Validating a questionnaire - prehospital preparedness for pediatric trauma patients
Introduction
Prehospital emergency care is the first link in the overall chain of acute care [1] and is provided in various settings, e.g., in the patients’ home or public places. Prehospital emergency care includes attending patients of all ages with various diseases and injuries [2], [3]. Occasionally, the care is provided in chaotic, hazardous, and often tumultuous settings [4]. Registered nurses working in prehospital emergency care (PENs) need to be flexible and able to change their initial approach instantaneously as dynamic situations are prone to quick changes [5]. Studies [6], [7] show that nurses are proven to be especially vulnerable to stress as many have heavy workloads combined with high stress and emotional interactions with others. The emotional demands on PENs are linked to an inability to cope with daily stress and traumatic situations [8], [9], [10].
Caring for pediatric trauma patients is a rare and demanding experience [11]. Pediatric trauma care coupled with the fear of failing in responsibility toward the particularly vulnerable pediatric patients was found to contribute to stress [12]. Emergency medical services rate their comfort level of caring for children lower than caring for adults [13]. In fact, several studies emphasize that PENs are not entirely prepared to care for children in advanced emergency situations such as critically ill or multiple children injured simultaneously [11], [14]. Several studies also emphasize the need for more training, training exercises, and equipment adapted to trauma care of children [13], [15], [16], [17]
A focus on improving the preparedness of PENs to care for pediatric trauma patients through, for example, more training sessions may increase the PENs proficiency levels. This might lead to improvements and higher quality pediatric trauma care and improved health among the PENs. However, no preparedness study concerning PENs caring for pediatric trauma patients has been found in the Swedish context. Some studies have developed tools to assess and analyze the preparedness among responders, e.g., nurses facing major incidents [18], [19], [20]. To our knowledge, no valid questionnaire assessing the preparedness of personnel caring for pediatric trauma patients in the prehospital emergency setting exists. Therefore, the development of a questionnaire to assess the preparedness of PENs caring for pediatric trauma patients is needed. However, it is important to confirm the validity and reliability of a questionnaire [21]. Thus, the aim was to develop and test a questionnaire on self-reported preparedness among PENs caring for pediatric trauma patients in a prehospital emergency setting.
Section snippets
Design and setting
A questionnaire was developed from a literature review and tested for validity among the PENs in three ambulance stations located in northern Sweden.
Development of the questionnaire
Initially, the questionnaire (Additional file 1) was designed in cooperation with experts in disaster medicine, emergency care and nursing. To develop the questionnaire, literature covering preparedness e.g. [16], [22], [23] were read and assessed and throughout their descriptions of preparedness we got ideas about the essentials for generating
Validity
All questions’ characteristics were tested for validity. In the process of establishing face and content validity, the analysis resulted in small modifications. Two questions aimed at the nurses’ ability to handle equipment specifically adapted to children and family-centered care were removed. Two questions with similar content were merged. Similarly, other questions were divided as the question content included various concepts. Several questions were reworded to improve intelligibility.
Discussion
In this study, we found that the questionnaire is valid as both face and content validity were judged to be reasonable, and the test-retest showed that most of the questions were stable. Concurrent and predictive criterion validity were not tested as, to our knowledge, there is no existing valid questionnaire related to PENs caring for pediatric trauma patients in the prehospital setting; therefore, not applicable to the investigated questionnaire.
In this study, the questionnaire with 35 valid
Conclusion
Using a validated questionnaire can be seen as part of the quality assurance development in the prehospital setting. The questionnaire can, therefore, be seen as contributing to both the clinical practice and the research measuring how prepared PENs are for caring for pediatric trauma patients. Before using the questionnaire we suggest further testing to increase the validity.
Furthermore, the results have provided ideas for training and training exercises. Even though the PENs chose to work in
Acknowledgements
The authors thank Jenny Sjölund, the graduate student for her contribution in the process of questionnaire development.
References (37)
- et al.
Being prepared for the unprepared: a phenomenology field study of Swedish prehospital care
J Emerg Nurs
(2012) - et al.
Ambulance nurses experiences of nursing critically ill and injured children: a difficult aspect of ambulance nursing care
Int Emerg Nurs
(2014) - et al.
Experiences of and actions towards worries among ambulance nurses in their professional life: a critical incident study
Int Emerg Nurs
(2008) - et al.
Design, validity, and reliability of a pediatric resident jumpSTART disaster triage scoring instrument
Acad Pediatr
(2013) - et al.
Understanding the error of our ways: mapping the concepts of validity and reliability
Nurs Outlook
(2006) - et al.
Ambulance alerting to hospital: the need for clearer guidance
Emerg Med J
(2006) - et al.
Ambulance provision for children: a UK national survey
Emerg Med J
(2010) - et al.
Caring for older people in prehospital emergency care: Can nurses make a difference?
J Clin Nurs
(2005) Work as a moral act: how emergency medical technicians understand their work
- et al.
Burnout and health behaviors in health professionals from seven European countries
Int Arch Occup Environ Health
(2016)