Patients participating in a qualitative study of cancer nursing care described the outcomes that resulted from patient centered nursing care:  increased fortitude and a sense of well-being with its constituents of trust, optimism, and authenticity (Radwin, 2000). Scales to measure four of the outcomes were developed (Radwin, Washko, Suchy, & Tyman, 2005). Content validity for the scales was found acceptable after expert panel review and cognitive interviewing of patients. The scales were pilot tested in a sample of 66 recently treated patients with cancer who attended a cancer support organization workshop. Internal consistency reliability was acceptable as were, using multi-trait/multi-item analysis methods, convergent and discriminant validity.

A confirmatory factor analysis (CFA) of the four desired health outcome scales was conducted in a study of patient-centered nursing care for a racially diverse sample of patients.  (Radwin, Cabral, & Wilkes, in press). The desired outcomes scales best fit the data with all original items for the Authentic Self-Representation Scale and for the Trust in Nurses Scale with one item removed. The original Cancer Patient Optimism Scale and Fortitude Scale did not fit the data. Conceptual and statistical considerations offered by exploratory factor analyses guided respecification. The new Cancer Patient Optimism Scale and a Cancer Patient Distress Scale fit statistics were acceptable. Moreover, correlations between the MHI-5 (Berwick et al., 1991) and each the Cancer Patient Optimism and Cancer Patient Distress Scales were in the expected direction and statistically significant.

Authentic self-representation is conceptually defined as the patient’s sense of genuine self-portrayal. Trust in nurses is conceptually defined as the patient’s confidence that care was as appropriate, reliable and potentially successful as possible. Cancer patient optimism is conceptually defined as the patient’s beliefs that he or she has made appropriate choices regarding treatment, and the patient’s feeling of hopefulness about treatment outcomes. Cancer patient distress is conceptually defined as the patient’s beliefs that things will not go well.

Internal consistency reliabilities for the four scales were evaluated with coefficient alpha: .82 for the Trust in Nurses Scale, .71 for the Authentic Self Representation Scale, .72 for the Cancer Patient Optimism Scale, and .72 for the Cancer Patient Distress Scale. Fit statistics to assess the scales included comparative fit index (CFI; criterio >.95), Tucker-Lewis Index (TLI; criterion>.95), root mean square error of approximation (RMSEA; criterion<.06); and the standardized root mean square residual (SRMR; criterion<.08). Fit statistics for the Trust in Nurses Scale were CFI=.994, TLI=.981, RMSEA=.067, SRMR=.022; Authentic Self-Representation Scale: CFI=1.00, TLI=1.00, RMSEA<.001, SRMR<.001; Cancer Patient Optimism Scale CFI=.960, TLI=.881, RMSEA=.145, SRMR=.042; and Cancer Patient Distress were CFI=.962, TLI=.885, RMSEA=.125, SRMR=.040.

References

Radwin, L. (2000).  Oncology patients' perceptions of quality nursing care.  Research in Nursing & Health, 23, 179-190. Qualitative study providing the basis for scale development.

Radwin, L., Washko, M., Suchy, K., & Tyman, K. (2005). Development and pilot psychometric testing of four desired health outcome scales: Fortitude, Trust in Nurses, Cancer Patient Optimism, and Authentic Self-Representation. Oncology Nursing Forum, 32, 92-96.

Radwin, L., Cabral, H., & Wilkes, G. (in press). Relationships between patient-centered cancer nursing interventions and desired health outcomes in the context of the health care system. Research in Nursing & Health. Outcome scales' confirmatory factor analyses; Outcome scales used to operationalize outcomes in the path model analysis.

To view a sample of the Desired Outcome Scales click on the links Below.

• Authentic Self-Representation Scale©
• Cancer Patient Distress Scale©
• Cancer Patient Optimism Scale©
• Trust in Nurses Scale©

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