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Title: The development and psychometric evaluation of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale.
Austin Authors: Chua, Wei Ling;Tee, Augustine;Hassan, Norasyikin Binte;Jones, Daryl A ;Tam, Wilson Wai San;Liaw, Sok Ying
Affiliation: Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Drive, Singapore
Intensive Care
Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
Nursing Education and Research, Changi General Hospital, 2 Simei Street 3, Singapore
Issue Date: Jul-2021
Date: 2020-10-23
Publication information: Australian Critical Care 2021; 34(4): 340-349
Abstract: Validated measures of ward nurses' safety cultures in relation to escalations of care in deteriorating patients are lacking. This study aimed to develop and evaluate the psychometric properties of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients (CARED) scale for use among ward nurses. The study was conducted in two phases: scale development and psychometric evaluation. The scale items were developed based on a systematic literature review, informant interviews, and expert reviews (n = 15). The reliability and validity of the scale were examined by administering the scale to 617 registered nurses with retest evaluations (n = 60). The factor structure of the CARED scale was examined in a split-half analysis with exploratory and confirmatory factor analyses. The internal consistency, test-retest reliability, convergent validity, and known-group validity of the scale were also analysed. A high overall content validity index of 0.95 was obtained from the validations of 15 international experts from seven countries. A three-factor solution was identified from the final 22 items: 'beliefs about rapid response system', 'fears about escalating care', and 'perceived confidence in responding to deteriorating patients'. The internal consistency reliability of the scale was supported with a good Cronbach's alpha value of 0.86 and a Spearman-Brown split-half coefficient of 0.87. An excellent test-retest reliability was demonstrated, with an intraclass correlation coefficient of 0.92. The convergent validity of the scale was supported with an existing validated scale. The CARED scale also demonstrated abilities to discriminate differences among the sample characteristics. The final 22-item CARED scale was tested to be a reliable and valid scale in the Singaporean setting. The scale may be used in other settings to review hospitals' rapid response systems and to identify strategies to support ward nurses in the process of escalating care in deteriorating ward patients.
DOI: 10.1016/j.aucc.2020.08.008
Journal: Australian Critical Care
PubMed URL: 33250402
ISSN: 1036-7314
Type: Journal Article
Subjects: Clinical deterioration
Escalation of care
Medical emergency team
Patient safety
Rapid response system
Scale development
Ward patients
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