Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)

Background There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability. Methods SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics. Results Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832). Conclusions Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.

A modest start, but a steady rise in research use : A longitudinal study of nurses during the first five years in professional life

Background: Newly graduated nurses are faced with a challenging work environment that may impede theirability to provide evidence-based practice. However, little is known about the trajectory of registered nurses’ use ofresearch during the first years of professional life. Thus, the aim of the current study was to prospectively examinethe extent of nurses’ use of research during the first five years after undergraduate education and specifically assesschanges over time.Method: Survey data from a prospective cohort of 1,501 Swedish newly graduated nurses within the nationalLANE study (Longitudinal Analyses of Nursing Education and Entry in Worklife) were used to investigate perceiveduse of research over the first five years as a nurse. The dependent variables consisted of three single itemsassessing instrumental, conceptual, and persuasive research use, where the nurses rated their use on a five-pointscale, from ‘never’ (1) to ‘on almost every shift’ (5). These data were collected annually and analyzed bothdescriptively and by longitudinal growth curve analysis.Results: Instrumental use of research was most frequently reported, closely followed by conceptual use, withpersuasive use occurring to a considerably lower extent. The development over time showed a substantial generalupward trend, which was most apparent for conceptual use, increasing from a mean of 2.6 at year one to 3.6 atyear five (unstandardized slope +0.25). However, the descriptive findings indicated that the increase started onlyafter the second year. Instrumental use had a year one mean of 2.8 and a year five mean of 3.5 (unstandardizedslope +0.19), and persuasive use showed a year one mean of 1.7 and a year five mean of 2.0 (unstandardized slope+0.09).Conclusion: There was a clear trend of increasing research use by nurses during their first five years of practice.The level of the initial ratings also indicated the level of research use in subsequent years. However, it took morethan two years of professional development before this increase ‘kicked in.’ These findings support previousresearch claiming that newly graduated nurses go through a ‘transition shock,’ reducing their ability to useresearch findings in clinical work.