Orchestration In Health Care and Nursing

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.