Compilation And Preliminary Application Of A Cognition Questionnaire For Operating Room Nurses In Transferring Postoperativr Critically Ill Patients

PurposeTo standardise in-hospital transfer of postoperative critically ill patients by operating room nurses(ORNs),a cognition questionnaire was compiled to evaluate the cognitive status of ORNs in transferring postoperative critically ill patients and its influencing factors.This is done so to provide a reference for ORNs to improve the safety and quality of transferring postoperative critically ill patients.Methods1.Development of the initial questionnaire: Based on program logic model,the initial item pool of the questionnaire was created based on group discussion,literature review,and semi-structured interview.2.Revision of the initial questionnaire: To revise the initial questionnaire items,the Delphi method was used and composed of two rounds of responses from 16 experts.3.Revision and testing of the questionnaire: A total of 408 ORNs in Huaihua Prefecture and Qiandongnan Miao and Dong Autonomous Prefecture were selected as research subjects.To evaluate the reliability and validity of the questionnaire,item discrimination,exploratory factor,reliability,and confirmatory factor analyses were performed.4.A total of 287 ORNs in Huaihua Prefecture and Qiandongnan Miao and Dong Autonomous Prefecture were selected as research subjects by cluster sampling to analyse the cognitive status of ORNs in transferring postoperative critically ill patients and its influencing factors.5.SPSS22.0 was used for data analysis,AMOS23.0 for scale model construction,and CR software for calculation.Enumeration data were expressed as frequency,percentage and rate.Measurement data of normal distribution were expressed as mean and standard deviation(?x±S).Measurement data of skewed distribution were expressed as median(M)and interquartile range(P25–P75).Cronbach’s α coefficient,item discrimination,exploratory factor,and confirmatory factor analyses were used to evaluate the item discrimination,reliability and validity,and feasibility of the questionnaire.Normality test was performed on measurement data.Normally distributed data were analysed by t test and one-way analysis of variance,and non-normally distributed data were analysed by Wilcoxon rank sum test.Kruskal–Wallis test was used for the univariate analysis.Statistically significant factors in the univariate analysis were included in the multiple regression analysis.Multivariate linear regression analysis was used to analyse factors influencing cognition of ORNs in transferring postoperative critically ill patients.Stepwise regression was chosen,and P value <0.05 was considered statistically significant.The calculation results were double-checked by two individuals.Results1.Development of the initial questionnaire: The initial questionnaire was divided into two parts,namely,general information and relevant cognitive assessment,with a total of five dimensions and 21 items,including transfer decision,transfer preparation,transfer-related parameter judgment,monitoring and treatment during transfer,quality control and transfer training.2.Consultation results from experts: This study consulted 16 experts from Beijing,Chongqing,Changsha,Guizhou and other regions,covering professional fields such as intensive care,emergency,pharmacology and nursing.After two rounds of consultation,nine items were deleted,four items were modified from the section of relevant knowledge assessment and 12 items were retained after the consultation.3.Results of the questionnaire revision: As regards content validity,the second-round scores from the experts were calculated,and both S-CVI and I-CVI were 1.In the item analysis,each item had good discrimination ability.In the exploratory factor analysis,the KMO value was 0.737 after deleting the separate factor loading item.Bartlett’s test of sphericity showed that 2 was 1430.598,and the P value was <0.000.Cronbach’s α of the overall questionnaire and all dimensions were >0.79.A retest was performed 2 weeks later,and Cronbach’s α of the overall questionnaire and all dimensions were >0.75.In the confirmatory factor analysis,the(1)normalised factor load λ >0.5,(2)combination degree CR value >0.6,(3)convergence validity average variance extraction amount(AVE)>0.36 and(4)the average of AVE of two factors was higher than the square of the correlation coefficient of the two factors,which indicated that the questionnaire had better combination reliability and inter-group degree of distinction.After revision,the questionnaire finally retained three dimensions and 11 items.4.Results of the questionnaire: The overall average score of the questionnaire was 5.31±2.65(with 11 as the maximum score),which was at the middle-low level.Professional titles and professional nurses’ qualification in the operating room or anaesthesia resuscitation room were the main factors affecting scores.Conclusion1.This questionnaire has good item discrimination,reliability and validity and stable factor structure.It can be used as an assessment tool in evaluating the cognition status of ORNs in transferring postoperative critically ill patients.2.In this survey,the cognitive scores of the ORNs are in the lower middle level,which is mainly affected by the professional titles,especially about whether the subjects are working in the operating room or in the anaesthesia resuscitation room.3.Managers should pay attention to nurses with lower professional titles and those who are not professional nurses,reduce the involvement of such nurses in transferring of patients,improve the management of transfer,strengthen the creation of the transfer team,improve ORNs’ ability of transferring postoperative critically ill patients to ensure patient safety.