Psychometric validation of Emotional Reaction Instrument-English to measure American children's emotional responses to hospitalisation

Preschool Confusion Assessment Method for the Intensive Care Unit-Spanish (psCAM-ICU-S): Cross-Cultural Adaptation and Validation in Colombia

Objective: The goal of the present study was to perform a cross-cultural adaptation and clinical validation of the Preschool Confusion Assessment Method for the Intensive Care Unit-Spanish (psCAM-ICU-S) for its clinical use in the Colombian Population. Methods: We designed a Cross-cultural adaptation study followed by a cross-sectional validation study at a Single-center Pediatric Intensive Care Unit (PICU) at a University Hospital in Bogotá, Colombia. The study population was children aged from 6 months to 5 years and 11 months who had been treated in the PICU with a Richmond sedation-agitation scale score of-3 or higher. A three-phase study was carried out. The first phase comprised the application of psychometric tests on the tool. In the second phase, the psCAM-ICU-S was applied to the target population. Patients were evaluated by a nurse and a pediatric intensivist using the psCAM-ICU-S; additionally, a child psychiatrist evaluated each patient using the DSM-V criteria; the psychiatrist evaluation was chosen as the gold standard for the diagnosis of delirium. In the third phase, an evaluation of the tool's effectiveness was carried out by using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. Interrater agreement was also assessed by using the Fleiss' kappa. Results: Psychometric tests established the instrument's reliability and consistency as well as the clarity of its items. A total of 31 patients were evaluated. On average, the instrument presented a sensitivity of 93.3%, specificity of 94.8%, PPV 78%, NPV 99%, a positive likelihood ratio of 19.93, and a negative ratio of 0.07. The prevalence of delirium was 16.1% by the child psychiatrist and 25.8% using de psCAM-ICU-S. We confirmed high Interrater agreement, Kappa index (0.672-0.902). Conclusions: The psCAM-ICU-S was a valid and reliable instrument for the diagnosis of delirium in critically ill pediatric patients.

Different psychometric properties of the Emotional Reaction Instrument-English (ERI-E) between hospitalized African American and Caucasian children

PURPOSE

To demonstrate the psychometric properties of the Emotional Reactions Instrument-English (ERI-E) between hospitalized African American and Caucasian children aged 7-12 years.

DESIGN AND METHOD

A methodological study was conducted to examine validity and reliability of the ERI-E with 230 hospitalized African American and Caucasian children. Data were collected with sociodemographic and clinical forms, and using the ERI-E, and the Facial Affective Scale (FAS).

RESULTS

Different factor structures were found between hospitalized African American and Caucasian children. In psychometric testing of the ERI-E with African American children, four items, alone, lonely, shy, and bored, were removed from the original 16-item ERI-E after exploratory factor analysis. Three factors, including Fear, Anxiety, and Distress, were identified explaining 60.71% of the total variance. Cronbach's alpha coefficient for the revised 12-item scale was 0.85. Six items, happy, sad, afraid, frightened, hurt, and uncomfortable, in the ERI-E were significantly correlated with the FAS (r = 0.20-0.59) as evidence of concurrent validity. In the sample with hospitalized Caucasian children, two items, bored and uncomfortable, were eliminated from the original ERI-E after exploratory factor analysis. Four factors including Fear, Anxiety, Distress, and Loneliness were extracted with 62.61% of total variance. Cronbach's alpha coefficient for the revised 14-item in the ERI-E was 0.84 for hospitalized Caucasian children. As evidence of concurrent validity, 10 items, happy, sad, afraid, frightened, bad, lonely, scary, bored, hurt, and uncomfortable, in the ERI-E were significantly correlated with the FAS (r = 0.20-0.69).

PRACTICE IMPLICATION

Because children with different cultural backgrounds understand or use words differently, healthcare providers should assess the cultural norms of pediatric patients and ensure steps have been taken to ensure clear, effective communication with pediatric patients. In addition, healthcare providers should evaluate the meanings of faces in the FAS before using it in a clinical setting because faces have different cultural connotations. The explosive growth of ethnic minority children in the United States makes it paramount for healthcare providers and researchers to consider the measurement equivalence of any measure to better serve different racial and cultural groups.

The waiting room as a relational space: young patients and their families' experience in a day hospital

BACKGROUND

Waiting in hospital is a condition of high stress for patients and their families, especially in childhood. The literature has investigated the emotional experiences of patients and their families, recognizing the need for a comfortable environment, attention from the staff, information and sharing emotions with others. Waiting time in day hospitals is a topic that has not yet been investigated in the literature, but is nevertheless interesting for researchers. This exploratory study investigates the experience of waiting young patients and their families go through during treatments in day hospitals.

METHOD

Fifty children and adolescents from ages 7 to 15 years, admitted to the day hospital of a paediatric haematology and oncology ward of an Italian hospital, completed the Emotional Reaction Instrument (ERI) and the Child Drawing: Hospital. Their parents or relatives completed a semi-structured interview on waiting.

RESULTS

The data showed that the young patients displayed a low level of anxiety and negative emotion. In contrast, the adults' experience of waiting in the day hospital entailed boredom, anxiety and concern for the emotional state of their children. These conditions can be alleviated by relationships and sharing emotions with other adults.

CONCLUSIONS

This study has shown that day hospital waiting rooms should be organized and should be experienced by adults and children as relational spaces. This could provide useful suggestions in order to improve the organization of day hospital waiting rooms.

Examining Validity and Reliability of the Emotional Reactions Checklist with Hospitalized Children

Fear, anxiety, and emotional upset are common experiences for hospitalized children. To identify and treat children's emotional reactions, health care professionals must be able to differentiate emotional reactions from pain and other symptoms. Clinical assessment of emotions requires the use of valid and reliable instruments in acute care settings. This study examined internal consistency, construct, and concurrent validity of the Emotional Reactions Checklist (ERC). A descriptive correlational design guided the psychometric approach. Children answered a sociodemographic questionnaire and responded to self-generated scenarios of pleasant and unpleasant events using two self-report scales of emotions. The convenience sample comprised 59 children admitted to an inpatient unit in a large children's hospital or to a community hospital emergency department. Construct validity was supported by significantly different ERC mean responses to recalled pleasant prehospitalization experiences and unpleasant hospitalization experiences (p < .001) for both ERC item responses and total scale scores. Children's explanations for seemingly inconsistent item responses further supported their ability to use the ERC to convey their emotions. Concurrent validity was supported by moderate (r = 0.32) to strong (r = 0.70) correlations between the Facial Affective Scale and ERC items and scale scores. Internal consistency was better supported for the recalled unpleasant experience (α = 0.77) than for the pleasant experience (α = 0.60). Results supported construct and concurrent validity and beginning internal consistency reliability for the ERC in an acute care setting. Further research is required to establish feasibility of repeated use with ill children.