RESUMEN
Decisional involvement is widely recognized as an essential component of a professional nursing practice environment. In recent years, researchers have added to the conceptualization of nurses' role in decision-making to differentiate between the content and context of nursing practice. Yet, instruments that clearly distinguish between these two dimensions of practice are lacking. The purpose of this study was to examine the factorial validity of the Decisional Involvement Scale (DIS) as a measure of both the content and context of nursing practice. This secondary analysis was conducted using data from a longitudinal action research project to improve the quality of nursing practice and patient care in six hospitals (N = 1,034) in medically underserved counties of Pennsylvania. A cross-sectional analysis of baseline data from the parent study was used to compare the factor structure of two models (one nested within the other) using confirmatory factor analysis. Although a comparison of the two models indicated that the addition of second-order factors for the content and context of nursing practice improved model fit, neither model provided optimal fit to the data. Additional model-generating research is needed to develop the DIS as a valid measure of decisional involvement for both the content and context of nursing practice.
Asunto(s)
Investigación en Enfermería Clínica/organización & administración , Toma de Decisiones , Modelos de Enfermería , Rol de la Enfermera , Atención de Enfermería/organización & administración , Personal de Enfermería en Hospital/organización & administración , Poder Psicológico , Adulto , Estudios Transversales , Análisis Factorial , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pennsylvania , Psicometría , Adulto JovenRESUMEN
The only effective treatment for symptomatic aortic stenosis in the older adult population is surgical aortic valve replacement. However, more than 30% of candidates are denied surgery due to advanced age and multiple comorbidities. Without surgical intervention, death from symptomatic aortic stenosis approximates 2% per month, with mortality rates of approximately 50% within 2 years of symptom onset. There is no effective medical treatment for severe symptomatic aortic stenosis; care has been limited to palliative remedies and end-of-life decisions. Nascent advances in miniaturization and catheter technologies provide a new and less invasive approach: transcatheter aortic valve replacement (TAVR). The current article summarizes treatment guidelines; pathophysiology; clinical manifestations, progression, and classification of severe symptomatic aortic stenosis; and introduces TAVR and discusses randomized controlled trials involving three patient populations from the United States, with relevant nursing implications.
Asunto(s)
Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/terapia , Guías de Práctica Clínica como Asunto , Reemplazo de la Válvula Aórtica Transcatéter/normas , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Estados UnidosRESUMEN
Longitudinal research designs involve data collection at multiple time points to measure change over time. Therefore, identification of the same respondents is essential at each time point so that data from the same respondents can be matched for comparison over time. Subject-generated identification codes permit an anonymous means to track respondents over multiple data collection points. This article describes the evolution of subject-generated identification codes, techniques to improve respondent match rates, and the authors' experience using this mechanism in a longitudinal study of staff registered nurses working in hospitals. Challenges, recommendations, and implications for using subject-generated identification codes are discussed.