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Rationale, aims and objectives Phlebitis is a common and painful complication of peripheral intravenous cannulation. The aim of this review was to identify the measures used in infusion phlebitis assessment and evaluate evidence regarding their reliability, validity, responsiveness and feasibility. Method We conducted a systematic literature review of the Cochrane library, Ovid MEDLINE and EBSCO CINAHL until September 2013. All English-language studies (randomized controlled trials, prospective cohort and cross-sectional) that used an infusion phlebitis scale were retrieved and analysed to determine which symptoms were included in each scale and how these were measured. We evaluated studies that reported testing the psychometric properties of phlebitis assessment scales using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Results Infusion phlebitis was the primary outcome measure in 233 studies. Fifty-three (23%) of these provided no actual definition of phlebitis. Of the 180 studies that reported measuring phlebitis incidence and/or severity, 101 (56%) used a scale and 79 (44%) used a definition alone. We identified 71 different phlebitis assessment scales. Three scales had undergone some psychometric analyses, but no scale had been rigorously tested. Conclusion Many phlebitis scales exist, but none has been thoroughly validated for use in clinical practice. A lack of consensus on phlebitis measures has likely contributed to disparities in reported phlebitis incidence, precluding meaningful comparison of phlebitis rates.

Blinding in randomized controlled trials (RCTs) is a strategy that is widely endorsed as a method of reducing the biases that can result from people's awareness of study participants' treatment group status. Blinding of participants and interventionists is often impossible in nursing RCTs, but data analysts can almost always be blinded. Yet, such blinding seldom occurs, perhaps because of misperceptions about the objectivity of statistical analysis. Data analysts make many semi-subjective decisions about such issues as handling missing data, transforming variables, undertaking subgroup analysis, and selecting covariates. These decisions ideally should be made without the analyst's knowledge of how treatment groups are coded. Strategies for achieving blinding among data analysts are discussed.

Background: Blinding is recommended widely as a strategy in randomized controlled trials (RCTs) to reduce biases that can result from awareness of who is receiving the intervention being tested. The absence of blinding, especially when the primary outcomes are subjective, has been found to be associated with inflated estimates of treatment effects, yet little is known about the use of blinding in nursing RCTs. Objectives: The purposes of this study were (a) to describe the extent to which nurse researchers state that they used blinding as a bias-reduction strategy or explain why it was not used, (b) to identify the groups that are blinded when blinding is used, (c) to assess whether the term blinding or masking is more prevalent, and (d) to explore factors that might affect the use or acknowledgement of blinding in nursing trials. Methods: Data regarding blinding were extracted systematically and coded from a consecutive sample of 199 RCTs published in 16 nursing journals in 2007 to 2009. Results: Blinding, the term used predominantly in nursing, was reported to have been used in 33% of the studies. Rates of blinding ranged from 2.5% for data analysts to 28% for data collectors. The absence of blinding was discussed as a limitation in only 13% of the studies in which blinding did not occur. The use or mention of blinding was related strongly to whether the journal in which the article was published had endorsed the Consolidated Standards for Reporting Trials guidelines (CONSORT). Conclusions: Nurse researchers conducting RCTs should be more diligent in following the CONSORT guidelines regarding the use and description of blinding. Although it is often impossible to blind study participants and intervention agents, the blinding of data collectors, data analysts, and nonresearch healthcare staff should be pursued.

Journal impact factors (IFs), a measure of citation frequency, are published annually in Journal Citation Reports (JCR). Journal IFs, although controversial because of the uses to which they have been put in academic arenas, remain a metric about which nurses should be informed. This paper discusses key issues in the controversy, explains how IFs are computed, and presents historical and 2009 IF data for nursing journals. The number of nursing journals indexed in JCR has grown from 35 in 2004 to 74 in 2009. The journals currently indexed are diverse in terms of focus (practice vs research), specialty areas, and country of publication. The median IF score for nursing journals (0.91 in 2009) is similar to that for several other health care categories. Given the controversies surrounding IFs, it may be useful for nurses to play a more active role in furthering the debate by undertaking research relating to IFs, including studies of how they affect nurses' scholarly pursuits and publication decisions.

The purpose of this article was to identify nonnursing journals that have relevance to nursing, that publish articles that cite the nursing literature and may offer excellent but seldom-considered publication opportunities for nurses. Using 22 indicators derived through citation analysis, 64 nonnursing journals that are highly related to nursing were identified. The authors provide information about these 64 journals related to their subject matter, number of issues annually, and their 2008 impact factor.

Scale developers often provide evidence of content validity by computing a content validity index (CVI), using ratings of item relevance by content experts. We analyzed how nurse researchers have defined and calculated the CVI, and found considerable consistency for item-level CVIs (I-CVIs). However, there are two alternative, but unacknowledged, methods of computing the scale-level index (S-CVI). One method requires universal agreement among experts, but a less conservative method averages the item-level CVIs. Using backward inference with a purposive sample of scale development studies, we found that both methods are being used by nurse researchers, although it was not always possible to infer the calculation method. The two approaches can lead to different values, making it risky to draw conclusions about content validity. Scale developers should indicate which method was used to provide readers with interpretable content validity information.

To focus attention on the need for rigorous and carefully designed test-retest reliability assessments for new patient-reported outcomes and to encourage retest researchers to be thoughtful, ambitious, and creative in their retest efforts.The paper outlines key challenges that confront retest researchers, calls attention to some limitations in meeting those challenges, and describes some strategies to improve retest research.Modest retest coefficients are often reported as acceptable, and many important decisions-such as the retest interval-appear not to be evidence-based. Retest assessments are seldom undertaken before a measure has been finalized, which rules out using retest data to select strong, reproducible items.Strategies for improving retest research include seeking input from patients or experts regarding the stability of the construct to support decisions about the retest interval, analyzing item-level retest data to identify items to revise or discard, establishing a priori standards of acceptability for reliability coefficients, using large, heterogeneous, and representative retest samples and collecting follow-up data to better understand consistent and inconsistent responses over time.

Data from 300 studies published in four research journals in 2010-2011 were analyzed to assess whether nurse researchers continue to oversample females. One-third of the studies had samples that were 100% female and, on average, 74% of all study participants were female. As was found for studies published 5 years earlier, the bias against male participants was consistent across studies differing in methods, specialty areas, funding, and sample characteristics. Studies with male first authors, however, were significantly less likely to have biased samples. Authors of only 23.6% of studies with mixed-sex samples provided information about sex differences in outcomes. Because of gender bias, the evidence base for nursing practice may suffer from problems with generalizability.

Background Intervention studies testing the efficacy of cardiorespiratory exercise have shown some promise in terms of improving cognitive function in later life. Recent developments suggest that a multi-modal exercise intervention that includes motor as well as physical training and requires sustained attention and concentration, may better elicit the actual potency of exercise to enhance cognitive performance. This study will test the effect of a multi-modal exercise program, for older women, on cognitive and physical functioning. Methods/design This randomised controlled trial involves community dwelling women, without cognitive impairment, aged 65–75 years. Participants are randomised to exercise intervention or non-exercise control groups, for 16 weeks. The intervention consists of twice weekly, 60 minute, exercise classes incorporating aerobic, strength, balance, flexibility, co-ordination and agility training. Primary outcomes are measures of cognitive function and secondary outcomes include physical functioning and a neurocognitive biomarker (brain derived neurotrophic factor). Measures are taken at baseline and 16 weeks later and qualitative data related to the experience and acceptability of the program are collected from a sub-sample of the intervention group. Discussion If this randomised controlled trial demonstrates that multimodal exercise (that includes motor fitness training) can improve cognitive performance in later life, the benefits will be two-fold. First, an inexpensive, effective strategy will have been developed that could ameliorate the increased prevalence of age-related cognitive impairment predicted to accompany population ageing. Second, more robust evidence will have been provided about the mechanisms that link exercise to cognitive improvement allowing future research to be better focused and potentially more productive. Trial registration Australian and New Zealand Clinical Trial Registration Number: ANZCTR12612000451808

In intervention studies in which randomization to groups is not possible, researchers typically use quasi-experimental designs. Time series designs are strong quasi-experimental designs but are seldom used, perhaps because of technical and analytic hurdles. Statistical process control (SPC) is an alternative analytic approach to testing hypotheses about intervention effects using data collected over time. SPC, like traditional statistical methods, is a tool for understanding variation and involves the construction of control charts that distinguish between normal, random fluctuations (common cause variation), and statistically significant special cause variation that can result from an innovation. The purpose of this article is to provide an overview of SPC and to illustrate its use in a study of a nursing practice improvement intervention.

The purpose of the present study was to describe the innovativeness and the rate of adoption of change among chief nursing officers (CNOs) of acute care hospitals, and explore the difference in the innovativeness of CNOs of Magnet hospitals vs. non-Magnet hospitals.There is little evidence to guide the description of innovativeness for nurse leaders, crucial to the implementation of evidence-based practice standards.CNOs of acute care hospitals of New York State participated in a mailed survey which incorporated the Scale for the Measurement of Innovativeness. The response rate was 41% (106/261).The majority of the sample was prepared at the master's level with 5-10 years of experience in the CNO role. A significant relationship was found between the innovativeness scale scores and the innovativeness diversity index. The CNOs who completed more leadership courses had implemented significantly more types of innovations and had higher innovativeness scale scores. Graduate level education, years of CNO experience and leadership course completion were identified as significantly influencing innovativeness of CNOs.The characteristics of innovativeness for nurse leaders presented in the present study may assist organizations, CNOs and the Magnet recognition programme to describe innovativeness that supports organizations to continuously improve the quality of patient care.

Aim: This paper describes the development and validation of the Revised Perioperative Competence Scale (PPCS-R). Background: There is a lack of a psychometrically tested sound self-assessment tools to measure nurses' perceived competence in the operating room. Methods: Content validity was established by a panel of international experts and the original 98-item scale was pilot tested with 345 nurses in Queensland, Australia. Following the removal of several items, a national sample that included all 3209 nurses who were members of the Australian College of Operating Room Nurses was surveyed using the 94-item version. Psychometric testing assessed content validity using exploratory factor analysis, internal consistency using Cronbach's alpha, and construct validity using the "known groups" technique. During item reduction, several preliminary factor analyses were performed on two random halves of the sample (n= 550). Results: Usable data for psychometric assessment were obtained from 1122 nurses. The original 94-item scale was reduced to 40 items. The final factor analysis using the entire sample resulted in a 40 item six-factor solution. Cronbach's alpha for the 40-item scale was .96. Construct validation demonstrated significant differences (p< .0001) in perceived competence scores relative to years of operating room experience and receipt of specialty education. Conclusions: On the basis of these results, the psychometric properties of the PPCS-R were considered encouraging. Further testing of the tool in different samples of operating room nurses is necessary to enable cross-cultural comparisons. © 2011 Elsevier Ltd.

Intention-to-treat (ITT) in randomized controlled trials involves keeping participants in the treatment groups to which they were randomized regardless of whether they withdraw following randomization. Intention-to-treat is a strategy for maintaining the integrity of randomization and strengthening the trial's internal validity. Although ITT is advocated by the Consolidated Standards of Reporting Trials (CONSORT) guidelines, there is confusion about what ITT means and little specific advice on how to achieve it. The purpose of this article is to present definitions of ITT and to suggest strategies for implementing ITT as a total design strategy in nursing clinical trials. Recommendations are offered regarding study planning, study design, subject retention, sampling, data collection, data analysis, and reporting within the context of ITT.

Purpose: To compare the characteristics of nursing research being done in different countries, using data from studies published in nonspecialty, English-language nursing journals. Design: Data for this cross-sectional analysis were retrieved from a consecutive sample of 1,072 studies published in eight leading English-language research journals in 2005 and 2006. Methods: For each study, data were extracted on the characteristics of the study participants and authors, study focus-specialty area, funding, and methodologic attributes. Studies from 15 countries or regional groupings were compared. Findings: International differences in authors, participants, and study characteristics were typically large and statistically significant. Studies that were focused on nurses were especially prevalent in Europe, Australia, and Canada, whereas patient-centered studies were most common in Asian countries and the US. Qualitative studies were predominant in Norway, Sweden, and the UK. Asian nurse researchers, by contrast, undertook mostly quantitative studies, and were especially likely to conduct intervention research. Significant country differences existed in the omission of demographic (age and sex) information about participants, with omissions most prevalent in the UK and Ireland and least prevalent in Asian countries. Research funding was reported for 62% of all studies, ranging from 13% in Turkey to over 75% in Canada and the US. Conclusions: Although this study had several limitations, especially with regard to potential biases in the sample of studies from non-English-speaking countries, this analysis of over 1,000 nursing studies indicates many important inter-country differences in the focus, methods, and authorship patterns of nursing research published in leading journals. Clinical Relevance: Because research “informs” practice, international differences that exist in the focus and methods of nursing research have implications for nursing practice in the respective countries.

This paper reports a study that examined the extent to which nurse researchers internationally disproportionately include females as participants in their research.A bias toward predominantly male samples has been well-documented in medical research, but recently a gender bias favoring women in nursing research has been identified in studies published in four North American journals.We extracted information about study samples and characteristics of the studies and authors from a consecutive sample of 834 studies published in eight leading English-language nursing research journals in 2005-2006. The primary analyses involved one-sample t-tests that tested the null hypothesis that males and females are equally represented as participants in nursing studies. Studies from different countries, in different specialty areas, and with varying author and methodologic characteristics were compared with regard to the key outcome variable, percent of participants who were female.Overall, 71% of participants, on average, were female, including 68% in client-focused research and 83% in nurse-focused studies (all p.001). Females were significantly overrepresented as participants in client-focused research in almost all specialty areas, particularly in mental health, community health, health promotion, and geriatrics. The bias favoring female participants in client-focused studies was especially strong in the United States and Canada, but was also present in European countries, most Asian countries, and in Australia. Female overrepresentation was persistent, regardless of methodological characteristics (e.g., qualitative versus quantitative), funding source, and most researcher characteristics (e.g., academic rank). Studies with male authors, however, had more sex-balanced samples. The mean percentage female in client-focused studies with a female lead author was 70.0, compared to 52.1 for male lead authors.Nurse researchers not only in North America but around the globe need to pay attention to who will benefit from their research and to whether they are adequately inclusive in studying client groups about which there are knowledge gaps.

The purpose of this study was to describe pediatric nurses' projected responses to children's pain as described in vignettes of hospitalized children and to explore nurse characteristics that might influence those responses. A survey was mailed to a national random sample of 700 RNs, and 334 nurses responded. The survey included case reports of three hospitalized school-aged children experiencing pain. Nurses were asked to rate their perceptions of the children's pain levels and to indicate how much analgesia they would recommend. Contrary to earlier studies, in response to the scenarios, nurses in this sample perceived high levels of pain, said they would administer doses of analgesia close to the maximum prescribed by physicians, and recommended an array of non-pharmacologic methods to treat pain. Variation in pain perceptions and decisions was not related to key personal and professional characteristics of the nurses, including their education level, race/ethnicity, age, years of clinical experience, and receipt of continuing education about pain. Findings from this large national study suggest that most nurses would make appropriate decisions relating to the treatment of children's pain, perhaps reflecting changes in the emphasis on pain management.

Using data from a consecutive sample of 259 studies published in four leading nursing research journals in 2005-2006, we examined whether nurse researchers favor females as study participants. On average, 75.3% of study participants were female, and 38% of studies had all-female samples. The bias favoring female participants was statistically significant and persistent. The bias was observed regardless of funding source, methodological features, and other participant and researcher characteristics, with one exception: studies that had male investigators had more sex-balanced samples. When designing studies, nurse researchers need to pay close attention to who will benefit from their research and to whether they are leaving out a specific group about which there is a gap in knowledge.

The purpose of this study was to examine whether nurses' recommendations for managing children's pain were influenced by stereotypes based on children's personal attributes. Three vignettes, in which hospitalized children's sex, race, and attractiveness were experimentally manipulated, were mailed to a national random sample of 700 pediatric nurses; 334 nurses responded. Responses to vignette questions indicated little evidence of stereotyping. Nurses perceived similar levels of pain and recommended similar pain treatments, regardless of sex, race, and attractiveness. Nurses, on average, perceived children's pain at levels consistent with the children's self-reports and recommended assertive analgesic and non-pharmacologic pain management strategies. The results appear consistent with prevailing views on providing adequate pain treatment for children.

Nurse researchers typically provide evidence of content validity for instruments by computing a content validity index (CVI), based on experts' ratings of item relevance. We compared the CVI to alternative indexes and concluded that the widely-used CVI has advantages with regard to ease of computation, understandability, focus on agreement of relevance rather than agreement per se, focus on consensus rather than consistency, and provision of both item and scale information. One weakness is its failure to adjust for chance agreement. We solved this by translating item-level CVIs (I-CVIs) into values of a modified kappa statistic. Our translation suggests that items with an I-CVI of .78 or higher for three or more experts could be considered evidence of good content validity.

This study examined the extent to which child sexual abuse was associated with an increased likelihood of premarital sex among adolescents at high risk of sexual abuse. The sample consisted of 177 teenage girls who, because of evidence of family dysfunction, had become part of a public child welfare system. Half the sample had been placed in a foster home and the remainder were receiving protective services in their own home. About 40% of the teens in both groups had been sexually abused, although teens still living at home were less likely to have reported abuse. Victims of sexual abuse were found to be more likely to have engaged in voluntary sexual intercourse, even after background factors were controlled. Teens in foster home were somewhat less likely to be sexually active than the teens who remained at home.This study examined the extent to which child sexual abuse was associated with an increased likelihood of premarital sex among adolescents at high risk of sexual abuse. The sample consisted of 177 US teenage girls between the ages of 13 and 18 years in a midwestern state, who, because of evidence of family dysfunction, had become part of a public child welfare system. Half the sample had been placed in a foster home and the remainder were receiving protective services in their own home. About 40% of the teens in both groups had been sexually abused, although teens still living at home were less likely to have reported abuse. Victims of sexual abuse were found to be more likely to have engaged in voluntary sexual intercourse, even after background factors were controlled. Teens in foster homes were somewhat less likely to be sexually active than the teens who remained at home.

This study investigated the antecedents and short-term consequences of an early subsequent pregnancy in a sample of economically disadvantaged teenage mothers. Data were gathered over a two-year period from a sample of 675 young mothers living in eight United States cities. Within two years of the initial interview, when half the sample was still pregnant with the index pregnancy, nearly half of the sample experienced a second- or higher-order pregnancy. Characteristics of the young women at entry into the study were relatively poor predictors of which teenagers would conceive again by the final interview. An early repeat pregnancy was associated with a number of negative short-term consequences in the areas of education, employment, and welfare dependency, even after background characteristics were statistically controlled.

SummaryA quantitative review of the literature on the intellectual achievement of only children indicated that only children were never at a disadvantage in relation to any comparison group; nor were they significantly different from first-born children or children from two-child families. Moreover, only children were at a significant advantage in comparison with later-born children and those from large families. The consistency of these findings across subgroups suggests that interpersonal mechanisms are largely responsible. The strong only-child advantage on tests of verbal ability, together with the overall pattern of findings, implicates parent–child interactions as responsible for the family size and birth order variations in intellectual achievement.

The past 10 years have seen a shift in the master's level preparation of nurses. The majority of nurses currently seeking advanced preparation choose clinical specialization as the functional area rather than teaching. Such a shift in focus reflects the ever increasing specialization of services associated with an ever-growing complex society. Although the shift in focus of preparation and the concomitant change in curriculum design have been documented, few scientific investigations have been conducted on the graduates from master's programmes. Of those studies that have been conducted, the majority have focused on the differential personal characteristics of graduate nursing students in different types of programmes. The purpose of the present study was to investigate the relationship between a nurse's area of functional preparation in a master's degree programme and the individual's level of professionalism. The independent variable of the study was functional area of preparation in a master's programme. The dependent variables became enrolment in a formal programme of study, subscription to professional journals, attendance at non-formal educational programmes, number of authored publications, membership in professional organizations and employment in prepared area, as these seemed to reflect the criteria of professionalism explicated by Flexner (1915). The data for the study were gleaned from questionnaires sent to the 637 individuals who had graduated from the programme. Of the 395 questionnaires that were returned, only 272 were usable. This number represented 43% of the graduate population. The chi-square test was used to analyse the data. Each of the chi-square values for association between professionalism and graduate specialty was found to be significant. Postgraduates prepared as teachers met Flexner's criteria more often than did postgraduates prepared as clinical specialists.