Locating Instruments and Measures for Advanced Practice Nursing Outcome Assessments
Marilyn Wolf Schwartz and Roger Green
1. Provide a guide for finding instruments, including questionnaires, scales, and tools, to measure treatment outcomes
2. Discuss the value of using both print and web-based library resources, rather than public Internet search engines. There is value in consulting a professional medical librarian to find the appropriate instruments in a timely manner
3. Explain the importance of requesting permission to use instruments, whether standard or unpublished. Permission to use an instrument is an ethical issue related to copyright and proper research method
Chapter Discussion Questions
1. What two databases are appropriate to start a search for an instrument to use for diabetes primary care outcomes? What terms and strategy were used to do the search? List a measurement tool found in the database search that an advanced practice registered nurse (APRN) could use in practice.
2. In what reference books would you find a review and description of the Minnesota Multiphasic Personality Inventory (MMPI)? Search a local medical, nursing, or university library’s online catalog to see if any of the books listed in the Resources section at the end of this chapter can be found in a local library.
3. What are two university websites that can serve as resources to learn about requesting permission to use an instrument? List an instrument on pain assessment and describe 70where to request permission to use it, whether training is required to use it, and if there is a cost.
4. What mobile applications could be used to access resources discussed in this chapter when seeking information on an instrument that could be used to measure the physician–nurse professional collaboration?
5. What are the most promising resources for an outcome assessment, nursing problem, or medical problem that needs to be studied?
This chapter is intended to help APRNs find the instruments that measure the impact of APRN care and interventions. APRNs and researchers must know how to find surveys, questionnaires, or other measurement instruments to determine if a treatment is effective. In this evidence-based health care era, APRNs as well as researchers should study, measure, and report significant changes in interventions. When APRNs report evidence-based findings in the literature, they are improving the quality of health care and contributing to the profession.
Providing information on finding instruments would not be complete without mentioning the responsible use of tests and measures. Many university library websites explain the ethical use of measurement tools or instruments. Authors doing authentic research must prove validity and reliability. Textbooks on developing measurement tools emphasize the importance of testing and validating tools. Consequently, respected instruments are copyrighted, costly to develop, and need to be used appropriately. In the section Resources (University Library Websites) at the end of this chapter, several of the listed websites note the importance of requesting permission, and how to make such inquiries. To read a summary of ethics of use and why permission should be requested, please refer to the website info.library.okstate.edu/tests. The authors present major resources that librarians and clinicians can use to find instruments. The terms instruments, questionnaires, surveys, and tools are used interchangeably. “Instrument” is the preferred term and is used by the database Cumulative Index to Nursing and Allied Health Literature (CINAHL) when indexing the field. The descriptor “instrument” is used for the tools mentioned in articles.
In this chapter, five types of resources are explored:
1. Books: The books described herein are standard reference texts regarded as the first sources to check in finding instruments.
2. Bibliographic databases: These are defined in the order of importance to nursing applications. Examples are given for the kinds of instruments that might be found in the CINAHL and the Health and Psychosocial Instruments (HaPI) databases. Some suggestions are given regarding fields in which to search these databases for the instruments. The reader may then apply some of the same techniques to searching other databases. Using the controlled vocabulary or thesauri for retrieval in databases is important, and medical librarians are adept at using them effectively. It is important to consult a medical librarian, when available, to process searches, especially when doing an evidence-based study or publishing or presenting papers.
713. Internet resources: Those listed include professional organizations and governmental sites as well as library guides to tools. Library websites are good places to check for mobile apps to access literature databases and electronic books. University librarians, especially in medical settings, are placing descriptions of mobile applications (apps) used on iPads, iPhones, tablets, and other handheld devices to access literature searching tools. Note the Internet resources and University Library resources sections for more details on apps. The Internet resources listed are by no means exhaustive but considered selective.
4. International literature and databases: APRNs who work together and publish research findings with colleagues in other countries have access to sources worthwhile delving into. These databases contain information about health issues in countries other than the United States. Allow plenty of time to follow links, which may prove to have gems in them providing information about instruments used, and sometimes making instruments available to those outside their countries. Three such sources are described in this chapter: Hinari produced by the World Health Organization (WHO); Patient-Reported Outcome and Quality of Life Instruments Database (ProQolid) from the Mapi Trust; and the Global Health Exchange maintained by the Institute for Health Metrics and Evaluation (IHME) in Seattle.
5. Open access resources: The open access movement began so that researchers could share their work and findings with colleagues before formally publishing them. This sharing enables others to provide comments and suggestions to the authors. Open access is practiced internationally. Open access for journals is called gold open access; and open access for institutional repositories is called green open access. Universities and corporations often maintain repositories containing the preserved, published, and unpublished work of their staff. Finding and using the open access resources is time-consuming but may lead the reader to authors working on studies of interest.
The resources described in entries 4 and 5 are new to this edition. Because URLs change frequently, the sites listed in this chapter may no longer be current. However, a general Internet search using a standard browser such as Google may provide a newer link.
In this age of technology, using standard textbooks is not the most popular source of information. However, following are some tried and true measurement tool books. Note the additional books listed in Resources at the end of this chapter, many of which are more specific to nursing and medicine. The books to consult are too numerous to describe individually. Many nursing and medical libraries own the books listed in Resources. Of course, most books may be purchased from online book vendors.
Mental Measurements Yearbooks (MMYBs) by Buros Institute of Mental Measurements
Check the website (www.buros.org) to see that this group has been around for 78+ years and are experts. MMYB has been published since 1938.
72This standard reference text is available in most university and public libraries on reference shelves. It is updated annually and may be accessed online through many library database menus. The book lists tests in alphabetical order including descriptive information with purpose, intended population, acronyms, authors, scores, time, prices, publishers, and cross references. Each volume provides information on reliability, validity, and includes reviews of tests and test materials. Many libraries have access to this book online. Buros also publishes Test Reviews Online. To find the link for Test Reviews Online, use Google search with “Buros Test Reviews.” This particular Buros site contains only review tests, which the user can decide to purchase.
Tests in Print (TIP) by Buros Institute of Mental Measurement
TIP lists target audience, length, score(s), and cost and is a companion to the Buros MMYB. The TIP and the MMYB are the main sources for finding information on published tests.
Tests: A Comprehensive Reference for Assessments in Psychology, Education, and Business, edited by Taddy Maddox. PRO-ED, Inc., published from 1983 to the present, with a 2008 edition
Descriptions are brief and contain information on test population, purpose, format, scoring, and cost and do not include reviews or evaluations of tests.
Test Critiques, Kansas City, Missouri, Test Corporation of America, published since 1984
This multivolume set is the companion to Tests and includes reliability and validity information.
Directory of Unpublished Experimental Mental Measures, edited by B.A. Goldman and D.F. Mitchell, published by the American Psychological Association since 1970 (latest volume 9 published 2008)
Volume 9 lists tests published in the 2001 to 2005 issues of the 36 journals covered. This directory includes information on recently developed or noncommercial, experimental tests in 24 categories. The entries cover 36 relevant professional journals published in the United States. The measures described in dissertations are not included. Volumes do not include reviews. Check the category index. However, the volumes do not have title indexes. Some of the categories of measures are achievement, adjustment, aptitude, attitude, behavior communication, concept meaning, development, motivation, perception, personality problem solving and reasoning, values, vocational interest and evaluation, and trait measurement.
Please note the many additional books listed in Resources at the end of this chapter. The McDowell book, with a guide to rating scales and questionnaires is an excellent source for finding health-related instruments and is cited in Resources. University libraries usually have the books listed, some of which are in reference sections. Remember that most university libraries now have their catalogs available online. If a library has a collection of tests or instruments, the information on the tests may be found through the catalogs. Library staff can request interlibrary loans for books not owned. Reference and selection librarians usually welcome requests for purchase of instrument resource books when not owned by the library.
73 BIBLIOGRAPHIC DATABASES
Although searching bibliographic databases retrieves references to articles about instruments, the articles do not always print copies of the instruments. Remember that searching databases may provide references to articles that occasionally include the instruments. Finding full-text journal articles online in databases may show instruments in the articles. The Resources (Internet) section of this chapter provides a description of how to find dissertations, which usually include instruments used in doctoral or PhD work.
LEVELS OF EVIDENCE
The Medical Literature Analysis and Retrieval System Online (MEDLINE) and the Cochrane databases contain references to the highest quality journals or peer-reviewed literature as do the CINAHL, PsycINFO, and Educational Resources Information Center (ERIC). The database producers, especially MEDLINE, publish on their websites statements of the criteria required for the journals to be indexed. APRNs need to critically appraise the literature to verify that the evidence presented is sound and that the measurement tools used were appropriate.
CINAHL is available from the EBSCO Publishing database vendor and journal subscription agency. EBSCO and other vendors now provide tutorials, offered on YouTube or other media formats, to explain the use of search strategies for their databases. For access information, go to www.ebscohost.com.
A starting point for finding any instrument is the CINAHL because instruments may be searched directly in the instrumentation field of the bibliographic record. Log into CINAHL, and search directly on the “instrumentation” field from the “indexes” on the main screen. If you search the “publication type” field and choose “research instrument,” you may actually find the full text of an instrument. This database is not free to the public, and users must request codes from institutional libraries, ask a librarian, or pay for a service to process searches. Remember that as technology changes for the vendors, screens may change. Call the technical support number or e-mail the vendor to learn how to search the indexes or “fields” as some vendors call them.
HEALTH AND PSYCHOSOCIAL INSTRUMENTS
HaPI is produced by Behavioral Measurement Database Service (BMDS). This database lists evaluation and measurement tools, questionnaires, and test instruments. HaPI is available through database vendors including Ovid, a Wolters Kluwer Publishing division (www.ovid.com), or EBSCOHost (www.ebscohost.com). University and medical school libraries pay for access to these databases for library patrons. Contact the HaPI publisher for direct access, and to find other database vendors who provide access.
The HaPI database does not provide copies of instruments. However, this database shows information on where to find the tool/instrument and often gives the address and phone number. This database is bibliographic, meaning that it retrieves references to articles about the instrument. The references are indicated as secondary sources, then below 74the citation the primary sources tell where the instruments were originally described and usually where to call or write to get a copy. Consult a librarian to find free access.
PubMed.gov is the National Library of Medicine’s database, which includes MEDLINE. This database is free to the public at pubmed.gov. Check with local medical resource libraries and librarians for instructions in using PubMed. Note that this database has brief tutorials with links to them on the home page. The time invested in looking at the tutorials usually pays off in terms of saving time in using the database.
APRNs may search this database for reference to articles on a specific instrument. The references often discuss the reliability and validity of the instrument. The articles, at times, provide a copy of the instrument discussed. In MEDLINE, e-mail addresses are provided with the authors’ names making it easier to find an author to contact for further information about an instrument that may have been discussed in the article. One of the limiters available for searching is the publication types, including questionnaires.
The Cochrane databases are excellent sources to find the highest level evidence-based studies that describe instruments used. These databases are usually available through libraries or institutions, such as hospitals or drug companies. Ovid and EBSCO are two vendors providing access to many of the databases, including:
Cochrane Database of Systematic Reviews
Cochrane Database of Abstracts of Reviews of Effects
Cochrane Central Register of Controlled Trials
Cochrane Methodology Register
Health Technology Assessment
ACP Journal Club
The website of the Cochrane collaboration, www.cochrane.org gives free access to a few references containing reviews. Many university library sites have information on the databases and how to search them. The Cochrane databases are international in scope and some have mobile apps. The Cochrane Collaboration groups have had a nonvoting representative in WHO meetings since 2011. As of February 2013, Cochrane reviews allow open access 12 months after publication. Wiley is the publisher of the Cochrane Library and provides some items in open access.
When searching the Cochrane databases, you can limit the topics by filtering, using the terms “instrument(s),” “questionnaire(s),” “scale(s),” or “survey(s).” Use the truncation symbols identified by the various vendors. Usually, a dollar sign ($) or asterisk (*) at the ends of root words retrieves various spellings. For example, type in Instrument$ or instrument* to retrieve instrument, instruments, or instrumentation. Results in searching the systematic reviews will provide fewer references than in literature searches because 75the subject may not have been studied. In retrieving actual reviews, load up the printer with plenty of paper because reviews often can be more than 50 pages, or download the review onto a thumb drive.
EDUCATION RESOURCES INFORMATION CENTER
ERIC is produced by the Institute of Education within the U.S. Department of Education in Washington, DC. This database is free to the public at www.eric.ed.gov. The Educational Testing Service (ETS) of ERIC also has tests in microfiche. This database lists evaluation and measurement tools, questionnaires, and test instruments. ERIC’s Clearinghouse on Assessment and Evaluation has a test locator at ericae.net/testcol.htm, which includes free tests. This site also has a link to Buros Institute of Mental Measurements and allows shopping and purchase of tests. The Test Reviews Online is on this link (buros.unl.edu/buros/jsp/search.jsp).
APRNs often participate in educating patient or staff about treatments or procedures. The challenge in the educational process is to show that what was presented caused a change in knowledge and practice. Although the ERIC database contains a limited amount of health or medical literature references, it does provide references to general educational concepts that may be applied to measure whether educational interventions are working.
PsycINFO is produced by the American Psychological Association and contains references to articles about various psychological instruments. Many database vendors offer PsycINFO, including Ovid, EBSCO, and ProQuest (formerly Dialog Knight-Ridder), and each has its own search engine
Depending on what the APRN is studying, the PsycINFO database may include references to articles relevant to measure psychological changes. This database covers professional and academic literature in psychology and related disciplines, including medicine and nursing. PsycINFO is international in scope and includes abstracts for citations in over 2,563 (in 2016) journals, dissertations, books, and book chapters. Some university libraries allow access to this database for users in the library or for students and staff to access remotely. Some libraries may require you to access via a professional librarian.
The strategy for using PsycINFO is different from CINAHL or HaPI. A search hint in using PsycINFO is to use the thesaurus and the “measurement” heading to find related topics. In PsycINFO, retrieval may be limited to “test & measures” using the limit button on Ovid. Retrieval will be for article references, and the possibility of the full instrument being in the article may occur occasionally. Rely on PsycINFO to find articles on validity or reliability of particular measures. Articles may be found on various measures used for a particular health or psychological issue.
Note: The American Psychological Association website listed in Resources under Internet is an excellent source for finding the actual instruments.
76 DISSERTATION ABSTRACTS INTERNATIONAL
Dissertation Abstracts is the index used for doctoral dissertations and master’s theses written at most North American graduate schools. The CINAHL database also contains dissertations. The dissertations may be searched and ordered through UMI/Proquest company. Go to the website www.proquest.com to order a dissertation online and click on “Dissertations and Theses.” On this database, the user may order a dissertation as an individual for the stated fee, or if your library/institution subscribes to this database, library service may request it for you. This site’s name is Dissertations Express and in 2016, the cost for a dissertation varied with the format. The PDF format costs $38.00; unbound, $39.00; and microfiche, $55.00 for a 357-page dissertation. Pricing is given for soft cover, hard cover, and microfilm when ordering.
If a dissertation is not available through Dissertations Express, check with a local medical librarian to request an interlibrary loan from the institution from which the dissertation was required and published.
ProQuest Dialog provides access to hundreds of databases used by most universities and many hospitals to conduct searches. Individuals may want to use these databases through their libraries or institutions because of the expense. To view descriptions of databases that might be relevant to use, go to the ProQuest.com website. Click on “Products and Services” at the top of the page, which has a drop-down menu for databases.
INTERNET RESOURCES AND ONLINE LIBRARY RESOURCES
Use Resources at the end of this chapter to find the links to library websites that have guides for finding instruments. This list is not extensive but does contain quality sites. Use Google to find other websites that may be helpful: Google (www.google.com) and Google Scholar (scholar.google.com).
Google may be used as a starting point or last resort. In using Google, try to use advanced search if the basic search does not retrieve information needed. Use Google Scholar (scholar.google.com) for articles about an instrument. A Google Scholar search on the Visual Analog Pain Scale Faces retrieves several articles discussing uses of the scale, some with pictures of faces rating pain. This is only one of many pain scales that are visual.
UNIVERSITY LIBRARY WEBSITES
Regarding sites listed in Resources, some of the university sites have charts and tables describing databases and step-by-step methods for finding instruments. The majority of these websites include most of the information in this chapter.
77 MOBILE/HANDHELD DEVICES AND MEDICAL APPLICATIONS (APPS)
Practitioners often use mobile devices for medical “apps” to access patient records, drug information, and bibliographic databases, to name a few. To see lists of databases or other medical apps, many university libraries are providing information in chart format on their websites to make it easy for users to see what is available. For example, Texas A&M University Libraries has a list of mobile databases that are accessible through various devices. The guide shows that “CINAHL Plus with Full Text Mobile” is available from EBSCO. Check msl.library.tamu.edu/services/mobile_resources.html. With the latest handheld technology, APRNs could check CINAHL in a patient setting or when not near a laptop to look up information on an instrument. Another well-presented example of mobile apps is from the University of Washington Health Sciences Library, titled “Mobile Accessible Resources,” available at guides.lib.uw.edu/hsl/mobile. San Jose State University library staff, in 2010, used the term “appography” to describe a bibliography for apps.
Many popular mobile or “handheld” (the term used by the National Library of Medicine) devices are utilized to access databases and websites when searching outcome measures. The APRN can access CINAHL, Medline/PubMed, HaPI, MMYB, TIP, and PsycINFO with mobile devices. The reader may do a Google search on each resource followed by the term “mobile” or “handheld” to retrieve university or vendor sites that describe how to access. Sometimes apps are free through local universities.
To learn about the National Library of Medicine’s Gallery of Mobile Apps, go to www.nlm.nih.gov/mobile.
PROFESSIONAL ASSOCIATION SITES
American Nurses Association publishes books and pamphlets that may help in finding instruments. Other specialized, advanced practice nursing sites may have clues to instrument information. For example, check the sites for the American Academy of Nurse Practitioners, the American Academy of Clinical Nurse Anesthetists, National League for Nursing, American Nephrology Nurses, Emergency Nurses Associations, or others. If an APRN is part of a special professional association, encourage the website manager to include dissertations or articles of members who may have used or developed instruments.
The Sigma Theta Tau International Honor Society of Nursing Virginia Henderson Library may be another source of information for instruments. The website describes their evidence-based practice publication (www.nursinglibrary.org/vhl).
Many professional health and medicine associations now publish reports that may contain measurement tools. A well-respected site described in the previous edition of this book was the Institute of Medicine, which has been renamed Health and Medicine Division (HMD) of the National Academies of Sciences, Engineering, and Medicine. The new URL is www.nationalacademies.org/hmd/about-HMD.aspx. This website has a plethora of reports, projects, and publications of global interest, many of which pertain 78to nursing. When looking through the publication lists, consult the abstracts of some of the projects that describe measurement tools that might be available for use.
The Medical Library Association continuing education programs offers information for librarians who publish guides for finding measurement tools on library websites. Readers are advised to check local medical library websites for such guides.
ProQolid is the acronym for Patient-Reported Outcome and Quality of Life Instruments Database. Go to eprovide.mapi-trust.org to learn about this database. Two access points are available on this website. A free-access section shows an alphabetical list of instruments available and listed by author’s name, targeted population, and pathology/disease. There is a member charge to subscribe and is priced in euros because of its Lyon, France, origin. There is an online payment option.
Survey Monkey is a site that helps you develop your own survey and lists other programs available to help do your surveys. Go to www.surveymonkey.com to learn about this program.
The Rand Corporation website publishes many summaries of research projects and reports with a special section on health instruments. Check Rand Health Surveys and Tools at www.rand.org/health/surveys_tools.html. Note the “underline” character between “surveys” and “tools” in the URL.
Some governmental agencies have sections on their sites that contain useful instruments. Instruments developed by governmental agencies may be found in the “government document” departments of university and law libraries. Tax dollars pay for these agencies’ work; they are free to use; and sites can be searched using the terms “surveys,” “questionnaires,” “measures,” “tools,” and “instruments.” Check with the librarians to help find the publications cited. Please note the following:
Agency for Healthcare Research and Quality (AHRQ): Tools and Resources for Better Health Care (www.ahrq.gov)
Health Resources and Services Administration (HRSA) U.S. Department of Health and Human Services: The HRSA provides a wealth of information on a search of its website www.ahrq.gov with terms “measures,” “tools,” and “instruments.” At the site www.hrsa.gov, the reader may click on “clinical quality measures” and find information on screening for various conditions.
National Guideline Clearinghouse published by the AHRQof the U.S. Department of Health and Human Services: The site, www.guideline.gov, has a section on outcome measures relevant to specific health problems.
National Technical Information Service (www.ntis.gov), Springfield, Virginia, Department of Commerce: This database is free and contains many reports of government-supported research. Searching the site using the terms “health surveys” or 79“health questionnaires” combined with specific health conditions retrieves citations to reports that may contain measurement tools. Unlike other literature search results, the system displays older references first. Reports may be ordered at a cost, and summaries are free. This database is a stretch for finding a copy of an instrument but is worthwhile to check.