Adapting cognitive interviewing for nursing research

Understanding Training Needs in Pediatric Feeding for Allied Health Professionals: An Australian Perspective

PURPOSE

Clinician experience and confidence can negatively impact pediatric feeding service availability, but limited research has investigated what training allied health professionals (AHPs) need to increase these factors. This study developed and distributed a survey investigating Australian AHPs' self-reported confidence and anxiousness, training needs, factors impacting training access, and training preferences.

METHOD

This study was conducted over two phases. Phase 1 involved development and refinement of the survey, and Phase 2 involved distribution to Australian AHPs. Questions pertained to general demographics, feeding experience, feeding confidence and skills perception, and training needs. The questions were composed of multiple-choice, Likert scale, and short-response options.

RESULTS

Overall, 198 complete responses were received. Participants reported significantly lower confidence and higher anxiousness working with infants compared to older children (p < .01). Increased frequency of service provision predicted higher self-reported confidence and lower anxiousness (p < .01). Practical training opportunities including case discussion, videos, and clinical feedback were preferred. Access facilitators were online, on-demand training; however, respondents reported preferring hands-on training opportunities. Common barriers included cost, time, competing professional development priorities, and distance/travel.

CONCLUSIONS

Findings have highlighted that recency and frequency of practice impact self-reported confidence and anxiousness, and that AHPs self-report lowest confidence and highest anxiety working with infants compared to older age groups. Overall, the findings highlight the need for flexible, practical, and remotely accessible training opportunities, as well as the need for access to regular clinical supervision and a pediatric feeding caseload.

Progressing the development of a food literacy questionnaire using cognitive interviews

OBJECTIVE

Food literacy is the knowledge, skills and behaviours needed to meet food needs and determine intake and is conceptualised as eleven components under four domains of planning and managing, selecting, preparing, and eating. Previous measures of food literacy vary in their adherence to the conceptualisation and ability to capture totality of eating. This study aimed to determine items for inclusion and exclusion in a food literacy item pool and capture the general public's interpretation of everyday food literacy practices.

DESIGN

Beginning with an item pool from previous studies, cognitive interviews were conducted using think-aloud and verbal probing methods. Data were first analysed for applicability, clarity, ambiguity and logic, then for emergent themes to ensure items captured the totality of the participant's eating.

SETTING

Australia.

PARTICIPANTS

Australian residents over 18 years of age recruited via Facebook residential groups (n 20).

RESULTS

Of the original 116 items, 11 items had limited applicability; 13 items had unclear references; 32 items had lexical problems and 11 items had logical problems. In total, 29 items were deleted, 31 retained and 56 revised. Thematic analysis revealed participants limited their responses to consider only conventional practices such as grocery shopping, cooking and planned meals rather than the totality of their eating. An additional eighty-four items were developed to address eating out, incidental eating occasions and inconsistencies between participants assumed correct knowledge and that of public health guidelines. This resulted in a refined 171-item pool.

CONCLUSIONS

This study progresses the development towards a comprehensive, validated food literacy questionnaire.

Using Cognitive Interviewing to Design Interventions for Implementation in Oncology Settings

BACKGROUND

Implementation of effective interventions into clinical practice is slow, in large part, because researchers do not sufficiently attend to the realities of nurses who implement interventions.

OBJECTIVES

The aim of the study was to provide an exemplar of how cognitive interviewing-an important and underused method for developing nursing research-can be used to design survey items and assess multilevel implementation factors.

METHODS

We utilized the Consolidated Framework for Implementation Research to create a survey to assess factors that influence how oncology nurses deliver physical activity interventions. Two rounds of cognitive interviews were conducted with five purposively selected oncology nurses to assess survey items' clarity and effectiveness at eliciting desired information. We used a cognitive interviewing coding scheme to code data and revise unclear items. Participants completed the revised survey online and underwent a second interview to provide additional feedback.

RESULTS

Seven important changes were made to the survey: how to assess nurses' perceptions of other nurses' beliefs and practices; language to capture data relating to nursing leadership and administration; increased detail to assess factors related to nurses' workplaces; language related to capturing factors related to policy; language to capture data related to equity, disparities, and cultural tailoring; terms replacement with language used by nurses; and strategy to capture data about nurses' knowledge of national physical activity recommendations for cancer survivors.

DISCUSSION

Cognitive interviewing can be applied to develop survey items that capture real-world experiences and perspectives of practicing nurses. This is an essential step in developing nursing interventions that are ready to be implemented and increasing the uptake of evidence-based nursing care. Cognitive interviewing can be used across nursing settings, populations, and interventions to develop understandings of attitudes, attributes, characteristics, and perceptions for a variety of nursing interventions.

Culture in the spotlight-cultural adaptation and content validity of the integrated palliative care outcome scale for dementia: A cognitive interview study

BACKGROUND

Dementia is a life-limiting disease with high symptom burden. The Integrated Palliative Care Outcome Scale for Dementia (IPOS-Dem) is the first comprehensive person-centered measure to identify and measure palliative care needs of people with dementia. However, such a measure is missing in the German health care system.

AIM

To develop a culturally adapted German version of the IPOS-Dem and determine its content validity as a foundation for comprehensive psychometric testing.

DESIGN

Cognitive interview study with intermittent analysis and questionnaire adaptation. Interview guide and coding frame followed thematic analysis according to Willis complemented by Tourangeau's model of cognitive aspects of survey methodology: comprehension, retrieval, judgment, response.

PARTICIPANTS

Purposive sample with professionals (n = 29) and family carers (n = 6) of people with advanced dementia in seven nursing homes and person's own home care in four interview rounds (n = 11; 10; 7; 7).

RESULTS

IPOS-Dem was regarded as comprehensive and accessible. Cultural adaption pertained to issues of comprehension and judgment. Comprehension challenges referred to the person-centered concept of "being affected by" used in the POS-measures. Judgment problems related to persons with limited communication causing challenges in assessment.

CONCLUSION

Most issues of cultural adaptation could be addressed by questionnaire modifications. However, interviews unveiled fundamental challenges for using proxy reported person-centered assessments. Continuous training on how to use the instrument is imperative to integrate the person-centered approach of palliative care into nursing homes as a key provider of generalist palliative care for people with dementia. The refined version is ready for psychometric testing.

The Reported Edmonton Frail Scale-Thai version: Development and Validation of a Culturally-Sensitive Instrument

Frailty may lead to increased vulnerability, disability, and adverse health outcomes in older adults. Early detection has been described as the best approach to manage frailty; however, frailty instruments are not widely available, particularly in the Thai language. The purpose of this cross-sectional study was to develop a culturally adapted Thai version of the Reported Edmonton Frail Scale and to validate the psychometric properties of the new instrument in hospitalized older Thai adults. Reliability and validity were examined. Participants completed questionnaires that included demographic and health information, and the Reported Edmonton Frail Scale-Thai version. Results revealed that the new instrument was reliable and had good content validity. Inter-rater reliability was strong. Confirmatory factor analysis showed a fair fit for the whole model, but most domains were strongly associated with frailty. On average, the instrument was completed under 7 minutes. The Thai version of the frailty instrument may be a practical tool for frailty evaluation, and could inform inpatient care, both locally and internationally; future research is needed to confirm predictability and feasibility in other clinical settings and populations.

Perineal management: Midwives' confidence and educational needs

OBJECTIVE

The overall aim of this study was to collate information to inform the updating of a perineal management educational programme for midwives. This paper explores midwives' confidence and educational needs in managing the woman's perineum during the second stage of labour, focusing on future quality initiatives to improve midwives' experiences and expertise in the prevention of perineal trauma during birth.

DESIGN

A mixed-methods sequential exploratory design was used.

PARTICIPANTS AND SETTING

Midwives and clinical midwife managers assisting with births in the labour ward of a large urban university stand-alone maternity hospital in the Republic of Ireland with approximately 9,000 births per year participated in the study.

MEASUREMENTS

A questionnaire and two focus groups were used to collect the data.

FINDINGS

Fifty-two midwives from a total of 64 eligible labour ward midwives completed the questionnaire, a response rate of 81.2%. Midwives indicated that perineal management workshops did not cover prevention of perineal trauma, and mainly focused on suturing and repair of the perineum. The majority of midwives (85%) indicated that they would like further education on the prevention of perineal trauma. Higher levels of confidence in making a decision to perform an episiotomy, infiltrating the perineum and at performing an episiotomy were reported in experienced midwives. Midwives want improved and additional education in the management of women's perinea during the second stage of labour and made various recommendations regarding the content, format, timing and frequency of the workshop. Suggestions for further education included techniques for preventing perineal trauma during labour and birth and how to perform an episiotomy.

KEY CONCLUSIONS

This study provides key insights into midwives' confidence and educational needs in relation to managing the woman's perineum during the second stage of labour. The findings from this study demonstrates the appetite of midwives for additional education in the area of perineal management, particularly prevention strategies.

IMPLICATIONS FOR PRACTICE

Midwives play an essential role in reducing the rates of perineal trauma through regular education. It is therefore important that midwives keep up to date with the best available evidence. Updating existing perineal management educational programmes that are tailor made to midwives' needs could not only improve clinical skills and perineal protection techniques but also midwives' confidence in decision making. The overall aim is to reduce perineal trauma in women having a spontaneous vaginal birth.

Nursing and midwifery students' perception of learning enablers and gains in the first semester of their BSc programmes: A cross sectional study

BACKGROUND

The student experience in the first year of university is fundamental to successful adaption to the higher education environment and shapes student engagement with their chosen degree. Students' feedback on this experience is essential when designing or reviewing curricula.

OBJECTIVES

The aim of this study was to explore students' perceptions of their learning gains to identify factors that support student learning and identify elements that need improvement if specific learning needs are to be met.

DESIGN

A cross sectional descriptive study.

SETTING

A large urban university in Ireland that provides undergraduate nursing and midwifery degree programmes.

PARTICIPANTS AND METHODS

The study was conducted using the Student Assessment of Learning Gains (SALG) questionnaire. This instrument consists of a series of closed questions which explore perceived student gains in skills, cognitions and attitudes. The questionnaire was adapted for a semester rather than a module evaluation. The tool also includes a series of open questions inviting students to comment in each section.

RESULTS

Students (n = 206) positively evaluated teaching and learning approaches used. The greatest enablers of learning were clinical skills laboratory small group teaching and support followed by online learning materials and multiple choice formative assessment questions. They reported gains in knowledge, generic skills development and an increase in confidence and enthusiasm for their chosen career.

CONCLUSION

The feedback gained in this study provides valuable knowledge about the elements that support nursing and midwifery students learning and highlights areas that require attention. This is particularly useful for faculty who are involved in curriculum review and enhancement and in student engagement and retention.

Using reusable learning objects (RLOs) in wound care education: Undergraduate student nurse's evaluation of their learning gain

BACKGROUND

Both nationally and internationally concerns have been expressed over the adequacy of preparation of undergraduate nurses for the clinical skill of wound care. This project describes the educational evaluation of a series of Reusable Learning Objects (RLOs) as a blended learning approach to facilitate undergraduate nursing students learning of wound care for competence development. Constructivism Learning Theory and Cognitive Theory of Multimedia Learning informed the design of the RLOs, promoting active learner approaches. Clinically based case studies and visual data from two large university teaching hospitals provided the authentic learning materials required. Interactive exercises and formative feedback were incorporated into the educational resource.

METHODS

Evaluation of student perceived learning gains in terms of knowledge, ability and attitudes were measured using a quantitative pre and posttest Wound Care Competency Outcomes Questionnaire. The RLO CETL Questionnaire was used to identify perceived learning enablers. Statistical and deductive thematic analyses inform the findings.

RESULTS

Students (n=192) reported that their ability to meet the competency outcomes for wound care had increased significantly after engaging with the RLOs. Students rated the RLOs highly across all categories of perceived usefulness, impact, access and integration.

CONCLUSION

These findings provide evidence that the use of RLOs for both knowledge-based and performance-based learning is effective. RLOs when designed using clinically real case scenarios reflect the true complexities of wound care and offer innovative interventions in nursing curricula.

Parents' Use of Nonpharmacologic Methods to Manage Procedural Pain in Infants

OBJECTIVE

To describe parents' use of nonpharmacologic methods to manage infant procedural pain in the NICU and determine the demographic factors related to such use.

DESIGN

A cross-sectional and descriptive study design.

SETTING

Level III and Level II NICUs (seven units) of four University Hospitals in Finland.

PARTICIPANTS

Parents (N = 178) whose infants were treated in Finnish NICUs.

METHODS

Parents were asked to respond to a structured questionnaire during their infants' hospitalizations. We analyzed the data using the nonparametric Kruskal-Wallis one-way analysis of variance and Mann-Whitney U test.

RESULTS

Most parents reported that they used physical methods, such as touching, holding, and positioning, nearly always/always (86%, 76%, and 55%, respectively). However, less commonly used strategies included recorded music (2%), breastfeeding (2%), and non-nutritive sucking with oral sucrose (6%). Many characteristics of the infants, such as their gestational ages and their conditions, were significantly related to the implementation of nonpharmacologic methods.

CONCLUSION

There is a clear need to extend parents' use of nonpharmacologic methods to manage their infants' procedural pain in the NICU. Because many methods were not considered as pain-relieving strategies, it is important to increase knowledge about the effectiveness of these interventions among parents and nurses.

Assessing Faculty and Student Interpretations of AACP Survey Items with Cognitive Interviewing

Objective. To use cognitive interviewing techniques to determine faculty and student interpretation of a subset of items from the AACP faculty and graduating student surveys. Methods. Students and faculty were interviewed individually in a private room. The interviewer asked each respondent for his/her interpretation of 15 randomly selected items from the graduating student survey or 20 items from the faculty survey. Results. While many items were interpreted consistently by respondents, the researchers identified several items that were either difficult to interpret or produced differing interpretations. Conclusion. Several interpretational inconsistencies and ambiguities were discovered that could compromise the usefulness of certain survey items.

Factors Influencing Parental Participation in Neonatal Pain Alleviation

PURPOSE

Neonates are likely to experience numerous painful procedures in neonatal intensive care units (NICUs). Parents have expressed a wish to be more involved in their infants' pain alleviation. The purpose of this study was to describe parents' perceptions concerning the factors that influence parental participation in pain alleviation in an NICU.

DESIGN AND METHODS

The qualitative study was conducted in level II and III NICUs (7 units) of Finland's four university hospitals. Data were collected through open-ended questionnaires and analyzed using inductive content analysis.

RESULTS

Factors that promoted parental participation consisted of five main categories: parental counseling by staff, parents' awareness of their own role, parents' motivation to participate in pain relief, family-friendly facilities and good communication. Factors hindering parental participation consisted of eight categories, including restrictive environment, lack of knowledge, everyday life requirements, underestimation of parents, the nature of the medical procedures, procedure- and pain-related emotions, deteriorated health status of the child and mother and (8) uncertainty of parenting.

CONCLUSIONS

This study revealed a number of factors that are important to take into account when improving parental involvement in neonatal pain alleviation. Especially, parental participation can be promoted by providing sufficient counseling based on the parents' needs and creating facilities that support parents' participation.

PRACTICE IMPLICATION

Parents should be engaged as partners in caregiving and decision making, and they should be given space to assume the role of parents during their child's hospitalization.

Nurses' and Parents' Perceptions of Parental Guidance on Using Nonpharmacological Pain-Relieving Methods Among Neonates in the NICU

Despite growing knowledge of parents' important role in their infants' pain management, the extent to which nurses in neonatal intensive care units (NICUs) provide guidance to parents on nonpharmacological methods is unclear. This study aimed to describe and compare the perceptions of parental guidance in using nonpharmacological pain-relieving methods among neonates in NICUs from the viewpoints of nurses and parents, and to examine the participants' demographics related to the guidance. A cross-sectional, descriptive, correlational study using questionnaire surveys was conducted. Eight NICUs of 5 university hospitals in Finland. A total of 427 participants, including 294 nurses and 178 parents. The participants indicated that the methods of touching and holding were the most commonly introduced strategies in infants' pain alleviation, as they were given as an alternative "nearly always/always" (nurses 91%, 87% and parents 61%, 58%, respectively). In contrast, music and breast-feeding were the less commonly introduced nonpharmacological methods (nurses 11%, 6% and parents 1%, 6%, respectively). A significant difference (p < .001) was found between the parents' and nurses' perceptions of parental guidance; nurses reported providing more guidance about all nonpharmacological methods compared with parents. In addition, many demographic factors of the nurses, the parents, and their infants were related to the parental guidance. Our findings indicate that parental guidance should not be based on nurses' evaluations of their activities without taking into account parents' perspectives. When counseling parents to use nonpharmacological methods, neonatal nurses should actively interact with families and discuss parents' individual needs.