ethics tool databaseiib.edu.mx/recursos-academicos/tools-base-de-datos-boston-2.pdf · 8 decision...

E t h i c s T o o l D a t a b a s e

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ETHICS TOOLS DATABASE

I Decision Making (DM)

1.0 Competence (DM/C)Assessment of Patient Competence (APC) .............................. 7

2.0 Factors (DM/F)Ethics Stress Scale ................................................................ 8Attribution of Responsibility Instrument (ARI) ........................ 9The Autonomy Preference Index (API) .................................10The Inventory of Cognitive Biases in Medicine (ICBM)...........11

3.0 Roles (DM/R) Mazur’s Patient Preference Tool (MPPT) ...............................12Krantz Health Opinion Survey (HOS) ....................................13

4.0 Satisfaction (DM/SA)Satisfaction with Decision Scale (SWD) .................................14Job Satisfaction Scale ......................................................... 15

5.0 Styles (DM/S) Case Vignettes of Restrictive Situations in Psychiatric Care .. 16

Participatory Decision-Making Styles (PDMS) .............. ........17

II Ethical Behaviors (EB) 1.0 ANA Code (EB/Code)

Judgments About Nursing Decisions (JAND)..........................18Judgements about Nursing Decisions (JAND), Adaptation by Rooks (1994)......................................................................19

2.0 Caring (EB/Caring) Caring Behaviors Assessment (CBA)....................................20Recall Tasks & Clinical Dilemma Questionnaire ................... 21Caring Assessment Report Evaluation (CARE - Q) .................22Nurse Caring Questionnaire (NCQ); Patient Caring Questionnaire (PCQ)................................................................................. 23

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Caring Behaviors Inventory (CBI)........................................ 24 Care and Justice Interview ................................................. 25

3.0 Coping (EB/CP)Jalowiec Coping Scale ........................................................ 26Coping Styles Inventory (CSI).............................................. 27

4.0 Empathy (EB/EM)Behavior Test of Interpersonal Skills (BTIS) ..........................28Barret-Lennard Relationship Inventory (BLRI) .................... 29Inventory of Socially Supportive Behaviors (ISSB)................ 30 Empathic Understanding in Interpersonal Processes(EUIPASM) ......................................................................... 31

5.0 Humanistic (EB/HUM) Scale of Humanistic Nursing Behaviors ................................32

6.0 Reciprocity (EB/R) Caregiver Reciprocity Scale (CRS) ...................................... 33

7.0 Self-Determining (EB/SD) Perceived Enactment of Autonomy (PEA Scale).................... 34 Competency Interview Schedule (CIS) .................................35

8.0 Truthtelling (EB/TR) Truthtelling Interview Schedule .......................................... 36

9.0 Unethical (EB/UETH)Unethical Teaching Behaviors Tool ......................................37

III Ethical Problems (EP)1.0 Ethical Issues (EP/EI)

Ethical Issue Scale (EIS) .......................................................38Moral Problems ..................................................................39ICU and Ethics .....................................................................40

2.0 Euthanasia/Assisted Suicide (EP/EAS) Assisted Suicide & Patient Requested Euthanasia Tool ..........41

3.0 Life Support (EP/LS)Advance Directive Questionnaire ........................................42Life Support Preferences Questionnaire (LSPQ) ................... 43

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Survey of implementation and impact of (PSDA) .................. 44

4.0 Moral Distress (EP/MD) Moral Distress Scale .......................................................... 45

5.0 Pain (EP/P) The Barriers Questionnaire (BQ) ......................................... 46

6.0 Physical Restraint Use (EP/PR) Revised Restraint Questionnaire .........................................47knowlege and Ethics of Restraint .........................................48

7.0 Quality of Life (EP/QOL) Quality of Life Questionnaire .............................................. 49Quality of Life Self-Assessment - Cancer Patients ................50Quality of Life - Adults with Chronic Illnesses .......................51Perceptual Quality of Life Interview / Questionnaire ............52 Enforced Social Dependency Scale (ESDS) ............................53McMaster Quality of Life Scale(MQLS) .................................54

Sickness Impact Profile (SIP) ...............................................55Quality of life Survey (QLS) ................................................. 57Quality of Well Being Scale (QWB) .......................................58Quality of Life Index (QLI) ................................................... 59Symptom Distress Scale ......................................................60Quality of Life Cancer Scale (QOV-CA) .................................61MOS Short Form ................................................................. 62

IV Moral Reasoning (MR) 1.0 Care Ethics (MR/CE)

2.0 General (MR/G) Responses to DNR orders in the NICU ...................................63Defining Issues Test (DIT-1 A & DIT-2) ................................ 64Nursing Dilemma Test (NDT) ............................................... 65Ethical Behavior Inventory ................................................. 66Advocacy Assessment Tool ................................................ 67

3.0 Health Care (MR/HC) Health Care Decision - Making Questionnaire (Nurses Version) ................................................................ 68

4.0 Principled Ethics (MR/PE)

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Values in the Choice of Treatment Inventory ........................69Ethical Reasoning in Terminal Care Interview ......................70

5.0 Sociomoral Reasoning (MR/SM) Social Reflection Measure (SRM) .........................................71Moral Judgment Interview: Kohlberg (MJI) ...........................72

V Values / Attitudes: (V/A) 1.0 Death (V/A/D)

Threat Index- elicited form (TIE) ......................................... 73Threat Index- Provided forms (Tip40) ................................. 74Templer Death Anxiety Scale (DAS) ..................................... 75Collet-Lester Fear of Death Scale (FDS) ................................76

2.0 General (V/A/G) Attitudes Toward Advance Directives .................................. 77Pankratz Nursing Autonomy & Patient’s Right Scale ............ 78Blaney/Hobson Nursing Attitude Scale ................................ 79Survey of Ethical Attitudes .................................................. 80Values History ................................................................... 81Allport-Vernon-Lindzey Study of Values............................ 82Attitudes Toward Resource Use ...........................................83Values Conflict Resolution Assessment (VCRA) .....................84Values Scale ...................................................................... 85Attitudes Toward Care at the End - of- Life (ATCEL) .............. 86

3.0 Moods (V/A/M)Profile of Mood States Inventory (POMS) .............................87Multiple Affect Adjective Check List (MAACL) ........................88Behavior Morale Scale ....................................................... 89Profile of Mood States Inventory - Short Version (PMOS)...... 90Life Regard Index (LRI) .......................................................91Abbreviated Loneliness Scale, Version 2 (ABLS - 2...............92

4.0 Proffesional (V/A/P)Nursing Professional Values Scale.......................................93Role Responsibilities Questionnaire.....................................94Whistle Blowing .................................................................95

5.0 Spiritual (V/A/SP) Religious Beliefs Instrument ............................................... 96Influence of Spiritual Well Being Scale (SWBS)..................... 97

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Spiritual Well Being Questionnaire ......................................98JAREL Spiritual Well - Being Scale ....................................... 99

VI Ethics (E)1.0 Ethics Consultation (E/EC)

Bioethics Consultation Questionnaire ................................100

2.0 Patient Outcomes (E/PO) Illness Severity Measures .................................................101SERVQUAL ........................................................................102SERVQUAL- Short form .....................................................103

VII World Views (W/V) 1.0 Ethical Ideologies (WV/EI)

Ethics Position Questionnaire ............................................104

2.0 Research (WV/RS) WorldViews of Faculty Research Investigators ...................105

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This list is an informationalresource only. We do not keepthe tools or instruments here.

If you wish to access the complete tool it is best to

contact the author(s) directlyfor permission.

7ETHICS TOOLS DATABASE

DESCRIPTION: The tool has specificquestions about a patient scenarioand questions about the law. Part I - scenario based onMassachusetts Appelate Court decision: Lane v. Cardura, 6 Mass.App. Ct. 377.1978. Part II - series ofmultiple choice, theoretical questions about the law pertainingto competence. The entire tool isincluded in the above-mentionedarticle.

Assesment oF PatientCompetence (APC)

WHERE TO FIND THE ARTICLE:Markson, L., Kern, D., Annas, G. andGlantz, L. (1994). Physician assessment of patient competence.Journal of American GeriatricsSociety, 42, 1074-1080.

COMPETENCE 1.0

P U R P O S E: Determines physicians’knowledge of applying legal standard for determining competence; and, determinesphysicians’ abilities to assess competence by physician age orspecialty.

B A C K G R O U N D : Unknown

RELIABILITY: Not provided

V A L I D I T Y : The instrument wasreviewed for face validity by bothclinicians and lawyers.

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D e c i s i o n M a k i n g

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Ethics Stress Scale-Luna-Tymchuk

V A L I D I T Y : Not provided.

B A C K G R O U N D : This new instrument for measuring the stressthat health care professionals mayexperience as they face ethicalissues with their patients, colleaguesor research subjects was developedby the author to use along with Dr.Anna Omery’s Moral ReasoningQuestionnaire and Lazarus andFolkman’s Way of Coping in her dissertation research on"Psychological Factors InfluencingEthical Decision Making". The instrument was tested in 1990.

DESCRITPTION: The scale consistsof 43 items; participants rank eachfor frequency of encounter andchoose a number reflecting intensityof related stress, 0 = never, 1 = mildto 7 = very strong.

WHERE TO FIND THE ARTICLE:Not available.

F A C T O R S 2 . 0

P U R P O S E : Measures stress relatedto ethical decision-making by healthcare professionals.

RELIABILITY: Not provided.

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Attribution ofResponsibilityInstrument (ARI)

F A C T O R S 2 . 0

R E L I A B I L I T Y : A pilot study of 53senior female BSN students and 25female graduate nursing studentsyielded CronbachÕs alpha reliabilitycoefficient of .85. Stability wasestablished by readministering thequestionnaires to 25 subjects wererandomly selected from the originalsample of 78 subjects. Five weeksafter the initial administration; test-retest reliability coefficient was.63. The amount of attribution ofresponsibility assigned did not differfor the two groups (t = 0.02, p>. 05).The dilemma solution did not differsignificantly between the groups.

V A L I D I T Y : Content validity wasestablished by two social psycholo-gists who agreed that each statement represented the designated ARI level.

education on three selected factors:ethical/moral reasoning, attributionof responsibility, and ethical/moraldilemma resolution. The resultssuggest that undergraduate andgraduate nursing programs mustplace more emphasis on identifyingdilemmas, increasing ethical/moralreasoning levels and attributingresponsibility in a justifiable manner.

P U R P O S E : Measures the attribution of responsibility in relation to ethical/moral dilemmas.

WHERE TO FIND THE ARTICLE:Felton, G. M. and Parsons, M.A.(1987). The impact of nursing education on ethical/moral decision-making. Journal of NursingEducation, 26, 7-11.

D E S C R I T P T I O N : The Attribution ofResponsibility Instrument wasdeveloped to measure the attribution of responsibility in relation to ethical/moral dilemmas.ARI measured the commission,foreseeability, intentionally, andjustification levels of responsibility.

B A C K G R O U N D : Developed to evaluate the influence of formal


Autonomy PreferenceIndex (API)

RELIABILITY: Test-retest: 0.84 fordecision making and 0.83 for information seeking CronbachÕsalpha: 0.82 for each.

V A L I D I T Y : Concurrent validity ofthe decision making scale wasestablished by correlation with anempirically related global itemappended to the instrument; r = 0.54,p = < 0.0001. Convergent validitywas obtained by administering thedecision making scale to diabeticpatients.

BACKGROUND: In an era in whichpatient autonomy has become atenet of medical ethics, relatively little attention has been given to thequestion of how much involvementin their own care patients reallywant. A modified Delphi studyinvolving 13 clinicians, medicalsociologists, and ethicists wasorganized to assist in identificationof the key measurable dimensions ofpatients’ preferences for autonomy.

P U R P O S E : Measures patients’preferences for two identifieddimensions of autonomy.

WHERE TO FIND THE ARTICLE:Ende, J., Kazis, L., Ash, A. andMoskowitz, M. (1989) Measuringpatients’ desire for autonomy; decision making and information-seeking preferences among medicalstudents. Journal of General InternalMedicine, 4, 23-30.

DESCRITPTION: The API consists oftwo scales: an 8 item scale on information seeking and a 15 itemscale on decision making. Itemsscored on a 5 point Likert scale andtotal scores were adjusted linearlyto range from 0 (no desire) to 100(strong desire). Three clinicalvignettes were used to representdifferent levels of illness severity forthe decision making scale.

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F A C T O R S 2 . 0



DESCRITPTION: The ICBM contains22 medical scenarios in whichrespondents choose between alternatives that represent bias-prone or statistically baseddecisions.

The Inventory ofCongnitive Biases inMedicine (ICBM)

FACTORS 2.0

R E L I A B I L I T Y : Kuder-Richardson20 internal consistency reliability:0.62 for faculty and 0.42 for students. The short length (22 items)of the ICBM prevented the test fromhaving a higher reliability. Grouphomogeneity was greater in studentand resident group than the facultygroup.V A L I D I T Y : The ICBM appears tohave content validity. Items weredeveloped from actual clinicalexperiences reported by physiciansand were scrutinized for inclusionfrom the perspectives of clinicalmedicine, cognitive psychology andstatistics. Construct validity is supported by the fact that the facultyscored higher (7.5%) than did students and residents.

B A C K G R O U N D : The ICBM wasdeveloped to evaluate the effectiveness of educational interventions aimed at minimizingthe biases associated with predictable information-processingtendencies when making medicaldecisions. It can serve as a trainingtool in the educational process, and

P U R P O S E : Measures the influenceof cognitive biases on medical decisions.

WHERE TO FIND THE ARTICLE:Hershberger, P., Part, H., Markert,R., Cohen, S. and Finger, W. (1994).Development of a test of cognitivebias in medical decision-making.Academic Medicine, 69 (10), 839-842.

be used to compare groups of physicians or physicians-in-training on the dimension of cognitive bias.

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Mazur’s PatientPreference Tool (MPPT)

R O L E S 3 . 0


V A L I D I T Y : Not provided

BACKGROUND: Unknown.

P U R P O S E : To access the level ofinvolvement patients want in decision making related to theacceptance or rejection of an invasive medical intervention andwhether their preference for decision making is related to theirpreference for qualitative (verbal)or quantitative (numeric) information about the risks of theprocedure.

D E S C R I T P T I O N : Definitions weregiven for procedure and risk. In astructured interview, patients wereasked to answer 4 questions relatedto their preferences in informationdisclosure about procedures. A fouritem demographic tool asked: age,educational level, present healthand medical conditions.

WHERE TO FIND THE ARTICLE:Mazur, D. and Hickam, D. (1997).Patients’ preferences for risk disclosure and role in decision making for invasive medical procedures. Journal of GeneralInternal Medicine, 12, 114-117.

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R O L E S 3 . 0

Krantz Health OpinionSurvey (HOS)

R E L I A B I L I T Y : Reliabilities of TheBehavioral Involvement andInformation subscales were .74 and.76, respectively. Kuder-Richardson 20 reliability of the HOSfor two subsequent college samplesremained over .74 for subscales andtotal scale. Test-retest reliabilityÕsfor the HOS components were .74,.71, and .59 for the total score,Behavioral Involvement scale, andInformation scales, respectively.There is a slight but non-significanttendency for females to score somewhat higher than males on allHOS scales.

V A L I D I T Y : Predictive Validity: TheHOS successfully discriminatedbetween a criterion group of highself-care subjects and the generalstudent population. Discriminatevadility: Both subscales show discriminate validity. Constructvalidity: is still being tested.

B A C K G R O U N D : Although currentideology suggests patients would beactive partners in decision makingabout their care, the literature

P U R P O S E : Measure patients’ attitudes toward treatments.

D E S C R I T P T I O N : HOS was developed to measure patient attitudes toward treatmentapproaches and uses two subscales:Information (7 items) and Behavior(9 items). A high score denotesfavorable attitudes toward self-directed or informed treatment participation, while a low scoredenotes a passive attitude. The totalcombined score of the 2 a priori subscales provides an overallmeasure of attitude toward medicaltreatment.

WHERE TO FIND THE ARTICLE:Krantz, D.S., Baum, A., Wildeman,M.V. (1980). Assessment of preferences for self-treatment andinformation in health care. Journalof Personality and SocialPsychology, 39(5): 977-990.

suggests that patients wish to beinformed but not involved.

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Satisfaction withDecision Scale (SWD)

SATISFACTION 4.0

RELIABILITY: Cronbach’s alpha is0.86.

V A L I D I T Y : Discriminate validity,tested by performing principal-components analysis of itemspooled from the SWD scale and twoconceptually related measures, wasgood.

BACKGROUND: Patient satisfactionmeasures have previously addresses satisfaction with medicalcare, satisfaction with providers,and satisfaction with outcomes, butnot satisfaction with the health caredecision itself. The SWD was developed in the context of post-menopausal hormone-replacement therapy decisions tohelp understand specific dynamicsof the decision itself.

P U R P O S E : The SWD measurespatient satisfaction with health caredecisions.

D E S C R I T P T I O N : The SWD is a six-item scale and each item isscored on a 5 point scale ("very certain would not take " to "very certain would take"). It can be usedin health care settings to evaluatedecision-assisting technologies orpatient-provider interactions aimedat involving patients in decision making.

WHERE TO FIND THE ARTICLE:Holmes-Rovner, M., Kroll, J.,Schmitt, N., Rovner, D., Breer, L.,Rothert, M., Padonu, G. andTalarczyk, G. (1996). Patient satisfaction with health care decisions: The Satisfaction withDecision Scale. Medical Decision-Making, 16 (1), 58-64.

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SATISFACTION 4.0

Job Satisfaction Scale

RELIABILITY: Internal consistency:alpha = 0.86.


B A C K G R O U N D : Tool designed byPrice and Mueller, 1981.

P U R P O S E : Measures job satisfaction.

D E S C R I T P T I O N : 7 - s u b s c a l einstrument incorporating 52 itemsscored in a variety of ranges. Some questions are indicated on a 5point Likert scale ranging from = strongly disagree to 5 = strongly

agree.

WHERE TO FIND THE ARTICLE:Packard, J. & Motowidlo, S. (1987)Subjective stress, job satisfactionand job performance of hospitalnurses. Research in Nursing &Health, 10, 253-261.

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S T Y L E S 5 . 0

Case Vignettes ofRestrictive Situations inPsychiatric Care (RSPC)

RELIABILITY: Test-retest reliabilitywith 20 nurse specialists demon-strated no significant differences inrankings for all interventions foreach vignette.

V A L I D I T Y : Content validity wasassured by selecting situations representative of a potential conflictbetween client needs, rights, andavailable resources. The vignettesand ethics-based interventionswere reviewed by a psychiatricnurse ethicist who confirmed thatthe intervention accurately represented the appropriate ethical principle. Content experts reviewedthe vignettes and the interrateragreement was .88.

BACKGROUND: Not known.

P U R P O S E : Measures nurses’ e t h i c a l l y - b a s e d n u r s i n g interventions in selected situations illustrate the discipline’s ethicalrelationship to clients and society.

D E S C R I T P T I O N : The tool containsthree case vignettes depictingrestrictive situations in psychiatriccare. Respondents ranked threeinterventions according to theiragreement with the approach andrationale represented by the intervention. In addition, therespondent was asked to commentonthe intervention chosen first.

WHERE TO FIND THE ARTICLE:Garritson, S.H. (1988). Ethical decision making patterns. Journal ofPsychosocial Nursing, 26(4), 22-29.

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Participatory Decision-Making Styles (PDMS)



B A C K G R O U N D : A representativecross-sectional sample of patientsparticipating in the MedicalOutcomes Study characterized eachphysician’s style by using a self-reported questionnaire. A singleaveraged style score was generatedfor each physician. Style scoreswere compared among physicianswho differed in age, sex, minoritystatus, specialty, primary care training or training in interviewingskills, satisfaction with professionalautonomy, and practice volume.

P U R P O S E : Measures how patientsrate their physician’s participatorydecision-making style.

D E S C R I T P T I O N : The PDMS is athree-item scale. Patients are askedto rate their physician’s style on afive-point scale in respond to thefollowing three questions: (1) If therewere a choice between treatments,would this doctor ask you to helpmake the decision?; (2) How oftendoes this doctor make an effort togive you some control over yourtreatment?; (3) How often does thisdoctor ask you to take some of theresponsibility for your treatment?Scoring instructions are provided.

WHERE TO FIND THE ARTICLE:Kaplan, S., Greenfield, S., Gandek,B., Rogers, W. and Ware, J. (1996).Characteristics of physicians withparticipatory decision-makingstyles. Annals of Internal Medicine,124, 497-504.

S T Y L E S 5 . 0

E t h i c a l B e h a v i o r s


ADAPATION/COMMENTS: *In herbook, Moral Reasoning and EthicalPractice in Nursing: An IntegrativeReview, which was co-authoredwith I Ormond, (1988, NLN Pub. No.15-2250) Ketefian describes a third,"C" column which asks explicitlywhat participants would do. The Ccolumn was found to have low reliability and is not used *See C.A.Rooks (1994) adaptation of Ketefiantool -EB Code -002

ANA CODE (EB/Code) 1.0

R E L I A B I L I T Y : Cronbach’s coeffi-cient alpha for column B ranged .66- .73. Reliability for column A scoresis low; it is not recommended for useas a separate scale in hypothesistesting.*

V A L I D I T Y : Demonstrated by significant correlation with the DITand comparison of results for samples of professional and technical nurses.

B A C K G R O U N D : Case Vignetteswere derived from approximately100 stories from practicing nursesand were assessed by nurse clinicians as representative of practice occurrences; these werefurther developed with consultantsand the Code for Nurses.

P U R P O S E : To measure moralbehavior in nursing practice in twodimensions: (1) professionally idealmoral behavior congruent with theCode for Nurses and (2) perceptionof realistically likely moral behaviorin nursing practice.

WHERE TO FIND THE ARTICLE:Ketefian, S. (1982). Tool development in nursing construction of as scale to measuremoral behavior. Journal of NewYork State Nurses Association, 13,13-19.

D E S C R I T P T I O N : The tool consistsof six vignettes with yes/noresponses regarding what ideallyshould be done and what realistically is likely to be done bythe nurse facing the ethical dilemmaposed in the vignette. The vignetteswere tested in a study of 43 professional nurses and 36 nursetechnicians.

Judgements AboutNursing Decisions (JAND)



ANA CODE (EB/Code) 1.0

RELIABILITY: Internal consistencyreliability for Column B responseswas tested using Cronbach’s coefficient alpha which showed arange from .66 to .73 across different samples of RNs (Ketefiam,1987). For this study, the Column Aresponses showed a coefficientalpha of .70; and for Column Bresponses, .71.

V A L I D I T Y : Content Validity wasestablished by Ketefian in 1982 and1987, Convergent Validity wasestablished by testing with the JANDand the DIT. The Pearson productmoment correlation of Column Bresponse with the DIT was .19, p <.05; shared variances was only3.6%. Construct validity was established by use of the knowngroup’s technique in 1990.

B A C K G R O U N D : The JAND wasadapted for the purpose of this studyand involved 33 EuropeanAmerican, 26 African American, and17 Filipino nurse subjects. Moralchoice was defined as the responseto Column A of the JAND; moralaction was defined as the responseto Column B of the JAND.

P U R P O S E : The purpose of the studywas to identify the moral choicesand actions of foreign-educated &domestic nurses in hypothetical ethical dilemmas.

WHERE TO FIND THE ARTICLE:Rooks, C.A. (1994). Cultural aspectsof moral actions & moral choices innursing. (Dissertation: University ofMaryland, Baltimore, graduateschool).

Judgements aboutNursing Decisions(JAND), Adaptations byRooks (1994)

D E S C R I T P T I O N : The JAND wasadapted by adding one additionalitem to the set of statements following each of the six vignettes.This item allowed nurse subjects towrite in other possibilities for actionwhich was not listed among thechoices but which the nurse shouldand/or would perform.



CARING (EB/Caring) 2.0

R E L I A B I L I T Y : Interrater: less an0.75 were recategorized into moreappropriated subscales Internalconsistency. Cronbach’s alpha foreach of the seven subscales.Reliability coefficients: ranged for0.66 to 0.90.

V A L I D I T Y : Face and content validity were established by a panelof four content specialists familiarwith Watson’s conceptual model.

B A C K G R O U N D : The tool operationnalizes the "carative"factors that nurses use as a framework for the caring process, asproposed by Jean Watson.

P U R P O S E : To identify nursingbehaviors perceived as indicators ofcaring by patients.

WHERE TO FIND THE ARTICLE:Cronin, S. & Harrison, B. (1988).Importance of nurse caring behaviors as perceived by patientsafter myocardial infarction. Heart &Lung, 17(4), 374-380.

D E S C R I T P T I O N : The CBA lists 61nursing behaviors ordered in 7 subscales that are congruent withJeanWatson’s carative factors.Watson’s 6th caratives factor wasomitted as a subscale as the authorsassumed that creative problem-solving caring processwas inherent in nursing. Authors didnot give ranges for responses. A 5Point Likert type scale was used.Interviews of 22(17 men and 5women) who had been hospitalizedin the CCU were conducted.Following the interview, subjectswere asked to complete the CBA.

Caring BehaviorsAssessment Tool CBA



WHERE TO FIND THE ARTICLE:Peter, E. & Gallop, R. (1994). Theethic of care: A comparison of nursing and medical students,IMAGE, 26(1), 47-51.

V A L I D I T Y : Not reported

RELIABILITY: Interrater reliabilitybetween 75 to 84% agreement wasestablished with Lyons CodingScheme.

P U R P O S E : This study was conducted to answer the following questions: 1) To what extent are careconsiderations reflected in themoral reasoning of female nursingstudents?; 2) Are care considerationsreflected more in the moral reasoning of nursing students (allfemale) than in medical studentsoverall?; 3) Are care considerationsreflected more often in the moral

BACKGROUND: Gilligan’s theory ofmoral development and Kolhberg’stheory of moral development structured this study of 199 nursingand medical students who describeda real-life moral dilemma andresponded to a hypothetical clinicalmoral dilemma. The study included68 female 3rd year nursing students, 25 female 3rd & 4th yearmedical students, & 25 male 3rd &4th year medical students.

Recall Tasks & ClinicalDilemma Questionnaire

reasoning of female nursing students than in female medical students?; 4) Are care considerationsreflected more often in the moralreasoning of female medical students than in male medical students?; and, 5) Are personaldilemmas associated with a higheruse of care considerations thanimpersonal dilemmas?

D E S C R I T P T I O N : A modified ver-sion of an instrument developed byPratt following Lyons 1982 face-to-face interview. The questionnaireconsists of two parts: Part I: the RecallTasks and Part II: the ClinicalDilemma. In Part I, personal dilemmas were described. In Part II,a dilemma is posed. Lyons CodingScheme was chosen to determinethe number of care and justice considerations made in response tothe Recall Task and ClinicalDilemma.




D E S C R I T P T I O N : The CARE-Q consists of 50 behavioral itemsordered in six sub scales of caring.Using the Caring Assessment ReportEvaluation Q-SORT (CARE-Q), 26patients and 26 nurses were askedto assign a degree of importance toeach of the 50 nursing caring behaviors in the CARE-Q.

WHERE TO FIND THE ARTICLE:McDermott Keane, S., Chastain, andB. and Rudisill, K (1987). Caringnurse-patient perceptions,Rehabilitation Nursing, 12(4), 182-188.

V A L I D I T Y : Reported in: Larson, P.(1981). Oncology patients’ and professional nurses’ perceptions ofimportant caring behaviors.Doctoral Dissertation: University ofCalifornia, San Francisco. UniversityMicrofilms #81-16511.

RELIABILITY: Reported in: Larson,P. (1981). Oncology patients’ andprofessional nurses’ perceptions ofimportant caring behaviors.Doctoral Dissertation: University ofCalifornia, San Francisco. UniversityMicrofilms #81-16511.

P U R P O S E : To obtain perceptions ofimportant nurse caring behaviors.

BACKGROUND: Not Known.

Caring AssessmentReport Evaluation Q-Sort (CARE-Q)




D E S C R I T P T I O N : The NCQ & PCQeach consists of 61 items scored on a5 point Likert scale ranging from 1 =strongly disagree to 3 = neitheragree/nor disagree to 5 = stronglyagree.

WHERE TO FIND THE ARTICLE:Valentine, K. (1991). Nurse-patientcaring: Challenging our conventional wisdom. In D. Gaut andM. Leininger (Eds.). Caring: TheCompassionate Healer, 99-113.NLN Pub: 15-2401.

V A L I D I T Y : The convergent validityis confirmed by the aggregatemeasures of caring.

R E L I A B I L I T Y : Alpha internal consistency reliability estimates of.99 each.

P U R P O S E : To measure the presence of caring which hadoccurred between specific nurse-patient interactions.

B A C K G R O U N D : For this studyinvolving 91 hysterectomy patients& their nurses, the measurement ofcongruence occurred within thecontext of a larger study. The largerstudy used a naturalistic approach todefine caring and its relationship toproductivity and health outcomevariables. Within the larger studythe conceptual domain of caring wasspecified through the use of multiplemeasures and methods. Based onqualitative data from the domainspecification phase, the NCQ & PCQwere developed.

Nurse CaringQuestionnaire (NCQ)




R E L I A B I L I T Y : Test-retest reliability was established: r = .96, p=.000, rho = .88, p = .000. The alphacoefficient was .83. Internal consistency reliability was: Alphacoefficient of .96 for the combinednurses and patient sample.Unpaired t-test revealed that thegroups were different: t = 3.01, of =539, p = .003.

V A L I D I T Y : Construct validity of thecontrasted groups nursing staff (n=278) and patient (n= 263) wasestablished.

BACKGROUND: Nursing caring andhuman caring have been studiedfrom philosophical and ethical perspectives. The transpersonalcare theory was developed byWatson (1988) based on this idea.Leininger (1980) described caring ashuman acts and processes that areconcerned with helping others meetthe needs of those requiring care.

P U R P O S E : To measure caringbehaviors.

WHERE TO FIND THE ARTICLE:Wolf, Z., Giardono. E., Osborne, P.and Ambrose, M. (1994).Dimensions of nurse caring. IMAGE:Journal of Nursing Scholarship, 26(2), 107-111.

D E S C R I T P T I O N : The CaringBehaviors Inventory is a 43-iteminstrument. A four point Likert scaleis used to elicit responses from (1)strongly disagree to (4) stronglyagree on each item.

Caring BehaviorsInventory (CBI)




D E S C R I T P T I O N : The coding stepsare: identifying the dilemma components, identifying the considerations, and categorizingconsiderations. The coding schemewas then used in a study of moraldilemmas reported by a sample of36 individuals (18 males & 18females).

WHERE TO FIND THE ARTICLE:Lyons, N. (1982). Conceptions of selfand morality and modes of moralchoice: identifying justice and care injudgments of actual moral dilemmas. Unpublished doctoraldissertation. Harvard University,Cambridge.



P U R P O S E : Lyon’s Coding Schemetests Gilligans’ hypotheses that justice and care are distinct modes ofmoral judgment & gender related.The coding scheme also makes itpossible to examine the relationshipbetween modes of moral judgment& modes of self-definition.

B A C K G R O U N D : The manual isdesigned for researchers interestedin analyzing moral dilemma data todetermine how a person uses considerations of rights (justice) orresponse (care). The coding methoddistinguishes considerations of justice and considerations of care inconstruction, resolution and evaluation of moral conflict andchoice.

Care and JusticeI n t e r v i e w




R E L I A B I L I T Y : No information provided.

V A L I D I T Y : No information provided.

BACKGROUND: This questionnaireconcerns how one copes with stressand tension, and how one handlesstressful situations.

P U R P O S E : To assess frequency andhelpfulness of specified copingstrategies.

WHERE TO FIND THE ARTICLE:Jalowiec, A. (1989). Revision &Testing of the Jalowiec Coping Scale.Loyola University of Chicago.

D E S C R I T P T I O N : Sixty item objective questionnaires list sixtyspecific coping behaviors.Researcher specifies stressor under investigation by filling in theblank in introductory paragraph.Participants indicates responses toeach item on two Likert scales, firstidentifying how often they have usedthe strategy, and second, indicatinghow helpful it has been to them.

Jalowiec Coping Scale

COPING (EB/Caring) 2.0



COPING (EB/CP) 3.0

D E S C R I T P T I O N : Seventy twostatements depicting various waysof dealing with terminal illnessesare rated by the respondents on a 5item Likert format ranging from "notat all" to "very much". The CSI haseight components: problem solving,cognitive restructuring, expressemotions, social support, problemavoidance, wishful thinking, andself-criticism and social withdrawal.The tool was used in a study of 44spouses of patients admitted toHospice. (Willert, M., Beckwith, B.,Holm,J. and Beckwith , S. (1995). Apreliminary study of the impact ofterminal illness of spouses: socialsupport and coping strategies. TheHospice Journal, 10(4), 35-48.).

WHERE TO FIND THE ARTICLE:Tobin, D., Holroyd, K., Reymolds, R.& Wigal, J. (1989). The hierarchicalfactor structure of the CopingStrategies Inventory. CognitiveTherapy & Research, 13(4): 343-361.


R E L I A B I L I T Y : The alpha coefficients for the primary factors ofthe CSI ranged form .71 to .94.Tested-retested reliability coefficients ranged for .67 to .83.

P U R P O S E : The CSI assesses theextent to which a person uses certaincoping thoughts and behaviors inresponse to a particular stress.

BACKGROUND: The format of theCSI adapts 49 items from the Ways ofCoping checklist (Falkman &Lazaras, 1980) sixty items weregenerated by the authors.

Coping Styles Inventory( C S I )



EMPATHY (EB/EM) 4.0

RELIABILITY: Non-reactivity of theempathy categories is demonstrated when no significant differencesresult between subjects’ initialscores and scores 6 and 16 weekslater.

V A L I D I T Y : Content validity wasestablished with input from healthprofessional & through comparisonof the content of actual nurse -patient interactions with BTIS situations. Moderate support forconstruct validity was demonstratedwhen the "content" category correlated positively (r= .32 - .51)with five tests. Evidence for criterion-related validity resultedwhen positive correlations (p< .05)were found between empathy components of the BTIS, and peer &supervisor ratings of nurses.


P U R P O S E : The BTIS measuresnurse-expressed empathy and consists of situations involvingpatients who have been role-playedand recorded on videotape.

WHERE TO FIND THE ARTICLE:Olson, J. (1995). Relationshipsbetween nurse-expressed empa-thy, patient-perceived empathy andpatient distress. IMAGE, 27(4), 317-322.

DESCRITPTION: The BTIS providesa standardized measure of verbalbehavior in response to a wide variety of interpersonal situationscommonly faced by health professionals. It contains 13 patientsituations and requires 15 minutesfor completion. Scoring of theaudiotaped responses is based onBTIS scoring guidelines (See Gerard,B. & Buzzell, M (1980). User’s manual for the behavioral test ofinterpesonal skills for health processionals. Reston, VA: Reston.)The subject is seated in front of a TVand as the TV plays each of therecorded situations; the subjectmakes a verbal response to the situation asthough interacting with a real person. The responses are audiotape and then scored.

Behavior Test ofInterpersonal Skills( B T I S )



EMPATHY (EB/EM) 4.0

R E L I A B I L I T Y : Has shown high levels of reliability (r = .64 - .92).

V A L I D I T Y : Nine studies havedemonstrated internal reliabilitycoefficients consistently exceedingintercorrelations among the BLRIsubscales.

B A C K G R O U N D : See Barrett-Lennard, G. (1981). The empathycycle: Refinement of a nuclear concept. Journal of CounselingPsychology, 28(2), 99-91.

P U R P O S E : Measures patient-perceived empathy.

WHERE TO FIND THE ARTICLE:Olson, J. (1995). Relationshipsbetween nurse-expressed empa-thy, patient-perceived empathy andpatient distress. IMAGE, 27(4), 317-322.

D E S C R I T P T I O N : The BLRI can becompleted in 5 minutes. Consists of16 statements of either an empathicor non-empathic clinician. Scoresrange from 48 to + 48.

Barret-LennardRelationship Inventory( B L R I )



EMPATHY (EB/EM) 4.0

D E S C R I T P T I O N : The ISSB is a 40item scale rated on a 5 point likertscale ranging from 1 (not at all) to 5(about every day).

WHERE TO FIND THE ARTICLE:Barrera, M., Sandler, I and Ramsey,T. (1981). Preliminary developmentof a scale of social supports of college students. American Journalof Community Psychology, 9 (4),435-447.

V A L I D I T Y : Indices of social network size proved to be significantcorrelates of the ISSB. The ISSB ispositively correlated with the FamilyEnvironment Scale (FES) Cohesionsubscale.

R E L I A B I L I T Y : Test-retest correlation coefficients for individual items ranged from 0.441to 0.912. r (69) = 0.882, p< 0.001.Internal consistency (alpha) wasfirst administration = 0.926; second= 0.940.

P U R P O S E : The ISSB was developedto evaluate how respondentsreported the frequency with whichthey were the recipients of supportive actions.

BACKGROUND: Growing researchinterest in social support underscores the need for reliableand valid measures of the concept. Itis argued that measures that assesswhat individuals actually do by wayof providing support make uniquecontributions to our understandingof natural helping processes. SeeBarrera, M., Sandler, I.N. & Ramsey,T.B. (1981). Preliminary development of a scale of socialsupport: Studies in college students.American Journal of CommunityPsychology, 9(4), 435-447.

Inventory of SociallySupportive Behaviors( I S S B )



EMPATHY (EB/EM) 4.0



BACKGROUND: The measure wasdeveloped by Carkhuff in conjunction with his work in operationalizing conceptual components of helping relation-ships.

P U R P O S E : To measure empathy asa component of a helping relationship.

WHERE TO FIND THE ARTICLE:Henderson, M. (1987). Effect ofempathy training on moral reasoning and empathic respondingof nursing students. Doctoral dissertation: Auburn University.

D E S C R I T P T I O N : EUIPASM is a five-point scale of empathic understanding reflected in the counselor’s response to helpee orclient statements. A level -1response communicates no awareness of the helpee’s feelings.A level-2 response shows awareness of obvious feelingsexpressed by the helpee. A level -3response is "accurate empathy" inwhich the expressions of the firstperson are interchangeable withthose of the seemed person in thatthey express essentially the sameaffect & meaning. Level-3 is considered the minimal level ofempathy necessary for therapeuticchange to occur. A level 4 responsecommunicates accurate empathyplus a deeper level of feeling. Alevel-5 response communicates fullawareness of the helpee’s experience, comprehensive under-standing of that experiental reality,and total acceptance of the person.

Empathic Understanding inInterpersonal Processes( E U I P A S M )



HUMANISTIC (EB/HUM) 5.0

D E S C R I T P T I O N : A list of 192 statements describing patient andnursing staff behaviors that occur onnursing units was initially developed. The scale, consist of 163items, was developed and scored ina 5 point Likert format ranging from1 to 5. The scale was reduced to 70items measuring four dimensions:shared decision making andresponsibility, holistic selves, statusequality, and empathy.

WHERE TO FIND THE ARTICLE:Fenton, M. (1986). Development ofthe scale of humanistic nursingbehaviors. Nursing Research, 36(2),82-87.

V A L I D I T Y : Construct validity wasestablished by a purposive samplingof 42 nurses. For the 70 item scale:Criterion-Related Validity: Sig. F (<.001) for each dimension determined, additional test supportive.

RELIABILITY: 1. For 70-item scale,subscale reliabilities are as follows:

26 items, shared decision making, alpha = 0.89

25 items, holistic selves, alpha = 0.88

2 items, status equality, alpha = 0.83

7 items, empathy, alpha = .60

2. Test-Retest Reliability: 0.85; 16 subjects, 2-week interval.

P U R P O S E : Measures the degree ofhumanistic health care in hospitalsettings as perceived by nursingpersonnel.

B A C K G R O U N D : Based onHoward’s (1975) theoretical modelof dimensions pertinent to thedomain of humanistic care. TheScale of Humanistic NursingBehaviors can be used as a diagnostic aid and as an instructional device.

Scale of HumanisticNursing Behaviors



RECIPROCITY (EB/R) 6.0

R E L I A B I L I T Y : All factors wereshown to be reliable by Cronbach’salpha.

V A L I D I T Y : Content validity wasestablished using exploratory andconfirmatory factor analysis. Initialconstruct validity was establishedusing exploratory factor analysis.The casual modeling approach wasused to establish convergent anddiscriminate validity.

B A C K G R O U N D : To develop the initial item pool, an extensive reviewof the literature was conducted. Inaddition, interviews were conductedwith 12 adults, the children or in-laws of elderly parents, in theirhome environments. The interviewswere transcribed and analyzed. Onehundred nine items were developedto reflect exchanges within the caregiver context and/or amongfamily members directly or indirectly involved in caregiving.

P U R P O S E : Measures the collectiveexpression of exchanges and balance in transactions between thecaregiver and an elderly patient orparent-in-law, as well as within thefamily network.

WHERE TO FIND THE ARTICLE:Carruth, A. (1996). Developmentand testing of the CaregiverReciprocity Scale. NursingResearch, 45(2), 92-97.

D E S C R I T P T I O N : The CRS is constructed as a five point Likert format ranging from 1 (strongly disagree) to five (strongly agree).Caregiver Information Sheet is usedto collect data pertaining to demographic data, illnesses/condi-tions, and exchanges given to andreceived from care reciprocity.

Caregiver ReciprocityScale (CRS)



SELF-DETERMINING (EB/SD) 7.0

D E S C R I T P T I O N : The PEA scaleconsists of 31 short phrased questions (8 factors) scored on a 4point Likert Scale ranging from 1 =not at all true to 4 = completely true.Scores range from 31 - 124 for totalscale.

WHERE TO FIND THE ARTICLE:Hertz, J. (1991). The Perceivedenactment of autonomy scale:Measuring the Potential for Self-Care Action in the Elderly.Dissertation: University of Texas atAustin.

V A L I D I T Y : Content & face validityestablished by panel of experts andthe pilot survey. Construct validityobtained by testing theoretical relationships between PEA & perceived control (r = .52, p=<. 001),and between PEA & morale (r = .56,p<. 001).

R E L I A B I L I T Y : CronbachÕs alphacoefficient and principal componentfactor analysis followed by varimaxorthogonal rotation were used toidentify factors and items for thefinal PEA scale. CronbachÕs alpha =.87. Reliability established by internal consistency (CronbachÕsalpha of .85 for the 31 items); as wellas content (CVI=. 86).

P U R P O S E : Measures a person’sperception of their ability to enactself-determined behavior.

B A C K G R O U N D : Perceived enactment of autonomy (PEA) issensing the ability to choosecourse of action for one’s self inaccordance with one’s goals to meetneeds for both dependence and independence. PEA represents thepotential for self-care action andconceptually links self-care

Perceived Enactment ofAutonomy (PEA Scale)

knowledge, resources, and action inModeling and Role-Modeling(Erickson, Tomlin and Swain, 1988).



SELF-DETERMINING (EB/SD) 7.0

R E L I A B I L I T Y : Inter-item correlation coefficients ranged from0.39 to 0.85. The average correlation between items was 0.64.Item correlation with the total testscore ranged form 0.69 to 0.89.Cronbach’s coefficient alpha was0.96.

V A L I D I T Y : Uncertain. Examinationof individual item score form CISindicated that, in some cases, a different standard of competencewas applied in routine clinical practice depending upon thepatient’s treatment decision.

B A C K G R O U N D : The instrumentwas developed from initial work onthe competency of patients to consent to hospital admission. Theoriginal formulation was revisedand extended into the CIS for usewith psychiatric patients referred forECT.

P U R P O S E : To compare physicians’judgments of patient competency inroutine clinical practice with findingsfrom a structured clinical interview.

WHERE TO FIND THE ARTICLE:1) Bean, G., Nishisato, S., Rector, N.and Glancy, G. (1996). The assessment of competence to make a treatment decision: An empirical approach. Canadian Journal of Psychiatry, 41, 85-92.

2) Bean, G., Nishisato, S., Rector, N. and Glancy, G. (1994). The psychometric properties of thecompetency interview schedule. Canadian Journal of Psychiatry, 39, 368-376.

D E S C R I T P T I O N : The CIS is a fifteen-item instrument, whichincorporates 4 major elements to beconsidered when evaluating competency: Ability to make a firmtreatment decision; understandingof treatment information; ability tomake a choice based upon rationalreasons; and, appreciation of thenature of the situation. Each elementis assessed by a series of questionsrated on a 7 point Likert scale ranging: 1-3 = adequate, 4 = marginal, 5-7 = inadequate.

Competency InterviewSchedule (CIS)





B A C K G R O U N D : The interviewschedule was made available to theresearcher by Dr. Carol Gilligan. Theresearcher revised the interviewschedule and used a coding schemedeveloped by the researcher.

P U R P O S E : To explore the behaviorof nurses when faced with clinicalsituations which required them tochoose one or more behaviors on acontinuum of total honesty (fullyinforming clients) to fully deceivingclients (upholding the physician’splan).

WHERE TO FIND THE ARTICLE:Shipps, T.B. (1988). Truth tellingbehavior of nurses: what nurses’ dowhen physicians deceive clients.Dissertation: Boston University.

D E S C R I T P T I O N : The interviewasks the respondent to recall a real-life dilemma from experience.The interview presents four hypothetical dilemmas: Placebo,Informed Consent, Negligence andWithheld Information. Truthtellingdilemmas were evaluated using theinterview schedule.

TRUTHTELLING (EB/TR) 8.0

Truthtelling InterviewS c h e d u l e



D E S C R I T P T I O N : Unstructured,open - ended questions. Subjectswere asked to describe examples ofteaching behaviors they encountered as nursing students,which they considered to be unethical. The behaviors could occurin classroom, non-classroom, or clinical settings.

WHERE TO FIND THE ARTICLE:Theis, E. C. (1998). Nursing studentsÕ perspectives of unethicalteaching behaviors. Journal ofNursing Education, 27(3), 102-106.



P U R P O S E : To identify nursing students’ perceptions of unethicalteaching behaviors.

B A C K G R O U N D : Conceptuallybased on statements from the AAUPStatement on Professional Ethicswhich deals with the professor’sethical obligations as a teacher.

UNETHICAL (EB/UETH) 9.0

Unethical TeachingBehaviors Tool

38

E t h i c a l P r o b l e m s


B A C K G R O U N D : The EIS was developed from a 32-item scaleused in a 1994 study of Marylandnurses. The items of the originalscale were derived from the litera-ture & focus groups interviews ofpracticing nurses.

P U R P O S E : To measure the frequency by which ethical issuesoccur in nursing.

WHERE TO FIND THE ARTICLE:Fry, S. T. & Duffy, M. E. (2001, inpress). Development and psychometric evaluation of theEthical Issue Scale (EIS). Image:Journal of Nursing Scholarship.

D E S C R I T P T I O N : Thirty two (32)item scale that represents threeconceptual categories of ethicalissues: end-of-life treatments(n=13), patient care (n=14), humanrights (n=5).

Ethical Issue Scale (EIS)

R E L I A B I L I T Y : End -of -life treatment issues scale =. 86(Cronbach’s alpha coefficient);patient care issues scale = .84;human rights scale = .74. Can beused as independent scales.

V A L I D I T Y : Confirmatory principalcomponents analysis of all itemsyielded a 3-component solutionaccounting for a total of 42.4% of initially extracted common variance.

ETHICAL ISSUES 1.0

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ETHICAL ISSUES 1.0

Moral Problems

BACKGROUND: There is little to noexisting research about actualmoral dilemmas faced by nurses.Those studies that have been donehave focused on medical ethics, notspecifically nursing ethics. Thisdeficit in research was discovered asthe Netherlands worked to makenursing a more viable and respectedprofession.

P U R P O S E : To answer the question:“What issues are experienced asmoral problems by nurses in different settings and healthcareinstitutions and how serious arethese moral problems for them?”

WHERE TO FIND THE ARTICLE:Arend, A. & Hurk, C. (1999). Moralproblems among Dutch nurses: Asurvey. Nursing Ethics, 6(6), 468-82.

DESCRITPTION: It is a questionnaire that includes several demographic questions and otherinformation about the respondent.The next section contains six types ofproblems that are graded on seriousness on a scale of 1 to 10. Thelast two sections consist of a list ofsituations; first the respondents areasked if these ate situations that theyrecognize as moral dilemmas. Theyare then asked to identify how oftenthey have experienced them.

40



ETHICAL ISSUES 1.0

ICU and Ethics

R E L I A B I L I T Y: Slightly skewed

V A L I D I T Y : Before being used thisquestionnaire was pilot tested andthen put before a review board containing nurse ethicists, researchspecialists and doctoral and mastersstudents.

BACKGROUND: Most of the studiesthat have been done on assisted suicide in a hospital setting havefocused on the physicians role, notthat of the nurse.

P U R P O S E : To learn about beliefsand ethical concerns of nurses caring for dying patients in intensivecare units.

WHERE TO FIND THE ARTICLE:Puntillo, K., Benner, P., Drought, T.,Drew, B., Stotts, N., Stannard, D.,Rushton, C., Scanlon, C., & White, S.(2001). End-of-life issues in intensive care units: A national random survey nurses’ knowledgeand beliefs. American Journal ofCritical Care, 10(4), 216-29.

D E S C R I T P T I O N : This tool is a questionnaire that contains threesections. The first is a series of clinical scenarios; the respondentsare asked to identify the action takenby the nurse using one of fiveresponses. They are also asked toidentify whether or not they agreedwith the action taken. A Likert scaleis used in the second section to evaluate knowledge and opinionabout pain management and end-of-life practices. The final section asks for demographics aboutthe respondent. Overall, the questionnaire contains 61 questionsas well as space for additional comments.

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BACKGROUND: The study was areplication and extension ofEmanual’s 1994 survey of NewEngland oncology physicians. Thestudy was conducted to provide reliable and valid empirical data toNew England ONS members practices of assisted suicide andpatient-requested euthanasia.Analysis focused on nurses’ practices, a comparison to a likesample of oncology physicians, andthe nurses’ utilization of the health-care team.

P U R P O S E : To determine oncologynurses’ practices and attitudestoward patient requested euthanasia and assisted suicide.

WHERE TO FIND THE ARTICLE:Matzo, M. and Emanual, E. (1997).Oncology nurses’ practices of assisted suicide and patient-requested euthanasia.Oncology Nurses’ Forum, 24 (10),1725-1732.

D E S C R I T P T I O N : Questionnaire of63 questions. Twenty-two questionsinvolved four clinical vignettesregarding personal experienceswith assisted and patient requestedeuthanasia in clinical practice.

EUTHANASIA/ASSISTED SUICIDE (EP/EAS) 2.0

Assisted Suicide &Patient RequestedEuthanasia Tool

42



R E L I A B I L I T Y: Not provided.

V A L I D I T Y : Content validity wasassessed by a panel of experts.

B A C K G R O U N D : The individual’sright to refuse life-prolonging treatments was the impetus for theinitiation of the Patient Self-Determination Act (PSDA), whichbecame effective in 1992. Althoughliving wills have been in existencefor years, it has only been since thePSDA legislation that most nurseshave had to assume a major role incollecting information and operationalizing advance directives.

P U R P O S E : To determine nurses’experience, confidence in counseling, and knowledge of statelaw concerning advance directives(AD).

WHERE TO FIND THE ARTICLE:Barta, K. and Neighbors, M. (1993).Nurses’ knowledge of and role inpatients’ end-of-life decision-making. Trends in Health Care, Law,& Ethics, 8 (4), 50-52.

DESCRITPTION: Three page, four-part questionnaire developed fromliterature & federal / state(Arkansas) legislation. Part I: nurse’sexperience with Ads; Part II:True/False; nurse’s knowledge ofstate law content on AD; Part III:nurse’s inclusion of ANA guidelinesin nursing assessments; & Part IV: 4point Likert scale ranging from 1 =not at all confident to 4 = very confident; nurse’s perception of self-confidence regarding counseling patients/families aboutAD.

LIFE SUPPORT (EP/LS) 3.0

Advance DirectiveQuestionnaire

43



R E L I A B I L I T Y : Consistency ofresponses ranged from 0.772 to0.947; average consistency was0.85.

V A L I D I T Y : Covariation 0.77.Internal consistency for the singlefactor solution was estimated at0.94. The nurses and one doctorallyprepared nurse researcher wereasked to act as expert judges andreview the revised vignettes for facevalidity and content sampling.

B A C K G R O U N D : The Patient Self-Determination Act, effective sinceDecember, 1991, has changed theimportance of introducing life support options to patients. Nurses,as patient advocates, are in the forefront of presenting life supportinformation.

P U R P O S E : This tool is designed togently introduce the topic of life support decision making andoptions to patients. If educatespatients and their families about thearray of life support choices beyondthe NR an mechanical ventilationoptions.

WHERE TO FIND THE ARTICLE:Beland, D. and Froman, R. (1995).Preliminary validation of a measureof life support preferences. IMAGE,27 (4), 307-310.

D E S C R I T P T I O N : The LSPQ is arapid, easy to use instrument thatprovides illustrations of life supportchoices to enhance discussion of lifesupport measures with patients. Itconsists of six vignettes with twochoices following each vignette.


Life Support PreferencesQuestionnaire (LSPQ)

44



R E L I A B I L I T Y: Not provided.


BACKGROUND: The PSDA becameeffective in December 1991 andmandates that patients be giveninformation about legal rightsregarding living wills and durablepowers of attorney for health care.This study investigated the impact ofthis law on hospitals, medical personnel and patients. Despiterecognition of the importance ofimplementation of the PSDA, little isknown about what institutions areactually doing.

P U R P O S E : Measures differentaspects of the PSDA: (a) hospital personnel’s development of awareness and information-gathering procedures, (b) the hospital’s present procedures forimplementing the law; (c) the

WHERE TO FIND THE ARTICLE:Park, D., Eaton, R., Larson, E., andPalmer, H. (1994). Implementationand impact of the patient self-deter-mination act. Southern MedicalJournal, 87 (10), 971-977.

DESCRITPTION: The survey instru-ment consisted of 60 questions thatwere printed in a booklet and mailedto hospital administrators. All but 17items were forced choice (true orfalse).


Survey of Implementationand Impact of (PSDA)

individual respondent’s personalknowledge and interpretation of thelaw; (d) the perceived effect of thePSDA with respect to completion ofadvance directives; and, (e) hospital personnel’s attitudes and opinionsabout the law.

45



RELIABILITY: Test-rest reliabilitywas r=. 86 (P <. .01). When identicalforms were administered threeweeks apart to 35 RNs, Cronbach’salpha was .93 (P<< .01).

V A L I D I T Y : Content validity wasestablished through 100% agreement on the content validityindex by three nursing ethicsexperts. Factors analysis using avarimax rotation yielded three theoretically meaningful factors: (1)action response (14 items); (2)aggressive care (9 items); and (3)honesty (8 items). There were lowsignificant correlations between thefactors.

B A C K G R O U N D : This instrumentwas used in the study of moral distress of critical care nurses. Afterinitial testing, the scale was extended from 5 to 7 points toincrease variability in responses.The tool is based on Jameton’s concept of moral distress andWilkinson’s results from a study ofmoral distress.

P U R P O S E : Measures nurses’ perceptions of level of moral distress and frequency of situation.

WHERE TO FIND THE ARTICLE:Corley, M. (1993). Moral distress ofcritical cares nurses. AmericanJournal of Critical Care, 4 (4), 280-285.

DESCRITPTION: The Moral DistressScale is a 32 item scale scored on a 7point Likert scale ranging from 1 =low to 7 = high.

MORAL DISTRESS (EP/MD) 4.0

Moral Distress Scale

46



R E L I A B I L I T Y: Researchers claimthat "the BQ has acceptable reliability "Test-retest reliability .90Internal consistency of 0.89 for theentire scale and 0.52 to 0.91 for thesub scales.

V A L I D I T Y : Researchers claim that"the BQ has acceptable validity" Nofurther information is provided.

BACKGROUND: The purpose of thisstudy was to examine concernsabout reporting pain and usinganalgesics in a sample of primarycare givers of cancer patientsreceiving care from a hospice program.

P U R P O S E : Measures eight commonbarriers to adequate managementof cancer pain.

WHERE TO FIND THE ARTICLE:Berry, P. and Ward, S. (1995).Barriers to pain management inhospice: a study of family caregivers. The Hospice Journal, 10(4), 19-33.

DESCRITPTION: The BQ is a 27 itemself-report instrument diagnosed tomeasure the extent to which personshave eight concerns about reportingpain and using analgesics. The 27items are scored on a 6 point Likerttypes scale ranging from 0 = do notagree at all to 5 = agree very much.The eight concerns are fear of opiodside effects fear of addiction. Thebelief that increasing pain signifiesdisease progression, fear of injections, concern about drug tolerant, believing "good" patientsdo not complain about pain. Thebelief that reporting pain may distract the physician from treatingor curing the Cancer and fatalism, orbelieving pain is inevitable with cancer and that is co not be relieved.

PAIN (EP/P) 5.0

The BarriersQuestionnaire (BQ)

47



RELIABILITY: Internal consistencyof the 15 item practice scale and the11 item attitudinal scale was 0.76and 0.49 respectively. Item totalcorrelation were recalculated foreach scale and items with the lowestsquared multiple correlation’s weredeleted. The revised 12 item practice scale and 8 item attitudescale had a CronbachÕs alpha of0.78 (standardized item alpha of0.82) and 0.63 (standardized itemalpha of 0.64) respectively.

V A L I D I T Y : Internal consistency ofthe 15 item practice scale and the 11item attitudinal scale was 0.76 and0.49 respectively. Item total correlation were recalculated foreach scale and items with the lowestsquared multiple correlation’s weredeleted. The revised 12 item practice scale and 8 item attitudescale had a CronbachÕs alpha of0.78 (standardized item alpha of0.82) and 0.63 (standardized itemalpha of 0.64) respectively.

B A C K G R O U N D : Specific aims: todescribe nurses’ knowledge, practice and attitudes about the use

P U R P O S E : Identifies issues relatedto the use of physical restraints witholder patients in hospital settings.

WHERE TO FIND THE ARTICLE:Matthiesen, V., Lamb, K., McCann, J.,Hollinger-Smith, L. and Walton, J.(1996). Hospital nurses’ views aboutphysical restraint use with olderpatients. Journal of GerontologicalNursing, 22 (6), 8-16.

PHYSICAL RESTRAINT USE (EP/PR) 6.0

Revised RestraintQuestionnaire

of physical restraints in this population; and, to determinewhether demographic characteris-tics or the hospital practice settinginfluence nurses’ knowledge, practice, attitudes regarding the useof physical restraints with olderpatients. Cross-sectional descrip-tive study.

DESCRITPTION: 20 item true/falsescale with 3 subscales: knowledgeabout physical restraints, clinicalpractice issues related to physicalrestraints, attitudes toward usingphysical restraints.

48



PHYSICAL RESTRAINT USE (EP/PR) 6.0

Knowledge and Ethics ofR e s t r a i n t

R E L I A B I L I T Y : Twenty-three nurses tested the questions forrelevance, reliability and repetition.

V A L I D I T Y : The shortcomings of thisquestionnaire are that it only dealswith physical restraints and dementia patients. There is no mention of chemical restraints or ofnon-dementia elderly. There is alsono way to know for sure if what thenurses answered is what they actually practice.

B A C K G R O U N D : The number ofdementia patients in Israel is on therise, as the population grows older.This increase puts a strain on nurseswho are not used to dealing withsuch patients. However, there hasbeen little to no research done onphysical restraint use with dementiapatients.

P U R P O S E : To compare the ethicaldilemmas faced by nurses in hospi-tals and psychogeriatric wards ofnursing homes in using physicalrestraints on dementia patients.Also, to obtain information about theknowledge of nurses about patients’

WHERE TO FIND THE ARTICLE:Weiner, C., Tabak, N. & Bergman, R.(2003). The use of physicalrestraints for patients suffering fromdementia. Nursing Ethics, 10(5),512-25.

D E S C R I T P T I O N : This is a three-part questionnaire. The first part isdemographic questions, includinglevel of education and geriatrictraining. The second part consists oftwenty-five items that test knowl-edge about the use of restraints. Ananswer of “yes” receives a score ofone, an answer of “no’ or “don’tknow” receives a score of zero. Thethird section is eighteen real-lifeepisodes devised by nurses in bothsettings being tested. The scenariosare organized into three categories:to protect the patient, to protect theinstitution, and to protect otherpatients at the institution. The sce-narios are rated on a scale of one tofour as to how appropriate aresponse the nurse feels thatrestraints are.

rights laws, the Israeli Code of Ethicsand guidelines on restraint.

49





BACKGROUND: Data for the Qualityof Life Study were obtained throughpersonal interviews with 2,164 persons, 18 years & over living inhouseholds in the U.S., exclusive ofhouseholds on military reservations, in 1971.

P U R P O S E : To measure respondents’ perception to theirsolid-psychological condition, theirneeds & expectations for life, & thedegree to which these needs aresatisfied.

WHERE TO FIND THE ARTICLE:Campbell A., Converse., P.E., &Rodgers, W.L. (1975). The Quality ofAmerican Life. The Institute forSocial Research, Survey ResearchCenter, University of Michigan.

D E S C R I T P T I O N : S e c t i o n a lQuestionnaire covering: City andneighborhood; housing; country;adjectives to describe life; education;employment; organizations, sparetime and income; friendships; satisfaction with life; feelings aboutown life; background information;and observation of the respondentby the interviewer.

QUALITY OF LIFE (EP/QOL) 7.0

Quality of LifeQuestionnaire

50



R E L I A B I L I T Y: Test-retest: .97 foranalogue scale and .72 for six pointscale CronbachÕs coefficient alpha:.80 for total instrument; .90 forsymptom distress and .70 for activities of daily living.

V A L I D I T Y : Indirectly evaluated dueto subjective feelings and difficulty ininterpreting their depth; face validity:includes the items considered by theinvestigators and previous studies;content validity established byinclusion of items identified byinvestigators and supported byinterviews; construct validity needsto be confirmed through future studies.

B A C K G R O U N D : The need for amethod by which to measure thequality of survival (QOL) is nowincreasingly recognized. Thisreflects a change on the part ofmembers of the health care team asthe value of cancer therapy is nowjudged not only on the duration ofsurvival but also on its quality.

P U R P O S E : To measure the qualityof survival following treatment of alife threating illness. Specificallymeasures self-assessment of lifechanges that have resulted from thepresence & treatment of malignantdisease.

WHERE TO FIND THE ARTICLE:Holmes, S. and Dickerson, J (1987).The quality of life: design and evaluation of a self-assessmentinstrument for use with cancerpatients. International Journal ofNursing Studies, 24, (1), 15-24.

DESCRITPTION: The questionnairecontains 11 symptoms statementsand 15 ADLs statements arranged ina linear analogue scale format.


Quality of Life Self-Assessment - CancerP a t i e n t s

51



R E L I A B I L I T Y : no reliability datareported.

V A L I D I T Y : factor analysis suggest-ed construct validity.

BACKGROUND: Developed to iden-tify the (a) terms that adults withchronic illnesses use to describetheir quality of life (b) importantdomains that constitute QOL, and (c)self-perceived QOL by persons withchronic illness.

P U R P O S E : Measures self-reportedQOL.

WHERE TO FIND THE ARTICLE:Burckhardt, C., Woods, S. Schultz, A.and Ziebarth, D. (1989). Quality oflife of adults with chronic illness: apsychometric study. Research inNursing and Health, 12, 347-354.

D E S C R I T P T I O N : 15 item domainspecific instrument rated on a 7 pointLikert scale ranging from 1 = unhap-py and terrible to 7 = delighted.Domains: material comforts, health,relationships with relatives, having& rearing children, close partner,close friends, helping/encouragingothers, organizations, learning,understanding self, work, express-ing self creatively, socializing withothers, reading, music or watchingentertainment, and participating inactive recreation.


Quality of Life - Adultswith Chronic Illnesses 3

52



R E L I A B I L I T Y: No information provided.


B A C K G R O U N D : The treatment ofcancer has resulted in an increasedawareness of the need to evaluateoutcome not only in terms of care &survival but also in terms of qualityof life.

P U R P O S E : Measures quality of lifeboth in objective and subjectiveterms of cancer patients.

WHERE TO FIND THE ARTICLE:Danoff, B., Kramer, S., Irwin, P. andGottlieb, A. (1983). Assessment ofthe quality of life in long-term survivors after definitive radiotherapy. American Journal ofClinical Oncology, 6, 339-345.

D E S C R I T P T I O N : An interviewquestionnaire was developed whichcontained both objective as well assubjective measures of quality oflife. The questionnaire consists offour sections: descriptive demographic items, medical data,perceptual quality of life questionsand health status questions. Thepatient was asked to rate his feelingsabout each of the 41 QOL items on a7-point scale that ranged from 1 =delighted to 7 = terrible. The perceptual quality of life questionswere selected from a series ofnational surveys on quality of life byAndrews & Withey (1976).


Perceptual Quality ofLife Interview /Questionnaire

53



RELIABILITY: Reliability coefficientalpha was 0.90 and the standardized-item alpha was 0.91.

V A L I D I T Y : Content vadity wasassessed by interviews of patientswith life - threatening illness.Discrimmant Validity established bydemonstrated ability to distinguishbetween situation in which recoveryis likely verses not likely. Two factorswere confirmed by factor analysis.Postine correlation with the SicknessImpact Profile, r= 0.89.

BACKGROUND: Social dependencewas defined in terms of three capacities identified as necessaryfor the performance of an adult role:everyday self-care competence,mobility competence, and socialcompetence.

P U R P O S E : Measures extent towhich patients require assistancefrom others in performing activitiesor roles that adults ordinarily canperform by themselves.

WHERE TO FIND THE ARTICLE:Benoliel, J., McCrokle, R. and Young,K. (1980). Development of a SocialDependency Scale. Research inNursing and Health, 3, 3-10.

D E S C R I T P T I O N : The instrumentconsists of 12, 6 -point scales (4 foreach capacity). Scores are computed for each capacity (range4-24) and for all three capacitiestogether (range 12-72). Higherscores representing a great deal ofsocial dependency and lowerscores representing little social dependency.


Enforced SocialDependency Scale (ESDS)

54



R E L I A B I L I T Y: Interrater andintrarater reliability was examinedusing repeated measures ANOVA;inter rater reliability was lower thanintra rater reliability. Internal consistency: overall alpha was 0.80.

V A L I D I T Y : Construct validity wereexamined using a t--test for the twoa priori hypotheses: p = 0.04:Concurrent validity was correlatedto be statistically significant with theSpitzer index.

B A C K G R O U N D : Quality of lifeassessment has been suggested asthe best method for determining theeffectiveness of various approachesto palliative care.

P U R P O S E : Measures quality of life.

WHERE TO FIND THE ARTICLE:Sterkenburg, C., King, B., andWoodward, C. (1996). A reliabilityand validity study of the McMasterQuality of Life Scale (MQLS) for apalliative population. Journal ofPalliative Care, 12 (1), 18-25.

D E S C R I T P T I O N : The McMasterQuality of Life Scale taps fourdimensions of quality of life: physical, emotional, social and spiritual. It contains 32 items ratedon a 7 point numerical scale rangingfrom negative descriptors to positivedescriptors.


McMaster Quality of LifeS c a l e ( M Q L S )

55



P U R P O S E : To measure outcomes ofcontact with the health care deliverysystem; also, to measure health status based on functioning.

RELIABILITY: The SIP’S test-retestreliability was reported by Pollardand associates (1976). After a 24-hour interval, the correlationbetween the test-retest situationwas .88 (p< .01). Several other combinations of teat-retest procedures were undertaken (e.g.,long form versus short form; interviews administered versusself-administered); all combinationsof these different conditions had correlations that were significant atp< .01. In addition, test-retest reliability correlation for each of the12 dimensions are of the same magnitude of significance.

V A L I D I T Y : The item pool wasselected from responses by "over1000" persons who mentioned1.250 specific dysfunctions ofbehavioral changes that were related to health (Gilson et al., 1975.p. 1307). By various grouping andtesting procedures, this list wasreduced to the current number ofitems. Various experiments relatedto the validity of the instrument werereported by Bergner, Bobbitt,

BACKGROUND: Although the needfor a method of measuring the quality of life of patients undergoingtherapy for cancer has been widelyrecognized, no adequately evaluated or feasible method hasbeen established. Thus the SIP wasdeveloped as an outcome measureof overall health as a consequenceof the use of the health-care delivery system.


Sickness Impact Profile( S I P )

Pollard, Martin and Gilson (1976).The successful (p< .001) tests ofvalidity indicated that the SIP percentage score correlates withself-assessment of sickness (r = .54),self-assessment of dysfunction (r =.52); the Activities of Daily LivingIndex (Spearman rank-order correlation = .46), a clinical assessment of dysfunction (r = .49)and the activity limitation questionion the National Health InterviewSurvey (r = .61).

56




Sickness Impact Profile( S I P )

D E S C R I T P T I O N : The SicknessImpact Profile contains 136 itemsgrouped into 12 dimensions of dailyactivity; sleep and rest, emotionalbehavior, body care & movement,home management, mobility, socialinteraction, ambulation, alertnessbehavior communication, work,recreation & pastimes, and eating.Respondents check those items thatapply to them at the time of the interview.

WHERE TO FIND THE ARTICLE:Selby, P., Chapman, A., Etazadi-Amoli, J., Dalley, D. andBoyd, N. (1984). The development ofa method for assessing the quality oflife of cancer patients. British Journalof Cancer, 50, 13-22.

57



R E L I A B I L I T Y : Test-retest reliability: r = 0.60 Internal consistency: CronbachÕsalpha: total = 0.82; sub scales: symptoms = 0.63; social concerns =0.68; psychological well-being =0.62; and, physical well-being =0.72.

V A L I D I T Y : Construct validity: F =36,1; p = 0.001Content validity: CVI = 0.90 Construct validity: 9 factors via factoranalysis.

BACKGROUND: The tool is modeledafter the QOL instrument tested byPadilla & Grant (1985) & Padilla, et.Al. (1983).

P U R P O S E : Measures quality of life.

WHERE TO FIND THE ARTICLE:Ferrell, B., Wisdom, C., Wenzl, C.and Brown, J. (1989). Effects of controlled release morphine onquality of life for cancer patients.Oncology Nursing Forum, 16 (4),521-526.

DESCRITPTION: The Quality of Lifesurvey is a multidimensional 100mm analogue scale with wordextremes as anchors at the end ofeach scale. Items for the 28-itemsurvey represented the areas ofpsychological well being, physicalwell being, general symptom control, specific symptom control,and social support.


Quality of l ife Survey( Q L S )

58



R E L I A B I L I T Y: Reported in: Kaplan,R.M. & Anderson, J. P. (1988). Thequality of well-being scale!Rationale for a single quality of lifeindex. In Walkee, S. R. & Rosser, R.(EDS). Quality of Life: Assessmentand Application, London, MTPPRESS, p.p. 51-77.

V A L I D I T Y : See above.

B A C K G R O U N D : QWB scores arederived from preference weight s forcombinations of symptom/problemcomplexes and classification offunctioning in terms of mobility,physical activity, and social activityobtained form a San Diego generalpopulation sample of 867 individu-als. These preference weights wereobtained in the mid 1970s but a 1991study of Oregon citizens yieldedvery similar results.

P U R P O S E : To provide an estimateof the value of health status

WHERE TO FIND THE ARTICLE:Hays, R., Siu, A., Keeler, E., Marshall,G., Kaplan, R., Simmons, S., ElMouchi, D. and Schnelle, J. (1996).Long term care residents’ preferences on the QWB scale.Medical Decision-Making, 16 (3),254-261.

D E S C R I T P T I O N : The QWB Scaleidentifies a health related symptomthat is most undesirable and gradesit by the degree to which it affectseveryday activities. By using QWBassessment, a single number isdeveloped that represents the current impact of disease.


Quality of Well BeingS c a l e ( Q W B )

necessary for cost-utility analyses.Also, to quantify health-relatedquality of life with a single numberthat represents community-basedpreferences for combinations ofsymptom/problem complexes,mobility, physical activity, and socialactivity.


RELIABILITY: Internal Consistency(CronbachÕs alpha) = 0.93 for thetotal scale and 0.87, 0.82, 0.90 and0.77 for the sub scales.

V A L I D I T Y : Construct validity wassupported by the contrasted groupsapproach and factor analysis.Convergent validity was providedby a correlation of r = 0.77 betweenthe QLI and an assessment of lifesatisfaction.

B A C K G R O U N D : The instrumentwas developed to provide information about specific lifedomains in order to allow healthcare professionals to pin point problem areas, examine practices,and plan interventions to improvequality of life.

P U R P O S E : Measures subjectivesatisfaction in with specific lifedomains; measures importance ofdomains to the subject.

WHERE TO FIND THE ARTICLE:Ferrans, C. and Powers, M. (1992).Psychometric assessment of qualityof life index. Research in Nursingand Health, 15, 29-38.

DESCRITPTION: Tool consists of 64items, 2 parts: Part I: measures satisfaction with various domains oflife on a 6 point Likert scale rangingfrom 1 = very satisfied to 6 = verydissatisfied; Part II: measuresimportance of the same domains tothe individual on a 6 point Likertscale ranging from 1 = very unimportant to 6 = very important.The domains of life measuredinclude, (1) health and functioning,(2) Socioleconomic status. (3)Psychological/spiritual status, and(4) family relationships.


Quality of Life Index( Q L I )


60



R E L I A B I L I T Y: Reliability coefficient= 0.82143Alpha coefficient = 0.82557.

V A L I D I T Y : Correlations were foundto be positive.


P U R P O S E : Measures symptom distress of patients.

WHERE TO FIND THE ARTICLE:McCorkle, R. and Young, K. (1978).Development of a symptom distressscale. Cancer Nursing, 373-378.

D E S C R I T P T I O N : Ten symptomsare evaluated (nausea, appetite,pain, fatigue, bowel patterns, concentration, appearance, breathing, outlook, & cough). Fiveby seven cards with a single symptom were prepared. Patientsrated their symptoms on a given dayfrom 1 (least distress) to 5 (most distress) on the cards.


Symptom Distress Scale

61



RELIABILITY: Internal consistencyalphas for QOL - CA range from .52to .88 total alpha is 0.91.

V A L I D I T Y : Construct validity &convergent construct validity isestablished. Factor analysis yielded5 factors.

B A C K G R O U N D : The multi-dimensional quality of life scale foruse with persons with cancerevolved form a need for a single,short, easy to administer, reliableand valid, graphic measure of wellbeing in persons with cancer. QOL;was originally defined as a personal, subjective e valuation ofphysical and psychological wellbeing and symptom distress.

P U R P O S E : To measure the qualityof life of cancer patients.

WHERE TO FIND THE ARTICLE:Padilla, G., Presant, C., Grant, M.,Metter, G., Lipsett, J. and Heide, F.(1983). Quality of life index forpatients with cancer. Research inNursing and Health, 6, 117-126.,also Padilla, G. V., Miskel, M H., &Grant, M. M. (1992). Urtainty,appraisal, and quality of life. Qualityof Life Research, 1(3), 155-165.

D E S C R I T P T I O N : In the originaltool, QOL was measured on 14 linear analogue scale items scoredfrom 0 - 100 in increments of 10.Average QOL score is 14. Itemsassess physical condition, normalactivities, and personal attitudes ongeneral quality of life. I n the QOL -CA tool, QOL is measured by 30times that assess (1) psychologicalexistential well-being, (2)physical/functions well-being, (3)symptoms distress & nutritum, (4)symptom distress & pain/bowelpattern, and (%) attitude of worry.


Quality of Life CancerScale (QOV-CA)

62



R E L I A B I L I T Y: Reliability coefficients ranged from 0.81 to0.88 for the multi-item scale.Internal consistency reliabilitieswere lower that the full length versions: health perception subscale= 0.87 (0.88 for 9 item version);mental health measure subscale =0.88 (0.96 for the 38 item version);physical function subscale = 0.86(0.90 for the 10 item version); rolesubscale = 0.81 (0.92 for the 3 itemversion).

V A L I D I T Y : All correlation’s werestatistically significant: p < 0.01 andmost were substantial in magnitude

BACKGROUND: Research showedthat the McMaster Health Index,Sickness Impact Profile, FunctionalStatus Questionnaire, Duck-UNCHealth Profile, RAND HealthExperience Measures, NottinghamHealth Profile and Index of WellBeing were instruments too long to

P U R P O S E : To measure generalhealth concepts for use in evaluatinghealth care.

WHERE TO FIND THE ARTICLE:Stewart A., Hays, R. and Ware, J.(1988). The MOS Short Form GeneralHealth Survey. Medical Care, 26 (7),724-732.

D E S C R I T P T I O N : The MOS-Shortform is a 20-item scale. Items arescored on a 5 point Likert Scale.


MOS Short Form

be practical in most clinical settings.Thus, a compromise betweenlengthy instruments and single-itemmeasures was sought. Twenty itemswere selected to represents sixhealth concepts: (1) physical functioning, (2) role functioning, (3)social functioning, (4) mental health,(5) health Perceptions, and (6) pain.

63

M o r a l R e a s o n i n g



B A C K G R O U N D : Based on priorwork by Ajzen and Fishbein’s theoryof reasoned action.


D E S C R I T P T I O N : Three part fixedresponse questionnaire: Part I: itemsascertain nurses’ awareness of hospital DNR policy, experienceswith DNR situations and beliefsabout who should make DNR decisions; Part II: tests nurses’ attitudes, subjective norms andbehavioral intentions toward compliance using hypothetical situations and scale responses; PartIII: collects demographic data.

WHERE TO FIND THE ARTICLE:Savage, T.A., Cullen, D.L., Kirchoff,K.T., Pugh, E.J. & Foreman, M.D.(1987). Nurses responses to do-not-resuscitate orders in theneonatal intensive care unit. NursingResearch, 36, 370-373.

P U R P O S E : Elicits nurses’ attitudes,subjective norms and behavioralintent with respect to DNR orders inneonatal intensive care units.

GENERAL (MR/G) 1.0

Responses to DNR ordersin the NICU

64



RELIABILITY: Cronbach’s alpha isin the upper .70s/low .80s. Test - retest is about the same.

VALIDITY: Has been assessedin terms of seven criteria over fifteen years. DIT scores show discriminant validity from verbalability/ general intelligence andfrom conservative/liberal political attitudes.

B A C K G R O U N D : The DIT is a multiple - choice, objective, andself- administered test derivedform Kohlberg’s Theory of moral development. It has been extensively tested and is now available in a new version, DIT - 2.

P U R P O S E : Measures how peoplereason morally about social problems.

DESCRITPTION: DIT - 1 containssix vignettes followed by multiple choice questions addressing recommended actionand prioritization of items. DIT -2 consists of five dilemmas that represent modern social problems.The DIT - 1 Short form consists ofjust the first three dilemmas of the DIT - 1.

WHERE TO FIND THE ARTICLE:Rest, J., Narvaez, D., Bebeau, M. J.& Thomas, S. J. (1998).Postconventional moral Thinking:A Neo-kohlbergian Approach.

GENERAL (MR/G) 1.0

Defining Issues Test(DIT-1 A & DIT-2)

65



V A L I D I T Y : Significant differencesdemonstrated among nurses withdifferent educational preparation inprincipled nursing considerations(F= 3.37, p < .001). Where those withhigher education scored higher andthose with lower. There is a significant correlation between theDiT and NDT (p < .001).

BACKGROUND: Uses the DIT as itsparadigm and measures a cognitiveprocess, moral judgment.

R E L I A B I L I T Y : Coefficient alpha =.57 for principled missing consideration.

D E S C R I T P T I O N : Tool contains sixvignettes, each followed by threesections of objective questions asking participant to indicate whatshe/he would do in the situation, torank six statements about relevantissues from most to least important,and to rate the extent of her/his previous involvement with similardilemmas.

WHERE TO FIND THE ARTICLE:Crisham, P. (1979). Measuringmoral judgment in nursing dilemmas: Nursing Research, 30(2),104-110.

P U R P O S E : Measures moral reasoning in nursing situations.

GENERAL (MR/G) 1.0

Nursing Dilemma Test( N D T )

66



R E L I A B I L I T Y : Point biserial foreach of the items was .40 or above.Haytis reliability with the total test(RH)= .93.

V A L I D I T Y : Content validity determined by experts.

B A C K G R O U N D : Based onCrisham’s scenarios that were not included in the NDT.

P U R P O S E : Measures nurses’ self-reported behaviors.

D E S C R I T P T I O N : Six patient carevignettes followed by multiplechoices questions with one choicecongruent with the ANA Code for Nurses.

WHERE TO FIND THE ARTICLE:Cox, J. L. (1985/1986). Ethical decision making by hospital nurses. (Doctoral Dissertation,Wayne State University) DissertationAbstracts International, 47, 131B.

GENERAL (MR/G) 1.0

Ethical BehaviorI n v e n t o r y

67




BACKGROUND: Client advocacy isan essential component of the professional role of the nurse,although relatively little is knownabout how this important concept isviewed by the average nurse.


D E S C R I T P T I O N : The advocacyassessment questionnaire consistsof three parts: Part I: order rankthe three models of advocacy and indicate on a Likert-scale the degreeof agreement or disagreement with the kind of advocacy. Part II:select and rank the three mostfavored and least favored responses to a written moral dilemma. Part III: Demographicinformation.

WHERE TO FIND THE ARTICLE:Millete, B.(1993). Client advocacyand the Moral orientation of nurses.Western Journal of NursingResearch,15(5), 607-618.

P U R P O S E : This tool measuresmodels of advocacy used in nurses’ethical decisions.

GENERAL (MR/G) 1.0

Advocacy AssessmentT o o l

68



RELIABILITY: Not reported.

V A L I D I T Y : Not reported.

BACKGROUND: The questionnaireis adapted from one used in astudy of physicians, the results of which are reported by Self in1983.

P U R P O S E : To determine the philosophical positions held bynurses with respect to their ethical decisions, and their relationship to the subjective-objection controversy in ValueTheory.

D E S C R I T P T I O N : The "nurse-version" of the tool is 9 questions.The questions are constructed so that three questions relate to each of three possible positions inthe subjective-objective issue; i.e., subjectivism, partial-subjectivism-partial objectivism,and complete objectivism.

WHERE TO FIND THE ARTICLE:Self, Donnie J. (1987). A study of thefoundation of ethical decision-making of nurses. TheoreticalMedicine, 8: 85-95.

HEALTH CARE (MR/HC) 2.0

Health Care Decision -Making Questionnaire(Nurses Version)

69



V A L I D I T Y : Correlation between the two scales for patients = .58, and for family sample = .64 ("moderately high").

B A C K G R O U N D : Researchers usedfour ethical principles as the basisfor values that would be held bypatients & patients’ families.

R E L I A B I L I T Y : Alpha reliability =patient sample: .69, dyad sample:.76.

D E S C R I T P T I O N : Sixteen itemsinventory, later refined to 12 items. 2 subscales: autonomy and beneficence. Items use Likert scale, 1 = strongly disagree,4 = strongly agree. Instrument administered 4th - 6th postopera-tive day.

WHERE TO FIND THE ARTICLE:Gortner, S. & Zyzanski, S. (1988).Values in the choice of treatment:Replication and refinement. NursingResearch, 37, 240-244.

P U R P O S E : To measure patients &family values in the choice of treatment, particularly in surgicaltreatment of cardiac disease.

PRINCIPLED ETHICS (MR/PE) 3.0

Values in the Choice ofTreatment Inventory

70





B A C K G R O U N D : In the terminalphase of life, some cancer patientshave problems eating. Caregiversthen have to decide whether or not to provide the patients with foodby artificial means. Taped interviews concerning treatment of terminally ill, mentally alert, old cancer patients who refusedfood were conducted with 20 RNswho were regarded as "experiencedand good nurses."

P U R P O S E : Identifies ethical reasoning in experienced registerednurses by an analysis of the conditions under which they thinkthat terminally ill, mentally alert, old cancer patients who refuse foodshould be fed, whether they thinkactive euthanasia should be used,how they explain their decision,

D E S C R I T P T I O N : The interviewerasks the respondent their opinion onactive euthanasia. The respondentranks in order the ethical principlesof autonomy, beneficence, justice,and sanctity of life for her professional as well as for her personal life, and explains how the ranking was determined.

WHERE TO FIND THE ARTICLE:Jansson, L. & Norberg, A. (1989).Ethical reasoning concerning thefeeding of terminally ill cancerpatients: Interviews with registerednurses experienced in the care of cancer patients. Cancer Nursing,12, 352-358.

PRINCIPLED ETHICS (MR/PE) 3.0

Ethical Reasoning inTerminal Care Interview

and how they would rank order ethical principles and explain theirranking.

71




B A C K G R O U N D : The SRM is a paperand pencil written version of theoriginal moral Judgment Interview(MJI) of Kohlberg.


D E S C R I T P T I O N : The SRM uses the same dileminas as the MJI but involves written responsesrather than one-on-one oral tape-recorded responses. The SRM is group administrable.

WHERE TO FIND THE ARTICLE:Gibbs, J. and Widaman, K. (1982).Social Intelligence: Measuring theDevelopment of SociomoralReflection, 191-211. Prentice-Hall:NJ.

P U R P O S E : To measure moral reasoning.

SOCIOMORAL REASONING (MR/SM) 4 . 0

Social Reflection Measure( S R M )

72



RELIABILITY: High alternative formreliability of up to 100% agreementon stage score has been reported.

V A L I D I T Y : Subjects measuredovertime more forward through thehypothesized stages of moral reasoning in an invariant sequence,supporting the construct of a develop mental sequence of moralreasoning.

B A C K G R O U N D : The MJI was theoriginal test developed by Kohlbergto measure the moral reasoningconstruct, and reflects his conceptualization of justice as the central core of morality. There are three forms of the MJI,each consisting of three dilemmas.

P U R P O S E : To evaluate the moraljudgment of persons using dilemmas.

D E S C R I T P T I O N : The MJI consists of a 45-minute semi structured oral tape-recorded interview in which subjects are asked to resolve a series of three moral dilemmas. Each dilemma isfollowed by a systematic set of open-ended probe questionsdesigned to enable the subject to reveal the structure of logic of his or her responses. Scoring yieldsan overall score, which is a continuous measure of moral maturity; and a score that reflects the subjectÕs stage of moral reasoning.

WHERE TO FIND THE ARTICLE:Kohlberg, L. (1984). The psychologyof moral development. Essays inMoral Development, II. Harper andRow: San Francisco.

SOCIOMORAL REASONING (MR/SM) 4.0

Moral JudgmentInterview: Kohlberg( M J I )

73

V a l u e s a n d A t t i t u d e s


WHERE TO FIND THE ARTICLE:Neimeyer, R., Epting, F. and Rigdon,M. (1984). A procedural manualfor the Threat Index.

Neimeyer, R., Fontana, D. and Gold,K. (1984) A manual for contentanalysis of death constructs. both In, F. Eptin, g and R. Neimeyer (eds.),Personal Meanings of Death, 299-327. WA: Hemisphere PublishingCompany.

D E S C R I T P T I O N : Structured 90minute interview; individuallyadministered. 9 situations are usedinvolving death. The interviewee is provided with 3 "death" cards with the situations on them and is questioned as to their similaritiesand differences.

R E L I A B I L I T Y : Coding systemjudged reliable using two independent judges.

V A L I D I T Y : Not addressed.

B A C K G R O U N D : This tool wasdeveloped to enable the contentanalysis of death related constructsas apposed to tools that measure the structure of elements within the construct.

P U R P O S E : Provides clinically richand personally relevant depiction of interviewee’s construal of death;may facilitate psychotherapeuticexploration of client’s death concern. The manual details the system for analyzing the content of constructs that person’s employ to conceptualizesituations involving death anddying.

DEATH (V/A/D) 1.0

T h r e a t I n d e x - e l i c i t e df o r m ( T I E )

74





B A C K G R O U N D : This tool wasdeveloped to enable the contentanalysis of death related constructsas apposed to tools that measure the structure of elements within the construct.

WHERE TO FIND THE ARTICLE:Neimeyer, R., Epting, F. and Rigdon,M. (1984). A procedural manual for the Threat Index. In, F. Epting and R. Neimeyer (eds.), PersonalMeanings of Death, 321-327. WA: Hemisphere PublishingCompany.

DESCRITPTION: 30 or 40 questionsthat investigate 3 elements: self, preferred self and death. A 7-point scale is used to scoreresponses. Scores on either actualization or integration can range from 0 to 40.

P U R P O S E : Standardized form of the Threat Index. Provides 40 bipolar dimensions on which the respondent rates "self", "idealself" and "own death" thinking about the latter as if it were personally imminent.

DEATH (V/A/D) 1.0

Threat Index- Providedforms (Tip40)

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WHERE TO FIND THE ARTICLE:Robinson, P. and Wood, K. (1984).Fear of death and physical illness: a personal construct approach. In,F. Epting and R. Neimeyer (eds.),Personal Meanings of Death, 213-228. WA: HemispherePublishing Company.

D E S C R I T P T I O N : 15 questionstrue/false questionnaire.

R E L I A B I L I T Y : Test-retest reliability = .83 internal consistencycoefficient =.76.

V A L I D I T Y : Supported by studies of psychiatric patients and college students. High correlation coefficient (.74) between the DAS and a similar tool (FODS).

B A C K G R O U N D : The DAS wasdeveloped to reflect a wider range of life experiences than in other tools that measure death fear/anxiety.

P U R P O S E : Elicits emotional reactions to death and dying.

D E A T H (V/A/D) 1.0

T e m p l e r D e a t h A n x i e t yScale (DAS)

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DEATH (V/A/D) 1.0

WHERE TO FIND THE ARTICLE:Collett, L., & Lester, D. (1969). Thefear of death and the fear of dying.Journal of Psychology, 72, 179-181.

D E S C R I T P T I O N : 36 questionsanswered on a 6 point Likert scalewith the higher score indicative of anendorsement of the fear-indicatingitems.

Collet-Lester Fear ofDeath Scale (FDS)


V A L I D I T Y : Supported by low correlation’s between four subscales.

B A C K G R O U N D : Developed to distinguish between the fear ofdeath & the fear of the process ofdying and to differentiate these fears for one self and for anotherperson.

P U R P O S E : Assesses overall fear ofdeath and dying as well as four separate fears: fear of death of self;fear of death of other; fear of dying ofself; fear of dying of other.

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WHERE TO FIND THE ARTICLE:Morrison, R., Morrison, E. andGlickman, D. (1994). Physicianreluctance to discuss advance directives. Archives of InternalMedicine, 154, 2311-2318.

D E S C R I T P T I O N : P h y s i c i a n ’ s attitudes toward advance directivesare assessed by their 14 responsesto statements. For physicians whohad experienced with advancedirectives, five additional questionsassess the type and extent of theirinvolvement. All responses areassessed on a five-point LickertScale.



BACKGROUND: The tool is reportedin Davidsen, K. W., Hackler, C.,Caradine, D. R. & McCord, M. D.(1998). Physician’s attitudes onadvance directives, JAMA, 262,2415-2419.

P U R P O S E : Measures physicians’attitudes toward advance directives.

GENERAL (V/A/G) 2.0

Attitudes TowardAdvance Directives

78



R E L I A B I L I T Y : established by twoanalysis techniques.

V A L I D I T Y : established by twoanalysis techniques.

BACKGROUND: The present studywas an attempt to focus on the viewsof nurses regarding dependence vs.independence for both nurses andpatients. The intent was to identifynot only how much freedom nursessee for themselves but also howmuch freedom they can allow for thepatient. The tool was administeredto 702 nurses in five different setting(200 RNs in a community teachinghospital; 206 nursing administratorsin the Western U.S., & 296 nursesform other hospital settings).

WHERE TO FIND THE ARTICLE:Pankratz, L. & Pankratz, D (1974).Nursing autonomy and patient’srights: Development of a nursingattitude scale. Journal of HealthSocial Behavior, 15, 211-216.

DESCRITPTION: The tool consistedof a 69 item attitudinal scale. A principal components factor analysis resulted in three sub scalesthat adequately represented theintent of the study: (1) nursing autonomy and advocacy; (2)patients’ rights; and (3) rejection oftraditional rule limitations. The subscale scores were associated witheducation, leadership, academicsettings and non-traditional socialclimate.

P U R P O S E : The purpose of the tool isto examine three separate attitudesin nurses: nursing autonomy,patients’ rights and rejection of thetraditional role.

G E N E R A L (V/A/G) 2.0

Pankratz NursingAutonomy & Patient’sRight Scale

79



WHERE TO FIND THE ARTICLE:Blaney, D. R., Hobson, C. J. &Stepniewski, A. B. (1990).Measuring nursing attitudes towardcost-effectiveness: Further devel-opment & evaluation of theBlaney/Hobson Scale. In Waltz, C., &Strickland, O. L. (Eds.) Measurementof Nursing Outcome Vol. 3. NewYork: Springer.

D E S C R I T P T I O N : Twenty-two itemquestionnaire posing cost-relatedstatements that elicit attitudes.Responses are scored on a 5 pointLikert Scale ranging from stronglydisagree to strongly agree.

RELIABILITY: The authors test thatthe tool is "highly reliable" andexceeds minimum standards.

V A L I D I T Y : Results of tool testingindicate that the tool is valid,according to the authors.

B A C K G R O U N D : The developmentof the tool is based on the Fishbein &Ajzen model (1972, 1975) whichindicates that attitudes are largelybased on beliefs about the attitudeobject. The model emphasizes thatthere is a critical connectionbetween attitudes and behavior,and that attitudes can be developedand changed by focusing on beliefsabout the attitude object.

P U R P O S E : Measures nurses’ attitudes about cost-effectiveness ofnursing practices and procedures.

GENERAL (V/A/G) 2.0

Blaney/Hobson NursingAttitude Scale

80



R E L I A B I L I T Y : Interrater reliabilitywas .92. Correlation reflecting theconsistency of subjects’ responsesacross items was .64.

V A L I D I T Y : Indicators of validity arereported.

BACKGROUND: A briefer and morereadily scorable test than Kohlberg’sMJI. Can be used in parallel withKohlberg’s MJI.

WHERE TO FIND THE ARTICLE:Hogan, R. & Dickstein, E. (1972). Ameasure of moral values. Journal ofConsulting & Clinical Psychology,39, (2), 210-214.

DESCRITPTION: A 15-itemprojective measure. Items are in theform of short statements concerningcontemporary social & moral issuesto which the subject responds as if hewere in a conversation. Theresponses are rated by 5 scores.Each response can receive a score of0-2.

P U R P O S E : To measure moral values expressed in moral judgments.


Survey of EthicalAttitudes

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WHERE TO FIND THE ARTICLE:Doukas, D, & Gorenflo, D. (1993).Analyzing the values history: Anevaluation of patients medical values and advance directives.Journal of Clinical Ethics, 4(1), 41-45.

D E S C R I T P T I O N : T w o - p a r t instrument using Likert scales andcertain demographic data: Part I -surveys values and beliefs in relation to terminal care including18 value stem questions rated on a 7point scale from favorable to unfavorable; Part II - assessesfamiliarity with advance directiveson a 5 point scale; Part III - rates 2quality versus length of life questions on a 5 point scale fromstrongly agree to strongly disagree;Part IV a scenario of terminal illnessis rated on a 5 point scale.

RELIABILITY: Principal componentfactor analysis of the 18 value statements discussed three psychologically meaningful factors(communication, family burden,physician compliance). Alphas were.69, .66, .67, respectively. PrincipalComponents analysis of the 11 terminal care directive statementsrevealed three factors (basic-ongoing care, fundamental- acute, code-support). Alphas were .80,.76, .87, respectively.

V A L I D I T Y : Not Reported.

BACKGROUND: The Values HistoryInstrument was developed becausedecision making has raised thequestion of the importance of valuesin eliciting advanced directives. Itsupplements the living will anddurable power of attorney in thedocumentation of AdvanceDirectives.

P U R P O S E : Identifies values relatedto advance directives preferences.

GENERAL (V/A/G) 2.0

Values History

82



RELIABILITY: Reported in Manual(1970).

V A L I D I T Y : Reported in Manual(1970).

BACKGROUND: Based on the workfor Spranger (1928/1966) whodescribed six values or evaluativeattitudes. According to his theory, aperson’s interest and motives can beunderstood best by determining therelative prominence of these sixbasic values. The six basic attitudesare: theoretical, economics, aesthetic, social, political & religious.

WHERE TO FIND THE ARTICLE:Allport, G. W., Vernon, P., & Lindsey,G. (1970). Manual for The Study ofValues (3rd. ed.) Boston, HoughtonMifflin.

DESCRITPTION: Two part tool: PartI - 30 questions or situations with 3points between two alternatives foreach question; Part II - 4 choicesranked to each of 15 questions inorder of personal preference. Thenumerical values for each item aretotaled for a score on each of the sixscales.

P U R P O S E : Measures the relativeimportance of six basic interests ormotives in personality.


Allport-Vernon-LindzeyStudy of Values

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WHERE TO FIND THE ARTICLE:Goold, S., Hofer, T., Zimmerman, M.,and Hayward, R. (1994). Measuringphysician attitudes toward cost,uncertainty, malpractice and utilization review. Journal ofGeneral Internal Medicine, 9, 544-548.

D E S C R I T P T I O N : The instrumentincludes 56 attitude statements in:costs of medical care; uncertainty indecision making; malpractice andliability; medical technology; practice style; and, utilizationreview. A five point Likert scale wasused ranging from (1) stronglyagree to (5) strongly disagrees.Questions about demographic &practice characteristics, as well asfour items requesting self appraisalof resource use relative to peers, arealso included.

R E L I A B I L I T Y : Scale reliabilitiesranged form 0.66 to 0.86)Cronbach’s alpha.

V A L I D I T Y : Exploratory factorsanalysis revealed four factors (fearof malpractice, cost-consciousness,annoyance with utilization review &discomfort for uncertainty).Congruency coefficients for the fourfactors across 2 data sets rangedfrom 0.92 to 0.96.

BACKGROUND: Statements relatedto attitudes that may influenceresource use were culled from literature and informal discussionswith physicians.

P U R P O S E : Measures attitudes thatinfluence resource utilization, especially cost consciousness, discomfort with uncertainty, fear ofmalpractice, and annoyance withutilization review.

GENERAL (V/A/G) 2.0

Attitudes TowardResource Use

84



RELIABILITY: Test/retest reliabilitywas .92 for total score; .84 forEthical-Emotional subscore, and .88for Rational-Behavioral Subscore.

V A L I D I T Y : Factor analysis yieldedtwo factors: Ethical-Emotional(eigenvalue =^6.9) and Rational -Behavioral (eigenvalue = 1.86)accounting for 31% of variance.

BACKGROUND: The developmentof this instrument was influenced bythe rejection of The ValuesClarification movement during the1970s. Based on the work of Raths etal. (1966, 1978) it attempts to meas-ure The state of being clarified interms of one’s values assuming thatclarifying one’s values is a worthygood.

WHERE TO FIND THE ARTICLE:Kinnier, R. (1995). A reconceptual-ization of value clarification: Valuesconflict resolution. Journal ofCounseling and Development, 74,18-24.

DESCRITPTION: The VCRA consistsof three parts: conflict description;forced conflict resolution; and, resolution evaluation. Part 1: identi-fication of the specific value conflictPart 2: instruction to attempt toresolve the particular conflict Part 3:evaluation of the resolution byresponding to 17 standardizedLikert scaled items. The VCRA yieldstwo subscores and a total score ofconflict resolution.

P U R P O S E : Assesses the extent towhich an individual has resolvedspecific values conflicts, one at atime.


Values ConflictResolution Assessment( V C R A )

85



WHERE TO FIND THE ARTICLE:Nevill, D. and Super, D. (1986). Thevalue scale: Theory, application andresearch manual. ConsultingPsychologists Press.

D E S C R I T P T I O N : The Values Scalecontains 106-items scored for 21values. The values measured areAbility Utilization, Achievement,Advancement, Aesthetics, Altruism,Authority, Autonomy, Creativity,Economic Rewards, Life Style,Personal Development, PhysicalActivity, Prestige, Risk, SocialInteractions, Social Relations,Variety, Working Conditions,Cultural, Identity, Physical Prowess,and Economic Security.

RELIABILITY: Reported to be goodfor survey purposes.

V A L I D I T Y : Construct validity is evidenced by the intercollations ofThe Scales and by their factor structure, construct and concurrentvalidity are confirmed by sex, age,and curricular data.


P U R P O S E : Provides measurementof a number of intrinsic and extrinsicvalues not assessed by existingmeasures. Can be used with upperelementary on middle school students as well as with adultsmembers of various work related orprofessional groups.

GENERAL (V/A/G) 2.0

Values Scale

86



R E L I A B I L I T Y : Was assessed foreach construct as well as for each ofthe 12 items. Intraclass "r" coefficients for the constructs wereprofessional responsibility = 0.75;efficacy of hospice = 0.85, and clinician /patient communication =0.79. All 12 items together was 0.86.

V A L I D I T Y : Construct validity wasassessed by factor analysis. Percentof total variance explained by 3 factors was 47.6%. Factor 1=40.9%;Factor 2=32.3%; Factor 3=26.8%.

B A C K G R O U N D : Improvement ofend of life care of patients is neededbut this will require attitude changesamong clinicians towards terminalillness. Programs to modify clinicians’ attitudes are underwaybut there are not adequate measures of their efficacy.

WHERE TO FIND THE ARTICLE:Bradley, E. H., Cicchetti, D. V., Fried,T. R.; et al (2000). Attitudes aboutcare at the end - oflife among clinicians: A Quick, reliable, andvalid assessment instrument.Journal of Palliative Care, 16(1): 6-14.

D E S C R I T P T I O N : The instrumentconsists of 12 items that measurethree attitudinal contracts: (1) extentof responsibility for care of dyingpatients, (2) The efficacy of hospice,and (3) the importance of clinicians-patient communication about dying.Uses a 5-point Lickert scale.

P U R P O S E : To measure physicians’and nurses’ attitudes towards careat the end - of - life.


Attitudes Toward Care atthe End - of- Life( A T C E L )


WHERE TO FIND THE ARTICLE:Olson, J. (1995). Relationshipsbetween nurse-expressed empa-thy, patient-perceived empathy andpatient distress. IMAGE, 27 (4), 317-322.

D E S C R I T P T I O N : 65 questionsscored on a 5-point scale.

R E L I A B I L I T Y : High reliabilityincluding good internal consistency.

V A L I D I T Y : Content validity wasconfirmed by factor analysis of eightmood factors.

BACKGROUND: Adjectives are usedto describe feelings and moods.Individual scores for tension, angerand depression are used by Olson inthe study.

P U R P O S E : Measure of patient dis-tress.

M O O D S (V/A/M) 4.0

Profile of Mood StatesInventory (POMS)



R E L I A B I L I T Y : Well supported byLake, Miles, Earle, 1973; Lubin andZuckerman, 1967; Zuckerman andBiase, 1962; Zuckerman and Lubin,1965; Zuckerman, Lubin, Vogel andValerius, 1964.

V A L I D I T Y : Well supported by Lake,Miles, Earle, 1973; Lubin andZuckerman, 1967; Zuckerman andBiase, 1962; Zuckerman and Lubin,1965; Zuckerman, Lubin, Vogel andValerius, 1964.


WHERE TO FIND THE ARTICLE:Olson, J. (1995). Relationshipsbetween nurse-expressed empa-thy, patient-perceived empathy andpatient distress. IMAGE, 27 (4), 317-322.

D E S C R I T P T I O N : Self-adminis-tered tool consisting of 132 adjectives from measuring states ofanxiety, depression and angerRange of scores: Anxiety: 0-21Depression: 0-40 Anger: 0-28.

P U R P O S E : Measures states of anxiety, depression and anger.

Multiple Affect AdjectiveCheck List (MAACL)

MOODS (V/A/M) 3.0



WHERE TO FIND THE ARTICLE:MacElveen, P. (1978). An observa-tional measure of patient morale:The Behavior Morale Scale.Common Nursing ResearchBicentennial Year, 9, 85-92.

D E S C R I T P T I O N : The BMS is a simple test, quick and easy toadminister. The rater observes verbal and nonverbal behavior ofthe patient for a brief period of timeand then rates him on each of 17items in a 5-point scale relating toposture, body attitude, motormovements, facial expression,speech and verbalizations, andgeneral attitude.

Behavior Morale Scale

R E L I A B I L I T Y : A reliability coeffi-cient of 0.95 was obtained usingCronbachÕs alpha. Elimination oftroublesome items 1 and 13 raisedthe alpha to 0.98.

V A L I D I T Y : Face validity was determined by a panel of experts.Rank order correlation coefficientsfrom a Denver study indicated significant correlation between theBMS and the morale question bypatients (0.60), dialysis partner(0.70) and staff (0.48) indicating thatthe BMS measured which patient’spartners and staff all viewed as"morale."

B A C K G R O U N D : The BMS wasdeveloped from the behavioral cuesderived from lengthy discussionwith dialysis center staff members,who reported that they were makingintuitive judgments of patientmorale.

P U R P O S E : Measures patientmorale.

M O O D S (V/A/M) 3.0



R E L I A B I L I T Y : high correlation: r=0.95.


B A C K G R O U N D : In an effort tofacilitate the use of the POMS withpatients under stress or pain, ashorter version of the POMS wasdeveloped. Each of the originalPOMS scales was reduced by 2 to 7items without losing internal consistency.

WHERE TO FIND THE ARTICLE:Shacham, S. (1983). A shortenedversion of the profile of mood states.Journal of Personality Assessment,47 (3), 305-306.

D E S C R I T P T I O N : The shortenedversion consists of 37 items rated ona 5-point scale from 1 = not at all to 5= extremely.

P U R P O S E : Measures transient, distinct mood states.

Profile of Mood StatesInventory - ShortVersion (PMOS)

MOODS (V/A/M) 3.0



WHERE TO FIND THE ARTICLE:Debats, D.L. (1998). Measurementsof personal meaning: The psychometric properties of the liferegard index. In P.T.P. Wong & P. S.Fry (Eds.), The Human Quest forMeaning: A Handbook ofPsychological Research and ClinicalApplication, (pp. 237-259).Lawrence Erlbaum Associates,Pales., Mahwah, N.J.

DESCRITPTION: This 28 item ques-tionnaire contains two subscales:Framework and Fulfillment (14items each), These items are ratedon 3 point Likert scales with half ofthe questions in each subscaleworded positively and half wordednegatively.

Life Regard Index (LRI)

R E L I A B I L I T Y : high Test-retest reliability reported (r=.80 for Index,r=.73 for sub scale Framework,r=.79 for Fulfillment sub scale.

V A L I D I T Y : Concurrent validity supported in several studies-content validity established by LRIscores significantly related to thedegree of subjectsÕ commitment totheir personal meanings in life, Thussupporting Theory from which LRIderived, Strong evidence for discrimenant construct validity andpredictive validity is reported.

B A C K G R O U N D : The tool wasdesigned by Battista & Almond(1973) to overcome the weaknessesof The Purpose in Life test (PIL)(Crumbaugh & Moholick, 1964). Theweaknesses of The PIL include: (a)blending of concepts such as personal meaning, fear of death,and freedom, (b) a lack of consisten-cy in The meanings of PIL itemsacross subcultual groups; and (c)

P U R P O S E : MeasureÕs personalmeaning or positive life regurd.

M O O D S (V/A/M) 3.0

substantial loading on social desirability with Crowne-MarloweSocial Desirability Scale.



RELIABILITY: Test-retest reliabilityof the ABLS-2 is r =. 85 (p < 0.001)with 121 students and one weekbetween testing. Internal consisten-cy, coefficient alpha, was 0.68.

V A L I D I T Y : Supported by the nearlyparallel correlations between boththe ABLS and UCLA measures ofloneliness and a variety of criterionvariables. (Self-esteem, socialskills, developmental backgroundvariables, emotional experienceswhen lonely.

B A C K G R O U N D : Developed to discover the emotional and behavioral correlates of lonelinessas it relates to quality of life and spiritual well being. Authors initiallyused the UCLA Loneliness Scale, butthree problems became apparent:all items were worded negativelyand in the same direction (responseset bias could influence the scale);responding to a long list of negative

WHERE TO FIND THE ARTICLE:Paloutzin, R. and Ellison, C. (1982)Loneliness, spiritual well being andquality of life. In L. People and D.Perlman (Eds). Loneliness: ASourcebook of Current Theory,Research, and Therapy, 224-237.Wiley Interscience: NY.

D E S C R I T P T I O N : The tool consistsof seven items scored on a 4 pointscale: O = often, S = sometimes, R =rarely, N = never. Four of the sevenitems are stated in the positivedirection.

P U R P O S E : Measures loneliness.

Abbreviated LonelinessScale, Version 2 (ABLS -2 )

MOODS (V/A/M) 3.0

items could be a negative experience; and, scale length.


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PROFESSIONAL ROLE (V/A/P) 4.0

WHERE TO FIND THE ARTICLE:Weis, D. & Schank, M. (2000). Aninstrument to measure professionalnursing values. Journal of NursingScholarship, 32(2), 201-204.

DESCRITPTION: A 44-item surveyusing Likert scale. Each item canreceive a score of one to five.Possible scores range from 44 to220, with the higher score indicatinga better understanding of nursingvalues. The items are statementstaken from the ANA code and presented with interpretve commentary.

Nursing ProfessionalV a l u e S c a l e

RELIABILITY: Reported to be good.

V A L I D I T Y : The validity was established by a panel of five judgeswho are experts on the code fornurses.

B A C K G R O U N D : This tool wasdeveleoped becuase values are inintegral part of nursing, yet no toolexisted to accurately measure them.It is based on a review of literatureabout the nursing code of ethics,values and professional valueindevelopment in nurses.

P U R P O S E : Measures professionalnursing values based on theAmerican Nurses’ Association (ANA)code.

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Role ResponsibilitiesQuestionnaire



BACKGROUND: This tool was cre-ated to compare the ethical views ofnurses around the world and to dis-cover how the Chinese, American,and Japanese nurses view thiewethical responsibilities.

WHERE TO FIND THE ARTICLE:Pang, S., Sawada, A., Konishi, D. Yu,P., Chan, M., & Mayumi, N. (2003). Acomparative study of Chinese,American and Japanese nurses’perceptions of ethical role responsi-bilities. Nursing Ethics 2003,10(3),295-311.

DESCRITPTION: A list of 56 state-ments that were taken from state-ments made by Chinese, American,and Japanese nurses during inter-views. The statements fall into fourrole-relationship categories:responsibilities in relation to society,patients and their families, profes-sional roles, and hospital practices.All 56 statements are ranked on ascale of zero to ten with zero being ofno importance. The data is analzedusing multidimensional preferenceanalysis.

P U R P O S E : To outline socioculturalfactors that influence nurses’ viewsof ethical responsibilities.

PROFESSIONAL ROLE (V/A/P) 4.0


PROFFESSIONAL ROLES 4.0

Whistle Blowing

R E L I A B I L I T Y : Reliability was lowbut that was expected by the design-ers of the survey because of thenature of the tool.

V A L I D I T Y : Established via Lynn’scontent validity index.

B A C K G R O U N D : The ethicalresponsibilities of a nurse dictatethat he or she report misconduct onthe part of another healthcareworker, which jeopardizes patientsafety. Such events often go unre-ported because of the personal andprofessional risks imposed on thewhistleblower. This survey wasdesigned to compare the differencesbetween the beliefs of those nurseswho do act as whistleblowers andthose who chose to ignore such inci-dents.

WHERE TO FIND THE ARTICLE:Ahern, K. & McDonald, S. (2002).The beliefs of nurses who wereinvolved in a whistleblowing event.Journal of Advanced Nursing, 38(3),303-309.

D E S C R I T P T I O N : This surveyincludes ten statements derivedfrom current codes of nursing ethics,traditional views of the role of anurse and basic beliefs. The state-ments are rated on a 5-point Likertscale.

P U R P O S E : To explore the actionsand beliefs of nurses who wrestledwith the ethical dilemma of whetheror not to be a whistleblower.



WHERE TO FIND THE ARTICLE:Olive, K. (1995). Physician religiousbeliefs and the physician-patientrelationship: A study of devoutphysicians. Southern MedicalJournal, 88 (12), 1249-1255.

D E S C R I T P T I O N : Tool contains: 4items of demographics; 18 items ofreligious beliefs survey; 19 items ofattitudes and practices regardinginteraction between religious beliefsand medical practice; 17 items onattitudes regarding specific biomedical issues; and a commentsection. The responses were ratedon a 5 point scale ranging from (1)strongly disagree to (5) stronglyagree.

RELIABILITY: Assessed by reviewof content experts.


B A C K G R O U N D : The tool wasdeveloped so that clinical situationswhere medical management ofpatients might be affected by physician’s religious beliefs.

P U R P O S E : Measures the type andfrequency of religious interactionsthat occur between devout physicians and their patients.

SPIRITUAL (V/A/SP) 5.0

Religious BeliefsInstrument



RELIABILITY: Test/retest reliabilitycoefficient was 0.93. Coefficientalpha was 0.89.

V A L I D I T Y : Face validity is suggested by as examination of item content.

B A C K G R O U N D : The tool wasdeveloped to provide additionalmeasurement of quality of life byproviding a reliable & valid measureof religious dimensions that contribute to quality of life.

WHERE TO FIND THE ARTICLE:Ellsion, C. (1983). Spiritual Wellbeing: conceptualization and measurement. Journal ofPsychology and Technology, 11 (4),330-340.

DESCRITPTION: The SWBS consistsof 20 items, 10 concentrated on religious well being and 10 on existential well being. The items arescored on a 7 point Likert scale.

P U R P O S E : Measures both religiousand existential well-being.

S P I R I T U A L ( V / A / S P ) 5 . 0

Influence of SpiritualWell Being Scale (SWBS)



WHERE TO FIND THE ARTICLE:Moberg, D. (1984). Subjectivemeasures of spiritual well-being.Review of Religious Research, 25(4), 351-364.

D E S C R I T P T I O N : 8 2 - i t e m questionnaire . Scoring varied fromtrue/false to a 4-point scale in thevarious indexes. Seven Indexeswere identified: Christian Faith: self-satisfaction, personal piety, subjective sell being, optimism, religious cynicism, and elitism.

R E L I A B I L I T Y : No information provided.


B A C K G R O U N D : This tool wasdeveloped by combining instruments that measure variousaspects of SWB & adding new itemsincluding several gallup Poll items(used with permission).

P U R P O S E : Measures spiritual well-being

SPIRITUAL (V/A/SP) 5.0

Spiritual Well BeingQuestionnaire



R E L I A B I L I T Y : Established by test-retest method. Pearson correlation of r=0.88 supports stability of instrument. Internal consistency using Cronbach’s Alphain four research studies ranged from0.79 to 0.91.

V A L I D I T Y : Criterion-related validity was assessed by correlatingscores of this scale with those of ThePaloutzian & Ellison Spiritual Well-Being Scale. A correlation of 0.82(p=. 000) between the two scale isreported.


WHERE TO FIND THE ARTICLE:Foley, L., Wagner, J., & Waskel, S.A.(1998). Spirituality in the lives ofolder women. Journal of Women &Aging, 10(2), 85-91.

DESCRITPTION: Scale of 21 itemsusing a 6 point Likert-type format torate response from strongly agree tostrongly disagree.

P U R P O S E : To measure spiritualwell-being.

S P I R I T U A L( V / A / S P ) 5 . 0

JAREL Spiritual Well -Being Scale



RELIABILITY: Not known.

V A L I D I T Y : Not known.

D E S C R I T P T I O N : The evaluationquestionnaire consists of three sections. In section 1, professionalstaff is asked the major reasons forcalling consultation. In section two,all respondents are asked to answer7 questions on a 3-point scale: veryhelpful, somewhat helpful and nothelpful. Section three contains 3written questions asking therespondents opinions and for othercomments.

P U R P O S E : Measures medicalethics consultation effectiveness.

B A C K G R O U N D : To study the perceived effectiveness of bioethicsconsultation as evaluated by bothprofessional staff and their families.An evaluation questionnaire wasforwarded to physicians, nurses andpatients or family members whowere associated with 20 sequentialcases referred for ethics consultation during a 2-year period.Respondents were asked to rate theconsult as very helpful, somewhathelpful or not helpful concerning avariety of issues related to the careof pts.

WHERE TO FIND THE ARTICLE:McClung, J., Kramer, R., DeLuca, M.and Barber, H. (1996). Evaluation ofa medical ethics consultation service: opinions of patient andhealth care providers. The AmericanJournal of Medicine, 100, 456-460.

ETHICS CONSULTATION (E/EC) 1.0

Bioethics ConsultationQuestionnaire

E t h i c s


R E L I A B I L I T Y : Cross-validationperformance was identical to or only0.01 points lower than the perform-ance of models developed using theentire data set.

V A L I D I T Y : Each of the six clinicalfindings has a strong relationship (P<0.001) with in-hospital death whichsupports the validity of the findings.

D E S C R I T P T I O N : Measures overallseverity based on: Admission medicgroup scores, physiology score, disease stagings scale, and allpatient refined diagnosis relatedgroups (APR-DRG). Patients rankedby predicted probability of death.

P U R P O S E : Measures illness severity and probability of death.

B A C K G R O U N D : To determinewhether assessments of illnessseverity, defined as risk for in-hospital death, varied across fourmeasures. For each patient, theprobability of death was rated oneach of the measure scales. Patientswere ranked according to the probability of death as predicted byeach severity measures and rankings were compared acrossmeasures.

WHERE TO FIND THE ARTICLE:Iezzoni, L., Ash, A., Shwartz, M.,Daley, J., Hughes, J. and Makiernan,Y. (1995). Predicting who diesdepend on how severity is measured: implications for evaluating patient outcomes. Annalsof Internal Medicine, 123, (10), 763-770.

PATIENT OUTCOMES (E/PO) 2.0

Illness SeverityM e a s u r e s

E t h i c s

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RELIABILITY: CronbachÕs alpha =0.959.

V A L I D I T Y : Not reported byresearchers - construct validityreported in original SERVQUALinstrument.

D E S C R I T P T I O N : 49 statementsrated on a 7 point Likert scale ranging from 7 = strongly agree to 1= strongly disagree.P U R P O S E : Measures patient’s

reported degree of satisfactionbased on consumer satisfaction withservices.


WHERE TO FIND THE ARTICLE:Tomes, A. and Ng, S. (1995). Servicequality in hospital care: The development of an inpatient questionnaire. International Journalof Health Care Quality Assurance, 8(3), 25-33.


S E R V Q U A L


R E L I A B I L I T Y : The total scale reliability was reported as Ôclose to.9Õ in each of the four instances.

V A L I D I T Y : Construct validityreports based on conceptual criterion and empirical measures.

D E S C R I T P T I O N : 22-item scalescored on a 7-point scale rangingfrom 7 = strongly agree to 1 =strongly disagree.

P U R P O S E : To assess consumerperceptions of service quality inservice and retailing organizations.


WHERE TO FIND THE ARTICLE:Parasurman, A., Zeithaml, V. andBerry, L. (1988). SERVQUAL: A multiple-item scale for measuringconsumer perceptions of servicequality. Journal of Retailing, 64 (1),12-40.


SERVQUAL- Short form

E t h i c s

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RELIABILITY:

CronbachÕs alpha was .80 for ide-alism and .73 for relativism

Test-retest was .67 for idealism and .66 for relativism.

V A L I D I T Y :

Varimax rotation for 16 items = 77%

Construct and discriminate validi-ty were established.

WHERE TO FIND THE ARTICLE:Forsyth, D. (1980). A taxonomy ofethical ideologies. Journal ofPersonality and Social Psychology,39(1), 175-184.

DESCRITPTION: The questionnairecontains 20 attitude statements, 10concerning idealism and 10 concerning relativism. Respondentsare asked to indicate their degree ofagreement or disagreement witheach item using a 9 point scale. Thescale ranges from 1 = completelydisagree to 9 = completely agree.

P U R P O S E : Measures the extent towhich individuals adopt one of fourethical ideologies: situations, absolutism, subjectivism, andexceptionism in making moraljudgements.

BACKGROUND: The EPQ assessesthe degree of idealism and rejectionof universal moral rules in favor ofrelativism to evaluate to what extentindividuals adopt the ethical ideologies under different types ofmoral judgements.

ETHICAL IDEOLOGIES (WV/EI) 1.0

Ethics PositionQuestionnaire

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WHERE TO FIND THE ARTICLE:Not available.

DESCRITPTION: The questionnaireconsists of 59 items scored on a fivepoint scale ranging from 1 = neverimportant to 5 = always important.

P U R P O S E : Asseses the world viewsof faculty investigators for recognition of ethical issues andweighing of ethical principles inhuman subject research.

BACKGROUND: Letter of introduc-tion and questionnaire sent to faculty members in dentistry, nursing or pharmacy holding both a professional and doctoral degree.

RESEARCH (WV/RS) 2.0

WorldViews of FacultyResearch Investigators

ethics tool databaseiib.edu.mx/recursos-academicos/tools-base-de-datos-boston-2.pdf · 8 decision...

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