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Background: In a study to establish the interrater reliability of the Irish Nursing Minimum Data Set (I-NMDS) for mental health difficulties relating to the choice of reliability test statistic were encountered., Objectives: The objective of this paper is to highlight the difficulties associated with testing interrater reliability for an ordinal scale using a relatively homogenous sample and the recommended kw statistic., Method: One pair of mental health nurses completed the I-NMDS for mental health for a total of 30 clients attending a mental health day centre over a two-week period. Data was analysed using the kw and percentage agreement statistics., Results: A total of 34 of the 38 I-NMDS for mental health variables with lower than acceptable levels of kw reliability scores achieved acceptable levels of reliability according to their percentage agreement scores., Conclusion: The study findings implied that, due to the homogeneity of the sample, low variability within the data resulted in the 'base rate problem' associated with the use of kw statistic. Conclusions point to the interpretation of kw in tandem with percentage agreement scores. Suggestions that kw scores were low due to chance agreement and that one should strive to use a study sample with known variability are queried.

Background: Nursing care provided at night has a different purpose and objective to that provided during the day. A review of the literature does not reveal any scientifically tested research instruments for evaluating and comparing the nurse's assessment of nursing care with the patient's perception at night., Aims and Objectives: The aim of this study was to develop and test an instrument for evaluating nursing care and to compare nurses' assessments with patients' perceptions of nursing care provided at night., Design: The study was carried out in two phases; the first had an explorative design and the second an evaluative and comparative design. The Night Nursing Care Instrument (NNCI) included two questionnaires; one for nurses and one for patients. These questionnaires were developed from a nursing framework and covered the following three areas: 'nursing interventions', 'medical interventions' and 'evaluation'., Methods: Nurses (n = 40) on night duty on a medical ward at a central hospital in southern Sweden were consecutively selected, to participate in the study. The patients (n = 80) were selected by means of convenience sampling. In order to achieve construct validity, factor analysis of each individual area was carried out. Reliability in terms of internal consistency was tested by Cronbach's alpha., Results: The overall NNCI had acceptable reliability and validity. There was no statistically significant difference between nurses' assessments and patients' perceptions in any of the three areas of 'nursing interventions', 'medical interventions' or 'evaluation'. The patients rated night nursing care as satisfactory for the majority of the items., Relevance to Clinical Practice: These findings demonstrate that it is possible to create a short instrument with acceptable reliability and validity, which is easy to use in clinical practice. The results also show that night nurses need to improve their ability to assess patients' needs during the night to increase the quality of night nursing care.

Background: We reviewed psycho-educational intervention studies that were designed to reduce interdialytic weight gain (IDWG) in adult hemodialysis patients. Our goals were to critique research methods, describe the effectiveness of tested interventions, and make recommendations for future research., Methods: Medline, PsychInfo, and the Cumulative Index to Nursing and Applied Health (CINAHL) databases were searched to identify empirical work. Each study was evaluated in terms of sample, design, theoretical framework, intervention delivery, and outcome., Results: Nine studies were reviewed. Self-monitoring appears to be a promising strategy to be considered to reduce IDWG. Theory was not usually used to guide interventions, designs generally had control groups, interventions were delivered individually, more than one intervention was delivered at a time, the duration of the intervention varied greatly, there was no long-term follow-up, IDWG was the only outcome, and IDWG was operationalized in different ways., Conclusions: Theoretical models and methodological rigor are needed to guide future research. Specific recommendations on design, measurement, and conceptual issues are offered to enhance the effectiveness of future research.

Woundcare Research for Appropriate Products (WRAP) is a novel collaboration WRAP between industry and clinicians, funded by the Engineering and Physical Research Sciences Council. WRAP objectives included the development and testing of methodologies to identify patients' and clinicians' needs with respect to wound dressings for exudate management. The management of exudate was the focus because it was demonstrated to be the pivotal problem for patients and clinicians in a study of malignant wounds, and is a recurring problem in other wound types. A clinical note-making system (Treatment Evaluation by Le Roux's method--TELER) was validated as a method of collecting observational data of dressing performance in the context of total patient care, thereby involving the users of dressing products. The validation process was a form of consensus where multiple sources of data were used to define patient problems, within the TELER indicators, to measure a change or lack of change in the problems during a period of treatment and care and to draw conclusions about dressing performance and patient experiences.

The purpose of this study was to assess the results, along with the feasibility, applicability and relative merits of paradigm triangulation in the field of nursing care quality by conducting, concurrently, a quantitative and a qualitative study of patient satisfaction. The sample consisted of 200 randomly selected in-patients from two large Greek metropolitan hospitals. Highest ratings were assigned to the technical aspects of care, whilst information delivery items were associated with the lowest ratings. Qualitative analysis revealed a perception of nurses as weak against organisational limitations as the core theme underlying all categories of patients' complaints with nursing care. Seven more common themes were identified. The interpersonal aspect of care was central to patients' experience. The combination of qualitative and quantitative methodology appeared to contribute to the completeness of description and understanding of the phenomenon.

Risk assessment scales (RASs) intended to identify patients most at risk of developing pressure ulcers have been widely used for many years. Numerous studies have evaluated their predictive validity but potential bias has been inherent in the design of all. To overcome these problems a simulation study was conducted in which clinical nurses were asked to identify the degree of risk experienced by four patients employing the three RASs discussed most frequently in the literature (Norton, Braden and Waterlow Scores). These findings were compared with nurses' clinical judgment rated on a visual analogue scale. The simulations consisted of high-resolution photographs accompanied by case studies of the patients. The nurses' scores were compared to estimates of risk generated by an expert panel. Nurses' clinical judgment agreed much more closely with expert opinion than any of the RASs. A replication study was undertaken to confirm these findings. One hundred and fifteen nurses participated in replication. Again the nurses' clinical judgment matched expert opinion much more closely than the results of the RASs. Replication also drew attention to a number of methodological issues which deserve consideration when using simulation to test the effectiveness of clinical tools and the need to establish adequate measures of external validity whenever use of this method is contemplated.

Evaluation has become a powerful, specialized discipline in recent decades, with its own sophisticated conceptual and technical apparatus. Evaluation of nursing has benefited strongly from these developments, as examples of cogent, recent evaluations demonstrate. Evaluation is already proving an indispensable practical tool for raising the quality of health care, and for advancing professional nursing standards. Nonetheless, there is room for further improvement. Neglected areas of nursing should be brought under the spotlight of evaluation, conceptual and methodological rigour should be strengthened, and training in research skills should be extended.

This paper takes a broad view of the work involved in pilot studies of evaluation research. Drawing on their experience of preparation for a field experiment in a British Accident and Emergency department, which was to evaluate the effectiveness of a nurse triage system, the authors stress the importance of careful observation of the system to be studied, in the environment in which it is to be studied. In addition, the usual evaluations of research instruments which comprise formal pilot studies are included.

The nature of health visiting is discussed. It operates in a radically different way from any of the curative services. Research into the effectiveness of health visiting must therefore take into account the many differences in context, in professional goals and in the nature of the interaction between health visitors and their "clients", compared with the work of the curative professions within their more controlled and controlling environments. The evaluation of one large scale health visitor intervention study is used here to highlight these differences. Health visiting research needs to free itself from the attempts by some to apply the laboratory model of evaluation, if it is to develop a corpus of "action research" thinking which reflects its more human and developmental characteristics.