Tools Base de Datos Boston 2

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Et h i c s T o o l D a t a b a s e


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Table of Contents

ETHICS TOOLS DATABASE

I Decision Making (DM)

1.0 Competence (DM/ C)Assessment of Patient Com petence (APC) .............................. 7

2.0 Factors (DM/ F)Ethics Stress Scale ................................................................ 8Attribution of Responsibili ty Instrument (ARI) ........................ 9The Autonomy Preference Index (API) ................................. 10The Inventor y of Cognitive Biases in Medicine (ICBM)...........11

3.0 Roles (DM/ R)Mazur ’s Patient Preference Tool (MPPT) ............................... 12Krantz Heal th Opinion Survey (HOS) .................................... 13

4.0 Satisfaction (DM/ SA)Satisfaction w ith Decision Scale (SWD) ................................. 14Job Satisfaction Scale ......................................................... 15

5.0 Sty les (DM/ S)Case Vignettes of Restrictive Situations in Psychiatr ic Care .. 16

Par ticipatory Decision- Making Styles (PDMS) .............. ........17

II Ethical Behavior s (EB)1.0 ANA Code (EB/ Code)

Judgments About Nursing Decisions (JAND).......................... 18

Judgements about Nursing Decisions (JAND), Adaptation byRooks (1994)...................................................................... 19

2.0 Caring (EB/ Caring)Car ing Behaviors Assessment (CBA).................................... 20Recall Tasks & Clinical Dilemma Questionnair e .................. . 21Car ing Assessment Repor t Evaluation (CARE - Q) .................22Nurse Car ing Questionnaire (NCQ); Patient Car ing Questionnair e(PCQ)................................................................................. 23


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Car ing Behavior s Inventory (CBI)........................................ 24Care and Justice Inter view ................................................. 25

3.0 Coping (EB/ CP)Jalow iec Coping Scale ........................................................ 26Coping Styles Inventory (CSI).............................................. 27

4.0 Empathy (EB/ EM)Behavior Test of Interpersonal Skil ls (BTIS) .......................... 28Barret- Lennard Relationship Inventory (BLRI) .................... 29Inventor y of Social ly Supportive Behav ior s (ISSB)................ 30 Empathic Understanding in Interpersonal Processes(EUIPASM) ......................................................................... 31

5.0 Humanistic (EB/ HUM)Scale of Humanistic Nursing Behavior s ................................ 32

6.0 Reciprocity (EB/ R)Caregiver Recipr ocity Scale (CRS) ...................................... 33

7.0 Self- Determining (EB/ SD)Perceived Enactment of Autonom y (PEA Scale).................... 34Competency Inter view Schedule (CIS) ................................ .35

8.0 Truthtell ing (EB/ TR)Truthtelling Interv iew Schedule .......................................... 36

9.0 Unethical (EB/ UETH)Unethical Teaching Behavior s Tool ...................................... 37

III Ethical Problems (EP)1.0 Ethical Issues (EP/ EI)

Ethical Issue Scale (EIS) ....................................................... 38Moral Problems .................................................................. 39ICU and Ethics ..................................................................... 40

2.0 Euthanasia/ Assisted Suicide (EP/ EAS)Assisted Suicide & Patient Requested Euthanasia Tool ..........41

3.0 Life Support (EP/ LS)Advance Directive Questionnaire ........................................ 42Life Suppor t Prefer ences Questionnair e (LSPQ) ................... 43


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Survey of implementation and impact of (PSDA) .................. 44

4.0 Moral Distress (EP/ MD)Mor al Distress Scale .......................................................... 45

5.0 Pain (EP/ P)The Barr iers Questionnaire (BQ) ......................................... 46

6.0 Physical Restraint Use (EP/ PR)Revised Restraint Questionnair e ......................................... 47knowlege and Ethics of Restraint ......................................... 48

7.0 Quality of Life (EP/ QOL)Qual ity of Life Questionnaire .............................................. 49Qual ity of Life Self- Assessment - Cancer Patients ................ 50Qual ity of Life - Adults w ith Chronic Illnesses ...................... .51Perceptual Quality of Life Interv iew / Questionnaire ............ 52 Enfor ced Social Dependency Scale (ESDS) ............................ 53McMaster Quali ty of Life Scale(MQLS) ................................. 54Sickness Impact Profi le (SIP) ............................................... 55Qual ity of l ife Survey (QLS) ................................................. 57Qual ity of Well Being Scale (QWB) ....................................... 58Qual ity of Life Index (QLI) ................................................... 59Sym ptom Distress Scale ...................................................... 60Quality of Life Cancer Scale (QOV- CA) ................................. 61MOS Short For m ................................................................. 62

IV Moral Reasoning (MR)1.0 Care Ethics (MR/ CE)

2.0 General (MR/ G)Responses to DNR or ders in the NICU.................................. .63Defining Issues Test (DIT- 1 A & DIT- 2) ................................ 64Nursing Dilemma Test (NDT) ............................................... 65Ethical Behavior Inventor y ................................................. 66Advocacy Assessment Tool ................................................ 67

3.0 Health Care (MR/ HC)Health Care Decision - Making Questionnaire(Nurses Version) ................................................................ 68

4.0 Principled Ethics (MR/ PE)


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Values in the Choice of Treatment Inventory ........................69Ethical Reasoning in Term inal Care Interview ......................70

5.0 Sociomoral Reasoning (MR/ SM)Social Reflection Measure (SRM) ......................................... 71Moral Judgment Interview: Kohlberg (MJI) ........................... 72

V Values / Attitudes: (V/ A)1.0 Death (V/ A/ D)

Threat Index- elicited form (TIE) ......................................... 73Threat Index- Prov ided forms (Tip40) ................................. 74Templer Death Anxiety Scale (DAS) ..................................... 75Col let- Lester Fear of Death Scale (FDS) ................................ 76

2.0 General (V/ A/ G)Attitudes Tow ard Advance Directives .................................. 77Pankratz Nursing Autonom y & Patient’s Right Scale ............ 78Blaney/ Hobson Nursing Attitude Scale ................................ 79Survey of Ethical Attitudes .................................................. 80Values History ................................................................... 81Allpor t- Vernon- Lindzey Study of Values............................ 82Attitudes Tow ard Resource Use ........................................... 83Values Confl ict Resolution Assessment (VCRA) .....................84Values Scale ...................................................................... 85Attitudes Tow ard Care at the End - of- Life (ATCEL) .............. 86

3.0 Moods (V/ A/ M)Profi le of Mood States Inventor y (POMS) ............................. 87Multiple Affect Adjective Check List (MAACL) ....................... .88Behavior Morale Scale ....................................................... 89Profile of Mood States Inventory - Shor t Version (PMOS)...... 90Life Regard Index (LRI) ....................................................... 91Abbreviated Lonel iness Scale, Version 2 (ABLS - 2...............92

4.0 Proffesional (V/ A/ P)Nursing Professional Values Scale....................................... 93Role Responsibil ities Questionnaire..................................... 94Whistle Blow ing ................................................................ .95

5.0 Spir i tual (V/ A/ SP)Religious Beliefs Instrument ............................................... 96Influence of Spir itual Well Being Scale (SWBS)..................... 97


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Spir itual Well Being Questionnaire ...................................... 98JAREL Spir itual Well - Being Scale ....................................... 99

VI Ethics (E)1.0 Ethics Consultation (E/ EC)

Bioethics Consulta tion Questionnaire ................................ 100

2.0 Patient Outcomes (E/ PO)Il lness Sever ity Measures ................................................. 101SERVQUAL ........................................................................ 102SERVQUAL- Short form ..................................................... 103

VII World Views (W/ V)1.0 Ethical Ideologies (WV/ EI)

Ethics Position Questionnair e ............................................ 104

2.0 Research (WV/ RS)WorldViews of Faculty Research Investigators ...................105


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This l ist is an info r m at io nalr esour ce onl y . We do not keepthe tool s or inst r um ents her e.

I f y ou w ish to access thecom pl ete too l i t is best to

con tact the au thor (s) d i r ect l yfor per m ission.


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DESCRI PTION: The tool has specificquestions about a patient scenarioand questions about the law.

Par t I - scenar io based onMassachusetts Appelate Courtdecision: Lane v. Cardura, 6 Mass.App. Ct. 377.1978. Par t II - series of multiple choice, theoreticalquestions about the law pertainingto competence. The entire tool isincluded in the above- mentionedarticle.

Assesm en t o F Pat ie ntCom pe ten ce (APC)

WHERE TO FIND THE ARTICLE:Mar kson, L., Kern, D., Annas, G. and

Glantz, L. (1994). Physicianassessment o f patient competence.Journal of American GeriatricsSociety, 42, 1074- 1080.

COMPETENCE 1 .0

PURPOSE: Determines physicians’knowledge of applying legalstandard for determiningcompetence; and, determinesphysicians’ abilities to assesscompetence by physician age orspecialty.

BACKGROUND:Unknown

RELI ABI LI TY:Not provided

VALIDITY: The instrument wasreviewed for face validity by bothclinicians and lawyers.

De c i s i o n M a k i n g


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Eth i cs Str ess Scal e-Lu n a - Ty m ch u k

VALI DITY: Not provided.

BA CKGROUND: This newinstrument for measuring the stressthat health care professionals mayexperience as they face ethicalissues with their patients, coll eaguesor research subjects was developed

by the author to use along with Dr.Anna Omery’s Moral ReasoningQuestionnaire and Lazarus andFolkman’s Way of Coping in herdissertation research on"Psychological Factors InfluencingEthical Decision Making". Theinstrument was tested in 1990.

DESCRITPTI ON: The scale consistsof 43 items; participants rank eachfor frequency of encounter andchoose a number r eflecting intensityof related stress, 0 = never , 1 = mildto 7 = very strong.

WHERE TO FIND THE ARTICLE:Not available.

FACTORS 2 .0

PURPOSE: Measures stress relatedto ethical decisionmaking by healthcare professionals.

RELI ABI LI TY:Not provided.


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Att r i bu t i on o f Respons ib i l i t yIns t r um ent (ARI )

FACTORS 2 .0

RELI ABI LI TY: A pilot study of 53senior female BSN students and 25female graduate nursing studentsyielded CronbachÕs alpha r eliabilitycoefficient of .85. Stability wasestablished by readministering thequestionnaires to 25 subjects wererandomly selected from the originalsample of 78 subjects. Five weeksafter the initial administration;test- retest reliability coefficient was.63. The amount of attribution of responsibil ity assigned did not differfor the two groups (t = 0.02, p>. 05).The dilemma solution d id not differsignificantly betw een the groups.

VALIDITY: Content validity wasestablished by tw o social psycholo-gists who agreed that eachstatement represented thedesignated ARI level .

education on three selected factors:ethical/ mor al reasoning, attributionof r esponsibility, and ethical/ mor al

dilemma resolution. The resultssuggest that undergraduate andgraduate nursing programs mustplace more emphasis on identifyingdilemmas, increasing ethical/ mor alreasoning levels and attributingresponsibility in a justif iablemanner.

PURPOSE: Measures theattribution of responsibility inrelation to ethical/ mor al dilemmas.

WHERE TO FIND THE ARTICLE:Felton, G. M. and Parsons, M.A.(1987). The impact of nursingeducation on ethical/ mor aldecision- making. Journal o f NursingEducation, 26, 7- 11.

DESCRITPTI ON: The Attribution of Responsibility Instrument wasdeveloped to measure theattribution of responsibility inrelation to ethical/ mor al dilemmas.ARI measured the commission,foreseeability, intentionally, and

justification levels of responsibi lity .BA CKGROUND: Developed toevaluate the influence of formal



Autonom y Pr e fe r enceIn dex (API )

RELI ABI LI TY: Test- retest: 0.84 fordecision making and 0.83 forinformation seeking CronbachÕs

alpha: 0.82 for each.

VALIDITY: Concurrent validity of the decision making scale wasestablished by correlation with anempirically related global itemappended to the instrument; r = 0.54,p = < 0.0001. Convergent validitywas obtained by administering thedecision making scale to diabeticpatients.

BACKGROUND: In an era in w hichpatient autonomy has become atenet of medical ethics, relativelylittle attention has been given to thequestion of how much involvementin their own care patients reallywant. A modified Delphi study

involving 13 clinicians, medicalsociologists, and ethicists wasorganized to assist in identificationof the key measurable dimensions of patients’ preferences for autonomy.

PURPOSE: Measures patien ts’preferences for two identifieddimensions of autonomy.

WHERE TO FIND THE ARTICLE:Ende, J., Kazis, L., Ash, A. andMoskowitz, M. (1989) Measuringpatients’ desire for autonomy;decision making and information-seeking preferences among medicalstudents. Jour nal of General InternalMedicine, 4, 23- 30.

DESCRI TPTI ON: The API consists of two scales: an 8 item scale oninformation seeking and a 15 itemscale on decision making. Itemsscored on a 5 point Liker t scale andtotal scores were adjusted linearlyto range from 0 (no desire) to 100(strong desire). Three clinical

vignettes were used to representdifferent levels of illness sever ity forthe decision m aking scale.

FACTORS 2 .0




DESCRITPTI ON: The ICBM contains22 medical scenarios in whichrespondents choose betweenalternatives that representbias- prone or statisticall y based

decisions.

The Inven to r y o f Congn i t i ve Bia ses inMed ic in e ( ICBM)

FACTORS 2.0

RELI ABI LI TY: Kuder- Richardson20 internal consistency reliability:0.62 for faculty and 0.42 for

students. The shor t length (22 items)of the ICBM prevented the test fromhaving a higher reliability. Grouphomogeneity was greater in studentand r esident group than the facultygroup.

VALIDITY: The ICBM appears tohave content validity. Items weredeveloped from actual clinical

experiences repor ted by physiciansand were scrutinized for inclusionfrom the perspectives of clinicalmedicine, cognitive psychology andstatistics. Construct validity issuppor ted by the fact that the facultyscored higher (7.5%) than didstudents and residents.

BACKGROUND: The ICBM was

developed to evaluate theeffectiveness of educationalinterventions aimed at minimizingthe biases associated withpredictable inform ation- processingtendencies when making medicaldecisions. It can serve as a trainingtool in the educational pr ocess, and

PURPOSE: Measures the influenceof cognitive biases on medicaldecisions.

WHERE TO FIND THE ARTICLE:Hershberger, P., Part, H., Markert,R., Cohen, S. and Finger, W. (1994).

Development of a test of cognitivebias in medical decisionmaking.Academic Medicine, 69 (10), 839-842.

be used to compare groups ofphysicians or physicians- in-training on the dimension of

cognitive bias.



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Mazur ’s Pat i en tPr efe r en ce Too l (MPPT)

ROLES 3 .0


VALI DITY: Not provided

BACKGROUND: Unknown.

PURPOSE: To access the level of involvement patients want in

decision making related to theacceptance or rejection of aninvasive medical intervention andwhether their preference fordecision making is related to theirpreference for qualitative (verbal)or quantitative (numeric)information about the risks of theprocedure.

DESCRITPTI ON: Definitions w eregiven for procedure and risk. In a

structured interview, patients wereasked to answer 4 questions relatedto their preferences in informationdisclosure about procedures. A fouritem demographic tool asked: age,educational level, present healthand medical conditions.

WHERE TO FIND THE ARTICLE:Mazur, D. and Hickam, D. (1997).

Patients’ preferences for riskdisclosure and role in decisionmaking for invasive medicalprocedures. Journal of GeneralInternal Medicine, 12, 114- 117.


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ROLES 3 .0

Kr an tz Hea l th Op in io nSur v ey (HOS)

RELI ABI LI TY: Reliabil i ties of TheBehavioral Involvement andInform ation subscales were .74 and.76, respectively. Kuder-Richardson 20 reliabil ity of the HOSfor two subsequent college samplesrem ained over .74 for subscales andtotal scale. Test- retest reliabil ityÕsfor the HOS components were .74,.71, and .59 for the total score,Behavioral Involvement scale, andInformation scales, respectively.

There is a slight but non- significanttendency for females to scoresomewhat higher than males on allHOS scales.

VALIDITY: Predictive Validity: TheHOS successfully discriminatedbetween a criterion group of highself- care subjects and the generalstudent population. Discriminate

vadility: Both subscales showdiscriminate validity. Constructval idity : is still being tested.

BACKGROUND: Although currentideology suggests patients would beactive partners in decision makingabout their care, the literature

PURPO SE: Measure pati en ts’attitudes towar d treatments.

DESCRI TPTI ON: HOS w asdeveloped to measure patientatt itudes toward treatmentappr oaches and uses two subscales:Inform ation (7 items) and Behavior(9 items). A high score denotes

favorable attitudes toward self-directed or informed treatmentpart icipation, while a low scoredenotes a passive attitude. The totalcombined score of the 2 a priorisubscales provides an overallmeasure of attitude towar d medicaltreatment.

WHERE TO FIND THE ARTICLE:Krantz, D.S., Baum, A., Wildeman,M.V. (1980). Assessment ofpreferences for self- treatment andinformation in health care. Journal

of Personality and SocialPsychology, 39(5): 977- 990.

suggests that patients wish to beinformed but not involved.


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Sat i sfac t io n w i thDeci sio n Scal e ( SWD)

SATISFACTI ON 4 .0

RELI ABI LI TY:Cronbach’s alpha is0.86.

VALIDITY: Discriminate validity,tested by performing principal-components analysis of itemspooled fr om the SWD scale and tw oconceptually related measures, wasgood.

BACKGROUND: Patient satisfactionmeasures have previously

addr esses satisfaction w ith medicalcare, satisfaction with providers,and satisfaction with outcomes, butnot satisfaction with the health caredecision itself. The SWD wasdeveloped in the context ofpost- menopausal hormone-replacement therapy decisions tohelp understand specific dynamicsof the decision itself.

PURPOSE: The SWD measurespatient satisfaction with health caredecisions.

DESCRI TPTI ON: The SWD is asix- item scale and each item isscored on a 5 point scale ("verycertain would not take " to "verycertain w ould take"). It can be usedin health care settings to evaluatedecision- assisting technologies orpatient- provider interactions aimedat involving patients in decisionmaking.

WHERE TO FIND THE ARTICLE:Holm es- Rovner , M., Kroll , J.,

Schmitt, N., Rovner, D., Breer, L.,Rothert, M., Padonu, G. andTalarczyk, G. (1996). Patientsatisfaction with health caredecisions: The Satisfaction withDecision Scale. Medical Decision-Making, 16 (1), 58- 64.


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SATISFACTION 4.0

Job Sat isfa ct io n Scal e

RELI ABI LI TY:Internal consistency:alpha = 0.86.


BACKGROUND: Tool designed byPrice and Mueller , 1981.

PURPOSE: Measures jobsatisfaction.

D ESC RI T PT I O N : 7 - su b sca l einstrument incorporating 52 itemsscored in a variety of ranges.Some questions are indicated on a 5point Likert scale ranging from= strongly disagree to 5 = strongly

agree.

WHERE TO FIND THE ARTICLE:Packard, J. & Motowidlo, S. (1987)

Subjective stress, job satisfactionand job performance of hospitalnurses. Research in Nursing &Health, 10, 253- 261.


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STYLES 5.0Case Vign et tes o f Rest r ic t iv e Si tua t io ns inPsych i at r i c Car e (RSPC)

RELI ABI LI TY:Test- retest reliabilitywith 20 nurse specialists demon-

strated no significant differences inrankings for all interventions foreach vignette.

VALIDITY: Content validity wasassured by selecting situationsrepr esentative of a potential conflictbetween client needs, rights, andavailable resources. The vignettes

and ethics- based inter ventionswere reviewed by a psychiatricnurse ethicist who confirmed thatthe intervention accuratelyrepr esented the appropr iate ethicalpr inciple. Content experts review edthe vignettes and the interrateragreement was .88.

BACKGROUND: Not know n.

PURPOSE: Measur es nur ses’e t h i c a l l y - b a s e d n u r s i n ginterventions in selected situationsillustrate the discipline’s ethicalrelationship to clients and society.

DESCRI TPTION: The tool containsthree case vignettes depictingrestrictive situations in psychiatriccare. Respondents ranked threeinterventions according to theiragreement with the approach andrationale represented by theintervention. In addition, therespondent was asked to comment

onthe intervention chosen fir st.

WHERE TO FIND THE ARTICLE:Garritson, S.H. (1988). Ethicaldecision making patterns. Journal of Psychosocial Nursing, 26(4), 22- 29.


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Par t i c ipa to r y Decis ion -Ma ki ng Sty l es (PDMS)



BACKGROUND: A representativecross- sectional sample of patientsparticipating in the MedicalOutcomes Study characterized eachphysician’s style by using a self-reported questionnaire. A singleaveraged style score was generated

for each physician. Style scoreswere compared among physicianswho differed in age, sex, minoritystatus, specialty, primary caretraining or training in interviewingskills, satisfaction with professionalautonomy, and practice volume.

PURPOSE: Measures how patientsrate their physician’s participatorydecision- making style.

DESCRI TPTION: The PDMS is athree- item scale. Patients are askedto rate their physician’s style on afive- point scale in respond to the

follow ing three questions: (1) If therewere a choice between treatments,would this doctor ask you to helpmake the decision?; (2) How oftendoes this doctor make an effort togive you some control over yourtreatment?; (3) How often does thisdoctor ask you to take some of theresponsibility for your treatment?Scoring instructions are provided.

WHERE TO FIND THE ARTICLE:Kaplan, S., Greenfield, S., Gandek,

B., Rogers, W. and Ware, J. (1996).Characteristics of physicians withpart icipatory decision- makingstyles. Annals of Internal Medicine,124, 497- 504.

STYLES 5.0


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Et h i c a l Be h a v i o r s


ADAPATI ON/ COMMENTS: * In herbook, Moral Reasoning and EthicalPractice in Nursing: An IntegrativeReview, w hich w as co- authoredw ith I Ormond, (1988, NLN Pub. No.15- 2250) Ketefian describes a third,"C" column which asks explicitlywhat participants would do. The Ccolumn was found to have lowreliability and is not used *See C.A.Rooks (1994) adaptation of Ketefiantool - EB Code - 002

ANA CODE (EB/ Co d e) 1 .0

RELI ABI LI TY: Cronbach’s coeff i-cient alpha for colum n B ranged .66- .73. Reliability for colum n A scores

is low; it is not recommended for useas a separate scale in hypothesistesting.*

VA LI DI TY: Demonstrated bysignificant correlation with the DITand comparison of results forsamples of professional andtechnical nurses.

BACKGROUND: Case Vignetteswere derived from approximately100 stories from practicing nursesand were assessed by nurseclinicians as representative ofpractice occurrences; these werefurther developed with consultantsand the Code for Nurses.

PURPOSE: To m easure m oralbehavior in nursing practice in twodimensions: (1) professionally idealmor al behavior congruent w ith theCode for Nurses and (2) perceptionof realistically likely moral behaviorin nursing practice.

WHERE TO FIND THE ARTICLE:Ketefian, S. (1982). Tooldevelopment in nursing

construction o f as scale to measuremoral behavior. Journal of NewYork State Nurses Association, 13,13- 19.

DESCRITPTI ON: The too l consistsof six vignettes w ith yes/ noresponses regarding what ideallyshould be done and whatrealistically is likely to be done by

the nurse facing the ethical di lemmaposed in the vignette. The v ignetteswere tested in a study of 43professional nurses and 36 nursetechnicians.

Jud gem ent s Abo utNur sin g Deci sio ns (JAND)


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ANA CODE (EB/ Co d e) 1 .0

RELI ABI LI TY: Internal consistencyreliability for Column B responseswas tested using Cronbach’s

coefficient alpha which showed arange from .66 to .73 acrossdifferent samples of RNs (Ketefiam,1987). For this study, the Column Aresponses showed a coefficientalpha of .70; and for Column Bresponses, .71.

VALIDITY: Content Validity was

established by Ketefian in 1982 and1987, Convergent Validity wasestablished by testing w ith the JANDand the DIT. The Pearson productmoment correlation of Column Bresponse with the DIT was .19, p <.05; shared variances was only3.6%. Construct validity wasestablished by use of the knowngroup’s technique in 1990.

BACKGROUND: The JAND wasadapted for the pur pose of this studyand involved 33 European

American, 26 African American, and17 Filipino nurse subjects. Moralchoice was defined as the responseto Column A of the JAND; moralaction was defined as the responseto Column B of the JAND.

PURPOSE: The purpose of the studywas to identify the moral choicesand actions of foreign- educated &domestic nurses in hypotheticalethical di lemm as.

WHERE TO FIND THE ARTICLE:Rooks, C.A. (1994). Cultural aspectsof mor al actions & moral choices in

nursing. (Dissertation: University of Maryland, Balt imore, graduateschool).

Judgem ents abou tNur sing Dec isio ns(JAND), Ada pt at io ns byRook s (19 94)

DESCRI TPTI ON: The JAND wasadapted by adding one additionalitem to the set of statementsfollowing each of the six vignettes.This item allowed nurse subjects to

write in other possibilities for actionwhich was not listed among thechoices but which the nurse shouldand/ or would perform.


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CARI NG (EB/ Ca r in g) 2 .0

RELI ABI LI TY: Interrater: less an0.75 w ere recategorized into more

appropriated subscales Internalconsistency. Cronbach’s alpha foreach of the seven subscales.Reliability coefficients: ranged for0.66 to 0.90.

VA LI DI TY: Face and contentval idity were established by a panelof four content specialists familiarw ith Watson’s conceptual model .

BA CKGROUND: The tooloperationnalizes the "carative"factors that nurses use as afram ework for the caring process, asproposed by Jean Watson.

PURPOSE: To identify nur sing

behavior s perceived as indicators of caring by patients.

WHERE TO FIND THE ARTICLE:Cronin, S. & Harrison, B. (1988).Importance of nurse caringbehavior s as perceived by patientsafter myocardial infarction. Heart &Lung, 17(4), 374- 380.

DESCRI TPTI ON: The CBA lists 61nursing behaviors ordered in 7subscales that are congruent withJeanWatson’s carative factors.

Watson’s 6th caratives factor wasomitted as a subscale as the authorsassumed that creativeprobl em- solving caring processwas inherent in nursing. Authors didnot give ranges for responses. A 5Point Likert type scale was used.Interviews of 22(17 men and 5women) who had been hospitalizedin the CCU were conducted.

Following the interview, subjectswere asked to complete the CBA.

Car ing Behav i o r sAssessme nt Too l CBA


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WHERE TO FIND THE ARTICLE:Peter, E. & Gallop, R. (1994). The

ethic of care: A comparison ofnursing and medical students,IMAGE, 26(1), 47- 51.

VALI DITY: Not reported

RELIA BILI TY: Interrater reliabil i tybetween 75 to 84% agreement wasestablished with Lyons Coding

Scheme.

PURPOSE: This study w asconducted to answer the followingquestions: 1) To w hat extent are care

considerations reflected in themor al r easoning of female nursingstudents?; 2) Are care considerationsreflected more in the moralreasoning of nursing students (allfemale) than in medical studentsoverall?; 3) Are care considerationsreflected more often in the moral

BACKGROUND: Gill igan’s theory of mor al development and Kolhberg’stheory of moral developmentstructured this study of 199 nursingand medical students who descr ibeda real- l i fe moral d i lemma and

responded to a hypothetical clinicalmoral dilemma. The study included68 female 3rd year nursingstudents, 25 female 3rd & 4th yearmedical students, & 25 male 3rd &4th year medical students.

Recal l Tasks & Cl in ica lDi l em m a Quest ionna i r e

reasoning of female nursingstudents than in female medicalstudents?; 4) Are care considerations

reflected more often in the moralreasoning of female medicalstudents than in male medicalstudents?; and, 5) Are personaldilemmas associated with a higheruse of care considerations thanimpersonal dilemm as?

DESCRI TPTI ON: A modif ied ver-sion of an instrument developed byPratt follow ing Lyons 1982 face- to-face interview. The questionnaireconsists of two par ts: Par t I: the Recal lTasks and Part II: the Clinical

Dilemma. In Part I, personaldilemmas were described. In Par t II,a dilemma is posed. Lyons CodingScheme was chosen to determinethe number of care and justiceconsiderations made in response tothe Recall Task and ClinicalDilemma.



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DESCRI TPTI ON: The CARE- Qconsists of 50 behavioral items

ordered in six sub scales of caring.Using the Car ing Assessment ReportEval uatio n Q- SORT (CARE- Q), 26patients and 26 nurses were askedto assign a degree of impor tance toeach of the 50 nursing caringbehavior s in the CARE- Q.

WHERE TO FIND THE ARTICLE:McDermott Keane, S., Chastain, andB. and Rudisill, K (1987). Caringnur se- patient perceptions,Rehabilitation Nursing, 12(4), 182-188.

VALIDITY: Reported in: Larson, P.(1981). Oncology patients’ andprofessional nurses’ perceptions of

important caring behaviors.Doctoral Dissertation: University of Cal ifornia, San Francisco. UniversityMicrofilms #81- 16511.

RELI ABI LI TY: Reported in: Larson,P. (1981). Oncology patients’ and

professional nurses’ perceptions of important caring behaviors.Doctoral Dissertation: University of Cal ifornia, San Francisco. UniversityMicrofilms #81- 16511.

PURPOSE: To obtain perceptions of impor tant nurse caring behaviors.

BACKGROUND: Not Known.

Car in g Assessme ntRepo r t Eva lu at io n Q-So r t (CARE- Q)



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DESCRI TPTION: The NCQ & PCQ each consists of 61 items scored on a5 point Likert scale ranging from 1 =strongly disagree to 3 = neitheragree/ nor disagree to 5 = strongly

agree.

WHERE TO FIND THE ARTICLE:Valentine, K. (1991). Nurse- patientcaring: Challenging ourconventional w isdom. In D. Gaut andM. Leininger (Eds.). Caring: TheCom passionate Healer , 99- 113 .

NLN Pub: 15- 2401.

VALI DITY: The convergent validityis confirmed by the aggregatemeasures of caring.

REL I ABI L I TY : Alpha inter nalconsistency reliability estimates of .99 each.

PURPOSE: To m easur e thepresence of caring which had

occurred between specificnurse- patient interactions.

BA CKGROUND: For this studyinvolving 91 hysterectomy patients& their nurses, the measurem ent of

congruence occurred within thecontext of a larger study. The lar gerstudy used a naturalistic approach todefine caring and its relationship toproductivity and health outcomevariables. Within the larger studythe conceptual domain of caring wasspecified through the use of multiplemeasures and methods. Based onqualitat ive data from the domainspecification phase, the NCQ & PCQ were developed.

Nur se Car in gQuest io nn ai r e (NCQ)



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RELI ABI LI TY: Test- retestreliabil ity w as established: r = .96, p=.000, rho = .88, p = .000. The alpha

coefficient was .83. Internalconsistency reliability was: Alphacoefficient of .96 for the combinednurses and patient sample.Unpair ed t- test revealed that thegroups were different: t = 3.01, of =539, p = .003.

VALI DITY: Construct validity of thecontrasted groups nursing staff (n=

278) and patient (n= 263) wasestablished.

BACKGROUND: Nursing caring andhuman caring have been studiedfrom philosophical and ethicalperspectives. The transpersonalcare theory was developed byWatson (1988) based on this idea.

Leininger (1980) described caring ashuman acts and processes that areconcerned w ith helping others meetthe needs of those requir ing care.

PURPOSE: To measure caringbehaviors.

WHERE TO FIND THE ARTICLE:Wolf, Z., Giardono. E., Osborne, P.and Ambrose, M. (1994).Dimensions of nurse caring. IMAGE:Journal of Nursing Scholarship, 26(2), 107- 111.

DESCRITPTI ON: The Car ing

Behavior s Inventory is a 43- iteminstrument. A four point Liker t scaleis used to elicit responses from (1)strongly disagree to (4) stronglyagree on each item.

Car ing Behav io r sInv en to r y (CBI )



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DESCRI TPTI ON: The coding stepsare: identifying the dilemma

components, identifying theconsiderations, and categorizingconsiderations. The coding schemewas then used in a study of moraldilemmas reported by a sample of 36 individuals (18 males & 18females).

WHERE TO FIND THE ARTICLE:Lyons, N. (1982). Conceptions of self

and morality and modes of moralchoice: identify ing justice and care in judgments of actual moraldi lemmas. Unpubl ished doctoraldissertation. Harvard University,Cambridge.


RELI ABI LI TY: Not provided.

PURPOSE: Lyon’s Coding Schemetests Gilligans’ hypotheses that

justice and car e are distinct modes of moral judgment & gender related.The coding scheme also makes itpossible to examine the relationshipbetween modes of mor al judgment& modes of self- definition.

BA CKGROUND: The manual isdesigned for researchers interestedin analyzing moral dilemma data todetermine how a person usesconsiderations of rights (justice) orresponse (care). The coding methoddistinguishes considerations of

justice and considerations of care inconstruction, resolution andevaluation of moral confl ict andchoice.

Car e an d Just i ceI n t e r v i e w



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REL I ABI L I TY : No infor m ationprovided.

VAL I DITY: No inform ationprovided.

BACKGROUND: This questionnaireconcerns how one copes w ith stressand tension, and how one handlesstressful situations.

PURPOSE: To assess frequency andhelpfulness of specified copingstrategies.

WHERE TO FIND THE ARTICLE:Jalowiec, A. (1989). Revision &Testing of the Jalow iec Coping Scale.Loyola University o f Chicago.

DESCRI TPTION: Sixty itemobjective questionnaires list sixtyspecific coping behaviors.Researcher specifies stressorunder investigation by fill ing in theblank in introductory paragraph.

Participants indicates responses toeach item on two Likert scales, firstidentifying how often they have usedthe strategy, and second, indicatinghow helpful it has been to them.

Jal ow iec Cop in g Scal e

COPI NG (EB/ Ca r i ng) 2 .0


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COPI NG (EB/ CP) 3 .0

DESCRI TPTI O N: Sev enty tw ostatements depicting various waysof dealing with terminal illnessesare rated by the respondents on a 5

item Likert form at ranging from "notat all" to "very much". The CSI haseight components: problem solv ing,cognitive restructuring, expressemotions, social support, problemavoidance, wishful thinking, andself- criticism and social w ithdraw al.The tool was used in a study of 44spouses of patients admitted toHospice. (Willert, M., Beckwith, B.,

Holm,J. and Beckwith , S. (1995). Apreliminary study of the impact of terminal illness of spouses: socialsupport and coping strategies. TheHospice Jour nal , 10(4), 35- 48.).

WHERE TO FIND THE ARTICLE:Tobin, D., Hol royd, K., Reym olds, R.& Wigal, J. (1989). The hier archical

factor structure of the CopingStrategies Inventory. CognitiveTherapy & Research, 13(4): 343-361.

VAL I DITY: No inform ationprovided.

RELI ABI LI TY: The alphacoefficients for the pr imary factors of the CSI ranged form .71 to .94.Tested- retested rel iabili tycoefficients ranged for .67 to .83.

PURPOSE: The CSI assesses theextent to which a person uses certaincoping thoughts and behaviors inresponse to a par ticular stress.

BACKGROUND: The format of theCSI adapts 49 item s from the Ways of

Coping checklist (Falkman &Lazaras, 1980) sixty items weregenerated by the authors.

Copi ng Sty les Inven tor y(CSI)


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EMPATHY (EB/ EM) 4 .0

RELI ABI LI TY: Non- reactivity of theempathy categories is demonstrated when no significant differences

result between subjects’ initialscores and scores 6 and 16 weekslater.

VALIDITY: Content validity wasestablished with input from healthprofessional & through comparisonof the content of actual nurse -patient interactions with BTISsituations. Moderate support for

construct val idity w as demonstratedwhen the "content" categorycorr elated positively (r= .32 - .51)with five tests. Evidence forcriterion- related validity resultedwhen positive correlations (p< .05)were found between empathycomponents of the BTIS, and peer &superv isor ratings of nurses.


PURPOSE: The BTIS measur esnurse- expressed empathy andconsists of situations involvingpatients who have been role- playedand recorded on videotape.

WHERE TO FIND THE ARTICLE:Olson, J. (1995). Relationshipsbetween nurse- expressed empa-

thy, patient- perceived empathy andpatient distress. IMAGE, 27(4), 317-322.

DESCRITPTI ON: The BTIS providesa standardized measure of verbalbehavior in response to a widevariety of interpersonal situationscommonly faced by health

professionals. It contains 13 patientsituations and requires 15 minutesfor completion. Scoring of theaudiotaped responses is based onBTIS scor ing guidelines (See Gerar d,B. & Buzzell, M (1980). User’s manual for the behavioral test of interpesonal skills for healthprocessionals. Reston, VA: Reston.)The subject is seated in front o f a TV

and as the TV plays each of therecorded situations; the subjectmakes averbal response to the situation asthough interacting with a realperson. The responses areaudiotape and then scored.

Behav io r Test o f I n te rpe r sona l Sk i l l s(BTIS)


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RELI AB I L I TY : Has shown h ighlevels of reliability (r = .64 - .92).

VA LI DI TY: Nine studies havedemonstrated internal reliabil i tycoefficients consistently exceedingintercorrelations among the BLRIsubscales.

BA CKGROUND: See Bar rett-Lennard, G. (1981). The empathycycle: Refinement of a nuclearconcept. Journal of CounselingPsychology, 28(2), 99- 91.

PURPOSE: Measur es patient-perceived empathy.

WHERE TO FIND THE ARTICLE:Olson, J. (1995). Relationshipsbetween nurse- expressed empa-thy, patient- perceived empathy andpatient distress. IMAGE, 27(4), 317-322.

DESCRI TPTI ON: The BLRI can becompleted in 5 m inutes. Consists of 16 statements of either an em pathic

or non- empathic clinician. Scoresrange from 48 to + 48.

Ba r r e t- Le nn a r dRe la t i onsh ip Inv en to r y(BLRI)


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DESCRI TPTI ON: The ISSB is a 40item scale rated on a 5 point likertscale ranging from 1 (not at all) to 5(about every day).

WHERE TO FIND THE ARTICLE:Barrera, M., Sandler, I and Ramsey,T. (1981). Prel iminary developmentof a scale of social supports ofcollege students. American Journalof Community Psychology, 9 (4),

435- 447.

VA LI DI TY: Indices of socialnetwork size proved to be significantcorrelates of the ISSB. The ISSB ispositively cor related with the Family

Environment Scale (FES) Cohesionsubscale.

RELI ABI LI TY: Test- retestcorrelation coefficients forindividual items ranged from 0.441to 0.912. r (69) = 0.882, p< 0.001.Internal consistency (alpha) wasfirst administration = 0.926; second= 0.940.

PURPOSE: The ISSB was developedto evaluate how respondentsreported the frequency with whichthey were the recipients ofsupportive actions.

BACKGROUND: Grow ing researchinterest in social supportunderscores the need for reliableand valid measures of the concept. Itis argued that m easures that assesswhat individuals actually do by wayof providing support make unique

contributions to our understandingof natural helping processes. SeeBarrera, M., Sandler, I.N. & Ramsey,T.B. (1981). Preliminarydevelopment of a scale of socialsupport: Studies in college students.American Journal of CommunityPsychology, 9(4), 435- 447.

I nven to r y o f Soc ia l l ySuppo r t i ve Behav io r s(ISSB)


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BACKGROUND: The measure wasdeveloped by Carkhuff inconjunction with his work inoperationalizing conceptualcomponents of helping relation-ships.

PURPOSE: To measure em pathy asa component of a helpingrelationship.

WHERE TO FIND THE ARTICLE:Henderson, M. (1987). Effect of empathy training on moralreasoning and empathic respondingof nursing students. Doctoral

dissertation: Auburn University.

DESCRI TPTION: EUIPASM is afive- point scale of em pathicunderstanding reflected in thecounselor’s response to helpee orclient statements. A level - 1response communicates noawareness of the helpee’s feelings.A level- 2 r esponse show sawareness of obvious feelingsexpressed by the helpee. A level - 3response is "accurate empathy" inwhich the expressions of the first

person are interchangeable withthose of the seemed person in thatthey express essentially the sameaffect & meaning. Level- 3 isconsidered the minimal level of empathy necessary for therapeuticchange to occur . A level 4 r esponsecommunicates accurate empathyplus a deeper level of feeling. Alevel- 5 response communicates full

awareness of the helpee’sexperience, comprehensive under -standing of that experiental reality,and total acceptance of the person.

Em path ic Under stand ing i nIn te r per sona l Pr ocesses(EUIPASM)


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HUMANISTI C (EB/ HUM) 5 .0

DESCRI TPTION: A list of 192

statements describing patient andnursing staff behaviors that occur onnursing units was initiallydeveloped. The scale, consist of 163items, was developed and scored ina 5 point Likert form at ranging from1 to 5. The scale w as reduced to 70items measuring four dimensions:shared decision making andresponsibil ity, hol istic selves, statusequality, and empathy.

WHERE TO FIND THE ARTICLE:Fenton, M. (1986). Development of the scale of humanistic nursingbehav ior s. Nursing Research, 36(2),82- 87.

VALI DITY: Construct val idity wasestablished by a purposive samplingof 42 nurses. For the 70 item scale:Cr iter ion- Related Val idi ty: Sig. F (


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RECI PROCI TY (EB/ R) 6 .0

RELI AB I L I TY : Al l facto r s wereshow n to be reliable by Cronbach’salpha.

VALIDITY: Content validity wasestablished using exploratory andconfirmatory factor analysis. Initialconstruct validity was establishedusing exploratory factor analysis.The casual m odeling appr oach wasused to establish convergent anddiscrim inate validity.

BA CKGROUND: To devel op theinitial item pool, an extensive reviewof the literature was conducted. Inaddition, interview s were conductedwith 12 adults, the children orin- laws of elderly parents, in theirhome environments. The interview swere transcribed and analyzed. Onehundred nine items were developedto reflect exchanges within the

caregiver context and/ or am ongfamily members directly orindirectly involved in caregiving.

PURPOSE: Measures the coll ectiveexpression of exchanges andbalance in transactions between the

caregiver and an elderly patient orparent- in- law, as well as within thefamily network.

WHERE TO FIND THE ARTICLE:Carruth, A. (1996). Developmentand testing of the CaregiverReciprocity Scale. NursingResearch, 45(2), 92- 97.

DESCRI TPTION: The CRS isconstructed as a five point Likertformat ranging from 1 (stronglydisagree) to five (strongly agree).Caregiver Information Sheet is usedto collect data pertaining todemographic data, illnesses/ condi-tions, and exchanges given to and

received from care reciprocity.

Car eg ive r Recip r oc i t ySca l e (CRS)


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SELF- DETERMI NI NG (EB/ SD) 7 .0

DESCRI TPTION: The PEA scaleconsists of 31 short phrasedquestions (8 factors) scored on a 4point Likert Scale r anging from 1 =not at all true to 4 = completely true.

Scores range from 31 - 124 for totalscale.

WHERE TO FIND THE ARTICLE:Hertz, J. (1991). The Perceivedenactment of autonomy scale:Measuring the Potential for

Self- Car e Action in the Elder ly .Dissertation: University of Texas atAustin.

VALIDITY: Content & face validity

established by panel of exper ts andthe pilot survey. Construct validityobtained by testing theoreticalrelationships between PEA &perceived control (r = .52, p=


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SELF- DETERMI NI NG (EB/ SD) 7 .0

RELI ABI LI TY: Inter - itemcor rela tion coefficients ranged from0.39 to 0.85. The averagecor rela tion between items was 0.64.Item correlation with the total testscore ranged form 0.69 to 0.89.Cronbach’s coefficient alpha was0.96.

VALIDITY: Uncertain. Examinationof individual item score form CISindicated that, in some cases, a

different standard of competencewas applied in routine clinicalpractice depending upon thepatient’s treatment decision.

BACKGROUND: The instrumentwas developed from initial work onthe competency of patients toconsent to hospital admission. Theoriginal formulation was revised

and extended into the CIS for usew ith psychiatric patients referred forECT.

PURPOSE: To compare physicians’ judgments of patient competency inroutine clinical practice with findingsfrom a structured clinical interview .

WHERE TO FIND THE ARTICLE:1) Bean, G., Nishisato, S., Rector, N.and Glancy, G. (1996). The assessment of competence to make atreatm ent decision: An empir icalappr oach. Canadian Journal o fPsychiatry, 41, 85- 92.

2) Bean, G., Nishisato, S.,Rector, N. and Glancy, G. (1994).The psychom etric proper ties of thecompetency interview schedule.Canadian Jour nal of Psychiatr y,39, 368- 376.

DESCRI TPTI ON: The CIS is afif teen- item instrum ent, w hichincorporates 4 major elements to beconsidered when evaluatingcompetency: Ability to make a firmtreatment decision; understandingof treatment information; ability to

make a choice based upon rationalreasons; and, appreciation of thenature of the situation. Each elementis assessed by a series of questionsrated on a 7 point Likert scaleranging: 1- 3 = adequate, 4 =mar ginal, 5- 7 = inadequate.

Com petency In te r v i ewSche du l e (CIS)


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BA CKGROUND: The inter viewschedule was made available to theresearcher by Dr. Carol Gill igan. Theresearcher revised the interviewschedule and used a coding schemedeveloped by the researcher.

PURPOSE: To explor e the behaviorof nurses when faced with clinicalsituations which required them tochoose one or m ore behaviors on acontinuum of total honesty (fullyinforming clients) to fully deceivingclients (upholding the physician’splan).

WHERE TO FIND THE ARTICLE:Shipps, T.B. (1988). Truth telling

behav ior of nurses: what nurses’ dowhen physicians deceive clients.Disser tation: Boston Univer sity.

DESCRI TPTION: The interv iewasks the respondent to recall areal- life dilemma from experience.The interview presents fourhypothetical dilemmas: Placebo,Informed Consent, Negligence andWithheld Information. Truthtellingdilemmas were evaluated using theinterview schedule.

TRUTHTELLI NG (EB/ TR) 8 .0

Tr u th tel l i ng I n te r v iewSchedule


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DESCRI T PTI O N: Unst ruc tu red ,open - ended questions. Subjectswere asked to describe examples of teaching behaviors they

encountered as nursing students,which they considered to beunethical. The behav ior s could occurin classroo m, non- classroo m, orclinical settings.

WHERE TO FIND THE ARTICLE:Theis, E. C. (1998). Nursing

studentsÕ perspectives of unethicalteaching behaviors. Journal of Nursing Education, 27(3), 102- 106.



PURPOSE: To identify nur singstudents’ perceptions of unethicalteaching behavior s.

BACKGROUND: Conceptuallybased on statements from the AAUPStatement on Professional Ethicswhich deals with the professor’sethical obl igations as a teacher.

UNETHICAL (EB/ UETH) 9 .0

Uneth ica l Teachi ngBehav io r s Too l


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Et h i c a l Pr o b l e m s


BA CKGROUND: The EIS w asdeveloped from a 32- item scaleused in a 1994 study of Marylandnurses. The items of the originalscale w ere derived from the litera-ture & focus groups interviews of

practicing nurses.

PURPOSE: To measur e thefrequency by which ethical issues

occur in nursing.

WHERE TO FIND THE ARTICLE:Fry, S. T. & Duffy, M. E. (2001, inpress). Development andpsychometric evaluation of theEthical Issue Scale (EIS). Image:Journal of Nursing Scholar ship.

DESCRI TPTION: Thirty tw o (32)item scale that represents threeconceptual categories of ethicalissues: end- of- life treatm ents(n=13), patient care (n=14), humanr ights (n=5).

Eth i cal I ssue Scal e (EI S)

REL I ABI L I TY : End - of - l i fetreatment issues scale =. 86

(Cronbach’s alpha coefficient);patient care issues scale = .84;human rights scale = .74. Can beused as independent scales.

VALIDITY: Confirmatory principalcomponents analysis of all itemsyielded a 3- component solutionaccounting for a total of 42.4% of

init ially extracted commonvariance.

ETHICAL I SSUES 1 .0


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ETHICAL ISSUES 1.0

M o r a l Pr o b l e m s

BACKGROUND: There is little to noexisting research about actualmoral dilemmas faced by nurses.Those studies that have been donehave focused on m edical ethics, notspecificall y nur sing ethics. Thisdeficit in research was discovered asthe Netherlands worked to makenursing a more v iable and respectedprofession.

PURPOSE: To answer the question:

“What issues are experienced asmoral problems by nurses indifferent settings and healthcareinstitutions and how serious arethese mor al problems for them?”

WHERE TO FIND THE ARTICLE:Arend, A. & Hurk, C. (1999). Moralproblems among Dutch nurses: A

survey. Nursing Ethics , 6(6), 468-82.

DESCRI TPTI ON: It is aquestionnaire that includes severaldemographic questions and otherinformation about the respondent.The next section contains six types of problems that are graded on

ser iousness on a scale of 1 to 10 . Thelast two sections consist of a list of situations; first the respondents areasked if these ate situations that theyrecognize as mora l dilemmas. Theyare then asked to identify how oftenthey have exper ienced them.


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ETHICAL I SSUES 1 .0

I CU an d Eth i cs

RELI ABI LI TY: Slightly skewed

VAL I DITY: Before being used thisquestionnaire was pilot tested andthen put before a review boardcontaining nurse ethicists, researchspecial ists and doctoral and m astersstudents.

BACKGROUND: Most of the studiesthat have been done on assisted

suicide in a hospital setting havefocused on the physicians role, notthat of the nurse.

PURPOSE: To learn about beliefsand ethical concerns of nursescar ing for dying patients in intensivecare uni ts.

WHERE TO FIND THE ARTICLE:Puntillo, K., Benner, P., Drought, T.,Drew, B., Stotts, N., Stannard, D.,Rushton, C., Scanlon, C., & White, S.(2001). End- of- life issues inintensive care units: A nationalrandom survey nurses’ knowledgeand beliefs. Amer ican Jour nal of Critical Care, 10(4), 216- 29.

DESCRITPTI ON: This tool is aquestionnaire that contains three

sections. The fir st is a series ofclinical scenarios; the respondentsare asked to identify the action takenby the nurse using one of fiveresponses. They are also asked toidentify whether or not they agreedw ith the action taken. A Likert scaleis used in the second section toevaluate knowledge and opinionabout pain management andend- of- l i fe practices. The f inalsection asks for demographics aboutthe respondent. Over all , thequestionnair e contains 61 questionsas well as space for additionalcomments.


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BACKGROUND: The study was areplication and extension of Emanual’s 1994 survey of NewEngland oncology physicians. Thestudy was conducted to providereliable and val id empir ical data toNew England ONS memberspractices of assisted suicide andpatient- r equested euthanasia.Analysis focused on nurses’practices, a comparison to a likesample of oncology physicians, andthe nurses’ utilization of thehealth- care team.

PURPOSE: To determine oncologynurses’ practices and attitudes

toward patient requestedeuthanasia and assisted suicide.

WHERE TO FIND THE ARTICLE:Matzo, M. and Emanual, E. (1997).Oncology nurses’ practices of

assisted suicide andpatient- requested euthanasia.Oncology Nurses’ Forum, 24 (10),1725- 1732.

DESCRI TPTION: Questionnaire of 63 questions. Twenty- two questionsinvolved four clinical vignettesregarding personal experiences

with assisted and patient requestedeuthanasia in clinical pr actice.

EUTHANASI A/ ASSI STED SUI CI DE (EP/ EAS) 2 .0Assisted Sui cid e &

Pat i ent Requ estedEuth an asia Too l


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RELI ABI LI TY: Not prov ided.

VALI DITY: Content val idi ty wasassessed by a panel of exper ts.

BACKGROUND: The individual’sright to refuse l ife- prol ongingtreatments was the impetus for theinitiation of the Patient Self-Determination Act (PSDA), whichbecame effective in 1992. Although

living wills have been in existencefor year s, it has only been since thePSDA legislation that most nurseshave had to assume a m ajor r ole incollecting information andoperationalizing advancedirectives.

PURPOSE: To determine nurses’experience, confidence in

counseling, and knowledge of statelaw concerning advance directives(AD).

WHERE TO FIND THE ARTICLE:Bar ta, K. and Neighbors, M. (1993).

Nurses’ knowledge of and role inpatients’ end- of- l i fe decision-making. Trends in Health Care, Law ,& Ethics, 8 (4), 50- 52.

DESCRI TPTION: Three page, four -part questionnaire developed fromliterature & federal / state(Arkansas) legislation. Par t I: nur se’sexperience with Ads; Part II:True/ False; nur se’s know ledge o f state law content on AD; Part III:nurse’s inclusion of ANA guidelinesin nur sing assessments; & Par t IV: 4point Likert scale ranging from 1 =not at all confident to 4 = veryconfident; nurse’s perception ofself- confidence regardingcounseling patients/ families about

AD.

LI FE SUPPORT (EP/ LS) 3 .0

Advance Di r ect i v eQues t ionna i re


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REL I ABI L I TY : Consistency of responses ranged from 0.772 to0.947; average consistency was0.85.

VA LI DI TY: Covar iation 0.77.Internal consistency for the singlefactor solution was estimated at0.94. The nurses and one doctoral lyprepared nurse researcher wereasked to act as expert judges andrev iew the revised vignettes for faceval idity and content sampling.

BACKGROUND: The Patient Self-Determination Act, effective sinceDecember, 1991, has changed theimportance of introducing lifesuppor t options to patients. Nurses,as patient advocates, are in theforefront of presenting life support

information.

PURPOSE: This tool is designed togently introduce the topic of lifesupport decision making andoptions to patients. If educatespatients and their famil ies about thear ray of life support choices beyondthe NR an mechanical ventilationoptions.

WHERE TO FIND THE ARTICLE:Beland, D. and Froman, R. (1995).Prelim inary validation of a m easure

of life support preferences. IMAGE,27 (4), 307- 310.

DESCRI TPTION: The LSPQ is arapid, easy to use instrument thatprovides illustrations of life supportchoices to enhance discussion of l ifesupport measures with patients. Itconsists of six vignettes with two

choices follow ing each vignette.


L i fe Supp or t Pr e fer encesQuest io nn ai r e (LSPQ)


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RELI ABI LI TY: Not prov ided.


BACKGROUND: The PSDA becameeffective in December 1991 andmandates that patients be giveninformation about legal r ightsregarding living wills and durablepowers of attorney for health care.This study investigated the impact of

this law on hospitals, medicalpersonnel and patients. Despiterecognition of the importance of implem entation of the PSDA, little isknown about what institutions areactually doing.

PURPOSE: Measures differ entaspects of the PSDA: (a) hospital

personnel’s development ofawareness and information-gathering procedures, (b) thehospital’s present procedures forimplementing the law; (c) the

WHERE TO FIND THE ARTICLE:Park, D., Eaton, R., Larson, E., andPalmer, H. (1994). Implementation

and impact of the patient self- deter-mination act. Southern MedicalJournal, 87 (10), 971- 977.

DESCRI TPTION: The survey instru-ment consisted of 60 questions thatwere printed in a booklet and mailedto hospital adm inistra tors. All but 17items were forced choice (true or

false).


Sur vey o f Im p lem en ta ti onan d Im pa ct o f (PSDA)

individual respondent’s personalknow ledge and interpr etation of the

law; (d) the perceived effect of thePSDA with respect to completion of advance directives; and, (e) hospitalpersonnel’s attitudes and opinionsabout the law .


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RELIA BILI TY: Test- rest reliabili tywas r=. 86 (P


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RELIABILITY: Researchers claimthat "the BQ has acceptablerel iability "Test- retest reliability .90Internal consistency of 0.89 for theentire scale and 0.52 to 0.91 for thesub scales.

VALI DITY: Researchers claim that" the BQ has acceptable valid ity" Nofurther information is provided.

BACKGROUND: The purpose of thisstudy was to examine concernsabout report ing pain and usinganalgesics in a sample of primarycare givers of cancer patientsreceiving care from a hospiceprogram.

PURPOSE: Measures eight commonbarriers to adequate managementof cancer pain.

WHERE TO FIND THE ARTICLE:Berry, P. and Ward, S. (1995).Barriers to pain management inhospice: a study of familycaregivers. The Hospice Journal, 10(4), 19- 33.

DESCRITPTI ON: The BQ is a 27 itemself- report instrument diagnosed tomeasure the extent to w hich personshave eight concerns about repor tingpain and using analgesics. The 27

items are scored on a 6 point Likerttypes scale r anging from 0 = do notagree at all to 5 = agree very m uch.The eight concerns are fear o f opiodside effects fear of addiction. Thebelief that increasing pain signifiesdisease progression, fear ofinjections, concern about drugtolerant, believing "good" patientsdo not complain about pain. The

belief that report ing pain maydistract the physician fr om treatingor curing the Cancer and fatalism, orbelieving pain is inevitable withcancer and that is co not be relieved.

PAIN (EP/ P) 5 .0

The Ba r r i e r sQuest ionn a i r e (BQ)


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RELI ABI LI TY: Internal consistencyof the 15 i tem pr actice scale and the11 item attitudinal scale was 0.76

and 0.49 respectively. Item totalcorrelation were recalculated foreach scale and items with the low estsquared multiple cor relation’s weredeleted. The revised 12 itempractice scale and 8 item attitudescale had a CronbachÕs alpha of 0.78 (standardized item alpha of 0.82) and 0.63 (standardized itemalpha of 0.64) r espectively.

VALIDITY: Internal consistency of the 15 item practice scale and the 11item attitudinal scale was 0.76 and0.49 respectively. Item totalcorrelation were recalculated foreach scale and items with the low estsquared multiple cor relation’s weredeleted. The revised 12 itempractice scale and 8 item attitude

scale had a CronbachÕs alpha of 0.78 (standardized item alpha of 0.82) and 0.63 (standardized itemalpha of 0.64) r espectively.

BACKGROUND: Specific aims: todescribe nurses’ knowledge,practice and attitudes about the use

PURPOSE: Identifies issues relatedto the use of physical restraints w itholder patients in hospital settings.

WHERE TO FIND THE ARTICLE:Matthiesen, V., Lamb, K., McCann, J.,Holl inger - Smith, L. and Walton , J.(1996). Hospital nur ses’ view s aboutphysical restraint use with olderpatients. Journal of GerontologicalNursing, 22 (6), 8- 16.

PHYSICAL RESTRAI NT USE (EP/ PR) 6 .0

Revi sed Rest ra in tQues t ionna i re

of physical restraints in thispopulation; and, to determinewhether demographic characteris-

tics or the hospital practice settinginfluence nurses’ knowledge,practice, attitudes regarding the useof physical restraints with olderpatients. Cross- sectional descrip-tive study.

DESCRI TPTI ON: 20 item true/ falsescale with 3 subscales: knowledgeabout physical restraints, clinicalpractice issues related to physicalrestraints, attitudes toward usingphysical restraints.


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PHYSI CAL RESTRAI NT USE (EP/ PR) 6 .0

Know led ge and Eth ics o f Res t ra in t

RELI ABI LI TY: Tw enty- threenurses tested the questions forrelevance, reliability and repetition.

VALI DITY: The shor tcomings of thisquestionnaire are that it only dealswith physical restraints anddem entia patien ts. Ther e is nomention of chemical restraints or of non- dementia elder ly. There is alsono way to know for sure if what thenurses answered is what theyactually practice.

BACKGROUND: The number of dementia patients in Israel is on therise, as the population grow s older .This increase puts a strain on nurseswho are not used to dealing withsuch patients. How ever , there hasbeen little to no research done onphysical restra int use w ith dementiapatients.

PURPOSE: To compare the ethicaldilemm as faced by nur ses in hospi-tals and psychogeriatric wards of nursing homes in using physicalrestraints on dementia patients.Also, to obtain information about theknow ledge of nurses about patients’

WHERE TO FIND THE ARTICLE:Weiner , C., Tabak, N. & Bergman, R.(2003). The use of phy sicalrestraints for patients suffer ing fromdem entia. Nursing Ethics, 10(5),512- 25.

DESCRITPTI ON: This is a three-par t questionnair e. The first par t isdemographic questions, including

level of education and geriatrictrain ing. The second par t consists of twenty- five items that test knowl -edge about the use of restraints. Ananswer of “ yes” r eceives a score of one, an answer of “no’ or “don’tknow ” receives a score of zero. Thethird section is eighteen real - lifeepisodes devised by nurses in bothsettings being tested. The scenar ios

are organized into three categories:to protect the patient, to protect theinstitution, and to protect otherpatients at the institution. The sce-nar ios are rated on a scale of one tofour as to how appropriate aresponse the nurse feels thatrestraints are.

r ights law s, the Israel i Code of Ethicsand guidelines on restraint.


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BACKGROUND: Data for the Qual ityof Life Study w ere obtained throughpersonal interviews with 2,164persons, 18 years & over living inhouseholds in the U.S., exclusive of households on militaryreservations, in 1971.

PURPOSE: To measur erespondents’ perception to theirsolid- psychological condition, theirneeds & expectations for life, & thedegree to which these needs aresatisfied.

WHERE TO FIND THE ARTICLE:Campbell A., Converse., P.E., &

Rodgers, W.L. (1975). The Quali ty of American Life. The Institute forSocial Research, Survey ResearchCenter, University of Michigan.

D E S C R I T P T I O N : Se c t i o n a lQuestionnaire covering: City andneighborhood; housing; country;adjectives to descr ibe l ife; education;

employment; organizations, sparetime and income; friendships;satisfaction with life; feelings aboutown life; background information;and observation of the respondentby the interview er.

QUALI TY OF LI FE (EP/ QOL) 7 .0

Qua l i t y o f Li feQues t ionna i re


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RELI AB I LI TY: Test- retest: .97 foranalogue scale and .72 for six pointscale CronbachÕs coefficient alpha:.80 for total instrument; .90 forsymptom distress and .70 foractivities of daily liv ing.

VALI DITY:Indirectly evaluated dueto subjective feelings and difficulty ininterpreting their depth; face val idity:includes the items considered by theinvestigators and previous studies;

content val id ity establ ished byinclusion of items identified byinvestigators and supported byinterview s; construct validity needsto be confirmed through futurestudies.

BACKGROUND: The need for amethod by which to measure the

quality of survival (QOL) is nowincreasingly recognized. Thisreflects a change on the part of members of the health care team asthe value of cancer therapy is now

judged not only on the dur ation of surv ival but also on its quality.

PURPOSE: To measure the qualityof survival follow ing treatment of a

life threating illness. Specificallymeasures self- assessment of l ifechanges that have resulted from thepresence & treatment of malignantdisease.

WHERE TO FIND THE ARTICLE:Holmes, S. and Dickerson, J (1987).The quality of life: design andevaluation of a self- assessment

instrument for use with cancerpatients. International Journal of Nursing Studies, 24, (1), 15- 24.

DESCRI TPTION: The questionnairecontains 11 symptoms statementsand 15 ADLs statements ar ranged ina linear analogue scale form at.

QUALI TY OF LI FE (EP/ QOL) 7 .0Qual i ty o f L i fe Se l f -Assessment - CancerPat ien ts


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RELIABI LITY: no rel iabi l ity datareported.

VALI DITY: factor analysis suggest-ed construct val idity .

BACKGROUND: Developed to iden-tify the (a) terms that adults withchronic illnesses use to describetheir quality of l i fe (b) importantdomains that constitute QOL, and (c)

self- perceived QOL by persons withchronic illness.

PURPOSE: Measures self- repor tedQOL.

WHERE TO FIND THE ARTICLE:Burckhardt, C., Woods, S. Schul tz, A.

and Ziebarth, D. (1989). Quality of life of adults with chronic illness: apsychometric study. Research inNursing and Health, 12, 347- 354.

DESCRI TPTI ON: 15 i tem domainspecific instrument rated on a 7 pointLikert scale ranging from 1 = unhap-py and terrible to 7 = delighted.

Domains: material comforts, health,relationships with relatives, having& rearing children, close partner,close friends, helping/ encouragingothers, organizations, learning,understanding self, w ork, express-ing self creatively, socializing withothers, reading, music or watchingentertainment, and participating inactive r ecreation.


Qua l i t y o f L i f e - Adu l t sw i th Chr on ic I l l nesses 3


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RELIABILITY: No informationprovided.

VALI DI TY: No inform ationprovided.

BACKGROUND: The treatment of cancer has resulted in an increasedawareness of the need to evaluateoutcome not only in terms of care &surv ival but also in terms of qualityof life.

PURPOSE: Measures qual ity of lifeboth in objective and subjectiveterm s of cancer patients.

WHERE TO FIND THE ARTICLE:Danoff, B., Kramer, S., Irw in, P. andGottlieb, A. (1983). Assessment of the quality of l i fe in long- term

survivors after definit iveradiotherapy. American Journal of Clinical Oncology, 6, 339- 345.

DESCRI TPTI ON: An interviewquestionnaire was developed which

contained both objective as well assubjective measures of quality of life. The questionnaire consists of four sections: descriptivedemographic items, medical data,perceptual quality of life questionsand health status questions. Thepatient w as asked to rate his feelingsabout each of the 41 QOL items on a7- point scale that ranged from 1 =

delighted to 7 = terrible. Theperceptual quality of life questionswere selected from a series of national surveys on quality of life byAndrews & Withey (1976).

QUALI TY OF LI FE (EP/ QOL) 7 .0Per cep tua l Qua l i t y o f Li f e I n te rv iew / Ques t ionna i re


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RELI ABI LI TY: Reliability coefficientalpha was 0.90 and the

standardized- item alpha w as 0.91.

VALIDITY: Content vadity wasassessed by interviews of patientsw ith l i fe - threatening i l lness.Discr immant Validity established bydemonstrated ability to distinguishbetween situation in which recoveryis likely verses not likely. Two factorswere confirmed by factor analysis.Postine correlation w ith the SicknessImpact Profile, r= 0.89.

BACKGROUND: Social dependencewas defined in terms of threecapacities identified as necessaryfor the perform ance of an adult role:everyday self- care competence,mobility competence, and social

competence.

PURPOSE: Measures extent towhich patients require assistance

from others in performing activitiesor roles that adults ordinarily canperform by themselves.

WHERE TO FIND THE ARTICLE:Benoliel, J., McCrokle, R. and Young,K. (1980). Development of a SocialDependency Scale. Research inNursing and Health, 3, 3- 10.

DESCRITPTI ON: The instrum entconsists of 12, 6 - point scales (4 foreach capacity). Scores arecomputed for each capacity (range4- 24) and for all three capacitiestogether (range 12- 72). Higherscores representing a great deal of social dependency and lowerscores representing little social

dependency.


Enfo r ced Socia lDep en den cy Sca l e (ESDS)


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RELIABILITY: Interrater andintrarater reliability was examined

using repeated measures ANOVA;inter r ater r eliability w as low er thanintra rater reliabil i ty. Internalconsistency: over all a lpha w as 0.80.

VALI DITY: Construct validity w ereexamined using a t- - test for the twoa priori hypotheses: p = 0.04:Concurrent validity was correlatedto be statisticall y significant with the

Spitzer index.

BACKGROUND: Quality of lifeassessment has been suggested asthe best method for determining theeffectiveness of var ious approachesto palliative care.

PURPOSE: Measures quality of l ife.

WHERE TO FIND THE ARTICLE:Sterkenburg, C., King, B., and

Woodward, C. (1996). A reliabilityand validity study of the McMasterQuality of Life Scale (MQLS) for apalliative population. Journal of Pallia tive Care, 12 (1), 18- 25.

DESCRITPTI ON: The McMasterQuality of Life Scale taps fourdimensions of quality of life:physical, emotional, social andspiritual. It contains 32 items ratedon a 7 point numerical scale rangingfrom negative descrip tors to positivedescriptors.


McMaste r Qua l i t y o f L i feScale(MQLS)


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PURPOSE: To measure outcomes of contact w ith the health care deliver ysystem; also, to measure healthstatus based on functioning.

RELI ABI LI TY: The SIP’S test- retestreliability was reported by Pollardand associates (1976). After a 24-

hour interval, the correlationbetween the test- retest situationwas .88 (p< .01). Several othercombinations of teat- retestprocedures were undertaken (e.g.,long form versus short form;interviews administered versusself- administered); all combinationsof these different conditions hadcor rela tions that w ere significant atp< .01. In addition, test- retestrel iability correlation for each of the12 dimensions are of the samemagnitude of significance.

VALIDITY: The item pool wasselected from responses by "over1000" persons who mentioned1.250 specific dysfunctions of

behavioral changes that wererelated to heal th (Gilson et al., 1975.p. 1307). By various grouping andtesting procedures, this list wasreduced to the current number of items. Various experiments relatedto the validity of the instrument werereported by Bergner, Bobbitt,

BACKGROUND: Although the needfor a method of measuring thequality of life of patients undergoingtherapy for cancer has been widelyrecognized, no adequatelyevaluated or feasible method hasbeen established. Thus the SIP wasdeveloped as an outcome measure

of overal l heal th as a consequenceof the use of the health- caredeliver y system.


Sickness Imp act Pr o f i le(SIP)

Pollard, Martin and Gilson (1976).The successful (p< .001) tests of validity indicated that the SIP

percentage score correlates withself- assessment of sickness (r = .54),self- assessment of dysfunction (r =.52); the Activities of Daily LivingIndex (Spearm an rank- ordercorrelation = .46), a clinicalassessment of dysfunction (r = .49)and the activity limitation questionion the National Health InterviewSurvey (r = .61).


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Sickness Imp act Pr o f i le(SIP)

DESCRI TPTI ON: The SicknessImpact Profile contains 136 itemsgrouped into 12 dimensions of dailyactivity; sleep and rest, emotionalbehavior, body care & movement,home management, mobil ity, socialinteraction, ambulation, alertnessbehavior communication, work,recreation & pastimes, and eating.Respondents check those items thatapply to them at the time of theinterview.

WHERE TO FIND THE ARTICLE:Selby, P., Chapman, A.,

Etazadi- Amol i, J., Dal ley , D. andBoyd, N. (1984). The developm ent of a method for assessing the qual ity of life of cancer patients. Br itish Jour nalof Cancer, 50, 13- 22.


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RELI ABI LI TY: Test- retestrel iability: r = 0.60

Internal consistency: CronbachÕsalpha: total = 0.82; sub scales:symptoms = 0.63; social concerns =0.68; psychological w ell- being =0.62; and, physical w ell- being =0.72.

VALIDITY: Construct validity: F =36,1; p = 0.001Content val idi ty: CVI = 0.90

Construct val idity : 9 factors via factoranalysis.

BACKGROUND: The tool is modeledafter the QOL instrument tested byPadilla & Grant (1985) & Padilla, et.Al. (1983).

PURPOSE: Measures quality of l ife.

WHERE TO FIND THE ARTICLE:Ferrell, B., Wisdom, C., Wenzl, C.

and Brown, J. (1989). Effects ofcontrolled release morphine onquality of life for cancer patients.Oncology Nursing Forum, 16 (4),521- 526.

DESCRITPTI ON: The Quali ty of Lifesurvey is a multidimensional 100mm analogue scale with wordextremes as anchors at the end of each scale. Items for the 28- itemsurvey represented the areas of psychological well being, physicalwell being, general symptomcontrol, specific symptom control,and social suppor t.


Qua l i t y o f l i f e Sur vey(QLS)


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RELIABILITY: Reported in: Kaplan,R.M. & Anderson, J. P. (1988). Thequality of well- being scale!Rationale for a single quality of l ifeindex. In Walkee, S. R. & Rosser, R.(EDS). Quality of Life: Assessmentand Application, London, MTPPRESS, p.p. 51- 77.

VALI DITY:See above.

BACKGROUND: QWB scores arederived from preference weight s forcombinations of symptom/ problemcomplexes and classification of functioning in terms of mobility,physical activity, and social activityobtained form a San Diego generalpopulation sample of 867 individu-als. These preference weights wereobtained in the mid 1970s but a 1991

study of Oregon citizens yieldedvery similar results.

PURPOSE: To provide an estimateof the value of health status

WHERE TO FIND THE ARTICLE:Hays, R., Siu, A., Keeler , E., Marshall ,G., Kaplan, R., Simmons, S., El

Mouchi, D. and Schnelle, J. (1996).Long term care residents’preferences on the QWB scale.Medical Decision- Making, 16 (3),254- 261.

DESCRI TPTI ON: The QWB Scaleidentifies a health r elated symptomthat is most undesirable and gradesit by the degree to which it affectseveryday activities. By using QWBassessment, a single number isdeveloped that represents thecurrent impact of disease.


Qua l i t y o f We l l BeingScal e ( QWB)

necessary for cost- utility analyses.Also, to quantify health- relatedquality of life with a single numberthat represents comm unity- basedpreferences for combinations of sym ptom/ problem compl exes,mobility, physical activity, and socialactivity.



RELI ABI LI TY: Internal Consistency(CronbachÕs alpha) = 0.93 for thetotal scale and 0.87, 0.82, 0.90 and0.77 for the sub scales.

VALIDITY: Construct validity wassuppor ted by the contrasted groupsapproach and factor analysis.Convergent validity was providedby a correlation of r = 0.77 betweenthe QLI and an assessment of lifesatisfaction.

BACKGROUND: The instrumentwas developed to provideinformation about specific lifedomains in order to allow healthcare professionals to pin pointproblem areas, examine practices,and plan interventions to improvequality of life.

PURPOSE: Measur es subjectiv esatisfaction in with specific lifedomains; measures importance of dom ains to the subject.

WHERE TO FIND THE ARTICLE:Ferrans, C. and Powers, M. (1992).

Psychometric assessment o f qual ityof life index. Research in Nursingand Health, 15, 29- 38.

DESCRITPTI ON: Tool consists of 64items, 2 parts: Part I: measuressatisfaction w ith var ious domains of life on a 6 point Likert scale r angingfrom 1 = very satisfied to 6 = verydissatisfied; Part II: measuresimpor tance of the same domains tothe individual on a 6 point Likertscale ranging from 1 = veryunimpor tant to 6 = very important.The domains of life measuredinclude, (1) health and functioning,(2) Socioleconomic status. (3)Psychological/ spiritua l status, and(4) family rela tionships.


Qua l i t y o f L i fe Index(QLI)



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RELIABILITY: Reliability coefficient= 0.82143Alpha coefficient = 0.82557.

VALI DITY:Corr elations were foundto be positive.


PURPOSE: Measures symptomdistress of patients.

WHERE TO FIND THE ARTICLE:McCorkle, R. and Young, K. (1978).Development of a symptom distressscale. Cancer Nursing, 373- 378.

DESCRI TPTI ON: Ten sym ptomsare evaluated (nausea, appetite,pain, fatigue, bowel patterns,concentration, appearance,breathing, outlook, & cough). Five

by seven cards with a singlesymptom were prepared. Patientsrated their symptom s on a given dayfrom 1 (least distress) to 5 (mostdistress) on the cards.


Sy m pto m Dist r ess Scale


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RELI ABI LI TY: Internal consistencyalphas for QOL - CA range from .52to .88 total alpha is 0.91.

VALIDITY: Construct validity &convergent construct validity isestablished. Factor analysis yielded5 factors.

BA CKGROUND: The multi -dimensional qualit

Tools Base de Datos Boston 2

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