Interprofessional Clinical Measure Development
Open Access DepositedQuantifying Stress in Infants Undergoing Cardiac Surgery
those with I-CVI < 0.8 were reviewed for inclusion. Following measure construction, a scale-level content validity index (S-CVI) score was evaluated by an expert panel. Pediatric cardiac clinical experts in nursing, anesthesia, surgery, and intensive care from three sites (n=17) participated in sematic content analysis. Seven themes emerged surrounding sources of infant stress, stress response, and clinical implications. A total of 92 items were reviewed by an interdisciplinary panel to establish I-CVI
69 moved forward to measurement construction with an I-CVI 0.8. Those with I-CVI < 0.8 were reviewed for inclusion (n=17). These items were combined with those from previously validated scales, and the total item bank was scored for perceived stress by the expert panel. The Cumulative Infant Stress Index– Cardiac Surgery (CISI-CS) was constructed from validated items and evaluated by the expert panel for scale-level content validity (S-CVI). S-CVI for the completed measure was 1.0. This instrumentation study resulted in a measure of physiologic stress in critically ill infants with cardiac disease. This measure is ready for assessments of feasibility, acceptability, reliability, and subsequent empirical validity testing to be conducted in the clinical setting. Quantification of the cumulative stress by an objective measure will empower direct care nursing staff to alert clinical care teams to the infants’ stress status and need to mitigate infant stress across phases of care, providing the foundation for new nursing care models aimed at stress mitigation and proactive cardiac arrest prevention strategies.
Infants requiring cardiac surgery are significantly impacted by postoperative cardiac arrest. However, many of the currently identified risk factors for cardiac arrest in this vulnerable population are difficult to mitigate in the clinical setting. Using the theoretical lens of Selye’s general adaptation syndrome, cumulative stress encountered by vulnerable infants undergoing cardiac surgery has been identified as an unexplored, potentially modifiable risk factor for cardiac arrest. However, currently no measure existed to quantify stress in critically ill infants with cardiac disease. The purpose of this study was to develop a measure of physiologic stress in this unique population.This instrument development study was conducted with two primary aims. First, semantic content analysis was utilized to identify, describe, and analyze sources of stress, stress cues, and stress responses in vulnerable infants undergoing high-risk cardiac surgery and to generate items specific to infants with congenital heart disease from experienced interdisciplinary clinicians. Second, a new clinical measure of infant stress for use in infants undergoing cardiac surgery was developed. A new conceptual model was constructed to guide measurement development, creating a foundation for content validity and subsequent construct validity. Item content validity index (I-CVI) scores were evaluated by an expert panel prior to measurement construction. Items with an I-CVI of at least 0.8 were moved forward to measurement construction
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