Measurement of Nursing Outcomes Second Edition Carolyn F. Waltz, PhD, RN, FANN, is Professor and Associate Dean for Academic Affairs at the University of Maryland School of Nursing. She received her BSN and MS degrees from the University of Maryland and her PhD from the University of Delaware. Dr. Waltz is an expert in the development of outcomes evaluation in clinical and educational settings. She has published numerous books and articles on measurement, nurs- ing outcomes, consultations, and workshops to varied health care audi- ences nationally and internationally and is widely acknowledged as a pioneer in outcomes evaluation and research. Louise S. Jenkins, PhD, RN, is Director of Graduate Studies at the University of Maryland School of Nursing. She received a BS degree from Northern Illinois University and MS and PhD degrees from the University of Maryland, Baltim9re. Her research program is in the area of individ- ual cardiac recovery and rehabilitation. She has developed and tested var- ious outcome measures for use with self-efficacy theory and the study of quality of life. She serves on a number of editorial and review boards. She is currently principal investigator on a grant to develop an Institute for Teaching and Learning with Technology in Health and Human Services and recently was a collaborator on the development and implementation of a new Clinical Education and Evaluation Laboratory. Measurement of Nursing Outcomes Second Edition Volume I; Measuring Nursing Performance in Practice, Education, and Research Carolyn Feher Waltz, PhD, RN, FAAN Louise Sherman Jenkins, PhD, RN, FAAN Editors Springer Publishing Company Copyright © 2001 by Springer Publishing Company, Inc. All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or other- wise, without the prior permission of Springer Publishing Company, Inc. Springer Publishing Company, Inc. 536 Broadway New York, NY 10012-3955 Acquisitions Editor: Ruth Chasek Production Editor: Jeanne Libby Cover design by Susan Hauley 00 01 02 03 04 / 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Measurement of nursing outcomes / Carolyn Feher Waltz, Louise Sherman Jenkins, editors,—2nd ed. p. ; cm. Includes bibliographical references and index. Contents: v. 1. Professional and education focus ISBN 0-8261-1417-2 (v. 1) 1. Nursing—Standards. 2. Nursing audit. I. Waltz, Carolyn Feher. II. Jenkins, Louise Sherman. [DNLM: 1. Nursing—methods. 2. Clinical Competence. 3. Nursing— standards. 4. Outcome and Process Assessment (Health Care). WY16 M484 2001] RT85.5 .M434 2001 610.73—dc21 00-054928 Printed in the United States of America CONTENTS Preface ix Contributors xi Part I MEASURING CLINICAL DECISION MAKING AND PERFORMANCE IN EDUCATION AND PRACTICE 1 Diagnostic Reasoning Simulations and Instruments 3 Jean M. Arnold 2 Clinical Decision Making in Nursing Scale 33 Helen M. Jenkins 3 Creativity in the Application of the Nursing Process Tool 41 Roberta J. Emerson 4 Measuring Clinical Judgment in Home Health Nursing 58 Angeline M. Jacobs and Felicitas A. dela Cruz 5 Postpartum Caseload Priority-Setting Instrument 73 Irene M. Bobak 6 Performance Appraisal Tool 79 Margaret R. Kostopoulos 1 Measuring Clinical Decision Making Using a Clinical Simulation Film 92 Donna Ketchum Story 8 Clinical Performance Examination for Critical Care Nurses 102 Barbara Clark Mims 9 Clinical Performance Measure 130 Kathryn S. Hegedus, Eloise M. Balasco, and Anne S. Black v vi Contents 10 Measuring Quality of Nursing Care for DRGs Using the HEW-Medicus Nursing Process Methodology 136 Elizabeth A. Barrett 11 Clinical Evaluation Tool 143 Carol L. Rossel, Barbara A. Kakta, Gail A. Vitale, Peggy R. Rice, Katherine N. McDannel, and Pamela A. Martyn 12 Clinical Competence Rating Scale 157 Linda J. Scheetz 13 Clinical Evaluation Tool 184 Elizabeth P. Howard 14 Measuring RN Students' Clinical Skills via Computer 194 Linda Finke, Patricia Messmer, Marie Spruck, Barbara Oilman, Elizabeth Weiner, and Lou Ann Emerson Part II MEASURING EDUCATIONAL OUTCOMES 15 Influence of Review Course Preparation on NCLEX-RN Scores 201 Nelda S.amarel 16 Influence of English Language on Ability to Pass the NCLEX-RN 204 Joan Gittins Johnston 17 Criterion-Related Validity of the NCLEX-RN 207 Muriel W. Lessner 18 Self-Assessment Leadership Instrument 210 Bonnie Ketchum Smola 19 Evaluation of Learning According to Objectives Tool 216 Joan M. Johnson 20 Student Stress and Coping Inventory 223 Barbara Jaffin Cohen 21 Faculty Role Preparation Self-Assessment Scale 237 Janet M. Burge 22 Assertiveness Behavior Inventory Tools 245 Paulette Freeman Adams and Linda Holbrook Freeman Contents vii Part III MEASURING PROFESSIONALISM 23 Nursing Activity Scale 253 Karen Kelly 24 Nursing Care Role Orientation Scale 267 Jacqueline Stemple 25 Justification of Moral Judgment and Action Tool 276 Sara T. Fry 26 Reliability and Validity of the Nursing Role Conceptions Instrument 282 Gretchen Reising Cornell 27 Attitudes Toward Physically Disabled College Students 293 Patricia R. Messmer, Alice Conway, Janice Giltinan, and Kathy Stroh 28 Organizational Climate Descriptive Questionnaire 301 Q. Kay Branum 29 Blaney/Hobson Nursing Attitude Scale 308 Doris R. Blaney, Charles J. Hobson, and Anna B. Stepniewski Part IV RESEARCH AND EVALUATION 30 Research Appraisal Checklist 323 Mary E. Duffy 31 Knowledge of Research Consumerism Instrument 332 Cheryl B. Stetler and E. Ann Sheridan 32 A Program Evaluation Model for Continuing Education Programs 357 Angeline M. Jacobs, DeAnn M. Young, and Felicitas A. dela Cruz 33 Opinionnaire: Computing in Nursing 364 Barbara S. Thomas 34 Software Evaluation Tool 370 Sandra Millon Underwood 35 Trends and Implications for Measurement 379 Carolyn F. Waltz and Louise S. Jenkins Index 393 This page intentionally left blank PREFACE This publication is a compendium of some of the finest tools and meth- ods available to nurses for the measurement of clinical and educational outcomes. It is a second edition of the highly acclaimed series of Measurement of Nursing Outcomes books published by Springer Publishing Company: Waltz, Carolyn F. and Strickland, Ora L. (1988), Volume One, Measuring Client Outcomes. Strickland, Ora L. and Waltz, Carolyn F. (1988), Volume Two, Measuring Nursing Performance: Practice, Education, and Research. Waltz, Carolyn F. and Strickland, Ora L. (1990), Volume Three, Measuring Clinical Skills and Professional Development in Education and Practice. Strickland, Ora L. and Waltz, Carolyn F. (1990), Volume Four, Measuring Client Self-Care and Coping Skills. A collection of tools and methods is presented with attention given in each chapter to purpose and utility, conceptual basis, development, test- ing, and the results of reliability and validity assessments. Many of the tools and methods included are the second generation of tools that were originally developed by participants in the Measurement of Clinical and Educational Outcomes Project. This project, administered by Dr. Carolyn F. Waltz and Dr. Ora L. Strickland and funded by the Division of Nursing, Special Projects Branch, U.S. Dept. of Health, Education, and Welfare (1983-1988), afforded nurse researchers, clini- cians, and educators from across the nation the opportunity to refine their skills in measurement through a series of intensive workshops and indi- vidualized consultations. The project focused on the development and testing of clinical and educational outcome tools by nurses who partici- pated. Enrollment was limited to those who were actively engaged in research or education, and selection of participants was on a competitive basis. Resulting tools and methods were presented at a conference open to the profession at large that was attended by approximately 250 indi- viduals. Selected tools and methods were subsequently disseminated in the four volumes edited by Drs. Waltz and Strickland and published by the Springer Publishing Company (1988-1990). Since that time, many of these tools have been widely used, further tested, and revised by the developers and others. Thus, it is time for a second edi- tion. Included here are tools and methods applicable to clinical and ix x Preface educational settings that focus on professional and education outcomes. The collection contains several clusters of topics that address professional- ism, clinical decision making, clinical performance, clinical simulation, stu- dent outcomes, factors affecting the clusters, and research outcomes. Major topic areas include but are not limited to: effect of language competence and review courses on graduates' NCLEX-RN performance, student lead- ership characteristics, outcomes of continuing education programs, atti- tudes toward cost effectiveness, faculty teaching role preparation, diagnostic reasoning, critical thinking, and clinical competence. Readers will find in this publication not only a collection of tools for measuring clinical and educational outcomes that address a variety of sub- stantive topic areas, but also prototypes of methodologies for the meas- urement of outcome variables whose utility extends well beyond a given topic area. Other notable features of the tools presented here follow: the tools are conceptually based and resulted from extensive reviews of the lit- erature; tools and methods are well grounded in sound measurement the- ory and practices; both norm-referenced and criterion-referenced frameworks and varied