A Measurement of Nurse Vigilance from the Patient\u27s Perspective

Problem: Since the landmark Institute of Medicine report, To Err is Human, was published in 1998, patient safety has become a major concern in healthcare systems. Although attention is being given to patient safety and preventing patient morbidity and mortality, experts indicate that little progress has been made in decreasing healthcare errors. Nurses are at the bedside twenty-four hours a day and are an important link in preventing patient healthcare errors. In an environment of patient centered care, patients are considered valued stakeholders that can help prevent healthcare errors by giving input. Vigilance is a phenomenon often identified in literature as a means to promote patient safety and well-being; however, little research has been conducted on the phenomenon of vigilance in healthcare. In one qualitative study, patients clearly watch for vigilance in nurses exhibited through a variety of behaviors. If patients can identify vigilance in nurses, then it is possible to examine relationships that may exist between vigilance and outcomes such as patient safety and well-being. Purpose: The purpose of this study was to design a valid instrument that will measure nurse vigilance from the patient perspective. Method: Three steps were completed to design the instrument: 1) A pool of items was developed from five domains of vigilance: knowledge, connectedness, hope, going beyond the call of duty, shared vigilance, and quality patient outcomes such as safety and quality of life. The subscales were derived from a qualitative study of patient-nurse experiences of vigilance and existing research literature, Twenty items were developed for each domain and then through card sorting the items were reduced to approximately 10 per domain to avoid repetition. 2) An expert panel, consisting of 8 professionals with knowledge about vigilance, quality, and safety was identified and will rate items for content validity. 3) A content validity index was developed to rate each individual item according to the expert analysis of its relevance to its domain of vigilance. The content validity index consists of a likert-type scale from 1-4, 1, not at all relevant to 4 very relevant. Experts will rate each item on this scale and the data will be analyzed to determine which items will be retained and which will be removed from the instrument. Items that are rated predominately as 3 or 4 are most often considered for retention. Results: We are still in the process of collecting and analyzing the data at this time