilitating patient care between physicians. However, between meeting the demands of the patients and following through doctors' orders, the roles nurses play are a high-stressed one, which influences on his or her overall well-being. The purpose of this paper is to display the findings from a study led by Pisanti (2008) regarding the relationship between nurses and their abilities to cope with environmental demands with the use of the Occupational Coping Self-Efficacy for Nurses (OCSE-N) Scale.

In order to gain a better understanding about the investigation, it is significant to comprehend about the foundation on which the study was based on, which is the Lazarus cognitive-medication theory of stress and Bandura's social cognitive theory. The former is about certain cognitive appraisals regarding one's work provokes stress and other negative notions for a person within his or her work environment. Cognitive appraisals can be primary or secondary. Primary appraisal is categorized as one's motivation and "personal relevance of a stressful situation" (Pisanti, 2008), or the length he or she is willing to go in order to attain one's objective. Secondary appraisal is the evaluation of coping methods and outcomes in terms of who is responsible for the circumstance, future expectancy or possibility of change, problem-focused coping or choices to impact the situation, and emotion-focused coping, which is the capability to emotionally adjust to the situation. The repercussions of the former appraisal are harm that has taken place, threat or the chance of future damage, and challenge, which is the probability for growth and progress. The consequences of the latter appraisal come from the coping tactics adopted to manage internal and/or external necessities. The latter cognitive theory is about the validity of self-efficacy beliefs. Coping self-efficacy or CSE beliefs is "someone's self-appraisals of their ability to cope with environmental demands may influence their reaction to stress and its outcomes" (Pisanti, 2008). It has been shown that the stronger one's self-efficacy, the greater the efforts the individual places in what he or she does, which differs depending on the venture or situation.

The research led by Pisanti used the premise of the Occupational Coping Self-Efficacy for Nurses (OCSE-N) Scale. The instrument development was for item generation, and validity and reliability testing. In conducting item generation, the sixty-two nurses who were interviewed were from two hospitals, and were part of another study. They were asked questions pertaining to their work life as nurses. Sampling was done throughout various departments, from emergency to surgical. 82% of the participants were female with an average age of forty years old. Open-ended interviews were administered to attain information regarding what were identified as stressors by nurses. Nurses were also asked what was their central predicament and obstacle they faced at work. In the end, nine occupational stressors were selected by eliminating identical responses and grouping together similar answers, and they were analyzed by eleven health professionals. The aforementioned stressful situations determined by nurses were difficulties with patients, relational difficulties with their supervisor, and insufficiently defined procedures. In addition, certain stressors were relational difficulties with a patient's relatives, difficulties in deciding how to do the work, and physical tiredness. Furthermore, nurses felt stressful when doing a lot of tasks simultaneously, relational difficulties with colleagues, and relational difficulties with other healthcare workers, like doctors. The validity and reliability testing was accomplished through various methods. Internal rationalization was done by calculating Conrach while the assessment for validity was done by paralleling dimensions of OSCE-N with burnout and coping tactics.

The team led by Pisanti corresponded with the Umbria and Lazio Regional Department of Health Care, and chose nine hospitals to participate in the investigation. Although 2186 nurses were selected at random, 1405 nurses consented to participate in the experiment. At first, they were approached at work and were given an anonymous questionnaire to fill out, which resulted in a 64% response rate. At the end, excluding unfinished surveys, the final study incorporated 1383 nurses. The instruments used and analyzed in the research were demographic data, OCSE-N scale, coping strategies, and burnout measure. A form was used to categorize the information regarding the participant's information like age, gender, and area of work in the hospital. The nine items of the OCSE-N were created due to the aforementioned item generation strategy, which is rated on a Likert scale of one to five. On such a rating element, one means uneasy to cope and five represents easy to deal with. Participants were asked to rate how certain and assured they would be in various situations.

Coping tactics were measured using the CISS-SV or known as the Coping Inventory for Stressful Situations, which is a shortened version of the CISS consisting of twenty-one items. Participants were asked to rate each coping item based on the extent they have used such tactic in an incidence at work. The evaluation is based on a five-point scale, with one being not at all and five being very much. The end results were then scored for three categories, which are task-oriented coping, emotion-oriented coping and avoidance-oriented coping. The aforementioned three coping scales involved seven items, and the caluculations based on the Cronbach alpha reliability test were "0.75 for task-oriented coping, 0.82 for emotion-oriented coping and 0.78 for avoidance-oriented coping" (Pisanti, 2008). Furthermore, for data analysis, the information was randomly separated into two independent groups, where one group was tested using EFA or exploratory factor analysis and another using CFA or confirmatory factor analysis with the use of AMOS statistical software. The rotation method selected was the oblique promax rotation, and information was assessed using "chi-square, the root-mean square error of approximation (RMSEA), the Comparative Fit Index (CFI) and Akaike's information criterion (AIC)." The test for internal reliability was evaluated by figuring out the Cronbach alpha coefficient, and the criterion validity was formed using the stress model used when developing the scale. The interrelationship between findings from data collected from OCSE-N, CISS-SV, and MBI were analyzed using the Pearson product-moment correlations.

The results of the study's demographics were that 39.1 was the average age, and 77.2% were women and 22.6% were men. EFA results showed "the assumptions of normality were not severely violated" (Pisanti, 2008) and due to the promax rotation, "the two rotated factors accounted for 46.9% of the total variance. The first factor accounted for 34.4% of the total variance…the second factor accounted for 12.5% of the total variance" (Pisanti, 2008). The former factor consisted of six items and was important because they "tapped the perception of 'CSE to manage the occupational burden" (Pisanti, 2008) while the latter was significant because it "contained three times that reflected the 'CSE to manage relational difficulties in the workplace" (Pisanti, 2008). EFA is important because it revealed the possibility of a two-dimensional possibility for the OCSE-N, which resulted in a two-factor analytical model and it indicated for "the existence of an underlined bidimensional conceptual structure" (Pisanti, 2008). CFA is important in that the study revealed age was the only distinguished factor that was different on the scales regarding the subscales of CSE to manage general nursing burden, and to manage the relational difficulties in the workplace. The reliability testing revealed, due to the Cronbach alpha value, satisfactory calculations for the two aforementioned subscales. The criterion-related validity test showed a positive correlation with the OSCE-N and task coping tactics. As well, there was a negative interrelation with "emotion-focused and avoidant strategies" (Pisanti, 2008). In terms of burnout, the OCSE-N scales revealed a negative association with emotional exhaustion and depersonalization. However, the scale was positive with personal accomplishment. Therefore, nurses with a low CSE reported more burnout, high emotional exhaustion and greater depersonalization with notions of reduced personal…

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