Orchestration In Health Care Introduction to Orchestration
Orchestration in nursing refers to the systematic process of developing, testing, and revising measures that are essential for accurately assessing various concepts in nursing practice. It encompasses all the activities involved in ensuring that these measures are reliable, valid, and sensitive, thereby minimizing errors in research and clinical practice. The term is often applied to psychosocial or self-report measures, which assess attitudes and behaviors. However, orchestration also extends to the validation of measures for physiological parameters or laboratory devices, aiming to achieve consistency, accuracy, and sensitivity across different types of measurements.
In the context of nursing, the primary objective of orchestration is to create robust tools and instruments that accurately capture the concept under study, whether they involve psychological states, behavioral patterns, or physiological measurements. By doing so, nurses can make informed decisions and deliver personalized care to their patients.
Psychometrics and Self-Reports
Psychometrics refers to the science of measuring psychological phenomena, often using self-report measures. In nursing, psychometrics involves the evaluation of self-report instruments to ensure they are reliable and valid. These instruments are typically categorized into two types: norm-referenced and criterion-referenced.
- Norm-Referenced Instruments: These are designed to spread scores across a wide range to distinguish between different subjects. The goal is to understand how an individual’s score compares to a broader population.
- Criterion-Referenced Instruments: These are developed to determine whether a subject has achieved a predetermined set of target behaviors. The focus is on measuring specific skills or knowledge against defined criteria.
The construction and testing of these instruments differ based on their purpose. Most attitudinal and behavioral measures relevant to nursing are norm-referenced, and their development often involves detailed psychometric evaluation to ensure they measure what they are intended to measure.
Phases of Orchestration
The orchestration process for self-report measures generally involves three main phases: development, testing, and revision.
- Development Phase:
- Concept Clarification: This involves reviewing existing literature to understand the consistencies and inconsistencies in how the concept has been used. Concept synthesis incorporates clinical observations to explore the phenomenon, while concept derivation involves transferring a concept from one field to another.
- Theoretical Definition: After clarifying the concept, a theoretical definition is developed. This definition outlines the dimensions of the concept to be measured.
- Operationalization: This step involves creating an operational variable that aligns with the theoretical definition, ensuring that it accurately represents the concept in question.
- Item Generation: Decisions are made regarding the dimensionality of the concept and the appropriate scaling methodology. Items are created to reflect each dimension of the concept, ensuring homogeneity within each dimension.
The theoretical definition’s level of abstraction dictates whether the instrument will be multidimensional or unidimensional. Highly abstract concepts may require a multidimensional approach with different subscales, whereas less abstract concepts can be indexed with items representing a single aspect.
- Testing Phase:
- Instrument Content Examination: The content of the instrument is assessed to ensure it accurately represents the theoretical definition of the concept. This involves checking whether the items sufficiently cover the concept and whether the format promotes consistent responses.
- Quantitative Testing: After initial content validation by experts, the instrument is tested on a sample from the target population. This testing provides quantitative data on the instrument’s reliability and validity.
- Revision Phase:
- Critical Examination and Revision: Testing results and individual items are critically analyzed. Items may be retained as is, modified to improve clarity or theoretical alignment, or eliminated if they do not meet the desired standards.
- Re-testing: The revised instrument undergoes another round of testing with a different sample from the target population to ensure it meets the required standards of reliability and validity.
Purposes of Orchestration
The orchestration process serves several purposes in the development and refinement of measurement instruments:
- Scaling: Decisions must be made regarding whether the focus is on scaling stimuli or people. There are various methods for both:
- Scaling Stimuli: Techniques such as paired comparisons, constant stimuli, successive categories, and psychophysical methods are used.
- Scaling People: Methods like cumulative (e.g., Guttman-type), differential (e.g., Thurstone-like), and summated (e.g., Likert-type) scaling are commonly used.
Nunnally (1978) provides a comprehensive overview of these scaling procedures, including factors such as levels of measurement, response scales, and the visual presentation of the instrument to respondents.
- Content Validation: The instrument’s content is validated to ensure its alignment with the theoretical definition of the concept. This involves confirming that the items adequately index the concept and that the format is clear and facilitates consistent responses.
- Reliability and Validity Testing: After content validation, the instrument is tested on a sample from the target population to evaluate its reliability (consistency of results over time) and validity (accuracy in measuring the intended concept).
Aspects of Orchestration
Orchestration also involves specific considerations when revising and validating instruments:
- Instrument Revision:
- This includes reviewing testing results and deciding on the status of individual items. Options include retaining the item as is, modifying it for clarity or alignment with the theory, or eliminating it altogether. The revised instrument is then tested again on a new sample.
- Laboratory Instrumentation:
- Similar to self-report measures, laboratory instruments undergo phases of development and testing. However, the focus in development is more on establishing procedures for using the device.
- Testing: The precision, accuracy, and sensitivity of the device are evaluated according to the established procedures. Precision is assessed through calibration and checks for consistency in readings under repeated use. Accuracy is verified against established standards and the correct theoretical specification of results.
- Procedure Revision: If testing reveals issues with precision or accuracy, the procedures are revised, and the instrument is retested to ensure it meets the required standards.
Conclusion
Orchestration in nursing care is a critical process that involves the careful development, testing, and revision of instruments to ensure they provide reliable, valid, and sensitive measures. Whether dealing with psychosocial self-report measures or laboratory devices, the goal remains the same: to create tools that accurately capture the concept under study, thereby reducing error and enhancing the quality of research and clinical practice. By understanding and applying the principles of orchestration, nurses can better assess patient needs, improve care quality, and contribute meaningfully to the advancement of nursing science.