Perceptions of adult intensive care unit patients regarding nursing presence and their intensive care experiences: A descriptive-correlational study

AIMS AND OBJECTIVES

This study aims to determine the relationship between perceptions of nursing presence and intensive care experiences in adult intensive care unit patients'.

BACKGROUND

Intensive care units (ICUs) are settings where patients have many negative emotions and experiences, which affect both treatment and post-discharge outcomes. The holistic presence of nurses may help patients turn their negative emotions and experiences into positive ones.

DESIGN

A descriptive-correlational design was used and reported according to the STROBE checklist.

METHODS

The sample consisted of 182 participants. Data were collected using a personal information form, the Glasgow Coma Scale (GCS), the Intensive Care Experience Scale (ICES), and the Presence of Nursing Scale (PONS).

RESULTS

A strong positive correlation existed between total ICES and PONS scores (r = 0.889, p < 0.001). There was a strong positive correlation between PONS total score and ICES subscales (awareness of surroundings (r = 0.751, p < 0.001), frightening experiences (r = 0.770, p < 0.001), recall of experience (r = 0.774, p < 0.001), and satisfaction with care (r = 0.746, p < 0.001)). Males (β = -0.139, p < 0.05), and patients who were university and higher education graduate (β = 0.137, p < 0.05) had higher positive ICU experiences. It was also found length of ICU stay was correlated with ICU experiences and nursing presence.

CONCLUSIONS

The more positively the patients perceive nurses, the better ICU experiences they have. Gender and education level were found determinants of adult ICU patients' experiences. ICU length of stay predicted what kind of experience patients have and how much they feel the presence of nurses.

RELEVANCE TO CLINICAL PRACTICE

Nurses should make their presence felt completely and holistically by using their communication skills for patients have more positive intensive care experiences. Nurses should consider variables which affects patients' ICU experiences and nursing presence.

Application of nursing presence to family-centered care: Supporting nursing practice in pediatric oncology

PURPOSE

In pediatric care settings, family-centered care (FCC) is an integral way to ensure family involvement in their child's care and has been known to improve health outcomes and families' psychosocial well-being. Similarly, nursing presence is deemed beneficial in the formation of authentic nurse-patient relationships and is known to facilitate healing and improve satisfaction for the patient and their family. The objective of this article is to explore how nursing presence supports FCC by closely examining the four concepts of FCC as described by Institute for Patient- and Family-Centered Care: dignity and respect, information sharing, participation, and collaboration. A case study is also presented to demonstrate how nursing presence can be applied in FCC, when caring for a pediatric oncology patient.

CONCLUSION

Nursing presence is essential in FCC since it plays a key role in the formation of relationships, a fundamental element in the four concepts. Attributes of nursing presence can be interwoven in the FCC framework and have positive clinical, social, and emotional outcomes for the patient and family. Although literature has explored associations between FCC and nursing presence, there is need for more scientific research to justify this argument to support the improvement of quality of family nursing care and strengthen the FCC model.

PRACTICE IMPLICATIONS

The four concepts of FCC lay a foundation for a model of care that can be enhanced by nursing presence, potentially providing a remedy for depersonalization of healthcare by improving nurse patient relationships in pediatric care settings. Nursing presence becomes less ambiguous when enacted in a FCC framework, revealing attributes that may be cultivated in family nursing to improve therapeutic relationships among nurses and family caregivers.

A concept analysis of facilitating presence through guided reflection for transformative learning in nursing education

AIM

The aim of the study was to report an analysis of the novel concept, facilitating presence through guided reflection for transformative learning.

DESIGN

A concept analysis.

METHODS

Search included keywords 'presence', 'reflective practices', 'nursing education' and 'concept analysis'. 65 peer-reviewed articles between 2000-2020 were included.

RESULTS

The final definition of the main concept is an interpersonal, co-constructed, intersubjective and intentional process to accompany nursing students in deep, constructive learning to discover new meanings and perspectives through self-inquiry and critical reflection on experiences. The nurse educator actively listens and intimately connect in the moment to create a safe environment. This leads to the nursing student's ability to learn to see what is important to the other and to respond by doing what can be done and/or by being who the other needs one to be.

PATIENT CONTRIBUTION

This concept will help to streamline the practice of presence ultimately enhancing the quality of patient care.

Factors limiting presence: Perceptions of nurses working in a public psychiatric hospital

BACKGROUND

 Presence is a therapeutic skill that has a healing effect not only on the mental healthcare user but also the nurse. There was a need to explore nurses' perceptions on factors that limit presence, especially in a public psychiatric hospital in a rural province such as North West, South Africa, where there are limited resources and nurses need to rely heavily on their therapeutic use of self.

OBJECTIVES

 To report on nurses' perceptions of factors limiting presence when working in a public psychiatric hospital.

METHOD

 A qualitative descriptive inquiry was applied, with purposive sampling. Semistructured individual interviews were held with 10 nurses. Thematic data analysis was applied.

RESULTS

 Intrapersonal factors that were found to limit presence arose from the view that mental healthcare users (MHUs) are difficult to engage with; the tendency to view 'good care' primarily as physical care with limited insight into presence was also recognised. Interpersonal and transpersonal factors related to difficulties in communicating with MHUs and in the work environment.

CONCLUSION

 Addressing factors that limit presence were found to require courage, the overcoming of interpersonal distance and a transformational process.Contribution: This article contributes important insights that can be used by nurse leaders to promote the practice of presence to improve the quality of psychiatric nursing care in developing contexts, such as a rural province in South Africa.

Exploring nursing presence as experienced by parents in pediatric oncology

BACKGROUND

Nursing presence has been viewed as a valuable way to create therapeutic relationships and has been linked to better health outcomes for patients and families. However, whether nursing presence can be described and how parents in pediatric oncology experience this phenomenon remains unanswered. Therefore, the purpose of this study was to explore how parents of children with cancer describe and experience nursing presence.

METHODS

This study used Giorgi's phenomenological approach to explore nursing presence as experienced by parents of children with cancer. Ten participants from a pediatric oncology clinic in Canada were interviewed. Giorgi's approach was used to analyze these data.

FINDINGS

Based upon participants' descriptions, a structure of nursing presence emerged which included six constituent features: An attitude of presence, a source of encouragement, clinical experience and expertise, therapeutic communication, family involvement, and a sense of home away from home. Most notably, nursing presence as experienced by parents was characterized by the 'being' and 'doing' of presence which were equally important.

CONCLUSION

The experiences described by parents provided rich and nuanced insights into what it meant to experience nursing presence in a pediatric oncology setting. This study provides a structure for this meaning making and expounds on its constituent features, describing what nursing presence resembles when experienced by parents of children with cancer.

PRACTICE IMPLICATIONS

This study informs nursing practice, policy, and education in ways that are likely to enhance care and the subsequent well-being of pediatric oncology patients and families.

Developing and validating the nursing presence scale for hospitalized patients

Aim

We developed and psychometrically tested the Nursing Presence Scale.

Background

Nursing presence is a foundation for professional nursing practice; therefore, it is critical to measure this concept.

Introduction

This instrument development study was designed to generate an itemized scale and psychometric testing using a sample of Iranian patients.

Methods

Based on both a concept development and literature review, and finally face and content validity 44-item draft scale was generated. During November 2018–2019, 774 patients were surveyed. Exploratory and confirmatory factor analyses were used to evaluate the scale’s construct validity; concurrent and predictive reliability of the nursing presence scale were also evaluated. We also examine the weighting to scale items.

Results

The analyses yielded a 36-item, 4-factor scale that adequately fit the data. Cronbach’s alpha coefficient for the whole instrument was 0.94. The intra class correlation coefficient was 0.91. Nursing Presence Scale scores were positively correlated with Revised Humane Caring Scale and predicted 25% of missed nursing care.

Conclusion

This 36-item has good reliability and validity, making it useful for measuring the current condition of nursing presence.

Implications for Nursing and Health Policy

Measuring the frequency of nursing presence allows for data-driven planning and upgrading the inpatient care services.

Taking the Time: Developing Trust with the Hospitalized Patient

Background and Purpose: Interpersonal trust is trust between two people and is an important component of the nurse-patient relationship in the hospital setting. Interpersonal trust entails good will, familiarity, risk, power imbalance, and vulnerability. This grounded theory study was undertaken to explain how interpersonal trust develops with the nurse from the perspective of the hospitalized adults. Methods: Face-to-face interviews were conducted with 20 hospitalized adults in their private hospital room. Data analysis was conducted concurrently with data collection using constant comparison. Results: The resulting model had six categories within the core category Taking the Time which reflected nursing presence. The beginning phase had two categories reflecting the patient Feeling Vulnerable and Relying on the Nurse. The middle phase had three categories reflecting the nurse Having a Positive Vibe, Seeing Me as a Person and Caring About Me. The endpoint of developing trust was the patient Feeling Comfortable. Patients perceived the nurse as in control of trust development in the hospital setting. Implications for Practice: The nurse conveying a positive attitude was a principal facilitator to trust development. A barrier to trust development was the nurse seeing the patient as a checklist and not as a person. When trust was established, the patient was more willing to ask questions. When trust did not develop, the patient avoided the nurse and attempted to complete activities on their own such as ambulating to the bathroom. The nurse taking the time and establishing trust contributes to safe patient care.

Nursing Presence in Pediatric Oncology: A Scoping Review

Background: Nursing presence creates meaningful and trusting relationships that facilitate healing for the patient and enhances the nurse's clinical experience. Although nursing presence has been linked to better health outcomes especially in chronic illnesses and end-of-life, little is known about its contribution in pediatric oncology. Purpose: The purpose of this scoping review was to explore how nursing presence is understood and expressed in pediatric oncology. Methods: Arksey and O'Malley's (2005) framework was used to guide the review, with Clarke and Braun's (2013) thematic analysis process used for collating, summarizing, and reporting the results. Key search terms were developed for searches between January 1999 and July 2020 in CINAHL, MEDLINE, and Psych INFO databases. Initially, 4,357 studies were identified with a final sample of nine articles meeting specific inclusion and exclusion criteria. Gray literature retrieved from the search was used to inform the review. Findings: Most notably, there is a limited understanding of nursing presence in pediatric oncology setting. However, findings revealed five themes that can be identified with nursing presence: Being With or Being There, Therapeutic Relationships, Communication, Family-centered Approach, and Perceived Outcomes of Nursing Presence. Nurses in pediatric oncology are in an ideal position to provide nursing presence in order to improve the quality of care in pediatric oncology settings. Discussion: There is a need to establish a comprehensive evidence-based understanding of the construct of nursing presence in pediatric oncology that health care providers can utilize to enhance their clinical practice and health research.

Mental healthcare users' self-reported medication adherence and their perception of the nursing presence of registered nurses in primary healthcare

Background

Medication adherence remains a challenge in the management of mental healthcare users (MHCUs), despite it being regarded as crucial for better health outcomes. Nurses at primary healthcare (PHC) facilities can play an important role through nursing presence in enhancing MHCUs’ medication adherence.

Aim

This article aimed to investigate the relationship between MHCUs’ self-reported medication adherence and their perception of the nursing presence by registered nurses in PHC.

Setting

An urban health district in Gauteng province, South Africa.

Methods

A quantitative, descriptive correlational, cross-sectional design was used. The sample included 180 MHCUs. Data were collected using the Medication Adherence Rating Scale and the Presence of Nursing Scale.

Results

The overall adherence level of respondents was partially adherent, with an average score of 6.45 out of a total score of 10. Respondents also reported a low level of perceived nursing presence demonstrated by registered nurses, with an average score of 72.2 out of 125. The results indicated a positive correlation between respondents’ self-reported medication adherence and their perceived nursing presence of registered nurses as evidenced by the positive value of the correlation coefficient of 0.69 with a corresponding significance probability value of 0.000 (r = 0.69; p = 0.00).

Conclusion

The level of perceived nursing presence demonstrated by registered nurses played a significant role in influencing MHCUs’ level of medication adherence. The registered nurses can improve MHCUs’ medication adherence by demonstrating nursing presence skills such as good listening skills and taking care of MHCUs as individuals and not as a disease.

Contribution

The results of this study confirm that there is a correlation between nursing presence and medication adherence. This holds significant value for future research in nursing presence. These findings also provide registered nurses in PHC with a valuable tool to improve medication adherence, namely nursing presence.

Defining Telepresence as Experienced in Telehealth Encounters: A Dimensional Analysis

PURPOSE

Telehealth's uptake has increased substantially in recent years, with an especially large jump in 2020 due to the emergence of COVID-19. This article provides background on and explores "telepresence" in healthcare literature. Telepresence strongly impacts the patient experience, but it is poorly defined in current research. The aim was to conceptually define telepresence using qualitative methods.

DESIGN

Dimensional analysis was used to analyze telepresence in clinical literature and create a clearer definition of telepresence as a concept. Multiple databases were searched for articles related to telepresence. Thirteen international articles related to telepresence were selected for analysis.

METHODS

Dimensional analysis allowed for multiple viewpoints to be explored within each distinct context and perspective.

FINDINGS

Twenty-five dimensions were discovered within the articles, which were synthesized to seven core dimensions of telepresence: connection, technological mediation, experienced realism, trust, being supportive, collaboration, and emotional consequence.

CONCLUSIONS

Telepresence is highly impactful on the patient's experience of telehealth care visits. The conceptual map produced by this dimensional analysis provides direction for clinicians to improve their ability to be present with patients during telehealth care. Potential implications include a starting point for future qualitative research, and the use of this dimensional analysis to inform clinical guidelines, improve clinician training, and assist in the development of new care models.

CLINICAL RELEVANCE

A telepresence definition brings clarity to an ill-defined concept. COVID-19 magnifies the need for a better understanding of telepresence, which allows clinicians to improve telehealth encounters.

Being present: Examining the efficacy of an Internet Mantram Program on RN-delivered patient-centered care

Background

The COVID-19 pandemic highlighted nurses’ compassionate presence during stressful conditions. Strategies to reduce workplace stress are needed.

Purpose

The purpose of this study was to evaluate a stress reduction strategy, an Internet-based Mantram Repetition Program (MRP), for nurses caring for hospitalized Veterans.

Methods

A one group pre-/post-test design was used to assess change in nurses’ perceived outcomes after participating in the MRP. A post-test-only design was used to assess hospitalized Veterans’ perceptions of nursing presence and satisfaction with care. Qualitative interviews were used to supplement quantitative data.

Findings

Patients perceived high levels of presence and satisfaction with care. Post MRP, nurses perceived increased mindfulness, compassion satisfaction, spiritual well-being, and nursing presence. Increased mindfulness was associated with greater compassion satisfaction and less burnout.

Discussion

For nurses working on the front lines of patient care, the potential for experiencing stress and burnout is a reality. Participating in a MRP could lessen these effects and facilitate nursing presence.

Here and now: Lived experiences of professional nurses practising caring presence in a rural public hospital in the North West Province, South Africa

BACKGROUND

Practising caring presence is recognised as an important nursing intervention indispensable to high-quality, patient-centred care. An awareness of the real world of professional nurses (PNs) practising caring presence will assist in expanding and supporting the existing literature on the same. A clear and rich description of what the concept of caring presence entails within the unique South African nursing context may guide nurses in the art of this nursing skill, enhance their professionalism and facilitate the formulation of recommendations on how to encourage nurses to implement the practice of caring presence within nursing.

AIM

This study explored and described the lived experiences of PNs practising caring presence in a rural public hospital.

SETTING

The study setting was a 120-bed, level-two district hospital in the North West Province of South Africa.

METHODS

A descriptive phenomenological method, specifically Husserl's approach, informed this study. Semi-structured interviews were conducted with a purposive sample of 10 PNs. Data were coded and analysed using Colaizzi's seven-step method.

RESULTS

Five themes emerged from the data analysis: professional caring presence, ethical caring presence, personal caring presence, healing caring presence and what caring presence is not.

CONCLUSION

Professional nurses experience practising caring presence as professionally and personally fulfilling, as an expression of their passion for the profession, as a way of portraying ethical care, as a willingness to be personally present and as a healing experience that involves commitment and taking care of patients holistically. Unprofessional, unethical behaviour and depersonalisation of patients were indicated as uncaring behaviour.

Trust towards nurses who care for haemodialysis patients: a cross-sectional study

BACKGROUND

Trust is widely acknowledged as the main component of relationships between patients and nurses.

AIMS

Considering the importance of building trust in the patient-nurse relationship especially in vulnerable patients such as patients undergoing haemodialysis, this study was carried out to assess the trust of these patients towards nurses in the haemodialysis unit and to explore its relationship with some characteristics of the patients.

METHODS

In this cross-sectional study, a total of 180 patients undergoing maintenance haemodialysis were selected using random sampling method. Data were collected by trust in nurses (TNS) scale. The collected data were analysed by SPSS (ver.21) software using anova, independent t-test and Pearson's correlation coefficient.

RESULTS

The mean score of patients' trust in nurses was 23.82, showing a high level of trust towards nurses. The lowest score (with a mean score of 4.17) was related to the providing of accurate information by nurses about the disease. Pearson's correlation coefficient indicated a positive significant relationship between the age and patient's trust (r = 0.17, p > 0.05), and there was a negative relationship between the mean score of trust and the mean of interdialytic weight gain (r = 0.57, p > 0.05).

CONCLUSIONS

Although the patient trust towards nurses was high in this study, there were some deficiencies in certain items especially in the provision of information and education to the patients. Education of specialised courses for nurses and empowering them to provide a high quality care to the patients on dialysis could help to increase the patents' trust.

Validation of the Presence of Nursing Scale Using Data Triangulation

BACKGROUND

Nursing presence has been developed as a distinct concept with identifiable behaviors but remains only partially defined as a quantifiable construct.

OBJECTIVES

This study asked if the Presence of Nursing Scale (PONS) is a reliable and valid instrument to measure nursing presence from the patient's perspective.

METHODS

A convenience sample of 75 adult acute care inpatients were verbally administered the 25-item PONS considering the registered nurse taking care of them on the day of data collection. Open-ended questions elicited the patients' explanations of their ratings. They also rated their overall satisfaction with the nursing care provided by the subject nurse using a 5-point scale.

RESULTS

The mean PONS score was 104.5 (SD = 17.26) on the 25-125 scale. Instrument reliability reported as a Cronbach's alpha coefficient of .95 was .94 in this study. Instrument validity was tested correlating PONS scores to the satisfaction rating. The Spearman's rho correlation was large and statistically significant, r (73) = .708. The higher the PONS score, the more satisfied the patient was with care from that nurse. Nineteen narratives selected from the lower quartile PONS scores (PONS < 99) and 11 from the upper quartile (PONS > 116) were thematically analyzed. Lower PONS scores corresponded with themes of patients being objectified as the work of the nurse without a respectful and caring nurse-patient relationship. Higher PONS scores coincided with patients' perceptions of enhanced nurse-patient rapport, feelings of better coping, and decreased anxiety.

DISCUSSION

These results demonstrate reliability and validity of the PONS and add to the body of evidence about nurse behaviors exhibited in the nurse-patient relationship, which influence patients' feelings of being cared for and satisfied with nursing care. These findings may be useful in the development of educational materials aimed at the advancement of nursing presence competency.

Spiritual Care in Nursing Practice in Veteran Health Care

Spiritual care is important in nursing practice, and spiritual well-being and spiritual care are associated with better health. Military veterans, a unique patient population, want spiritual care to cope with chronic conditions. It is unclear whether spiritual care is provided in veteran health care in the United States. This study used a qualitative descriptive method, guided by the Spiritual Care in Nursing Practice (SCNiP) theory, to describe spiritual care in nursing practice and facilitators/barriers in veteran health care. Individual interviews were conducted with 39 registered nurses (RNs) at a U.S. veteran health system. Findings were consistent with the SCNiP theory but revealed additional categorical attributes and processes as it applied to veteran health care. Facilitators that promoted spiritual care include nurse professionalism, collegial support, and available spiritual resources. Barriers included lack of time, task-oriented culture, unclear knowledge of accessing resources, and unclear organization policy in providing spiritual care. Findings further refined the theory.

Capturing the Interpersonal Process of Psychiatric Nurses: A Model for Engagement

Staff members' engagement with patients is a critical element of inpatient psychiatric care, essential to safety, the hospitalization experience and the development of a culture of care. Currently broad concerns exist around the amount of time inpatient psychiatric nurses expend in patient engagement and the quality of these interactions. In this paper we present a model of engagement that clarifies necessary skills to support the engagement process. The model is based on Peplau's theory of interpersonal relations, patients' ideas on healing elements of psychiatric hospitalization and research on inpatient therapeutic relationships. We are currently using this model for a web-based teaching/learning course to cultivate interpersonal engagement, and to explicate how through operationalizing their inpatient role, nurses support patients in the development of their mental health and well-being.

Concept Development of "Nursing Presence": Application of Schwartz-Barcott and Kim's Hybrid Model

PURPOSE

Although nursing presence is a foundation for professional nursing practice and has known positive outcomes such as patient satisfaction and recovery; it is not well known. The ambiguity surrounding how to define nursing presence has challenged its evaluation and education. Therefore, in an attempt to discover attributes of this underdeveloped concept and studying it in a new context, concept development is essential. The purpose of this study was to clarify the concept of nursing presence through concept development, to produce a tentative definition of this subjective concept in clinical practice.

METHODS

Concept development was carried out using Schwartz-Barcott and Kim's hybrid model including, theoretical, fieldwork and final analysis phases. First, 29 related articles available on the databases from 1990-2015 were reviewed and analyzed. Then, 22 interviews were conducted with 19 participants, followed with inductive content analysis. At last, an overall definition was performed.

RESULTS

Nursing presence can be explained as co-constructed interaction identified by deliberate focus, task-oriented/patient-oriented relationship, accountability, clarification, and ubiquitous participation. Nursing presence requires clinical competence, self-actualization, reciprocating openness, and conducive working environment. Worthwhile communications, balance/recovery, and growth and transcendence are the main consequences of this concept.

CONCLUSION

Co-constructed interaction underscored the value of the nursing presence as an integral component of caring with humanistic and patient-centered approaches. The findings could help clinical nurses have a better understanding of the nursing presence. Findings also can improve educators' and managers' knowledge for developing and conducting appropriate education strategies and caring activities to facilitate the promotion of nursing presence.

Validation of an instrument to measure moral distress within the Australian residential and community care environments

AIM AND OBJECTIVES

The aim of this study was to gain insight into the experience of moral distress within the aged care workforce. The objective of this study was to use and validate an existing instrument to measure moral distress within the aged care setting.

BACKGROUND

Moral distress, a phenomenon associated with worker satisfaction and retention, is common within nursing. Instruments to measure moral distress exist; however, there are no validated instruments to measure moral distress within an aged care setting.

DESIGN AND METHOD

An existing instrument, the Moral Distress Scale (Revised) was identified and amended. Amendments were subject to expert review for face and content validity. Data were collected from aged care nurses working in residential and community aged care, in Australia. Reliability was assessed using Cronbach's alpha with exploratory factor analysis undertaken for construct validity.

RESULTS

106 participants completed the survey, 93 (87.7%) identified as female and 13 (12.3%) male. Participants ranged in age from 21 to 73 years, with a mean time working in nursing of 20.6 years. The frequency component of the instrument demonstrated an alpha of 0.89, the intensity component 0.95 and the instrument as a whole 0.94. Three factors were identified and labelled as: Quality of Care, Capacity of Team and Professional Practice. Mean scores indicate a low occurrence of moral distress, but this distress, when experienced, was felt with a moderate level of intensity. Primary causes of moral distress were insufficient staff competency levels, poor quality care because of poor communication and delays in implementing palliation.

CONCLUSION

The instrument demonstrates validity and reliability within the Australian aged care setting. Further analysis with larger populations is required to support these findings.

IMPLICATIONS FOR PRACTICE

Australian aged care workers do experience moral distress. They suffer adverse consequences of this distress and quality of care is negatively impacted. This newly validated instrument can be used to quantify the occurrence of moral distress and to inform targeted interventions to reduce the occurrence and intensity of the experience.

Presence with Scenario-Based High Fidelity Human Patient Simulation

The aim of this grounded theory study was to explain the nature of presence among nursing students participating in scenario-based high fidelity human patient simulation. Data were derived from observations and interviews with 145 participants. Among participants, presence was found to be a multidimensional, dynamic interaction characterized by a centricity between the simulation and the natural environment. Presence, the core concept from the explanatory model that emerged from this study, is delineated in this article. Presence centricity in simulation may impact the learning experience and outcomes. These study results may support development of the educational science related to clinical simulation.

Self-report questionnaire for measuring presence: development and initial validation

BACKGROUND

The concept of 'presence' appears frequently in the literature and seems to be a highly relevant concept in discussing and evaluating quality of relations in healthcare practices. However, no existing self-report measure of presence for health professionals was found.

PURPOSE

The purpose of this study was (i) to develop a self-report questionnaire for measuring presence and (ii) to conduct initial psychometric testing of the questionnaire.

METHOD

The process followed two steps. Phase 1 consisted of the development of 64 items that were derived from the 'theory of presence' (ToP) as developed by Andries Baart in the Netherlands in 2001. Face and content validity were completed by a panel of experts in ToP. A pilot study to test understandability was done (N = 22). During Phase 2, 48 remaining items of the Presence Questionnaire for Caregivers (PQ-C) were tested among 723 healthcare professionals. Exploratory principal component analysis was conducted, and reliability coefficients and known-group validity were assessed.

RESULTS

Principal component analysis showed three new components that were labelled 'dedicated attitude', 'openness in perception' and 'reciprocal humaneness'. Thirty-one items were retained which explain 25.4% of the variance. An initial psychometric assessment of the shortened scale showed a Cronbach's alpha of 0.82 and a Spearman-Brown coefficient (for equal length) of 0.63. There were significant differences in sum scores between groups based on age, years of experience and familiarity with ToP.

CONCLUSION

It appeared possible to develop a self-report questionnaire for measuring presence and establish face and content validity. In initial exploratory factor analysis, the eight theoretical principles of ToP used to develop the questionnaire were not reflected, and three new components appeared. Further research is needed to examine the value of the three new dimensions, and investigation into the construct validity and reliability of the three new components is recommended.