Relationship between scores on a nurse-psychiatric patient interaction inventory and nurse performance

The study was an attempt to further validate the Nurse-Psychiatric Patient Interaction Inventory (NPPII). The NPPII is an 18-item, empirically derived inventory designed to measure the extent to which a nurse can select potentially therapeutic verbal responses in nurse-psychiatric patient situations. In the original development in the inventory, baccalaureate nursing students performed significantly better than diploma or associated degree students on the inventory. This was interpreted as a very limited validity check.. A further validity check of the NPPI was measured in the present study by correlating scores on the NPPII with performance rating of a group of registered nurses who were employed on hospital psychiatric units. The performance ratings were scores on the Nurse Performance Description Scales (NPDS). During the first phase of the study, the NPPII was given to the nurses. During the second phase, the immediate supervisors of the subjects completed the NPDS as an evaluation of the nurse's overall nursing performance. The NPPII and the NPDS were expected to correlate highly on the assumption that the nurse who is effective in nurse-patient relationships with other people in the work situation, and would be judged a "good" nurse by her supervisor. Product moment correlations were calculated between the NPPII scores and the NPDS total and subscale scores. There was no tendency for high scorers on the NPPII to receive high NPDS ratings. When the ten high scorers and the ten low scorers on the NPDS were compared, the mean scores on the NPPII for these two groups were equal. Several possible explanations were offered for lack of expected correlations between the NPPII and the NPDS scores. The NPDS may not be an appropriate tool for evaluation of specific psychiatric nursing skills. Another explanation offered was that the lack of correlation may indicate that a nurse who is a potentially therapeutic force in nurse-patient interactions, as measured by the NPPII, is not necessarily an effective nurse in other important aspects of nursing. However, further research was recommended to determine the validity of the NPPII. Another possible reason for the lack of correlation was the rater error, "halo," which could have favored qualities other than those measured by the NPPII. Contrary to predictions, the associated program graduates had the highest mean score, followed by the baccalaureate and diploma program graduates. However, sample sizes were too small to make a meaningful comparison of the group means.

THE RELATIONSHIP BETWEEN SCORES ON A NURSE-PSYCHIATRIC PATIENT INTERACTION INVENTOR Y AND NURSE PERFORMANCE by Marilyn McKay Park A thesis submitted to the faculty of the Univer sity of Utah in partial fulfillment of the requirements for the degree of Master of Science College of Nursing University of Utah June, 1967 This Thesis for the Master of Science Degree by Marilyn McKay Park has been approved May, Reader, 1967 Supervisory Com.·· ittee 11< 'c'< i� .� i:� " '"( 1 ; i··e� t, \ ACKNOWLEDGEMENT Sincere appreciation is expressed to my committee, Dr. John A. Wolfer, Miss Sumiko Fujiki, Dr. B. Jack White, and Mrs. Bonnie Clayton for their help in preparing this thesis.. I am grateful also to my family and friends for their encouragement and help during its preparation. A special thanks is given to the nur ses who served as subjects and raters for the study. iii TABLE OF CONTENTS Page v ABSTRACT. • • • • LIST OF TABLES. vii CHAPTER I. INTRODUCTION. 1 II. METHOD. . 9 III. RESULTS AND DISCUSSION. . 12 IV. SUMMAR Y . • • • . . . . . 18 . . . REFERENCES . 20 APPENDIX A . . 22 APPENDIX B. 42 iv ABSTRACT The study was an attempt to further validate the Nurse-Psychiatric Patient Interaction Inventory (NPPII). The NPPII is an IS-item, empirically derived inventory designed to measure the extent to which a nurse can select potentially therapeutic verbal responses in nursepsychiatric patient situations. In the original development of the in- ventory, baccalaureate nursing students performed significantly better than diploma or associate degree students on the inventory. interpreted as a very limited validity check. This was A further validity check of the NPPII was measured in the present study by correlating scores on the NPPII with performance ratings of a group of registered nurses who were employed on hospital psychiatric units. The performance ratings were scores on the Nurse Performance Description Scales (NPDS). During the first phase of the study, the NPPII was given to the nurses. During the second phase, the immediate supervisors of the subjects completed the NPDS as an evaluation of the nurse r S overall nur sing performance. The NPPII and the NPDS were expected to correlate highly on the as sumption that the nurse who is effective in nurse -patient relationships would also be effective in her relationships with other people in the work situation, and would be judged a her supervisor. v tt good" nurse by Product moment correlations were calculated between the NPPII scores and the NPDS total and subscale scores. There was no tendency for high scorers on the NPPII to receive high NPDS ratings. When the ten high scorers and the ten low scorers on the NPDS were compared, the mean scores on the NPPII for these two groups were equal. Several possible explanations were offered for the lack of expected correlations between the NPPII and the NPDS scores. The NPDS may not be an appropriate tool for the evaluation of specific psychiatric nursing skills. Another explanation offered was that the lack of correlation may indicate that a nurse who is a potentially therapeutic force in nurse-patient interactions, as measured by the NPPII, is not necessarily an effective nurse in other important aspects of nursing. How- ever, further research was recommended to determine the validity of the NPPII. Another possible reason for the lack of correlation was the rater error, "halo," which could have favored qualities other than those measured by the NPPII. Contrary to predictions, the associate program graduates had the highest mean score, followed by the baccalaureate and diploma program graduates. However, sample sizes were too small to make a meaningful comparison of the group means. vi LIST OF TABLES TABLE Page 1 Nur sing Experience of Sample Nur s e s . . . • • . • . . . . • • • . •. 10 2 NPPII Means, Standard Deviations, and Ranges of Graduate Nurses Compared with Jensen· s Senior Nur sing Students. • • • • . • • • • • . • • . . • • . • • • .• 16 vii CHAPTER I INTRODUCTION One of the problem.s in nursing today is the lack of effective m.ethods of m.easuring the quality of nursing care. This problem. is particularly difficult in psychiatric nursing because the nursing care consists alm.ost entirely of verbal and nonverbal com.m.unication with the patient, rather than som.e m.ore definitive physical procedures. The concept of nurse-patient relationships as a psychodynam.ic aspect of nur sing began to appear in the literature around the m.iddle of this century, when it was stated that "Nursing is a significant, therapeutic, interpersonal process';" (Peplau, 1952, p. 16). "Through these (em.otionally im.portant) relationships, personnel can m.ake a significant contribution to an im.provem.ent in the patient's living with him.self and others," (Schwartz & Shockley, 1956, p. 14). Nur sing has been defined as a "proce s s of verbal and nonverbal interaction directed toward the healthful status of the recipient within an institution, an agency, or the com.m.unity,l1 (Brown & Fowler, 1966, p. 5). Recipient is defined as any individual or group of individuals receiving the services of a nur see A Nurse-Psychiatric Patient Interaction Inventory (Jensen, 1966) was developed in an attem.pt to m.easure the appropriateness of verbal responses which nurses give to psychiatric patients. The present study was an attem.pt to further validate this inventory. 2 The Nurse -Psychiatric Patient Interaction Inventory (NPPII) is an empirically derived test which purports to measure the important aspect of psychiatric nursing care, the nurse-patient verbal interaction. The NPPII (see Appendix A) was developed by collecting actual nurse-patient situations which occurred on psychiatric wards and obtaining responses nurses said they might make to patients in these interactions. The responses which show that the nurse has an "under- standing of the patient's needs" and would "encourage him to use his own resources in problem-solving, reduce anxiety patient welfare II and promote (Jensen, 1966, p. 1) were considered the correct responses and were based on psychiatric nursing theory. The inven- tory consists of 18 written situations taken from actual verbalizations in nurse-psychiatric patient interactions. The multiple choice re- sponses were developed from those answers which nurses working on psychiatric wards were asked to write for each situation. The re- sponses were categorized by seven judges into 6 types of responses. The judges had all completed a two-year psychiatric nursing program and were nurse educators or practicing psychiatric nurse clinicians. The 6 types of responses were, briefly: Type I - - awarenes s of the patient's problem or need, understanding or concern for the patient, stimulation toward using his own resources to solve the problem; Type II -- conveying the intent to investigate the problem and promote discussion, but dealing with tangential aspects rather than 3 the real problem; Type III -- conveying sympathy or reassurance for the superficial aspects of the patient's problem, without attempting to identify the real need or problem; Type IV -- giving advice; Type V seeking to explain or justify the nur se I s or other per sonnel l s point of view; Type VI - - conveying rejection or disapproval of the patient to relieve the nursels own anxiety in the situation (Jensen, 1966). From 4 to 6 representative responses to each situation were chosen for the inventory. Type I responses were considered the "correct" responses. One point was given for each correct answer. In the process of standardization, the test was given to 100 senior nursing students in three different types of nursing school programs- baccalaureate (4 year), diploma (3 year), and associate (2 year). As a test of internal consistency of the NPPll, point biserial correlation coefficients were calculated for each item with the total score. Correlations of 15 items with the total score were significant beyond the. 01 level; 2 items were significant at the. 05 level of confidence. The remaining item did not significantly correlate with the total score. Seventy-nine of the 84 response choices were selected at least once, indicating that most answers were plausible replies to the situations. Jensen I S development of the inventory included only a very limited validity check. On the basis of the expectation that baccalaur- 4 ea te students would perform better on the inventory than diploma students and that both groups would perform better than the associate students, the differences in the means of these groups were compared. The baccalaureate group did perform significantly better on the test than the other two groups. There was no significant difference be- tween the means of the associate and the diploma groups, however. The subjects in Jensen's study were all enrolled in nursing programs with a varying emphasis upon the aspect of nursing care measured by the NPPII, communication with patients. It was not known whether the subjects would give the same types of responses in an actual situation as they would on a paper and pencil test. In the present investigation, the NPPII was given to graduate nurses working on psychiatric wards and the results correlated with supervisor's ratings of the nurses' actual performance in the clinical situation. The assumption was that the nurse who is effective in nurse-patient relationships would also be effective in her relationships with other people in the work situation, and would be judged a "good l1 nurse by her supervisor. The NPPII has considerable face validity since it is consistent with a theory of psychiatric nursing which emphasizes understanding of the patient's needs and assisting him to find better ways to solve his problems. It is a paper and pencil test which can reflect only the type of verbal response a nur se believes would be correct in the described situation. However, the lIcorrect" response on the NPPII 5 is considered an appropriate type of response which would usually move the patient toward more healthy interactions with people. The nurse who has a high score on the test does demonstrate knowledge of what theoretically cons titute s a potentially therapeutic nur se -psychiatric patient interaction. There is other support in the literature for the importance of the response to the patient as a means of therapeutic com.m.unication. The nur se needs to be able to listen, to gather information objective1y, and to reply in a manner that will allow the patient to express his own ideas and find more effective ways to interact with people. TlTo be able to listen and to gather information from another per son in this other person's own right, without reacting along the lines of one1s own problems or experiences, of which one may be reminded, perhaps in a disturbing way, is an art of interper sonal exchange which few people are able to practice without special training, It (From.m.-Reichmann, 1960, p. 7). The correct response on the NPPIi is thought to be nonjudgmental and to encourage the patient to move on to explore ways of solving his problem. TI The presence of concern and the freedom from having judgment imposed permit the patient to interpret the responses to his messages as beneficial rather than threatening, II (Beier, 1966, p. 9). Another method of measuring the quality of patient care is 6 evaluation of nurse performance by a supervisor. The problem of nurse performance evaluation has been approached in almost as many different ways as there are hospitals. Methods used have included complaints and comments pypatients and doctors (Drew, 1964); critical incident technique (Gorham, 1962); subjective written comments by the supervisor, head nurse, and psychiatrist (Chernushin & Galvin, 1962); direct observation (Heslin, 1963); profile checklist, graphic rating form, forced choice profile, preference checklist, and observation checklist (Gorham, 1963); descriptive rating scale (Tate, 1962, 1964); and the Nurse Performance Description Scales (Dyer, 1967). "No such thing as a precise measure exists or can exist for the complex behaviors involved in P. 1). nursing performance," (Tate, 1964, However, the criterion measure chosen for the present study, the Nurse Performance Description Scales (NPDS) has had rather extensive reliability and validity checks during its development in the last six year. The NPDS (see Appendix B) contains 50 items of be- havior descriptive of a nursing function plust 2 items which repeat the meaning of other items in the test, worded differently, as a rater reliability check, and 1 item used as a validity check. Only one item, #34, "Uses complicated equipment effectively if it is required for patient care, II chiatric ward. would not ordinarily be observed in nur sing on a psyThe items are rated on a 10 point continuum by a super- visor, usually the head nurse. The total possible score ranges from 7 50 to 500. Three of the 53 item.s are not scored; 2 of these are reliabi- lity checks and 1 is a validity check. The NPDS was tested in four Utah hospitals. The sam.ple of nurses in the study num.bered 200, including 21 nurses on psychiatric wards. Rater reliability within a short tim.e span was m.easured by repeating the two item.s in m.eaning within the test; correlations were .86 to .89. Test-retest reliability was assessed by repeating the ratings in ten to twelve weeks. Correlations of . 80 to . 88 were found in the four Utah hospitals in the study (Dyer, 1967). Concurrent validity was assessed by several m.ethods. A supervisor's rating of 1 to lIon im.portant characteristic s of a good nurse correlated. 61 with the NPDS. The two ratings were done by different supervisors for each nurse. A second validity check was m.ade by com.paring the rank order of the NPDS scores with a rank order of nurses as to overall effectiveness. The ranking of overall effectiveness was done by the director or assistant director of nursing at each hospital. Spearm.an's coeffi- cient of rank correlation was com.puted for each of the four hospitals; the correlation coefficients were. 48, .59, .66, and. 67. One item., #53, "Would you choose this nurse to take care of you or a loved one if illness occurred and you required care in her type of area?" correlated. 79 with the total score. This was also con- sidered evidence of construct and content validity (Dyer, 1967). 8 Five subscales were built into the NPDS. These subscales were IIProfessional orientation, " "Thrust, " "Consideration, " "Clinical competence, II and "Leading and teaching. 11 the form, a factor analysis was done. In the process of evaluation of Six factors emerged; five of the factors resembled the subscales, the sixth was named "Ability to Observe Patients, Identify Their Needs, and Organize to Fulfill Their Needs," (Dyer, 1967, p. 56). The factors were highly correlated. One explanation offered for this intercorrelation was the rater error, "halo, " which refer s to the tendency for rater s to consider the over all effectiveness rather than rating the subject differentially on each individual trait. A validity check of the Nurse-Psychiatric Patient Interaction Inventory was measured in the present study by correlating scores on the NPPII and NPDS ratings of a group of registered nurses who were employe4 on hospital psychiatric units. It was expected that nurses who are presumably proficient in nurse-psychiatric patient interactions as measured by the NPPII will tend to receive high performance ratings from their immediate supervisors on the psychiatric unit. Particularly, the subscales "Clinical competence" and "Consideration" were expected to correlate highly with the NPPII scores. CHAPTER II METHOD Nine psychiatric wards in six Utah hospitals were selected as the setting for the study. Two hospitals were located in Ogden: the Thomas D. Dee Memorial Hospital and the St. Benedict's Hospital. The remaining four hospitals were located in Salt Lake City: the Latter Day Saints Hospita1 1 the Veterans Administration Hospital, the University of Utah Hospital, and the Holy Cross Hospital. Sample The subjects selected fo+ the study included nearly all of the registered nurses working as staff nurses on the day and evening shifts on the nine psychiatric wards. Four of the wards were in the Veterans· Hospital; the remaining five wards were in each of the other hospitals. The nurses were from three formal educational backgrounds: 5 had graduated from baccalaureate (4 year) programs, 19 from diploma (3 year) programs, and 5 from associate degree (2 year) programs. The years of experience since graduation in all types of nursing and in psychiatric nursing are listed in Table 1. 30 years. The mean age reported was Three nurses did not report all of this information. Procedure The Nurse-Psychiatric Patient Interaction Inventory was administered to groups of 1 to 4 nurses while they were on duty. The proctor 10 Table 1 Nursing Experience of Sample Nurses Number of years experience since graduation Number of Nurses Experience in Experience in all types of nur sing psychiatric nursing 10 16 From 2 - 6 years 7 8 From 6 - 10 years 2 3 10 2 3 3 32 32 Under 2 year s Over 10 years Not reported Total number of nur ses 11 endeavored to make appointments with the nur ses during Ie ss busy hours on the ward. activity. The tests were given in a room away from ward The proctor read the directions with the nur ses and allowed time for questions. The tests were not timed, but usually 25 -35 minutes were required for completion. The nurses were told that the inventory was part of a research project and that they would be apprised of the results. They were asked to use a code name to identify the forms in order that they might remain anonymous, and to inform their immediate supervisor of their code name in order tha t she might identify a rating form which she was being asked to complete for the study. In this manner, it was planned that neither the investigator nor the supervisor would know individual nurses' scores) since the supervisor did not see the NPPll1s and the investigator did not have the nurses' real names available. The Nurse Performance Description Scales were completed by the immediate supervisors, usually the head nurse. There were nine raters who evaluated from I to 7 nurses on each ward. Four of the raters had master's degrees in nursing, one had a baccalaureate degree, and the remaining four raters had diplomas in nursing. of the raters worked directly with the nurses on the wards. All Two of the raters were familiar with the NPDS, having participated in the re search during its development and evaluation. tions were given to the raters. No special instruc- CHAPTER III RESULTS AND DISCUSSION Product moment correlations were calculated between the NPPII scores and the NPDS total and subscale scores. tions were from. 01 to . 13. The correla- There was no tendency for high scorer s on the NPPII to receive high ratings on any of the NPDS scores. When the ten high scorer s and the ten low scorer s on the NPDS were compared, the mean scores on the NPPII for these two groups were equal (M=8. 5). The two lowest scorers on the NPPII received the two highest scores on the NPDS total ratings. These scores were 1 and 3 out of 18 possible on the NPPII and 429 and 444 out of 500 possible on the NPDS. There are several possible explanations for the lack of expected correlations between the NPPII and the NPDS scores. The NPDS may not be an appropriate tool for the evaluation of specific psychiatric nursing skills. This performance scale consists of items of be- havior thought to describe a "good" nurse mainly from an administrative point of view. The validity of the instrument was shown when it correlated highly with concurrent evaluations of the nurses by other supervisors and when scrutinized for content by nurses from all administrative levels of nursing. The true measure of a nurse l s ability, however, would be whether the patients move toward physical and mental health under her direct care or as a result of her teaching 13 or supervision of other per sonnel who care directly for patients. Such a measure of the patient's improvement as a direct result of the care of one nurse is very difficult to obtain. In an attempt to measure the effectiveness of individual nurses from a patient's point of view, it was found that lithe patients were reluctant to com.m.ent on an individual nurse. Continually the emphasis was on the 'group' of nursing per- sonnel who were caring for them ..•. According to the interviewer s those nurses engaged in a leadership capacity could rarely be identified II (Law, 1966, p. 46). It would seem, then, that the patient him- self would not or could not always give the necessary information about which nurses were effective in moving him toward health. The supervisor, then, must judge whether the patient care has improved as a result of a nursels performance. Only one item on the NPDS, #47, "Develops nursing care plans that reflect an under standing of the patient's physical, emotional and mental functioning," specifically mentions the emotional care of the patient, although it would seem that this aspect of care was implicit in many of the items, depending upon the supervisor I s interpretation of the item. For instance, item #22, giving expert care to patients, each rater. It II Is vitally concerned about might be interpreted differently by One rater might evaluate II expert care" as the extent to which the patients proceed through the day's activitie s in an orderly manner, receiving all medications and treatments accurately and on 14 time, being on time to all activities and appointments, being noncomplaintive, well-dressed, neat, and clean. Another rater might interpret item #22 as the extent to which the nurse is able to coordinate all activities and interpersonal relationships surrounding the patient to increase the patient I s ability and motivation for moving toward physical and mental health. The former example would be more from an administrative point of view; the latter example would be more from the patient! s point of view. It is suggested that items be incorporated into the NPDS which would elicit the supervisor's evaluation of the effectivene s s of the nur se -patient inter actions and the influence of the nurse on the interactions of other personnel with patients. This skill in effective com.m.unication with patients is thought to be important, not only to the psychiatric patient, but to all patients. Another reason for the lack of correlation may be that the nurse who is a potentially therapeutic force in nur se -patient interactions as measured by the NPPII is not necessarily an effective nurse in other important aspects of nursing. The NPPII measures only one aspect of nursing, the understanding, helpful reply of a nurse to a patient's problem. The results of the study did not support the assumption that the nurse who scores well on the NPPII is effective in her relationships with other people in the work situation as well as in nurse-patient relationships, and would be judged a "good ll 15 nurse by her supervisor as she performs on the psychiatric ward. Another pos sible reason for the lack of correlation of the NPPII and the NPDS is the rater error, "halo. II Raters using the NPDS during its development had shown a tendency to make this error. If supervisor s are more interested in patient welfare from an administrative, rather than a strictly patient-centered point Of view, then the error might be in favor of such qualities as neatness, accuracy, punctuality, reporting, and supervising, for instance, rather than another important quality, the nurse-patient interaction effectiveness. Moreover, most of the raters had little acquaintance with the rating scales. Possibly with some further knowledge and training in rating each item according to the nurse's specific performance, the clinical competence subscale would have been correlated with the NPPII, when the nur se s I per formance on psychiatric wards was being rated. The NPPII scores ranged from 1 to 14. 9. 13. The mean score was The means, standard deviations, and ranges of the groups according to education are listed in Table 2 together with the same information from Jensen's study with senior nursing students. Con- trary to Jensen's results, the associate program graduates had the highest mean score, followed by the baccalaureate and diploma program graduates. However, sample sizes were too small to make a meaningful comparison of the group means. In addition, three of the 16 Table 2 NPPII Means, Standard Deviations, and Ranges of Graduate Nurses Compared with Jensen's Senior Nur sing Students a Education Mean S. D. Baccalaureate Graduates (N=5) Students (N=35) 9.00 10.46 3.29 5. 13 9 13 8.32 8.00 3.92 2.72 13 11 11.20 8.06 1.94 3.35 5 10 Diploma Graduates (N=19) Student$ (N=29) Associate Graduates (N=5) Students (N=36) a Adapted from Jensen, 1966. Range 17 five baccalaureate nur ses worked at one hospital; four of the five associate nur ses worked at another hospital. The difference here may be a l"esult of, among other things, the different philosophies of nursing care at the different hospitals. The mean total score for the NPDS was 346. 79, which was slightly below a mean of 348 for the nur ses in Dyer I s study. The standard deviation was 64. 10, compared to 76. 08 in the Dyer study (1967). These nurses, then, were "average" nurses as compared with other Utah nurses. It was concluded that further research is necessary to determine the validity of the NPPII. CHAPTER IV SUMMARY The study was an attempt to further validate the Nurse-Psychiatric Patient Interaction Inventory (NPPII). The NPPII is an IS-item, empirically derived inventory designed to measure the extent to which a nurse can select potentially therapeutic verbal responses in nursepsychiatric patient situations. In the original development of the in- ventory, baccalaureate nursing students performed significantly better than diploma or associate degree $tudents on the inventory. interpreted as a very limited validity check. This was A further validity check of the NPPII was measured in the present study by correlating scores on the NPPII with performance ratings of a group of registered nurses who were employed on hospital psychiatric units. The performance ratings were scores on the Nurse Performance Description Scales (NPDS). During the first phase of the study, the NPPII was given to the nurses. During the second phase, the immediate supervisors of the subjects completed the NPDS as an evaluation of the nurse IS overall nur sing performance. The NPPII and the NPDS were expected to correlate highly on the assumption that the nurse who is effective in nurse-patient relationships would also be effective in her relationships with other people in the work situation, and would be judged a "good" nur se by 19 her supervisor. Product moment correlations were calculated between the NPPII scores and the NPDS total and subscale scores. There was no tendency for high scorers on the NPPII to receive high NPDS ratings. When the ten high scorers and the ten low scorers on the NPDS were compared, the mean scores on the NPPII for these two groups were equal. Several pos sible explanations were offered for the lack of expected correlations between the NPPII and the NPDS scores. The NPDS may not be an appropriate tool for the evaluation of specific psychiatric nur sing skills. Another explanation offered was that the lack of correlation may indicate that a nurse who is a potentially therapeutic force in nurse-patient interactions, as measured by the NPPII, is not necessarily an effective nurse in other important aspects of nursing. How- ever, further research was recommended to determine the validity of the NPPII. Another possible reason for the lack of correlation was the rater error, "halo, II which could have favored qualities other than those measured pythe NPPII. Contrary to predictions, the associate program graduates had the highest mean score, followed by the baccalaureate and diploma program graduates. However, sample sizes were too small to make a meaningful comparison of the group means. 20 REFERENCES Beier, E. G., The silent language of psychotherapy. Publishing Company, 1966. Chicago: AIdine Brown, Martha & Fowler, Grace. Psychodynamic nursing. Philadelphia: Saunders, 1966. (3rd ed.) Chernushin, Mary & Galvin, J. Evaluation that is frankly subjective. American Journal of Nursing, 1962, 62(2), 92-93. Drew, Jacqueline. Determining quality of nursing care. Journal of Nursing, 1964, 64(10), 82-85. American Dyer, Elaine. Nurse performance description: Criteria, predictors, and correlates. Salt Lake City: University of Utah Pres s, 1967. Fromm-Reichmann, Frieda. Principles of intensive psychotherapy. Chicago: The Univer sity of Chicago Pres s, 1960. Gorham, W. A. Staff nursing behaviors contributing to patient care and improvement. Nur sing Research, 1962, 11, 68-79. Gorham, W. A. Methods for measuring staff nursing performance. Nursing Research, 1963, 12, 4-11. Heslin, Phyllis. Evaluating clinical performance. 1963, 11 (5), 344-345. Nursing Outlook, Jensen, Joan. The development of a nur se -psychiatric patient inter ""' action inventory. Unpublished master1s thesis, University of Utah, 1966. Law, Eva Jean. A study of the verbal responses of nurses to problem situations. Unpublished master's thesis, University of Utah, 1966. Pep1au, Hildegard. Interper sonal relations in nursing. G. P. Putnam's Sons, 1952. New York: Schwartz, M. S. & Shockley, Emmy. The nurse and the mental patient. New York: Russell Sage Foundation, 1956. 21 Tate, Barbara. Evaluation of clinical performance of the staff nurse. Nur sing Research, 11, 1962, 7 -9. Tate, Barbara. Test of a nursing performance evaluation instrument. New York: National League for Nursing, 1964. APPENDIX A THE NURSE-PSYCHIATRIC PATIENT INTERACTION INVENTORY INSTRUCTIONS: This inventory consists of 18 situations which describe the patient's history and/or illness, a description of the setting in which the nurse-patient interaction takes place, followed by a statement which the patient makes to the nur se. Following each situation are responses which the nurse could give in that situation. Please carefully read the situation and each of the response choices, then choose the most appropriate response for that situation. Indicate your choice by marking an X in the blank space next to that choice. 24 1. Mrs. L., 20, was admitted to the psychiatric ward from the medical ward after she had recovered from ingesting a large amount of barbiturates. She had a history of juvenile delinquency, an early marriage and motherhood. During her hospitalization, she was depressed and anxious. She received electroshock therapy which caused her to be nervous and forgetful. One morning the nurse was sitting at the patient's bedside while Mrs. L. put on her make-up. She used a great deal of make -up, and this morning she made up only one side of her face. After putting her cosmetics away, she turned to the nurse to show her without a word. The nurse responds: a. I!you have done a very fine job of applying your cosmetics. Do you mind if I wait until you have finished the other side of your face? II b. IIMrs. L., you have forgotten to put your makeup on the other side of your face. Your treatments are being effective for you're forgetful these days. II c. "Mrs. L., you haven't finished with your makeup. Is there something you are trying to tell me?! d.. There is plenty of time for A. M. care before breakfast and activities. II e. "Make-up on only one side of your face, Mrs. L. How corne? II f. "Mrs. L., remember to think through every motion taken after awakening until you retire. You will be more satisfied. Look in your mirror! n II 25 2. Mr. M., 50, is paraplegic as a result of an autom.obile accident 8 year s ago. He has spent m.uch tim.e in the hospital with infected decubiti. He had one psychiatric adm.ission when he attem.pted to take his life by ingesting Seconal pills. Since he was greatly depressed and his fam.ily feared he would m.ake a further attem.pt on his life, he was adm.itted to the psychiatric ward for observation and treatm.ent. One m.orning as the nurse was giving him. skin care, he said, IIIt's no·use. I can't take it any longer, so I am. going to kill m.yself. 11 The nur se responds: a. "It does seem. difficult at tim.es. b. "Mr. M., give us this opportunity to care for you. " c. II That is quite a statem.ent to m.ake. You m.ust be feeling m.ore despondent today. Have you thought what an unsuccessful attem.pt m.ight m.ean to you? There are m.any angles to consider about a decision like this and perhaps, if we talk a little mor.e about it, there m.ay be som.e area of interest to you that m.ight have a m.ore constructive outlook. Suicide is such a final answer and how can you be sure it is the best one? " d. "What is no use? II e. Ilyou feel like giving up today, Mr. M." £. "Do you really m.ean this? If so, you had better talk to your doctor. He can help you change your m.ind. After all, you are only m.iddle-aged. 11 II 26 3. Mr. C., 62, was brought into the hospital by the police who found him lying on the street in a drunken state. He was a 40 year history of alcoholism. He was admitted to the psychiatric ward and placed in a seclusion room because he was having delerium tremons and hallucinations. When the nurse entered his room to check on him, Mr. C. was holding his urinary drainage tube in his hand. Belligerently, he yells at the nur se, "Give me an ashtray, so I can put out this cigarette. If you don't give me an ashtray, I'm going to burn down this whole damn building. II The nurse responds: a. Do you consider your drainage tube to be a cigarette? 'I 11 b. "Mr. C., you must be very frightened and sick today. I'm your nurse and I'm here to help you. " c. Summ..on an orderly to restrain his hands. "I will be right back to help you. I'm going to have X help us, too. 'I d. "Mr. C., you are just upset from your illness, and we never let anyone smoke without someone in attendance. I can give you some medication to relax you. 'I e. II I'll help you, Mr. C. II 27 4. Mr s. D., 64, was admitted to the psychiatric ward because of extreme depression, continual crying, and various vague physical complaints for which no physical basis could be found. Mrs. D. had lived an active and productive life. She had raised a family and had been active in civic affairs. She had had no abnormal signs of anxiety or depression until the marriage of her younge st child two months ago. On the psychiatric ward, the nurse accompanies the patients to the community breakfast table. One morning, Mrs. D. sat at the table with her head bowed, her hand over her mouth, and her eyes tearful. She turned her body from side to side. The nurse said, "Mrs. D., can you try eating some of your breakfast?" Mrs. D. replied, lIyou wouldn't make me eat if you knew what horrible things I've done." The nurse then responds: a. "You don It need to eat breakfast if you don 't want to. II b. "Try to eat something at this time. a reward. " c. "What horrible things have you done? " d. "You feel that you don't deserve to eat? Eating is not II 28 5, Ml". P., 32, was admitted to the psychiatric ward by court order on a charge of m.olesting his 7 -year -old stepdaughter. He is a suspicious -acting man who likes to be by him.self. One day the nurse engaged him. in a conversation: Nurse, "I noticed you were m.aking a wallet in occupational therapy. " Mr. P., "Yes. II Nurse, "Have you ever done leather-craft before?" Mr. P., "Yes." At this point, Mr. P. began to openly m.asturbate. The nurse responds: a. "Mr. P., come over to the table by the window and let's look at the other piece s of leather. It b. "You seem. to be quite uneasy, Mr. P. Is it som.etim.es hard for you to be on closer contact with other people? " c. "Please leave m.e until you have control of your behavior; then we will try talking again. II d. "Why do you do that in m.y presence? " e. III'm. a little concerned at your behavior of the m.om.ent. Perhaps it would be better if you were to go to the privacy of your room.. We under stand that som.e of this behavior has been your problem., but som.e of the other patients m.ight not under stand, and it m.ight be upsetting if they were to see you. The doctor will be in later, and it m.ight be a good idea for you to talk this over with him.. Will you let m.e see your wallet when it is com.pleted? " 29 6. Mrs. K., 38, was admitted to the psychiatric ward for treatment because she was no longer able to carryon her household duties. She had an uncontrollable desire to scrub herself, her two children, and the walls and furniture because she felt everything was contaminated with virulent disease germs. One day while she was scrubbing a chair, she said to the nurse, "I know this isn't sensible. I can't go out into crowds for fear of being contaminated. II The nur se re sponds: a. "Sometimes, Mrs. K., even when we can say things aren't sensible, it's hard for us to do differently. II b. IIEveryone has to live in this world with other people, and you have to accept the idea that a great many people do survive those germs without ill effect. " c. "If you know this isn1t sensible, why do you do it? d. IIWhy do you feel everything is dirty? " II 30 7. Mrs. B., 17, is married and has a newborn child. The conditions of her own childhood were emotionally deprived. As a youngster, she was not afforded parent.al control which resulted inher being delinquent and sexually promiscuous. After the birth of her child, Mrs. B. became so depressed that she was unable to care for the infant, and she was admitted to the psychiatric ward. One morning, she said to the nurse, "I don't deserve the wonderful husband I have, and my baby. I am no good because I have done everything in the world that there is to do that is bad. My husband is a good guy, and he doesn't even know some of the awful things I have done. He would leave me if he did. I met him when I was in a detention home for girls, but he doesn't know why I was there. I ought to kill myself and let him find some nice girl to marry. " The nurse responds: a. "You've done everything in the world that is bad? " b. "You seem to be feeling pretty discouraged about things today." c. "Try to forget your bad experiences and think more of the good things you have. Your husband and baby need you. " d. "It isn1t unusual to feel unworthy of someone -especially if we are unable to accept our own behavior. There is usually a reason why we do the things we do. Your doctor is interested in helping you, and I'm sure if you tell him about how you feel, he will be able to help you under stand your actions and plan how the situation would be best handled. I'm sure you have many good qualities. Have you ever looked for them? " 31 8. Mrs. G., 54, was admitted to the psychiatric ward in acute depression. She remains apart from the other patients and cries when anyone approaches her. Mrs. G. 's chief complaint is that she cannot see, and she attributes this to cataracts. A complete work-up was done with no evidence of cataracts or other visual abnormalities found. Mr s. G.' s inability to see began shortly after her husband had a stroke and became bedridden. One sunny morning, Mr s. G. and the nurse were standing at the window. Mrs .. G. said, "It's so dark. So very, very dark." She began to cry. The nurse responds: a. "What is dark? " b. "It's a most beautiful morning outside. " c. liAs I shine day. mere d. "Darkness can be very lonely and frightening. stand at this window, Mrs. G., the sunis really overwhelming. It is a beautiful I am sure that if you dry your eyes for one second, you will notice a ray of light. " II 32 9. Mis s M., a schizophrenic patient, was sitting in the lounge. She looked distressed: her eyebrows were knit, and she bit her fingernails. The nurse approached, and asked her what the matter was. Miss M. said, "They increased my medications. I dontt like to take Thorazine because my eyes can1t focus, and I can It go outside because my skin breaks out. But the doctor says I'll need to take tranquilizers the rest of my life. II The nurse responds: a. "Miss M., your doctor will arrange your tranquilizer s as you need them. I! b. "Sometimes medicine will make you feel differently, such as your eyes not focusing. After youlve taken it for some time, perhaps it won1t bother your eyes. You sound discouraged now, but later when you feel better, perhaps he will reduce the amount. It is important for you to follow your doctor IS order s. Then, you will be able to go home sooner. If you have some more questions about your medicine, lett s remember to ask Dr. X about them. He can help you understand. II c. "Sometimes it is necessary to take medication for long periods of time, and it is true that with Thorazine you have to be careful oi the sun. Are you afraid of taking medications for the rest of your life? 11 d. "What else has the doctor told you? e. "We have some good lotion for your skin that I will be glad to give you, and if your eyes continue to bother you, be sure to tell the doctor. He may want to try one of the other tranquilizers. \I II 33 lO. Mr. S., 54, was admitted to the psychiatric ward for acute depression following an admission to the medical ward for diagnosis for the cause of a dysfunctioning left hand and arm, No physical basis for this phenomena could be found. Mr. S. had worked as a carpenter all of his life. The firm for which he had worked had dissolved due to financial difficulties. Mr. S. had not been able to find another carpentry job, and shortly thereafter, his arm became dysfunctioning. The physical appearance of his arm indicated no atrophy of the musculature, yet on one occasion he said to the nurse, "Just look - - this arm is shrivelling up to nothing. It's getting smaller and smaller, isn't it?" The nurse responds: a. "Why do you feel that your arm is getting smaller? " b. "No. It is the same as your other arm. Why not exercise and keep strong. Then you will be ready for any job when you leave. 'I c. "I see no change, but you do, and this must make you feel very useless." d. "I really haven't noticed any difference in your arm. " 34 11. Miss T., 25, was admitted to the psychiatric ward because she was becoming increasingly hyperactive and unable to manage her affairs. She had quit her job and moved into an apartment with her boyfriend in order to keep an eye on him, as she feared he might return to his wife. In the hospital, she constantly paced the hall, laughed, talked, and ate candy bars. One day as she was behaving in this way, she said to the nurse, liMy belt, my belt. I forgot to put on my belt. A belt is when you hit someone. Ha, ha, ha, ha, ha. Isn't that funny? I guess I'll have to be more quiet. They said if I laugh like this I won It be able to leave the hospital and go to work." The nur se responds: a. You do seem to be having a difficult time today. It's quiet in your room. Come, I'll sit with you ther e. I' b. "This behavior is inappropriate, isn't it? c. "When you are well again, Miss T., you will not need your belt or to laugh like this, and you will be able to leave the hospital and go to work. " d. "Do you think because you laugh you are kept in the hospital? II e. "Miss T., do you really want to go back to work? If you do, there is lots to be done here for you. Let us help you. 11 II 1T 35 12. Miss P., 22, was brought to the hospital by court order. In the last year, she had become pregnant, but waited until the pregnancy was evident to tell the father. He refused to marry the girl, whereupon she aborted her self. The girl's mother then dismissed the girl from her home. The girl attempted suicide by cutting her wrists. In the hospital, she withdrew from other persons and spent long hours sitting by herself. The nurse spent a great deal of time sitting quietly beside the patient. After several days of this kind of support, the patient bur st into tear s, and said, II It I S all so long and involved. If I can't help myself, I don't know how anyone else can." The nurse responds: a. "Things always look the worst when you have not allowed your feelings to be ventilated. Your problem is not unique to us, but it is to you. Help can be given if you will only start talking. ,. b. III think you can help yourself, and I want to help you do it. " c. "The help must come from you first, and staff is available to give additional help. IIf d. II Why did you tell me about it? II e. "It sounds like you feel pretty helpless, but aren't sure if you can trust others to be of help. " f. "Would you like to tell me what l s troubling you? II 36 13. The nurse entered the ward on Monday morning. Several patients were sitting in the lounge. The nurse greeted each patient individually and asked how each per son I s weekend had been. Each person gave a "standard" reply, such as, "My husband carne to visit me, II or flI didn't do much of anything except sit around and watch T. V. II However i the last patient, a schizophrenic girl, said, flI had a nice weekend. I went into hysterics. I got sick to my stomach three times, and went into hysterics -- laughing hysterics. II The nurse responds: a. III feel that you must have had a very upsetting weekend. II b. "This may seem nice to you, but we feel you can enjoy a better weekend than this by more thinking and acting. II c. "You went into hysterics? d. "Sounds like you got the attention around here and nobody else enjoyed themselves so much. II e. II fI What were you hysterical about? II 37 14. Mr. W., 35, is a very hostile man with chronic alcoholism. He has had several admissions to the psychiatric ward by order of his family who "want something done with him". One morning, he was talking to himself and using a great deal of profanity_ The nurse approached him to determine what the problem was. He said, "That goddarnn doctor. He doesn't know which end is sticking up. You tell him anything, and he just looks at you like a dumb jackass. How in the hell did they ever let him be a doctor?" The nurse responds: a. "You seeIn upset with your doctor. Can you tell me about this? But, please watch your language, because this type of language is not acceptable to me. II b. "Your doctor is trying to help you, but you have to help your self by trusting him. II c. "Your visit with your doctor seems to have made you awfully angry. Perhaps you'd like to talk about it. 11 d. "Are you upset with your doctor? e. II I think he is a very good doctor. He has helped many people, and he will help you, too, if you try to cooperate. II II 38 15. Mrs. G., 35, was brought into the hospital by her husband because she spent the entire day ~n her bedroom and refused to take care of her children. Mrs. G. has 4 children under the age of six, and is expecting her fifth child. She was greatly upset about this last pregnancy and had been acting bitterly towards her childr en: she had taken to slapping them and punishing them for minor misdemeanors. One day as she was conversing with the nurse, she said, III just withdrew. I spent most of my time in my bedroom away from the kids. I was afraid of what Pd do. I just didn't know what Pd do. My bedroom became my refuge. II The nurse responds: a. Ilyou probably went to yo-iJ.r room because it is a difficult task to raise four children. Maybe you could talk to your husband about ways in which he could help you. II b. IIWhat did you feel you would do, Mrs. G.? II c. III can understand that you were afraid of your own aggressive feelings and that you felt safer away from the children. II d. It's an overwhelming feeling to be afraid of losing self-control, isn't it? II II 39 16. The nurse was conversing with several patients on the psychiatric ward. One of the patients asked if Patient Government Meeting would be held today. This started the patients talking about the meeting. Most of the talk centered around the patient's dislike for the meeting. One of the patients turned to the nurse and said, liThe thing I don't like about them is that they make a guinea pig out of one person. I'm not going to talk about the other patients in front of the whole group and make one per son feel bad and cry. I was the one they picked on last week. II The nur se re sponds: a. liAs one of the group members, can't you point out to them how uncomfortable they make you feel? It b. lilt's difficult sometimes to be the one who is being criticized, isn't it? I' c. "I understand the way you must feel, but you must realize that this type of therapy helps you understand your problems and those of the other patients may help you. " d. II I'm sure we all feel badly when the center of a group. What do you feel the group is trying to do? " 40 17. Mrs. F., 35, was admitted to the psychiatric ward because she was addicted to barbiturate$. The nurse spent a good deal of time with Mrs. F. and finally, one day, Mrs. F. started talking about her addiction. She said, II I don 't want to be an addict. I want to be able to take care of my children. But, I have such a craving for barbiturates. I know if they were sitting right here in front of me I wouldn't take one. But, 11m afraid that if I get out of the hospital that I'll need some very badly. II The nurse responds: a. b. lilt is understandable that this is a very hard thing to go through, Mrs. F., even though you don It want to. " 11 Do your children make you very nervous? II c. "With time and treatment, you will find that your craving willIes sen. I realize that you feel that you need these drugs now, but you must try very hard to overcome these feelings. " d. "You feel that the problems that cause you to take barbiturates are only outside the hospital. " 41 18. M:r. P., a 25..:year -old schizophrenic patient, has been ~dmitted to the psychiatric ward several times. The nur se has spent a good deal of time wi th him, and he is beginning to tell her some of hi s history. One day he said, "Did I tell you about the time I tried to kill myself? I was driving on the freeway at 120 miles an hour. The police tried to stop me with roadblocks, but I crossed the bank and drove on the other side until 1 ran out of gas. The newspaper s took pictures of them taking me off to jail, and it was on T. V. When I came to the hospital, the patients laughed at me because they had seen it on T. V., and they said I didn't really try to kill myself. Believe me, it's no joke. It's not funny when you're desperate. If The nurse responds: a. "I can accept how upset you must have been, but can you realizen.'ow how dangerous this was and how many people you could have harmed besides yourself in doing this? This may have been what the patients thought when they saw you on T. V. You do realize this is not acceptable behavior. II b.. "I see. c. "Mr. P., Ididn'tlaughatyou." d. II e. II Why did you want to kill your self? II "It must be very frightening to be desperate, and it certainly is no joke. II APPENDIX B NURSE PERFORMANCE DESCRIPTION SCALES Research Form No.5. The purpose of this inquiry is to discover the characteristics of an effective nurse. The resultant tool may be used as one basis to measure a nurse's performance. The information received will be held in confidence and used only for research purposes. It will not in any way affect the status or official evaluation of the rater or ratee. INSTR UCTIONS: 1. Please write the ratees code name. 2. Based on your observation of the ratee, please answer each of the questions. Circle the response that most nearly describes the ratee. 3. If you have not observed the ratee in this situation, make an X through the number that you predict would best describe her performance. 4. If you do not understand the question or wish to comment, respond immediately below the item in question. 5. Make only one response to each question. 6. Return the completed form to Marilyn Park as soon as possible. 44 NURSE PERFORMANCE DESCRIPTION SCALES Name (Ratee) ----------------------Position ---------------------------- Name (Rater) ------------------Position ------------------------- Rate the extent the nurse does or is involved in the following: (Circle the number. ) 1. Works toward improving the standards of nursing by reading the current literature and making useful suggestions. 1 2 / Makes some 3 effort to read and keep up. 2. 5 ) 6 Usually reads literature but makes few suggestions. 7 8 Re~ litera- ture and makes useful sugge stions. \ 10 Reads literature and make s many sugge stions. Recognizes the immediate and long-range objectives of nur sing s ervic e . 1/ 3 Implements changes after decisions have been made. 4 L 5 tilne permits, works to improve patient care or nursing admini s tr a ... tion. 6 / 7 8 Works productively to improve patient care or nursing adm.inistration. 9 \ 10 Assumes initiative to stimulate improvements in patient care or nursing administration. 45 til til (I) J.t (I) > (I) Z ~ J,;.j (I) > (I) 4. 5. 6. 7. 8. 0 8 >...... (I) J.t til cO U u ~< (I) ~< , (I) 8r:: a~ ocO til >- m ~ ~ >- ..... ..... cO ::s til ~ r:: (I) ~ til til >- 0 8 cO ~ ::> 0 < < 6 7 8 9 10 5 6 7 8 9 10 4 5 6 7 8 9 10 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Her assistance is sought by others when they need help, either personal or in matters 1 concerning work. 2 3 4 5 6 7 8 9 10 z ~ cO ~ 0 1 2 3 4 5 1 2 3 4 Demonstrates ingenuity in solving unusual problems that arise in the work situation. 1 2 3 Teaches the patient so he understands his role as a member of the therapeutic team .. 1 2 Other nurses complain that her assignments are not complete. 1 Spends time in the nur ses station when she could be giving additional patient care. Circle the appropriate number. 3. til ~ >- (1)00 0(1) ..... ..... ..... m 800 cd m ~J.t ~J.t r:: m(l) m(l) 0 ..c:> ..c:> '1"'4 Sought by worker s when per sonal or profes sional help is required. U).;i 0..c:: U)~, \+-I 46 II) '>"' r-I>r-I reS V V Z ..j-l Z < 1 2 3 4 5 Goes out of her way or uses special effort to meet or learn of patient's needs. 1 2 3 4 Is able to elicit cooperation from a difficult patient after others have given up and called the patient impossible. 1 2 3 Displays an honest attempt to improve her professional effectiveness by attending workshops, seminars, classes, etc. 1 2 Could be expected to be engaged in unproductive activities during slack periods. 1 Assists others toward achieving their personal or profes sional goals .. '"' v> Circle the appropriate number 10 . 11. 12 .. 13. 0 VbO 1 I'll 0 "pot I'll reS (.) I'll '"' °v ro>- abO r-Iro ro ~'"' ~'"' rov ~v ..c:> ~> r-I>v reS'"' txt V 9. ~ I'll I'll V ~ 0)< ~ >r-I r-I reS < ~ ~ I'll 0 I'll >- ::> a ro 0 < < 6 7 8 9 10 5 6 7 8 9 10 4 5 6 7 8 9 10 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 a (.) 0 a~ St.i1 oro oreS Ulfj Ul.;l :;j I'll v ..j-l ~ ~ 47 cp til J.c cp ~ > Q) 1""'4 ";d Z +oJ J.c Q) > 15. 16. 17. 18. 19. 0 a ~ ~ 1""'4 Q) J.c Q)o.o I""'4 nt +oJJ.c til ~ ~ Ocp abCeO ~ eOQ) eOQ) .....0 ~> ~.~. ~ til 1""'4 Q)<! eO 0 0 < +oJ"", a~ 0'" as:: oeO eO ::1 +oJ s::Q) til 0 til ~ a eO 0 < < +oJ ~ < ~ 0 1 2 3 4 5 6 7 8 9 10 Observes and reports subtle change s in patients conditions. 1 2 3 4 5 6 7 8 9 10 Demonstrates the ability to help the patient plan realis ... tic goals by recog ... nizing hi s true assets and limitations. 1 2 3 4 5 6 7 8 9 10 Is a leader in her area of responsibility as evidenced by her ability to make decisions and accept the responsibility for these decisions. 1 2 3 4 5 6 7 8 9 10 Seeks and uses sugge stions that improve patient care. 1 2 3 4 5 6 7 8 9 10 other s and encour age s them to make decisions. 1 2 3 4 5 6 7 8 9 10 Records her nur sing notes so they are clear, concise, and pertinent. 1 2 3 4 5 6 7 8 9 10 Circle the appropriate number. 14 .. til tIlcp ~ ClS riJ5 mii til p "H Supp~r ts 48 QJ III J.I >r-I r-I cd QJ :> QJ Z ~ J.I III :> E QJ 22. 23. 24. 25. J.I U QJ III cd ..d:> ~:> ~<t! Q) QJ< S~ ocd z < ~ cd a Uli1 Uli1 u >- 1 2 3 4 5 1 2 3 4 Makes recommendations for needed policy or procedure changes. 1 2 3 Is vitally concerned about giving expert care to patients. 1 2 Creates and/or utilize s learning opportunitie s for co-workers. 1 cd ~ ~ r-I cd ~ III < ~ ~ QJ ~ III 0 III >- E cd ~ ::> a < < 6 7 8 9 10 5 6 7 8 9 10 4 5 6 7 8 9 10 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 Administer s medication and/or electrolytic therapy accur ately. 1 2 3 4 5 6 7 8 9 10 Works in a manner that radiates professional selfc onfidenc e . 1 2 3 4 5 6 7 8 9 10 Circle the appropriate number. 21. -r-! E~ ocd QJ 20. 0 ~ 0 >r-I III J.I IIlQJ OQJ QJbO r-Icd SbO cd ~J.I ~J.I cdQJ cdQJ Keeps others informe d of new problems, materials, or objective s arising in her area. '+-I 49 Q) I'll J.t 1'Il<u :> I"""'i I"""'i <u cd. Z ... <u :> <u 28. 29. 30. 31 .. >- I"""'i a J.t <u rO 0 .~ I'll rO u U ... rOcp ~~ ~~ ,< ><u <u +o)J.t ~ ~ ~ I"""'i I"""'i +0) I'll I'll >- <u +0) 0 ~ s::l tf.lr:S ~r:S p 4-1 I"""'i 0 < < as::l a~ orO rO I'll a rO ~ I"""'i < 0 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Puts off an assign ... ment when it could be done immed:' iately .. 1 2 3 4 5 6 7 8 9 10 Under stands and appreciates the opinions of other s without ac cepting them or changing her own. 1 2 3 4 5 6 7 8 9 10 Administers treatments skillfully and with a minimal amount of discomfort to the patient. 1 2 3 4 5 6 7 8 9 10 Makes assignments that reflect an interest in the development of personnel. 1 2 3 4 5 6 7 8 9 10 Works productively on special committee assignments that are designed to improve patient care or ward administr ation. 1 2 3 4 5 6 7 8 9 10 Circle the appropriate number. 27. s::l 0 I"""'i >- rO p:f Z 26. I'll I'll >- <DbO abO rfcd. rO <u +0) ... 0<u Works effectively with groups and motiva te s them in group planning. 50 M >- G) > I"""i I"""i G) cd Z ~ M G) > G) 33. 34. 35. 36. 37. 38. 0 a >I"""i G) M cd CIl >- cd ~ '"""cd cd ~M ~M cdG) cdG) .,...0 ..d> ~~) >CIl ~< G) G) '"cd"" cd I"""i u u 0 U)~ as:: a; Z < Il:i 1 2 3 4 5 6 Motivates others without pushing them beyond their ability. 1 2 3 4 5 Concedes a point gracefully when sound contrary evidence is presented. 1 2 3 4 Uses complicated equipment effectively if it is required for patient care. 1 2 3 Expresses herself articulately. 1 2 Perceives the value of using community health agencies in planning for the post-hospital care of some patients. 1 :;:$ < ~ CIl s:: G) 0 ~ a CIl >- cd ~ 0 < 7 8 9 10 6 7 8 9 10 5 6 7 8 9 10 4 5 6 7 8 9 10: 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 Identifies and plans for the needs of the therapeutic team. 1 2 3 4 5 6 7 8 9 10 Counsels or criticizes people in front of other s. 2 3 4 5 6 7 8 9 10 Circle the appropriate number. 32. CIl s:: G) CIl M CIlG) OG) G)Q.() aQ.() 1 oed CIl ~~ ::> '+-I I"""i < 51 (J) Jot >. r-l (J) :> (J) r-l c..s ~ Z ..j...l Jot 41. 42. 43. 44. .....0 ell c..s (J) (J) Z :( c..s ~ 0 1 2 3 4 1 2 3 Is sensitive to the atmosphere of the ward and the feelings of those with whom she works. 1 2 Expresses herself in' a gr oup and then supports the group decision. 1 S Jot U u >. c..s SbO ' c..s ..j...lJ.4 ..j..)Jot c..s(J) c..s(J) ..Q:> ~:> ~< (J)< (J) S~ ell J.4 O(J) e.~ ~ :( >. r-l r-l c..s ::s ..j...l ell ~ (J) ell >. 0 c..s 0 :( :( ~ S ~ oro '1) 5 6 7 8 9 10 4 5 6 7 8 9 10 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 Organizes her work so that fir st things are done fir st. 1 2 3 4 5 6 7 8 9 10 Offer s criticism in a manner that invites acceptance. 1 2 3 4 5 6 7 8 9 10 Is able to make ingenious adaptation s of nur sing procedure to meet unusual patient needs. 2 3 4 5 6 7 8 9 10 Circle the appropriate num.ber. 40. >. r-l (J) :> 39. ell 0 ell eIl(J) (J)bI) r-lc..s Reacts promptly and appropriately in emergency situations. 1 oc..s U)r£1 CI).:;t 0 52 J.f Q) >. ....-t :>Q) ....-t nS Z +J J.f Q) 47. 48. 49. 50. a til >. abOnS nS ~ ....-tnS +JJ.f +JJ.f nSQ) nSQ) IX! u u ~~. i~ Q) a,:: a,:: onS 0 ooii ooo:S ::> >. ....-t Q) J.f nS 0 • .-i til nS Q) 5 6 4 5 3 4 2 3 Attempts to understand her self and others. 1 2 Works well without supervision. 1 Demonstr ate s acceptance of other I s ideas and sugge stions by using them. 1 < 1 2 3 4 Demonstrates cleverness in preventing friction from developing among per sonne!. 1 2 3 Evalutes and handles fairly questions and problems arising in the work situa .. tion. 1 2 Develops nur sing care plans that reflect an unders tanding of the patient ' s physica1 1 emotional, and mental functioning. 1 < >. ....-t ....-t nS om Z Circle the appropriate number. 46. 0 Q)~ Q) J.f OQ) ::stil :>Q) 45. til ,:: til til ,:: Q) +J I +J til 0 nS til a >. ~ 0 < < 7 8 9 10 6 7 8 9 10 5 6 7 8 9 10 4 5 6 7 8 9 10 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 2 3 4 5 6 7 8 9 10 \.i-; ....-t 53 J.f 0) >. ...... ...... Z ~ > 0) -+-l J.f 0) > 0) 52. 53. 0 E >. ...... 0) J.f ro 0 .~ tOO) 00) ~~J.f -+-l~ 0)' ~~ >. ro EbOro ro ..t:~ ..d> ~< ~< 0) (I)' ~ >. ...... ...... ro < -+-l to to Ulr5 Ulr5 p 0 S ...... < < 5 6 7 8 9 10 4 5 6 7 8 9 10 4 5 6 7 8 9 10 ro U u < 0 1 2 3 4 Her assistance is sought by other s when they need help with personal or work problems. 1 2 3 Administer s treatments skillfully and with minimal discomfort to patients. 1 2 3 z to J.f >. ro ~ ...... to p:f Circle the appropriate number. 51. to ro 0) to E~ E~ oro oro ~ to ~ Q) -+-l 4-1 0 I! I I Would you choose this nurse to take care of you or a loved one if illnes s occurred and required care in her type of area? t Never. 2 ollY if no one else available. 3 4 \ If not 5 seriously ill. 7 li Lre did not require technical skills. ill) Third Second Fir st choice choice choice