Title

Instrument Development and Psychometric Analysis: Nurses' Urinary Incontinence Knowledge, Beliefs, and Practices

Date of Award

12-1-2007

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

Abstract

The purpose of this research was to develop and psychometrically assess an instrument to measure nurses’ urinary incontinence (UI) knowledge, beliefs, and practices (NU1KBAP) in the female population using content experts and nursing students. This multiple methodology investigation was framed by Feminist and Orem’s Self-Care Deficit theories. UI prevalence among women ranges from 9-72% with $19.5 billion dollars spent in the US on direct UI expenses in the year 2000. Many nurses do not have adequate knowledge regarding female UI and little is known about their UI-related beliefs and practices.

The foci of Phase 1 were to develop, estimate validity, and revise NUIKBAP. A purposive sample of content experts and a pilot of practical nursing (PN) students provided data regarding NUIKBAP’s layout, validity, logistics, and utility. The foci of Phase II were to assess NUIKBAP’s psychometric properties and to capture qualitative- descriptive (QD) input. A convenience sample of graduating students from Northern Minnesota PN programs were recruited. Reliability and validity estimates included t- tests; content validity indices (CVIs); Cronbach’s alpha; and item, exploratory factor, and content analyses.

Experts (n=7) rated NUIKBAP content valid (item CVI > 0.800 on 71/74 retained items; instrument CVI 0.856; inter-rater reliability 0.730). The pilot («= 11) revealed high instrument utility and significant divergent validity (p=0.002) between groups. Phase II («=205) post-elimination Cronbach’s alphas were adequate for knowledge (0.740), beliefs (0.729-0.776), and practices (0.704). A 6-factor Principal Axis factor solution reduced and organized items. QD («=21) analysis led to the emergence of five UI themes. Implications for nursing are vast. Our aging nation will lead to rising UI prevalence. There is a lack of evidence regarding the effectiveness of nursing education in preparing nurses to competently provide female UI care. Translation of research into practice must be brokered by nurses, yet limited information exists on nurses as mediators of female UI care. NUIKBAP will be useful longitudinally to gauge nursing practice progress as efforts are implemented to raise UI awareness, initiate standardized UI screening protocols, and distribute first-line UI treatment guidelines. This research contributes to the body of nursing knowledge and will influence Ul-related nursing education, practice, and policy.

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