Evaluation of psychometric properties of instruments measuring nursing-sensitive outcomes: a systematic review.

AIM: To evaluate the psychometric properties of instruments measuring Nursing-sensitive Outcomes in acute care hospitals.

INTRODUCTION: Nursing-sensitive outcomes have been shown to play an active role in the quality of care and cost-effectiveness of health systems. Tools for assessing nursing-sensitive outcomes are necessary to evaluate the nurses' contributions to the health of patients.

METHODS: Psychometric systematic review. The SCOPUS, PubMed, CINAHL, PsychoINFO, EMBASE, Science Direct and Web of Science databases were used. Searches were performed between March and May 2018. A search with screened titles and abstracts, assessment of methodological quality using the COSMIN checklist and risk of bias assessment using QUADAS-2 were carried out.

RESULTS: Twenty-nine studies validated 26 different instruments. The methodological quality, measured with the COSMIN checklist, showed that the studies which assessed fewer psychometric properties had poorer quality. The majority of studies had high quality, and optimally assessed the risk of bias evaluated with QUADAS-2.

DISCUSSION: Concerning the focus of the scales, some of them focused on the patients while others focused on the nursing staff. The scales found assessed aspects such as nursing-care quality, complexity and personalization.

CONCLUSION: The majority of studies had a high methodological strength and a thorough validation process. The Nurse Caring Behaviours Scale, the MISSCARE Survey, the Patient Advocacy Engagement Scale and the INICIARE scale were the tools which best combined structure, methodological quality and risk of bias.

IMPLICATIONS FOR NURSING AND HEALTH POLICY: The instruments with the best psychometric properties should be implemented in acute care settings to improve the quality of care, assess the effectiveness of nursing interventions, reduce health expenditure and reduce the occurrence of adverse events.