Thesis (Ph. D.)--Illinois State University, 2006. / Title from title page screen, viewed on February 4, 2008. Dissertation Committee: George A. Padavil (chair), Paul J. Baker, Eileen R. Fowles, James C. Palmer, W. Paul Vogt. Includes bibliographical references (leaves 245-257) and abstract. Also available in print.

abstract: The measurement of competency in nursing is critical to ensure safe and effective care of patients. This study had two purposes. First, the psychometric characteristics of the Nursing Performance Profile (NPP), an instrument used to measure nursing competency, were evaluated using generalizability theory and a sample of 18 nurses in the Measuring Competency with Simulation (MCWS) Phase I dataset. The relative magnitudes of various error sources and their interactions were estimated in a generalizability study involving a fully crossed, three-facet random design with nurse participants as the object of measurement and scenarios, raters, and items as the three facets. A design corresponding to that of the MCWS Phase I data--involving three scenarios, three raters, and 41 items--showed nurse participants contributed the greatest proportion to total variance (50.00%), followed, in decreasing magnitude, by: rater (19.40%), the two-way participant x scenario interaction (12.93%), and the two-way participant x rater interaction (8.62%). The generalizability (G) coefficient was .65 and the dependability coefficient was .50. In decision study designs minimizing number of scenarios, the desired generalizability coefficients of .70 and .80 were reached at three scenarios with five raters, and five scenarios with nine raters, respectively. In designs minimizing number of raters, G coefficients of .72 and .80 were reached at three raters and five scenarios and four raters and nine scenarios, respectively. A dependability coefficient of .71 was attained with six scenarios and nine raters or seven raters and nine scenarios. Achieving high reliability with designs involving fewer raters may be possible with enhanced rater training to decrease variance components for rater main and interaction effects. The second part of this study involved the design and implementation of a validation process for evidence-based human patient simulation scenarios in assessment of nursing competency. A team of experts validated the new scenario using a modified Delphi technique, involving three rounds of iterative feedback and revisions. In tandem, the psychometric study of the NPP and the development of a validation process for human patient simulation scenarios both advance and encourage best practices for studying the validity of simulation-based assessments. / Dissertation/Thesis / Doctoral Dissertation Educational Psychology 2014

Background: Approximately 32% of all lymphoma patients experience immunocompromised severe avoidable side effects of nadir at home after discharge postchemotherapy. The certified oncology nurses employed at a large metropolitan hospital in Atlanta, Georgia, lack standardized discharge guidelines that include regulatory organizations’ recommendations to assist patients/families with at-home self-management of the avoidable side effects. Purpose: The purpose of this quality improvement project was to utilize the institution’s existing postchemotherapy discharge protocol to assess certified oncology nurses’ knowledge of severe avoidable side effects of nadir; modify the existing healthcare institution’s postchemotherapy discharge protocol to reflect standardized practice for promoting clinical practice continuity by leading organizations; conduct multifaceted training seminars to disseminate the modified postchemotherapy discharge guideline; evaluate the oncology nurses’ knowledge of severe avoidable side effects of nadir postchemotherapy after modified guideline implementation; and collaborate with the intraprofessional team to determine if the modified postchemotherapy discharge guideline was feasible and acceptable for system wide hospital implementation. Theoretical Framework: The theoretical framework used was Benner’s model of nurse proficiency: expert nurses develop skills and understanding of patient care through a sound educational base and a multitude of experiences. Methods: The existing postchemotherapy discharge protocol was used to develop a developed standardized guideline incorporating regulatory organizations’ recommendations for severe avoidable side effects of nadir postchemotherapy for nursing discharge information and patients’ at-home management. Ten oncology registered nurses on a 16-bed oncology unit participated in two 10-question Likert scale questionnaires based on the existing guideline (pretest) and the modified guideline (posttest) before and after an educational intervention. A quantitative nonparametric descriptive design was used. The questionnaires were analyzed with a two-tailed paired t test, p = 0.05, CI = 95, SD = 12. Results: Nurses significantly improved from pretest to posttest—63% before receiving modified guideline education and 83% after receiving education (p < 0.005). Conclusion: A standardized guideline that included regulatory organizations’ recommendations for at-home management of severe avoidable side effects of nadir showed significant nurses’ improvement in knowledge and competency. The effectiveness of nurses disseminating discharge information was paramount when knowledge awareness and appropriate patient/family assessment were incorporated in the discharge instructions.