Nursing Care and Orchestration
What is Orchestration, Psychometrics and Self Reports,Phases of Orchestration,Purposes of Orchestration,Aspects of Orchestration.
What is Orchestration
Instrumentation
is a general term for the activities involved in developing, testing, and
revising measures of concepts important to nursing. The term is usually applied
to these processes as they relate to psychosocial or self report measures of
attitudes and behaviors.
However, instrumentation also refers to the validating
of measures for physiological parameters or laboratory devices. The goal of
instrumentation is to create measures that reduce error in research through
consistency, accuracy, and sensitivity of measurement. For self report
instruments, consistency is analogous to reliability, and accuracy is analogous
to validity.
With laboratory instruments, validity is also used to describe the
accuracy of the measures, but precision refers to the instrument’s consistency
in measurement. Sensitivity is directly applicable to both types of measurement
and refers to the instrument’s ability to finely discriminate in individual
differences and changes in the concept under study.
Control of measurement error
is achieved by assuring that as much response variability as possible is due to
the subject’s relationship to the concept under study rather than to
inconsistent or systematic extraneous factors.
Psychometrics and Self Reports
The
term psychometrics is often used to refer to the results of testing self-report
measures and to the statistics that are utilized in that examination.
Self-report measures generally fall into the categories of norm-referenced and
criterion-referenced.
With norm- referenced instruments the goal is to obtain a
spread of scores across a wide range for the purpose of discriminating between
subjects. Criterion referenced measures are constructed for the purpose of
determining whether a subject has or has not achieved a predetermined set of
target behaviors.
Steps in instrumentation for these two categories differ,
however, the majority of attitudinal and behavioral measures applicable to
nursing are norm-referenced, and their construction and testing is emphasized.
Phases of Orchestration
Instrumentation
for self-report measures involves three general phases: development, testing,
and revision. Instrument development involves concept clarification, developing
a theoretical definition, operationalizing the concept, and generating items.
Concept analysis involves a careful review of literature with attention to
consistencies and inconsistencies in the use of the concept. Concept synthesis
uses clinical observations to explore the phenomenon of interest. Concept
derivation consists of moving a concept from one field or discipline to
another.
After the concept to be measured is clarified, a theoretical
definition is formulated that delineates the dimensions of the concept to be
measured based on the result of concept clarification.
Operationalization is
the process of moving to an operational variable that is isomorphic with the
theoretical definition. Item generation involves decisions about concept
dimensionality and scaling methodology.
When
the phenomenon of interest is a highly abstract concept, the theoretical
definition will include a number of conceptual aspects. Less abstract concepts
can often be indexed with items that tap only one, more finite aspect.
For each
aspect of the concept, items must be developed in a manner that assures
homogeneity within that conceptual dimension. Thus, the instrument may have to
be multidimensional or unidimensional, depending on the concept of interest.
Typically, multidimensional concepts will be measured with instruments that
have a subscale that relates to each dimension.
Purposes of Orchestration
Decisions
about scaling involve whether the model is meant to scale stimuli or people.
Methods used for scaling stimuli are paired comparisons, constant stimuli,
successive categories, and psychophysical methods. Common approaches to scaling
people are cumulative (eg, Guttman type), differential (eg, Thurstone-like),
and summated (eg, Likert-type) instruments.
Nunnally (1978) provided an
excellent overview of these scaling procedures. Other decisions in item
generation include factors involved with instrument formatting. These factors
relate to levels of measurement, scaling responses, and the appearance of the
scale to the respondent.
Instrument
testing for self-report measures involves two aspects. Initially, the content
of the instrument is examined to assure its relationship to the theoretical
definition of the concept.
The procedures include estimates of whether the
concept has been sufficiently indexed by the instrument’s items and whether the
format is clear and promotes response consistency.
Evaluation of the link
between the concept and items is primarily performed by a panel of content and
instrument experts. Once it is determined that the concept is adequately
indexed, a second phase of testing involves the use of the instrument with a
sample from the target population.
testing results in a quantitative
examination of reliability and validity measures (see “Reliability”
and “Validity”).
Aspects of Orchestration
Instrument
revision for self-report measures includes a critical examination of testing
results and individual items. Options for items are (a) inclusion as is, (b)
alteration to clarify or meet theory, and (c) elimination. Once the instrument
has been revised, it must be tested again with another sample from the target
population.
Instrumentation
for laboratory measures involves the similar phases of development and testing.
However, the development phase typically focuses on the establishment of
procedures for the use of the device.
Testing evaluates the precision,
accuracy, and sensitivity of the device, given the procedures established. Examination
of precision must include calibration of the device and evaluation for
inconsistency in readings, given repetitive use.
Assessment for accuracy
includes not only the meeting of established standards but appraisal of
appropriate theoretical specification of results to the concept of interest.
Revision of procedures may be needed when results of testing do not meet
established standards for precision and accuracy.