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Validity and Reliability of the Questionnaire for Compliance with Standard Precaution for Nurses

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Validity and Reliability of the Questionnaire for Compliance with Standard Precaution for Nurses View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Cadernos Espinosanos (E-Journal) Rev Saúde Pública 2015;49:87 Original Articles DOI:10.1590/S0034-8910.2015049005975 Marília Duarte ValimI Validity and reliability of the Maria Helena Palucci MarzialeII Miyeko HayashidaII Questionnaire for Compliance Fernanda Ludmilla Rossi RochaIII with Standard Precaution Jair Lício Ferreira SantosIV ABSTRACT OBJECTIVE: To evaluate the validity and reliability of the Questionnaire for Compliance with Standard Precaution for nurses. METHODS: This methodological study was conducted with 121 nurses from health care facilities in Sao Paulo’s countryside, who were represented by two high-complexity and by three average-complexity health care facilities. Internal consistency was calculated using Cronbach’s alpha and stability was calculated by the intraclass correlation coefficient, through test-retest. Convergent, discriminant, and known-groups construct validity techniques were conducted. RESULTS: The questionnaire was found to be reliable (Cronbach’s alpha: 0.80; intraclass correlation coefficient: (0.97) In regards to the convergent and discriminant construct validity, strong correlation was found between compliance to standard precautions, the perception of a safe environment, and the smaller perception of obstacles to follow such precautions (r = 0.614 and r = 0.537, respectively). The nurses who were trained on the standard precautions and worked on the health care facilities of higher complexity were shown to comply more (p = 0.028 and p = 0.006, respectively). CONCLUSIONS: The Brazilian version of the Questionnaire for I Departamento de Enfermagem. Centro Compliance with Standard Precaution was shown to be valid and reliable. Universitário da Fundação de Ensino Octávio Further investigation must be conducted with nurse samples that are more Bastos. São João da Boa Vista, SP, Brasil representative of the Brazilian reality. The use of the questionnaire may support the creation of educational measures considering the possible II Departamento de Enfermagem Fundamental. Escola de Enfermagem de gaps that can be identified, focusing on the workers’ health and on the Ribeirão Preto. Universidade de São Paulo. patients’ safety. Ribeirão Preto, SP, Brasil III Departamento de Enfermagem. Seção de DESCRIPTORS: Nurses. Universal Precautions. Training. Apoio Laboratorial. Escola de Enfermagem Questionnaires. Translations. Reproducibility of Results. Validity of de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil Tests. Validation Studies. IV Departamento de Medicina Social. Faculdade de Medicina de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil Correspondence: Marília Duarte Valim Av. Dr. Durval Nicolau, 1830 apto 21 Jardim Santa Clara 13874-788 São João da Boa Vista, SP, Brasil E-mail: [email protected] Received: 11/7/2014 Approved: 3/24/2015 2 Validity of the Questionnaire for Compliance with SP Valim MD et al INTRODUCTION The standard precautions include hand hygiene, use item is the number 20 one. The related questionnaire of personal protective equipment (PPE), prevention of was created based on the Questionnaire of Practice of accidents with sharp objects, environment cleaning and Standard Precaution that was developed by Askarian disinfection measures, cough etiquette, and safe prac- et al2 and on the international guidelines23 on standard tices during injections.23 When correctly implemented, precaution measures. they are the main strategy to protect workers against exposure to biological materials and to prevent health The aim is to resume the adaptation process of care-related infections.6,17 the Questionnaire for Compliance with Standard Precaution (QCSP),27 by the analysis of measurement Even with the creation and disclosure of protocols equivalence. Three main approaches are suggested: regarding standard precautions in health care institu- evaluation of the dimensional structure of the instru- tions, workplace accidents with potentially contaminated ment, including the adaptation of items it comprises; 5,16 biological material are frequent. Health care-related analysis of the reliability of information; and the veri- infections are the most common and studied adverse fication of the instrument validity.21 effect from hospitalization. They are the main health care problem in developed and developing countries due As a theoretical and methodological reference, the to deaths, prolonged hospitalization periods, and nega- process for validating measurement instruments 29 tive effects to patients to the well-being of the nation. proposed by Pasquali was adopted.20 According to Compliance to standard precautions is below recom- that author, instruments are only validated when a mended levels worldwide.3,7,26 Some variables are previous theory serves as base for the behavioral pointed out to influence compliance to standard representation, which constitutes a hypothesis that precautions, such as: previous training on standard can be deduced from that theory. precautions;2,14 perceived organizational safety;4 The aim of this study was to evaluate the validity and perceived obstacles to comply with standard precau- reliability of the Questionnaire for Compliance with tions;11 perceived self-efficacy;14 complexity of health Standard Precaution that was adapted for nurses. care facilities – once compliance was shown to be higher in larger, more complex facilities12,14 –, and knowledge regarding such measures.19 METHODS Compliance to standard precaution measures as a This was a methodological study, and it was conducted primary strategy to prevent workplace accidents and with nurses from health care institutions in Sao Paulo’s professional diseases resulting from contact with countryside, Brazil. A sample of nurses belonging to potentially-contaminated biological material is essen- high-complexity facilities was randomly picked from tial and must be evaluated by health care institutions, one of the municipalities in Sao Paulo countryside, considering individual variables and variables from the and so was another one with nurses from medium- very work organization. complexity health care facilities from another munic- Despite the need for using valid and reliable instruments ipality in the countryside of the same state. A crite- to evaluate constructs of interest,28 few instruments in rion to choose different institutions according to their the literature aim to measure such construct.2,8,14,19,27 The complexity levels was adopted to enable the conduc- Brazilian Portuguese version14 of the Questionnaire for tion of known or contrasted groups construct validity. Compliance with Standard Precaution27 has adequate The high-complexity health care facilities were repre- psychometric characteristics and covers important concepts regarding compliance with standard precau- sented by a teaching hospital and by an emergency unit tion measures, such as hand hygiene, safe practices tied to such hospital, which were classified as being of 18 while handling sharp objects, and use of PPE – safety size IV. The medium-complexity health care facili- gloves, masks, glasses, and aprons. ties were represented by a private charity hospital, a private hospital, and an emergency unit that belonged The Questionnaire for Compliance with Standard to a private health care service. Precaution, which was created and validated in a sample of 1,444 Chinese nurses,14 has proper psycho- According to Sapnas and Zeller,22 samples of at least metric characteristics. It comprises twenty Likert scale 50 and maximum 100 subjects are sufficient when questions with scores from 0 to 4 points, with score one intends to evaluate the psychometric proper- ranges from zero to eighty points. Four points are ties of instruments for measuring constructs. The added with every “always” answer, whereas “never” authors believe that 10 respondents per item repre- answers add no points whatsoever. The only inverse sents sample size overkill. Rev Saúde Pública 2015;49:87 3 The number of nurses who were connected with the validity. The known-groups validity of QCSP tested the emergency unit (125) and to the teaching hospital hypothesis that nurses working at high-complexity units (286) in 2011 totaled 411 nurses, according to infor- complied more with standard precautions than the ones mation obtained by the human resources department. who worked in medium-complexity units. The number of nurses working in the three medium- complexity health care facilities was 39. According The content validity was tested by the presence of to Sapnas and Zeller22 and to possible losses and maximum and minimum effects. Reliability was tested refusals, a sample of 120 nurses was randomly picked using test-retest, which represents the ability of a test by Statistical Package for Social Science (SPSS) soft- to measure the same subjects at different times and to ware, version 16.0, who worked at the high-complexity produce identical results; i.e., the correlation between the teaching hospital. The 39 nurses from the medium- two measures that were obtained at different times must 20 complexity services were chosen to be included. be the closest to 1 as possible. To perform the retest, a sample of 30 nurses was selected, with workers from Nurses included could not be on vacation, medical or high-complexity health care facilities , according to the maternity leave, or on any other kinds of leave. They interpolation of values as indicated by the
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