The Journal of Continuing Education in Nursing

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An Instrument Designed to Measure the Job-Time Educational Participation of Staff Nurses

Mary E Bevis

Abstract

Houle's concept of the learner as the unifying element in educational participation ' has provided a base for a number of learner-centered studies. Such a learner-centered study was conducted by the writer.1 In this study, both job-time and leisure-time educational participation of staff nurses were measured. The Leisure Activity Survey, constructed by Litchfield,3 was used to obtain a measure of leisure-time educational participation.* The report which follows concerns the construction and pretesting of an instrument designed to measure jobtime educational participation.

Construction of the Instrument

In order to avoid confusing the respondents and to prevent over-lapping of responses to the leisure-time and jobtime instruments, a precise and limiting definition of job-time was needed. Jobtime was defined as time spent on the assigned nursing unit and, in addition, as any time outside of the normal working day for which the staff nurse is compensated by the employer in time or money.

"Educational participation" and "participation in continuing learning activities" were considered synonymous phrases. Continuing learning, the generic process of which these actions are a part, was defined as a process in which an individual undertakes voluntarily, alone or in groups, to increase knowledge, skill, or sensitivity.

This definition of continuing learning provided guidelines for selection of educational activities for the instrument. Activities were included which could increase knowledge, skill, or sensitivity and which could be engaged in alone or as a member of a group.

It was decided that provision for judgments by staff nurses concerning voluntary or required participation in educational activities was beyond the scope of the instrument. Empirical support for this decision was provided by Netherton's experience with county extension agents. The difficulties encountered when such decision-making was required are documented in Netherton's study.4

Litchfield's three-dimensional concept of extent of educational participation (and the related scoring procedure) was accepted for use in the instrument. Litchfield defined extent of educational participation as (a) the number of educational activities engaged in; (b) the degree of educativeness of the educational activities; and (c) the amount of time spent in the educational activities.5

Ten practical guidelines were formulated prior to construction of the instrument:

1. In order to reduce bias (positive or negative) of the respondents toward education, the purpose of the instrument would be masked. The title of the instrument, Job Activity Survey, was selected to enhance masking.

2. Items describing two types of activities would be constructed: (a) educational activities for determination of extent of educational participation; and (b) noneducational activities for masking purposes. An educational activity was defined as an activity in which a staff nurse participates for the primary purpose of increasing her knowledge, skill, or sensitivity. A non-educational activity or job activity was defined as an activity in which a staff nurse participates for the primary purpose of promoting the welfare of the patient, the nursing unit, the unit's personnel, or the hospital.

3. Two areas of job-time would be examined in the development of educational activity items: (a) time spent on the assigned nursing unit and (b) time spent outside the normal working day for which the staff nurse is compensated by the employer in time or money. It was assumed that a similar procedure would not be necessary in the development of job activity items. When a staff nurse is paid for "over-time" work, the range of job activities engaged in during over-time does not differ from that of a normal working day.

4. Breadth and comprehensiveness of activities would be desired. It was assumed that both the type and frequency of job activities performed would vary according to a nurse's area of clinical practice.…

Houle's concept of the learner as the unifying element in educational participation ' has provided a base for a number of learner-centered studies. Such a learner-centered study was conducted by the writer.1 In this study, both job-time and leisure-time educational participation of staff nurses were measured. The Leisure Activity Survey, constructed by Litchfield,3 was used to obtain a measure of leisure-time educational participation.* The report which follows concerns the construction and pretesting of an instrument designed to measure jobtime educational participation.

Construction of the Instrument

In order to avoid confusing the respondents and to prevent over-lapping of responses to the leisure-time and jobtime instruments, a precise and limiting definition of job-time was needed. Jobtime was defined as time spent on the assigned nursing unit and, in addition, as any time outside of the normal working day for which the staff nurse is compensated by the employer in time or money.

"Educational participation" and "participation in continuing learning activities" were considered synonymous phrases. Continuing learning, the generic process of which these actions are a part, was defined as a process in which an individual undertakes voluntarily, alone or in groups, to increase knowledge, skill, or sensitivity.

This definition of continuing learning provided guidelines for selection of educational activities for the instrument. Activities were included which could increase knowledge, skill, or sensitivity and which could be engaged in alone or as a member of a group.

It was decided that provision for judgments by staff nurses concerning voluntary or required participation in educational activities was beyond the scope of the instrument. Empirical support for this decision was provided by Netherton's experience with county extension agents. The difficulties encountered when such decision-making was required are documented in Netherton's study.4

Litchfield's three-dimensional concept of extent of educational participation (and the related scoring procedure) was accepted for use in the instrument. Litchfield defined extent of educational participation as (a) the number of educational activities engaged in; (b) the degree of educativeness of the educational activities; and (c) the amount of time spent in the educational activities.5

Ten practical guidelines were formulated prior to construction of the instrument:

1. In order to reduce bias (positive or negative) of the respondents toward education, the purpose of the instrument would be masked. The title of the instrument, Job Activity Survey, was selected to enhance masking.

2. Items describing two types of activities would be constructed: (a) educational activities for determination of extent of educational participation; and (b) noneducational activities for masking purposes. An educational activity was defined as an activity in which a staff nurse participates for the primary purpose of increasing her knowledge, skill, or sensitivity. A non-educational activity or job activity was defined as an activity in which a staff nurse participates for the primary purpose of promoting the welfare of the patient, the nursing unit, the unit's personnel, or the hospital.

3. Two areas of job-time would be examined in the development of educational activity items: (a) time spent on the assigned nursing unit and (b) time spent outside the normal working day for which the staff nurse is compensated by the employer in time or money. It was assumed that a similar procedure would not be necessary in the development of job activity items. When a staff nurse is paid for "over-time" work, the range of job activities engaged in during over-time does not differ from that of a normal working day.

4. Breadth and comprehensiveness of activities would be desired. It was assumed that both the type and frequency of job activities performed would vary according to a nurse's area of clinical practice. A comprehensive list of job activities for all staff nurses in all areas of clinical practice in a large general hospital would be included in the instrument.

Only the limitation would be placed on the selection of job activities. Those job activities beyond the generally accepted legal limits of nursing would be excluded. Admittedly, despite legal implications, such activities are engaged in by some nurses. These activities would be excluded in order to enhance the respondent's freedom of reporting activities and to prevent the development of negative feelings toward the instrument on the part of the respondent.

5. The selection of job activities would not be based on a definition of nursing. Use of any one of the currently accepted definitions of nursing would limit the inclusion of certain job activities. With the exception of job activities beyond the legal limits of nursing, the instrument would be concerned with job activities that are engaged in by the staff nurse, not with job activities that should be engaged in by the staff nurse. The respondents would be permitted to report what they actually do during job-time.

6. Degree of learning and quality of an educational experience would be considered beyond the scope of the instrument.

7. The instrument would be designed for self-administration.

8. The instrument would be of reasonable length. Length would not be a prime concern during the early stages of activity selection, item construction, and item revision. After the activities were classified by judges as either educational or noneducational, a concentrated effort would be made to combine various noneducational activities and, thus, to reduce the length of the instrument.

9. The instrument would be designed to be scored either by hand or by machine.

10. The terms used in the items would be easily understood by all staff nurses. Because nursing terminology often varies according to geographical location, the language of the items would be selected carefully in order for the instrument to be valid and of future practical value in nursing.

Item Construction

Over 600 staff nurse activities were identified through the use of the following sources: interviews with directors of inservice education; texts in fundamentals of nursing; texts designed for use in "refresher courses"; studies of staff nurse functions; and staff nurse job descriptions.

Items were formed by the process of generalization; that is, a common core was found for a number of activities and an item written based on this common core. No one system of generalization was used.

In some instances» the generalization was obvious. "Administered a medication" was a generalization that would encompass many other single activities such as the administration of oral medications, subcutaneous injections, intramuscular injections, suppositories, sprays, gargles, and ointments. In other instances, the generalizations were based on such common cores as purpose, technique, or recipient of action. In this fashion, the 600 staff nurse activities were reduced eventually to 110 items.

Throughout construction of the instrument (a period of time which covered nine months) a cyclic process was in operation. This process involved constructing the items, obtaining the criticism of others, revising the items, again seeking the criticism of others, and so on.

Nine experienced nurses representing education, administration, and clinical practice were asked to evaluate the items for comprehensiveness, level of specificity, representativeness, duplication, and clarity. In addition, in a further effort to improve clarity, the items were reviewed by an individual with a graduate English major.

Identification of Educational Items

Three panels of nurses reviewed the items and classified the activity described in each item as either educational or noneducational. One panel was composed of baccalaureate educators; one, of diploma educators; and one, of administrators. The panels classified 47 of the 110 items as educational.

The educational items were then submitted to sixteen nurses (educators, administrators, and practitioners) who judged the items for degree of educativeness. On the basis of these judgments, weights were assigned to the educational items. The weights ranged from a low of one to a high of four. This use of weights for degree of educativeness satisfied the requirements of Litchfield's second dimension of extent of educational participation.

Table

TABLE 1

TABLE 1

Placement of Items in Time Categories

To determine the frequency with which staff nurses engage in job-time activities, a special survey of staff nurses was conducted. Twenty-two staff nurses (one from each of eleven clinical areas in two large general hospitals) participated in the survey.

On the basis of the results of the survey, the items were placed in four time categories. Each category had a six-point time-interval scale, with a short statement describing each interval. Assigned to the intervals were weights ranging from a low of zero for no participation to a high of five for the greatest participation. The use of weights for time intervals satisfied the requirements of Litchfield's third dimension of extent of education participation.

Format of the Instrument

The format of the instrument is illustrated in Table 1. Six representative items are shown. Of these six items, the activities described in three items were judged to be educational activities. Item 2 has an educational weight of three; Item 5, of four; and Item 6, of one.

Pretesting the Instrument

The instrument was administered to a sample composed of sixty-eight staff nurses from five large general hospitals. The sample was stratified according to basic nursing preparation (eighty percent diploma-prepared nurses and twenty percent baccalaureate-prepared nurses) and according to area of clinical practice (ten areas of clinical practice were represented).

Analysis of the results of the pretesting indicated that (a) the purpose of the instrument had been masked successfully; (b) the instrument included a comprehensive list of job-time activities for a staff nurse in any clinical area of a large general hospital; and (c) each item was placed in the most appropriate time category.

Reliability

The split-half (odd-even) reliability of the instrument was determined on the basis of the responses of the sixty-eight nurses to the 110 items of the instrument. The coefficient of reliability (corrected for attenuation) was .96.

The responses of twenty-two nurses on the first testing were compared with their responses (two and one-half weeks later) on a second testing. A coefficient of .88 was obtained for test-retest reliability.

Validity

Prior to pretesting, the instrument was submitted to the members of the writer's advisory committee. Since the committee members agreed that the instrument appeared to be valid for its purpose, it was concluded that the conditions for face validity had been met.6

During the various stages in construction of the instrument, the items were evaluated by more than forty nurse educators, administrators, and practitioners. The instrument was administered successfully to twenty-two professional nurses for the purpose of determining the placement of items in time categories; to eighty-seven professional nurses in the pretesting situation (sixty-eight in the sample and nineteen in a concurrent validity study); and to fifteen practical nurses in a construct validity study. On the basis of these facts, it was concluded that the conditions for content validity had been met.7

Table

TABLE II

TABLE II

The results of a special study to provide evidence of concurrent validity were inconclusive. The criterion was thought to be valid, but the procedure itself was of questionable validity due to its contamination by an intervening variable.

For the purpose of providing evidence to support construct validity, the instrument was administered to fifteen licensed practical nurses employed in a large general hospital. It was predicted that the mean score in job-time educational participation for a group of practical nurses would be significantly lower than the mean score for a group of professional nurses.

This prediction was based on theoretical guidelines used in construction of the instrument and on findings of previous studies in educational participation. It was assumed that if the instrument were administered to two groups of nurses classified by type of !icensure (which is based on level of educational attainment), the group with the lower level of educational attainment would have significantly lower scores in job-time educational participation.

As indicated in Table II, the mean computed for the practical nurse group was lower than that computed for the professional nurse group. Scores for the two groups were compared using analysis of variance. An F statistic of 4. 51 /with a probability of less than .04 (1 and 81 degrees of freedom) was obtained. It was concluded that a reliable difference in job-time educational participation could be determined with the use of the instrument when two groups of nurses were classified as to level of educational attainment.

It should be noted that the determination of construct validity is a much more complex procedure than that of other types of validity. Construct validation should include a study of the influence not of just one factor but of several factors. This process involves a wide variety of procedures and many different types of evidence.8 The constraint of time precluded further investigation of the construct validity of the instrument.

The face validity and the content validity of the instrument were assumed to be established. Although a special study intended to provide evidence of concurrent validity was inconclusive, an attempt to provide statisitcal support for construct validity was successful.

Addendum

Although the instrument was designed to measure job-time educational participation, an item analysis of nurses1 responses in the pretesting situation revealed other possible uses. The instrument holds potential promise as a tool for evaluating the quality of nursing practice (Example 1) and the quality of on-the-job learning experiences (Example 2).

Table

Example 1 (non-educational item):"Devised, evaluated, or revised a written or informal plan for meeting the nursing needs of a patient."

Example 1 (non-educational item):

"Devised, evaluated, or revised a written or informal plan for meeting the nursing needs of a patient."

Table

Example 2 (educational itemh"Participated in teaching rounds with a group of physicians or nurses."

Example 2 (educational itemh

"Participated in teaching rounds with a group of physicians or nurses."

Since the instrument purports to measure what no other instrument measures, it does have practical value and is promising for further development. It is advisable, however, until additional support for validity is provided, to use a reasonable degree of caution in interpreting data obtained from the administration of the instrument.

References

  • 1. Houle CO: The Inquiring Mind. Madison: University of Wisconsin Press, 1961.
  • 2. Bevis ME: Role Conception and the Continuing Learning Activities of Neophyte Collegiate Nurses. Unpublished Ph.D. dissertation, University of Chicago, 1971.
  • 3. Litchfield A: The Nature and Pattern of Participation in Adult Education Activities. Unpublished Ph.D. dissertation, University of Chicago, 1965.
  • 4. Netheiton JD: The Relationship Between Educational Participation and Innovativeness of County Extension Agents. Unpublished Ph.D. dissertation, University of Chicago, 1967.
  • 5. Litchfield, op, cit., 38-39.
  • 6. Fox DJ: The Research Process In Education. New York: Holt, Rinehart, and Winston, 1969, 369-369.
  • 7. Ibid., 369-371.
  • 8. Cronbach LJ: Essential of Psychological Testing. 2d ed. New York: Harper and Row, 1960, 120-123.
  • Acknowledgements
  • This investigation was supported in part by a National Institutes of Health Fellowship (4F04-NU27, 181) from the Division of Nursing, Public Health Service, United States Department of Health, Education, and Welfare. Funds to help defray the costs of research were provided by Sigma Theta Tau, Inc., the National Honor Society for Nursing.

TABLE 1

TABLE II

Example 1 (non-educational item):

"Devised, evaluated, or revised a written or informal plan for meeting the nursing needs of a patient."

Example 2 (educational itemh

"Participated in teaching rounds with a group of physicians or nurses."

10.3928/0022-0124-19721101-08

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