Standardized Nursing Measurement PDF

Standardized Approaches to Measurement Supervised by: Prof. Muayyad Ahmad Presented by: Nesreen Alkhatib & Rawan Alasaf  Outline Introduction and Definition Standardized versus non-standardized measures The Importance of a Standardized Healthcare System Const...

Standardized Approaches to Measurement Supervised by: Prof. Muayyad Ahmad Presented by: Nesreen Alkhatib & Rawan Alasaf  Outline Introduction and Definition Standardized versus non-standardized measures The Importance of a Standardized Healthcare System Construction of standardized measures. Developing, administering and scoring standardized measures. Standardized Electronic Health Measures Establishing , selecting and administering norming Selecting the measure and evaluating standardized measures. Conclusion References  Introduction Standardization is a key process in measurement. It includes : Uniformity of procedures in developing, administering, and scoring measures. Establishing norms to interpret scores. Standardized measures are considered norm-referenced, because an individual score is interpreted by comparing it with scores obtained from other subjects in a well-defined comparison group.  Definition Standardized measure was defined by Kelley (1914), as measure that is constructed, administered, scored, and interpreted in a prescribed, precise, and consistent manner in order to reduce external influences that compromise reliability.  Standardized measures characteristics Standardized measures have four essential characteristics: 1. A fixed set of items or operations designed to measure a clearly defined concept, entity, attribute, or behavior. 2. Explicit rules and procedures for administration and scoring. 3. Provision of norms to assist in interpreting scores. 4. An ongoing development process that involves careful testing, analysis, and revision in order to ensure high technical quality.  Standardized measures characteristics Not all tools used in nursing research follow a standard criteria. Some tools might have some, but not all, of the key features that standardized tools should have. These tools are called non-standardized measurements. Standardized versus non-standardized measures Decisions regarding the use of standardized or non- standardized measures should be based on: The purpose for which the information will be used. The types of questions that need to be answered. Whether a standardized measure exists or can be developed successfully.  Standardized versus non-standardized measures For example: researcher wanting to measure preoperative anxiety might combine a standardized laboratory procedure (e.g., measurement of catecholamines in the urine), standardized measure of anxiety (e.g., the State– Trait Anxiety Inventory [Spielberger, 2003]), and a non standardized verbal self-rating of anxiety.  TABLE 7.1 Comparative Advantages and Disadvantages of Standardized and Non standardized Measures Standardized measures Non standardized measures Construction Constructions of theses measures Flexible construction Involves experts to enhance quality, Quick to constructed and utilizing the reliability, and validity resource efficiently. The procedure used in construction and testing is usually well documented. It requires adequate resources. Content Its applied on variety of settings and Its applied to specialized situations. situations. Inclusion of biased and irrelevant Its well defined and allowing content. consistent comparison.  TABLE 7.1 Comparative Advantages and Disadvantages of Standardized and Non standardized Measures Standardized Measures Non standardized Measures Psychometrics Reliability (internal consistency and Technical properties to be optimized are test–retest) is high, yielding stable determined based on purposes of the results. measure (e.g., qualitative studies). Administration and Scoring  Established details procedures steps,  flexible procedures that provide consistency and giving comparable results.  hand scoring is cost-efficient for  Its considered costly and time- small samples consuming.  Centralized or automated scoring is  different rules may be applied in cost-efficient for large-scale efforts. scoring, thus yielding incomparable results.  TABLE 7.1 Comparative Advantages and Disadvantages of Standardized and Non standardized Measures Standardized measures Non standardized Measures Interpretation of Scores  Scores can be uniformly compared  Comparisons and interpretations with norm groups, often at the can be geared to specific needs and national level. unique circumstances.  Explicit instructions may be provided  No established basis for to facilitate interpretation. interpretation exists.  consistency and accuracy of interpretation is variable, depending on the statistical skill of the interpreter. Example of standardized measures Example of standardized measures Braden Scale The Importance of a Standardized Healthcare System Adhering to a standardized healthcare system offers significant benefits such as:  Improved Quality of Care: Ensures consistent, reliable, and high-quality care through the use of evidence-based practices and security measures.  Efficiency: Reduces waste and enables healthcare systems to operate more effectively by utilizing standardized procedures and protocols. The Importance of a Standardized Healthcare System Cost-Effectiveness: Healthcare professionals save time and resources by adhering to standardized methods of care delivery. Research Basis: Information was compiled from global sources, including the World Health Organization, national statistics departments, and health ministries, to evaluate healthcare standardization. The Importance of a Standardized Healthcare System  Interoperability Enhancement: Achieves improved coordination among healthcare professionals through the standardization of health data and communication.  International Comparability: Facilitates the comparison of healthcare systems across different countries, promoting the exchange of best practices and identifying potential areas for improvement. The Importance of a Standardized Healthcare System  Jordan has made strides in recent years toward the implementation of a health information system that is more integrated and accessible.  Hakeem Program operationalized in Jordan for both public hospitals and primary care centers. The Importance of a Standardized Healthcare System The primary goal of this program is to develop a countrywide EHR system in order to simplify and improve the process of exchanging patient information. The EHR in Jordan faces many challenges related to standardization of regulations, practices, and procedures. Steps for establishing norms include:  Sequential steps in constructing Standardized measures 1. Develop objectives, specifications, and a blueprint. 2. Items are written and the operations identified 3. The items are pretested and analyzed using item statistics 4. Acceptable items are assembled into a preliminary form (or preliminary equivalent forms) of the measure. 5. The preliminary form of the measure is experimentally administered to criterion groups of examinees to determine or verify the adequacy of item limits and instructions, difficulty level, discriminating power, reliability, and validity. 6. Revisions are made to eliminate items or operations that are unnecessary, problematic, or do not contribute to the measure’s reliability and validity. 7. A final form of the measure is assembled 8. Uniform mechanisms for administration and explicit instructions for scoring are established. 9. The final form of the measure is administered to carefully selected referent groups in order to develop norms. 10. The final version of the measure, a manual, the norms, and supplementary materials are made available for use.  Content for standardized measure Based on :-  A statement of purpose, stated in non-specific situation.  The blueprint reflects a definition of the domain that is potentially acceptable across settings and defensible on the basis of published research or expert opinion.  Content for standardized measure Standardized tests are characterized by content that is:  Sufficiently generic for applicability in a variety of settings.  Not time-bound.  Fixed or predefined. (Portney & Watkins, 2015)  Administration  Standardization ensures consistency across different administrations of a measure.  The process begins with a norming administration, where the measure is administered to a representative referent group to establish norms.  This requires administering the measure to subsamples, which may vary in characteristics and geographical location.  Administration  Uniform administration conditions are vital for comparability of results.  The process involves collecting data about the referent sample members during norming administration, which aids in creating differentiated norms for various subgroups.  Administration Rigid control over administration conditions is critical for maintaining the standardization's integrity. This involves providing detailed instructions for users, including time limits and directions to ensure consistency across administrations. The computerized administration has improved control over administration, although it introduces new expectations regarding equipment availability and technological support.  Scoring The process for calculating scores on standardized tests is established in advance by the developer. This involves applying specific, clear rules to ensure that a particular performance consistently receives the same numerical score. The primary considerations in scoring are adhering to the scoring rules and accuracy in scores computation.  Scoring  Machine-scoring by optical scanners and computer scoring are more accurate and cost-efficient than hand- scoring and are usually the methods of choice for instruments scoring. Random checks for accuracy are advisable for both methods. The scoring rules for standardized measures are clearly defined , and often very detailed. User manuals with explicit scoring procedures have been developed for many standardized Instruments.  Scoring Nonstandardized measures may involve consistent procedures for both administration and scoring ; however, procedures usually are more flexible and less explicit than procedures for standardized measures.  Standardized Electronic Health Measures The Health Measures encompass PROMIS, Neuro-QoL, and NIH Toolbox. These precise and flexible measurement systems build comprehensive measures of physical, mental, and social health, symptoms, well-being and life satisfaction, and sensory, motor and cognitive function. For example : PROMIS (Patient- Reported Outcomes Measurement Information System). It includes over 300 measures of physical, mental, and social health for use both with the general population and with individuals living with chronic conditions. Example of standardized measures  Standard versus Norm  Norms are based on a reference group that is composed of individuals from widespread geographic areas, so that an individual’s score is interpreted by comparing it with a national or international distribution.  Standard refers to a set of criteria, guidelines, or specifications established and recognized as a benchmark for quality, correctness, or compatibility.  Types of Norms Norms can be classified based on the scope of the population: National norms / International norms The norming sample contain individuals who vary in sociodemographic characteristics, such as age, gender, race, social status, and educational background. National norms classify into: - Total group norms it is national norms that display the distribution of the sample as a whole. - Differentiated norms the distributions of subgroups selected according to relevant characteristics.  Types of norms  Regional and local norms are those established with more geographically circumscribed samples. The developer of a nationally standardized measure may supply norms specific to given multistate regions of the country.  Statistical units for presenting norms may also be used to classify them. e.g t-scores.  Establishing Norms The following multistep process , used to establish norms, it should be implemented after the final version of the instrument produced: 1. A sample group (or groups) of individuals who are representative of those for whom the measure is designed is (are) selected. 2. The final form of the measure is administered to these individuals according to the set procedure or protocol that has been developed and under conditions that are identical to those recommended for administration. 3. Raw scores of the sample individuals are plotted in one or more frequency distributions and descriptive statistics are computed. 4. A decision is made regarding the statistical units that will be used to express the norms and these statistics are computed (e.g., t-scores, Z-scores). Tables or graphs displaying the norms are prepared.  SELECTING THE NORMING SAMPLE(S) scores from the basis Establish The norms sample (referent Comparisons for group) Probability sampling bias is minimized, sampling error can be estimated, and the characteristics of the sample can be generalized to the larger population for whom the measure is intended Application: Selecting the norming sample N=8 27 SAMPLE SIZE The larger the sample, the more likely it is to be representative of the population mathematical practical the degree calculation of considerations of precision sampling such as time required error and cost Application: Sample Size NORMING ADMINISTRATION AND SCORING Norming Administration the administration of the measure to the referent group in order to generate a frequency distribution that will serve as the basis for comparing and interpreting scores on the measure. Raw scores earned by the entire referent sample are represented in a frequency distribution. If the measure has several component parts (subscales), a separate frequency distribution is developed for each. Application: Norming Administration and Scoring COMMUNICATING THE NORMS Must be accurate and clear Tables and graphs are Specific instructions for the use prepared to portray the referent Simple narrative group data Application: Communicating the norms Application: Communicating the norms Application: Communicating the norms UPDATING NORMS Establishing norms for a standardized measure is an ongoing activity, even though it is time-consuming and costly norms must be updated depends on the likelihood that the attribute or behavior being measured has been influenced by recent changes. cultural lifestyle technological ADEQUACY OF NORMS Criteria for determining the adequacy of norms include the following 1. The norms were established based on a representative sample from a clearly specified population. 2. The norms were established using a referent group with known (accurately described) characteristics. 3. The norms were established under conditions of uniform administration and scoring. 4. The date of the norming administration is known. 5. The statistical procedures used in deriving the norms were appropriate and accurately described. 6. The norms are clearly presented, and include instructions for interpretation. 7. Differentiated norms are available to reflect relevant differences among subgroups with specific characteristics. 8. The norms are up to date. INTERPRETATION OF SCORES Takes into account the generic meaning the purposes context within which of the score the information (always normative) ultimately will be used The meaning derives from comparison of an individual score with the scores earned by others (the defined referent group) on the same measure. INTERPRETATION OF SCORES…contd. The scores on standardized measures are most frequently used for the purposes of making:-  Interindividual comparisons ranking a group of applicants prior to selecting the one most qualified for a position  evaluating the anxiety level of a given patient as high or low in comparison with that of the typical adult. Intergroup comparisons average satisfaction ratings of students and faculty in doctoral program A are higher than those in program B Intraindividual (also termed ipsative) comparisons comparisons involving two or more scores earned by a single individual, subscales measuring different dimensions of behavior in order to develop a profile INTERPRETATION OF SCORES…contd. The following guidelines should be kept in mind to make an informed judgment about the meaning of the score 1- The conceptual meaning of whatever derived score is used should be clear to the user. 2- The score has meaning only in relation to the specific measure from which it was derived. 3- The score has meaning only in relation to the referent group used to establish norms; thus, the characteristics of the referent group must be communicated carefully. 4. Measurement error must be taken into account. 5. Differentiated norms should be used as the basis for comparison because they allow for more precise meaning to be inferred. 6. Relevant characteristics of the subject(s) should be taken into account. SELECTING THE MEASURE Consideration of the nature of the purposes to be achieved by the phenomenon acquiring the information Unique in assumptions specific the aspects of cognition, affect, or skill content behavior that it measures. Application: Selecting the measure Application: The measure USING THE MEASURE Sample sets of those measures deemed potentially useful and accompanying test manuals can be ordered for review and evaluation Measures should be examined carefully for A. Evidence of high technical quality B. Characteristics that are desirable for the particular use intended Criteria specific to the particular situation for which the measure is to be used should be identified in order to facilitate the selection process. Evaluation of standardized measures Article  Conclusion Standardized measures offer a reliable, consistent approach to measurement, this approach is essential in health research and practice. Their use allows for the comparability of data across studies and contributing significantly to evidence-based practice.  References Bertocchi, L., Dante, A., La Cerra, C., Masotta, V., Marcotullio, A., Jones, D., Petrucci, C., & Lancia, L. (2023). Impact of standardized nursing terminologies on patient and organizational outcomes: A systematic review and meta-analysis. Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing, 55(6), 1126–1153. https://doi.org/10.1111/jnu.12894. https://www.healthmeasures.net/. Macieira, T. G. R., Yao, Y., Marcelle, C., Mena, N., Mino, M. M., Huynh, T. M. L., Chiampou, C., Garcia, A. L., Montoya, N., Sargent, L., & Keenan, G. M. (2024). Standardizing nursing data extracted from electronic health records for integration into a statewide clinical data research network. International journal of medical informatics, 183, 105325. https://doi.org/10.1016/j.ijmedinf.2023.105325. Muayyad, A. (2023). Perspectives on the standardization of health care systems globally (1st ed.). LAP LAMBERT ACADEMIC PUBLISHING. Shin, C., Ko, Y. H., An, H., Yoon, H. K., & Han, C. (2020). Normative data and psychometric properties of the Patient Health Questionnaire-9 in a nationally representative Korean population. BMC psychiatry, 20(1), 194. https://doi.org/10.1186/s12888-020-02613-0. Vermeulen, M.A., Hill, J.M., van Vilsteren, B., Brandt-Hagemans, S.C., & van Loon, F.H. (2024). Personality characteristics of Dutch nurse anesthetists and surgical nurses when compared to the normative Dutch population, a quantitative survey study. Applied nursing research : ANR, 76, 151781. Waltz, C., F. Strickland, O., L. Lenz, E., L.(2017). Measurement in Nursing and Health Research (5th ed). Springer publishing company. New York. West, E. C., Williams, L. J., Stuart, A. L., & Pasco, J. A. (2023). Quality of life in south-eastern Australia: normative values for the WHOQOL- BREF in a population-based sample of adults. BMJ open, 13(12), e073556. https://doi.org/10.1136/bmjopen-2023-073556.