title: Evidence on the validity and reliability of the German, French and Italian nursing home version of the Basel Extent of Rationing of Nursing Care instrument.
abstract: OBJECTIVE
  To develop and test psychometrically the Basel Extent of Rationing of Nursing Care for Nursing Homes instrument, providing initial evidence on the validity and reliability of the German, French and Italian-language versions.
  
  
  BACKGROUND
  In the hospital setting, implicit rationing of nursing care is defined as the withholding of nursing activities due to lack of resources, such as staffing or time. No instrument existed to measure this concept in nursing homes.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  We developed the instrument in three phases: (1) adaption and translation; (2) content validity testing; and (3) initial validity and reliability testing. For phase 3, we analysed survey data from 4748 care workers collected between May 2012-April 2013 from a randomly selected sample of 162 nursing homes in the German-, French- and Italian-speaking regions of Switzerland to provide evidence from response processes (e.g. missing), internal structure (exploratory factor analysis), inter-item inconsistencies (e.g. Cronbach's alpha) and interscorer differences (e.g. within-group agreement).
  
  
  RESULTS
  Exploratory factor analysis revealed a four-factor structure with good fit statistics. Rationing of nursing care was structured in four domains: (1) activities of daily living; (2) caring, rehabilitation and monitoring; (3) documentation; and (4) social care. Items of the social care subscale showed lower content validity and more missing values than items of other subscales.
  
  
  CONCLUSIONS
  First evidence indicates that the new instrument can be recommended for research and practice to measure implicit rationing of nursing care in nursing homes. Further refinements of single items are needed.
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.
authors.forename: Franziska
authors.initials: F
authors.lastname: Zúñiga
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.|University Hospital Insel, Bern, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Schubert
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of Health Services Research, Maastricht University, the Netherlands.
authors.forename: Jan P H
authors.initials: JP
authors.lastname: Hamers
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.|Inselspital Bern University Hospital, Nursing & Midwifery Research Unit, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Simon
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Schwendimann
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.|Department of Health Promotion & Development, School of Nursing, University of Pittsburgh, Pennsylvania, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Engberg
authors.affiliation: Institute of Nursing Science, University of Basel, Switzerland.|College for Health-Care Professionals Claudiana, Research Department, Bozen, Italy.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Ausserhofer
mesh_terms: D000203:Activities of Daily Living; D003430:Cross-Sectional Studies; D006801:Humans; D009732:Nursing Care / Q000592:standards*; D009735:Nursing Homes; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013557:Switzerland
keywords: factor analysis; instrument development; nursing home care; psychometric testing; rationing