Applied Nursing Research
Volume 22, Issue 4 , Pages 264-273, November 2009

Summative index: Acute pain management in older adults☆

  • Marita G. Titler, PhD, RN, FAAN

      Affiliations

    • Research, Quality and Outcomes Management, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1009, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 319 353 6995; fax: +1 319 356 4348.
    • ,
  • Keela Herr, PhD, RN, FAAN

      Affiliations

    • Adult and Gerontology Area and John A. Hartford Center for Geriatric Nursing Excellence, University of Iowa College of Nursing, Iowa City, IA 52242, USA
    • ,
  • Xian-Jin Xie, PhD

      Affiliations

    • Division of Biostatistics, Department of Clinical Sciences, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
    • ,
  • John M. Brooks, PhD

      Affiliations

    • College of Pharmacy, University of Iowa, Program in Pharmaceutical Socioeconomics, Iowa City, IA 52242, USA
    • ,
  • Margo L. Schilling, MD

      Affiliations

    • Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
    • ,
  • J. Lawrence Marsh, MD

      Affiliations

    • Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA

Received 23 March 2007; received in revised form 14 January 2008; accepted 29 March 2008. published online 16 January 2009.

Abstract 

One of the challenges in measuring adoption of complex evidence-based practices (EBPs) such as acute pain management is determining what constitutes adherence to an EBP guideline. Traditionally, individual process indicators extrapolated from an EBP guideline are selected as dependent measures of guideline adoption. When using multiple indicators, the challenge is determining the number of indicators that must be met to define adherence to the EBP guideline. The primary goal of the study reported herein was to develop and test a summative index (SI) of guideline adherence for acute pain management of hospitalized older adults. Steps in formulating the initial index are described as well as refinement of this metric. Techniques used included factor analysis, discriminate validity, and split-half reliability. The resulting SI is composed of 18 indicators each scored as 0 (not present) or 1 (present), with a total SI score of 0 to 18.

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☆ This project was supported in part by an Agency for Healthcare Research and Quality (AHRQ) Centers for Education and Research on Therapeutics cooperative agreement #5 U18 HSO16094, and by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (HFP 04-149). Dr. Titler is Director of Institute of Translational Practice in the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center, Iowa City, IA. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

PII: S0897-1897(08)00034-7

doi:10.1016/j.apnr.2008.03.002

Applied Nursing Research
Volume 22, Issue 4 , Pages 264-273, November 2009

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