Development and psychometric testing of a scale for assessing the associative stigma of mental illness in nursing

Aims and objectives: To develop a new scale for assessing the associative stigma of mental illness in nursing based on Peplau's model of psychodynamic nursing and to examine its psychometric properties. Background: The stigma of mental illness continues to cause problems today for patients, families and mental health professionals. For individuals with a mental disorder, stigma can result in restricted opportunities, social exclusion and the denial of rights. Associative stigma in mental health professionals is becoming a major problem and is related to increased depersonalisation, higher levels of emotional exhaustion and diminished job satisfaction among mental health professionals. Nursing may play a key role in reducing the stigma associated with mental illness, but there are no specific scales for the measurement of associative stigma in nursing. Design: Development of an instrument. A STROBE checklist was completed. Methods: This study involved two stages: (a) item generation and content validation; (b) examining the reliability and convergent/discriminant validity of the scale. A developmental and methodological design was used. Data were collected between November 2016–December 2017 from a sample of 737 nursing undergraduates. Results: The results indicated good internal consistency for the final 20‐item scale for assessing the associative stigma of mental illness in nursing, which is considered in terms of three dimensions: Violence/Dangerousness, Disability, and Irresponsibility/Lack of Competence. Exploratory and confirmatory factor analyses supported a three‐factor structure consistent with the theoretical model. Conclusions: The 20‐item EVEPEM (from its Spanish acronym) derived from Peplau's theory was shown to be a valid and reliable tool for assessing the stigma of mental illness in the nursing setting. Relevance to clinical practice: Reliable instruments are needed to measure the effectiveness of anti‐stigma interventions for mental health professionals. The results indicate that the tool developed is a valid and reliable instrument for use in the nursing setting.The present study received financial assistance via the XV Premio de investigación Beca de la AEESME Asociación Española de Enfermería de Salud Mental

Research on missed nursing care during the COVID-19 pandemic: A scoping review

COVID-19; Atenció d'infermeria perduda; Atenció al pacientCOVID-19; Atención de enfermería perdida; Atención al pacienteCOVID-19; Missed nursing care; Patient careAbstract Background: Missed nursing care is defined as care that is delayed, partially completed, or not completed at all. The scenario created by the COVID-19 pandemic may have influenced multifactorial determinants related to the care environment, nursing processes, internal processes, and decision-making processes, increasing missed nursing care. Aim: This scoping review aimed to establish the quantity and type of research undertaken on missed nursing care during the COVID-19 pandemic. Methods: This review was conducted following the Joanna Briggs Institute methodology for scoping reviews. We searched CINAHL, MEDLINE, Scopus, two national and regional databases, two dissertations and theses databases, a gray literature database, two study registers, and a search engine from November 1, 2019, to March 23, 2023. We included quantitative, qualitative, and mixed studies carried out in all healthcare settings that examined missed nursing care during the COVID-19 pandemic. Language restrictions were not applied. Two independent reviewers conducted study selection and data extraction. Disagreements between the reviewers were resolved through discussion or with an additional reviewer. Results: We included 25 studies with different designs, the most common being acute care cross-sectional survey designs. Studies focused on determining the frequency and reasons for missed nursing care and its influence on nurses and organizational outcomes. Linking Evidence to Action: Missed nursing care studies during the COVID-19 pandemic were essentially nurses-based prevalence surveys. There is an urgent need to advance the design and development of longitudinal and intervention studies, as well as to broaden the focus of research beyond acute care. Further research is needed to determine the impact of missed nursing care on nursing-sensitive outcomes and from the patient's perspective

Multidimensional instruments with an integral approach to identify frailty in community-dwelling people: protocol for a systematic psychometric review

Introduction An increasing number of investigations highlight the complex nature of frailty; therefore, the use of multidimensional assessment instruments could be useful in clinical decision-making. Frail people are found mainly in the community setting which is why this is the ideal environment for early screening and intervention. For this purpose, it is necessary to have valid, time-effective and easy-to-use frailty assessment instruments. The aim of this review is to critically appraise, compare and summarise the quality of the measurement properties of all multidimensional instruments with an integral approach to identify frailty in community-dwelling people. Methods and analysis Medline, Psychological Information Database (PsycINFO) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from their inception dates. We will also conduct searches in databases of grey literature. No limits will be applied for language. A highly sensitive validated search filter will be used for finding studies on measurement properties. An additional search including the names of the instruments found in the initial search will also be undertaken. Studies aiming at the development of a measurement instrument, the evaluation of one or more measurement properties or the evaluation of its interpretability will be included. The instrument should have an integral approach (physical, psychological and social) and it should measure all three domains. The context of use should be a community setting. Two reviewers independently will screen the references and assess the risk of bias by consensus-based standards for the selection of health measurement instruments checklist. To assess the overall evidence for the measurement properties of the identified instruments, the results of the different studies, adjusted for their methodological quality, will be combined. Ethics and dissemination Ethical approval and patient consent are not required as this is a psychometric review based on published studies. The results of this review will be disseminated at conferences and published in an international peer-reviewed journal. PROSPERO registration number CRD42019120212

Construcción y validación de una escala para la evaluación del estigma de la enfermedad mental en Enfermería (EVEPEM)

[spa] El estigma de la enfermedad mental es una realidad que aún hoy existe. Uno de los grupos profesionales que pueden tener mayor impacto en la reducción del estigma son los profesionales de Enfermería. Es importante disponer de instrumentos de evaluación del estigma de la Enfermedad mental vinculados a la profesión enfermera. El primer objetivo del presente estudio fue construir y evaluar las propiedades psicométricas de una escala para evaluar el estigma de la Enfermedad Mental basada en el modelo conceptual de Enfermería Psicodinámica propuesto por Peplau. La escala se denominó EVEPEM (Escala para la evaluación del estigma en la enfermedad mental en los profesionales de Enfermería) quedando configurada con 20 ítems distribuidos de forma desigual entre tres factores denominados: Factor 1 Violencia y peligrosidad (8 ítems), Factor 2 Incapacidad (5 ítems) y Factor 3 Irresponsabilidad e incompetencia (7 ítems). El estudio se organizó en dos fases secuenciales: (1) generación de ítems y validación de contenido y (2) evaluación de las propiedades psicométricas de fiabilidad, validez de constructo y de criterio del instrumento. En el estudio se incluyó una muestra de 737 estudiantes de Grado de Enfermería, recogiéndose los datos entre noviembre del 2016 y diciembre del 2017. Los resultados mostraron una buena consistencia interna (alfa de Cronbach = 0,825) para la escala final de 20 ítems. El análisis factorial exploratorio aportó datos favorables para la consideración de la estructura trifactorial de la EVEPEM, mientras que el análisis factorial confirmatorio apoyó el modelo hipotético de tres factores. El segundo objetivo de esta investigación fue evaluar los niveles de estigma hacía la enfermedad mental en estudiantes de Grado de Enfermería y en profesionales de Enfermería. La muestra estuvo configurada por un total de 837 profesionales y estudiantes de enfermería. Los resultados mostraron que los estudiantes de Enfermería disminuyen los niveles de estigma hacía la enfermedad mental a medida que avanza su formación universitaria. Asimismo, se evidencia que los profesionales que trabajan en la salud mental presentan menos actitudes estigmatizantes hacia la enfermedad mental que los profesionales de otros ámbitos. Del mismo modo, se exploraron las relaciones entre el nivel de estigma y las variables sociodemográficas y académicas. En los profesionales de enfermería, se observa que los niveles de estigma global EVEPEM son significativamente superiores en las mujeres, mientras que la edad y la experiencia no parecen influir sobre el estigma de la enfermedad mental. Por otro lado, los estudiantes que han tenido contacto previo con la enfermedad mental presentan niveles más bajos de estigma hacia las personas con un trastorno mental. Si bien es cierto que se precisan de estudios más amplios para incrementar la robustez psicométrica, se concluye que la escala EVEPEM de 20 ítems es un instrumento válido y fiable para evaluar el estigma de la enfermedad mental en Enfermería, considerando que el constructo comprende tres dimensiones: Violencia-Peligrosidad, Incapacidad y Responsabilidad-Competencia.[eng] Mental illness continues to be associated with considerable stigma. The nursing profession can play a key role in reducing this stigma, and it is therefore important to be able to assess the attitudes and beliefs of nurses about mental illness. The aim of the study was to develop and test the psychometric properties of a scale for assessing the stigma of mental illness in nursing. Conceptually, the scale (EVEPEM, in accordance with its original name in Spanish) is based on Peplau’s model of psychodynamic nursing. The study involved two stages: (1) item generation and content validation and (2) examining the scale’s reliability and convergent/discriminant validity. Data were collected between November 2016 and December 2017 from a sample of 737 nursing undergraduates. The results indicated good internal consistency (total Cronbach’s alpha = 0,825) for the final 20-item scale. Exploratory and confirmatory factor analyses supported a three-factor structure consistent with the theoretical model. The results obtained in the present sample suggest that the EVEPEM is a valid and reliable instrument for assessing the stigma associated with mental illness in the nursing context. The second aim of this research was to assess the levels of stigma towards mental illness among nursing students and nursing professionals. The sample consisted of 837 nurses and undergraduate nurses. The results show that nursing students reduce their stigma levels towards mental illness as training progresses and that stigma levels towards mental illness are lower in mental health nursing than in other settings. In the same way, the relationships between the level of global stigma and factors and, in addition, sociodemographic and academic variables were explored. The levels EVEPEM stigma are significantly higher in women in nursing, although age and experience are variables that do not influence the stigma of mental illness in Nursing. On the other hand, students who have had previous contact with mental illness have lower levels of stigma toward people with a mental disorder. Although more research is needed to increase the psychometric properties of the scale, the results obtained in the present sample suggest that the 20 EVEPEM items is a valid and reliable instrument for assessing the stigma associated with mental illness in the nursing context. The exploration of the factors confirmed the proposed hypothesis, and the final scale consists of three dimensions of the stigma concept of mental illness: Violence-Hazard, Disability and Lack of Competence

Reducing mental health stigma among nursing students through an educational intervention

Background: Patient-centred care must consider service consumers’ needs and improve their health and well-being as well as their satisfaction and the quality of their healthcare assistance. However, individuals experiencing mental illness often struggle with barriers and misunderstandings by health care professionals. Nursing Faculties are uniquely positioned to reduce stigmatising attitudes via new educational interventions that could align nursing curricula and individuals with mental illness needs. However, there are few studies about the stigma toward mental illness among nursing students in Spain. Objectives: The present study aimed to analyse the effect of a 9-month educational intervention on the level of stigma in nursing students. Design: a one-group pre-postintervention design with no control group was conducted. Methods: A total of 194 nursing students completed the EVEPEM scale before and after the intervention. The intervention comprised 55 hours of campus sessions and 150 h practicum in mental health settings. Results: A destigmatising tendency was captured by a large main effect and a statistically significant stigma reduction. Conclusions: The educational 9-month intervention was effective in reducing students’ stigma by providing theoretical education, personal contact with mental health service consumers, and critical reflection activities.This work was supported by AEESME Asociación Española de Enfermería de Salud Mental: [Grant Number XV Premio de investigación Beca de la AEESME Asoc]

Multidimensional instruments with an integral approach to identify frailty in community-dwelling people: protocol for a systematic psychometric review

Community-dwelling; Frailty; Psychometrics; ScreeningVivienda comunitaria; Fragilidad; Psicometría; RevisiónVivenda comunitària; Fragilitat; Psicometria; RevisióIntroduction An increasing number of investigations highlight the complex nature of frailty; therefore, the use of multidimensional assessment instruments could be useful in clinical decision-making. Frail people are found mainly in the community setting which is why this is the ideal environment for early screening and intervention. For this purpose, it is necessary to have valid, time-effective and easy-to-use frailty assessment instruments. The aim of this review is to critically appraise, compare and summarise the quality of the measurement properties of all multidimensional instruments with an integral approach to identify frailty in community-dwelling people. Methods and analysis Medline, Psychological Information Database (PsycINFO) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) will be searched from their inception dates. We will also conduct searches in databases of grey literature. No limits will be applied for language. A highly sensitive validated search filter will be used for finding studies on measurement properties. An additional search including the names of the instruments found in the initial search will also be undertaken. Studies aiming at the development of a measurement instrument, the evaluation of one or more measurement properties or the evaluation of its interpretability will be included. The instrument should have an integral approach (physical, psychological and social) and it should measure all three domains. The context of use should be a community setting. Two reviewers independently will screen the references and assess the risk of bias by consensus-based standards for the selection of health measurement instruments checklist. To assess the overall evidence for the measurement properties of the identified instruments, the results of the different studies, adjusted for their methodological quality, will be combined. Ethics and dissemination Ethical approval and patient consent are not required as this is a psychometric review based on published studies. The results of this review will be disseminated at conferences and published in an international peer-reviewed journal

The Tilburg frailty indicator: a psychometric systematic review

The Tilburg Frailty Indicator (TFI) is one of the most prominent multidimensional frailty assessment instruments. This review aimed to critically appraise and summarise its measurement properties. Methods Reports were eligible if they included results of studies aimed at developing the TFI or evaluating its measurement properties. We performed a literature search in MEDLINE, CINAHL, and PsycINFO databases from their inception until September 17, 2020. We also searched grey literature databases. We assessed the methodological quality of the included studies using the 'COSMIN Risk of Bias'. The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a GRADE approach. Results Fifty-five studies were included. We found moderate sufficient evidence for TFI content validity, although it is still insufficient for the comprehensiveness of its items. TFI construct validity was based on sufficient evidence from a single study of its structural validity as well as multiple hypothesis-testing for construct validity studies with inconsistent results. We did not find any studies that assessed cross-cultural validity. The TFI showed high sufficient concurrent validity with the comprehensive geriatric assessment. We identified several studies assessing its predictive validity for adverse frailty-related outcomes, although most of the evidence from these studies was insufficient. We did not find any studies that assessed the responsiveness of TFI scores. Conclusions The TFI is a simple measurement instrument that may be helpful in the assessment of frailty. However, more studies are needed to strengthen its usefulness as a clinical decision-making tool

The Tilburg Frailty Indicator : A psychometric systematic review

Background: The Tilburg Frailty Indicator (TFI) is one of the most prominent multidimensional frailty assessment instruments. This review aimed to critically appraise and summarise its measurement properties. Methods: Reports were eligible if they included results of studies aimed at developing the TFI or evaluating its measurement properties. We performed a literature search in MEDLINE, CINAHL, and PsycINFO databases from their inception until December 8, 2021. We also searched grey literature databases. We assessed the methodological quality of the included studies using the "COSMIN Risk of Bias". The measurement properties were evaluated using specific criteria. We graded the quality of the evidence using a GRADE approach. Results: Sixty-three studies were included. We found moderate sufficient evidence for TFI content validity, although it is still insufficient for the comprehensiveness of its items. TFI construct validity was based on sufficient evidence from two studies of its structural validity as well as multiple hypothesis-testing for construct validity studies with inconsistent results. We did not find any studies that assessed cross-cultural validity. Only one of TFI's three dimensions showed sufficient evidence for the internal consistency of its scores, and results in test-retest reliability were inconsistent. The TFI showed high sufficient concurrent validity with the comprehensive geriatric assessment. We identified several studies assessing its predictive validity for adverse frailty-related outcomes, although most of the evidence from these studies was insufficient. We did not find any studies that assessed the responsiveness of TFI scores. Conclusions: The TFI had evidence gaps in several relevant measurement properties. Further research is needed to strengthen its usefulness as a clinical decision-making tool