title: Overcoming redundancies in bedside nursing assessments by validating a parsimonious meta-tool: findings from a methodological exercise study.
abstract: BACKGROUND
  There is growing interest in validating tools aimed at supporting the clinical decision-making process and research. However, an increased bureaucratization of clinical practice and redundancies in the measures collected have been reported by clinicians. Redundancies in clinical assessments affect negatively both patients and nurses.
  
  
  METHODS
  To validate a meta-tool measuring the risks/problems currently estimated by multiple tools used in daily practice. A secondary analysis of a database was performed, using a cross-validation and a longitudinal study designs. In total, 1464 patients admitted to 12 medical units in 2012 were assessed at admission with the Brass, Barthel, Conley and Braden tools. Pertinent outcomes such as the occurrence of post-discharge need for resources and functional decline at discharge, as well as falls and pressure sores, were measured. Explorative factor analysis of each tool, inter-tool correlations and a conceptual evaluation of the redundant/similar items across tools were performed. Therefore, the validation of the meta-tool was performed through explorative factor analysis, confirmatory factor analysis and the structural equation model to establish the ability of the meta-tool to predict the outcomes estimated by the original tools.
  
  
  RESULTS
  High correlations between the tools have emerged (from r 0.428 to 0.867) with a common variance from 18.3% to 75.1%. Through a conceptual evaluation and explorative factor analysis, the items were reduced from 42 to 20, and the three factors that emerged were confirmed by confirmatory factor analysis. According to the structural equation model results, two out of three emerged factors predicted the outcomes.
  
  
  CONCLUSIONS
  From the initial 42 items, the meta-tool is composed of 20 items capable of predicting the outcomes as with the original tools.
authors.affiliation: Nursing Science, Udine University, Udine, Italy. alvisa.palese@uniud.it.
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
authors.affiliation: Udine University, Udine, Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Marini
authors.affiliation: Azienda provinciale per i Servizi Sanitari, Trento, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Guarnier
authors.affiliation: Azienda provinciale per i Servizi Sanitari, Trento, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Barelli
authors.affiliation: Azienda provinciale per i Servizi Sanitari, Trento, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Zambiasi
authors.affiliation: Azienda Ospedaliero-Universitaria, Verona, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Allegrini
authors.affiliation: Fondazione Poliambulanza, Brescia, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Bazoli
authors.affiliation: Azienda per i Servizi Sanitari, Treviso, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Casson
authors.affiliation: Azienda per i Servizi Sanitari, Gorizia, Italy.
authors.forename: Meri
authors.initials: M
authors.lastname: Marin
authors.affiliation: Azienda per i Servizi Sanitari, Vicenza, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: Padovan
authors.affiliation: Azienda per i Servizi Sanitari, Udine, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Picogna
authors.affiliation: Azienda Ospedaliera-Universitaria, Bologna, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Taddia
authors.affiliation: Nursing Science, Bologna University, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiari
authors.affiliation: Fondazione Zancan, Padua, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Salmaso
authors.affiliation: Nursing Students' Clinical Placements, Verona University, Verona, Italy.
authors.forename: Oliva
authors.initials: O
authors.lastname: Marognolli
authors.affiliation: Verona University, Verona, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Canzan
authors.affiliation: Verona University, Verona, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ambrosi
authors.affiliation: Verona University, Verona, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Saiani
authors.affiliation: Udine University, Udine, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Grassetti
mesh_terms: D000368:Aged; D016208:Databases, Factual; D017598:Efficiency, Organizational; D005163:Factor Analysis, Statistical; D005260:Female; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D007558:Italy; D008297:Male; D009730:Nursing Assessment / Q000458:organization & administration*; D019370:Observation; D010362:Patients' Rooms; D036301:Qualitative Research
keywords: acute medical; confirmatory factor analysis; explorative factor analysis; hospital admission; instrument; nursing; nursing assessment; risk assessment; structural equation model; tool; validation