Differences In Item Scores Research Articles

Relating violations of measurement invariance to group differences in response times.

Measurement invariance is an assumption underlying the regression of a latent variable on a background variable. It requires the measurement model parameters of the latent variable to be equal across the levels of the background variable. Item-specific violations of this assumption are referred to as differential item functioning and are ideally substantively explainable to warrant theoretically valid and meaningful results. Past research has focused on developing statistical approaches to explain differential item functioning effects in terms of item- or person-specific covariates. In this study, we propose a modeling approach that can be used to test if differences in item response times can be used to statistically explain differential item functioning. To this end, we operationalize a latent response process factor and test if item-specific group differences on this factor can account for the observed differences in item scores. We investigate the properties of the model in a simulation study, and we apply the model to a real data set. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychometric properties of the Chinese version of Sport Anxiety Scale-2.

The Sport Anxiety Scale-2 (SAS-2) is a validated measure of sports trait anxiety, with promising psychometric properties. However, its cross-cultural applicability in Chinese samples remains unexplored. Thus, the primary objectives of this study were twofold: to translate the SAS-2 into Chinese and assess the psychometric properties of the Chinese version. In Study 1, we initiated the translation of the SAS-2 into Chinese. This assessment involved bilingual Chinese students proficient in both English and Chinese. Additionally, we conducted a cross-linguistic measurement invariance analysis. In Study 2, we delved into the psychometric properties of the Chinese SAS-2 using a sample of Chinese student athletes. This examination encompassed an evaluation of its factor structure, convergent and discriminant validity, and measurement invariance across genders. Our findings in Study 1 indicated no significant differences in item scores between the Chinese SAS-2 and the English version, and measurement invariance across languages. In Study 2, we uncovered that the Chinese SAS-2 and its factors exhibited excellent reliability, with Cronbach's alpha values exceeding 0.80. Confirmatory factor analyses upheld the original three-factor model, demonstrating acceptable model fit indices (CFI = 0.96, TLI = 0.93, RMSEA = 0.08). Furthermore, all three factors of the Chinese SAS-2 displayed significant and positive correlations with athlete burnout and State-Trait anxiety. Additionally, this study elucidated the mediating role of Concentration Disruption (Somatic anxiety and Concentration Disruption) in the relationship between the Trait (State) anxiety, and athlete burnout. Moreover, we identified measurement invariance of the Chinese version of the SAS-2 across genders. Finally, female college athletes exhibited significantly higher scores in somatic anxiety and worry compared to their male counterparts. In sum, our findings affirm that the Chinese version of the SAS-2 demonstrates robust reliability and correlates effectively with related criteria, thus validating its suitability for use in a Chinese context.

Pre-Service Primary School Teacher University Training for Inclusive Education in the Czech Republic and Ukraine: An Exploratory Study

The present exploratory study examines pre-service primary school teacher university training in inclusive education in the Czech Republic and Ukraine. Based on the theory of planned behavior (TPB), attitudes, subjective norms, and self-efficacy of first- and last-year students were assessed. The overall differences in item scores between first-year and last-year students are in both countries small and insignificant. These results suggest that the potential of professional training is not fulfilled. Therefore, we suggest further proactive university curriculum development based on the research-supported forms of training.

Validating the Autism Diagnostic Interview-Revised in the Korean Population.

ObjectiveThis study aimed to examine the validity of the Korean version of the Autism Diagnostic Interview-Revised (K-ADI-R) and determine its efficacy in identifying individuals with autism spectrum disorder (ASD). MethodsData were pooled from several past and ongoing studies as well as clinical records acquired at Seoul National University Bundang Hospital from 2008 to 2017. The K-ADI-R were administered and scored by trained research reliable examiners. Measurements to investigate the validity of the K-ADI-R was through sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and Cohen’s kappa. ResultsA total of 1,271 (age 88.9±62.42 months, male=927) participants were included. The K-ADI-R yielded strong psychometric properties with high sensitivity (86.06–99.27%), specificity (84.75–99.55%), PPV (92.33–99.72%), and NPV (79.43–98.64%). There were significant differences in item scores across the K-ADI-R diagnostic algorithm regardless of age and sex (p<0.001). Agreement between the K-ADI-R and other ASD related measurements ranged between levels of good to excellent. ConclusionDespite language or cultural boundaries, the K-ADI-R demonstrated high levels of sensitivity, specificity, PPV, and NPV within a wide range of participants; hence, suggesting promising usage as a valuable diagnostic instrument for individuals with ASD.

Smartphone Technology: Impact on Interprofessional Working Relations between Doctors and Nurses.

For decades, the main communication technology in hospitals has been the paging system. In the era of digital communication, smartphones have been adopted by hospitals seeking to modernize processes and offer real-time, two-way communication to increase efficiency. The aim of this study was to explore physicians' and nurses' perceptions of the impact of smartphones on communication and efficiency. Mann-Whitney U-tests were used to compare differences in item scores between physicians and nurses on 17 questionnaire items relating to smartphone impact on interpersonal relationships and communication, efficiency and reliability. An open-ended question was used to elicit additional feedback. In total, 43 nurses and 27 physicians participated in the study. Nurses' ratings were significantly higher than physicians' on a number of questionnaire items, including the following: smartphones have a positive impact on efficiency (Mdn = 4.0 vs. 3.0, U = 321.0, p = 0.027, r = .33), smartphones increase my accessibility to physicians (Mdn = 5.0 vs. 3.0, U = 277.0, p = 0.009, r = 0.42) and smartphones reduce interruptions versus pagers (Mdn = 4.0 vs. 2.0, U = 224.0, p > 0.0001, r = 0.47). The findings suggest that smartphone technology may reduce the locus of control for physicians, potentially limiting their ability to prioritize patients' needs and manage workflow efficiently.

Potential Mediators of Load-Related Decreases in Movement Quality in Young, Healthy Adults.

Predicting and promoting physical performance are important goals within the tactical professional community. Movement screens are frequently used in this capacity but are poor predictors of performance outcomes. It has recently been shown that prediction improved when movement quality was evaluated under load, but the mechanisms underlying this improvement remain unclear. Because balance, range of motion, and strength are mutually relevant to physical performance and movement quality, these attributes may mediate load-related decreases in movement quality and account for the resulting increase in performance prediction. To quantify the roles of balance, range of motion, and strength in mediating load-related decreases in clinical movement-screen scores. Crossover study. Research laboratory. Twenty-five male (age = 23.96 ± 3.74 years, height = 178.82 ± 7.51 cm, mass = 79.66 ± 12.66 kg) and 25 female (age = 22.00 ± 2.02 years, height = 165.40 ± 10.24 cm, mass = 63.98 ± 11.07 kg) recreationally active adults. Participants completed a clinical movement screen under a control condition and while wearing an 18.10-kg weighted vest as well as tests of balance, range of motion, and strength. Item score differences were assessed using Wilcoxon signed rank tests for matched pairs. Interactions between (1) balance, range of motion, and strength and (2) load condition were modeled using penalized varying-coefficients regression with item scores as the dependent measure. Except for the hurdle step, item scores were lower in the weighted-vest than in the control condition for all tests ( P < .05). Except for rotary stability, F statistics were significant for all models ( P values < .05, R2 values = 0.22-0.77). Main effects of balance, range of motion, and strength on Functional Movement Screen scores were observed ( P < .05); however, little evidence was found to suggest that these attributes mediated load-related decreases in Functional Movement Screen item scores. Balance, range of motion, and strength affected movement quality but did not mediate the effect of the load treatment.

The Chinese version of Instrument of Professional Attitude for Student Nurses (IPASN): Assessment of reliability and validity

BackgroundProfessional attitude is of great importance for nursing talents in the modern society. To develop an effective educational program for student nurses in China, an appropriate instrument is required for the assessment of their professional attitude. ObjectiveTo assess the validity and reliability of the Instrument of Professional Attitude for Student Nurses (IPASN) in Chinese version. MethodsThe original version of IPASN was translated through Brislin model (translation, back translation, culture adaption and pilot study) with the authorization from the developer. A total of 681 nursing students were chosen by stratified convenience sampling to assess construct validity using exploratory factor analysis (EFA). Besides, item analysis, Cronbach's alpha coefficients, test-retest reliability were conducted to test the psychometric properties in this part. A total of 204 nursing undergraduate trainees were selected by cluster convenience sampling to confirm the structure using confirmatory factor analysis (CFA) in another time. ResultsCorrected item-total correlations, alpha if item deleted were between 0.33 and 0.69, 0.906 and 0.913, respectively, indicating no item should be deleted. Cronbach alpha value was 0.91 for the total scale and Cronbach alpha coefficient for subscales ranged from 0.67 to 0.89. Test-retest reliability estimated from intraclass correlation coefficient (ICC) was 0.74 (P<0.05). Differences in item scores between the high-score group (the first 27%) and low-score group (the last 27%) were significant (P<0.001), indicating that the item discrimination ability was good. Seven subscales (contribution to increase of scientific information load, autonomy, community service, continuous education, to promote professional development, cooperation and theory guiding practice) were identified in EFA and confirmed in CFA, and explained 65.5% of the total variance. ConclusionIt indicated that the Chinese version of IPASN was valid and reliable for the evaluation of nursing students' professional attitude.

Measuring changes in perception using the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE) instrument.

BackgroundThe Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE) instrument contains 10 items, 3 factors (interprofessional teamwork and team-based practice, roles/responsibilities for collaborative practice, and patient outcomes from collaborative practice), and utilizes a five-point response scale (1 = strongly disagree, 5 = strongly agree). Given the SPICE instrument’s demonstrated validity and reliability, the objective of this study was to evaluate whether it was capable of measuring changes in medical (MS) and pharmacy students’ (PS) perceptions following an interprofessional education (IPE) experience.MethodsIn this prospective cohort study, MS and PS completed the SPICE instrument before and after participation in a predefined IPE experience. Descriptive statistics were used to characterize students and pre-post responses. Independent samples t tests and Fisher’s Exact tests were used to assess group difference in demographic variables. Mann Whitney U tests were used to assess between-group differences in item scores. Wilcoxon Signed-Rank tests were used to evaluate post-participation changes in item scores. Spearman correlations were calculated to assess associations between ordinal demographic variables and item scores, and whether the number of clinic visits completed was associated with post-test responses. Paired samples t tests were used to calculate mean score changes for each of the factors.ResultsThirty-four MS and 15 PS were enroled. Baseline differences included age (25.3. ± 1.3 MS vs. 28.7 ± 4.4 PS; p = 0.013), years full-time employment (0.71 ± 0.97 MS vs. 4.60 ± 4.55 PS; p < 0.001), and number of prior IPE rotations (1.41 ± 1.74 MS vs. 3.13 ± 2.1 PS; p < 0.001). Two items generated baseline differences; 1 persisted post-participation: whether MS/PS should be involved in teamwork (3.91 MS vs. 4.60 PS; p < 0.001). For all students, significant mean score increases were observed for role clarity (“my role” [3.72 vs. 4.11; p = 0.001] and “others’ roles” [3.87 vs. 4.17; p = 0.001]), impact of teamwork on patient satisfaction (3.72 vs. 4.34; p < 0.001), and ideal curricular location for IPE (4.06 vs. 4.34; p = 0.002). Significant increases were observed for all three factors (teamwork, p = 0.003; roles/responsibilities and patient outcomes, p < 0.001).ConclusionsThis study demonstrated the SPICE instrument’s ability to measure changes in perception for medical and pharmacy students exposed to an IPE experience, both at the individual item level and at the factor level.

Context factors in consultations of general practitioner trainees and their impact on communication assessment in the authentic setting

ObjectiveAcquiring adequate communication skills is an essential part of general practice (GP) specialty training. In assessing trainee proficiency, the context in which trainees communicate is usually not taken into account. The present paper aims to explore what context factors can be found in regular GP trainee consultations and how these influence their communication performance. MethodsIn a randomly selected sample of 44 videotaped, real-life GP trainee consultations, we searched for context factors previously identified in GP consultations and explored how trainee ratings change if context factors are taken into account. Trainee performance was rated twice using the MAAS-Global, first without and then with incorporating context factors. Item score differences were calculated using a paired samples t-test and effect sizes were computed. ResultsAll previously identified context factors were again observed in GP trainee consultations. In communication assessment scores, we found a significant difference in 5 out of 13 MAAS-Global items, mostly in a positive direction. The effect size was moderate (0.57). ConclusionsGP trainee communication is influenced by contextual factors; they seem to adapt to context in a professional way. Practice implicationsGP specialty training needs to focus on a context-specific application of communication skills. Communication raters need to be taught how to incorporate context factors into their assessments.

Context factors in general practitioner - patient encounters and their impact on assessing communication skills - an exploratory study

BackgroundAssessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor’s proficiency.Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account.MethodsWe used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests.ResultsIn 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p < 0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17.ConclusionsApplying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent ‘adequate GP communication behaviour’. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as ‘signal’ instead of ‘noise’ in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.

Pittsburgh and Epworth Sleep Scale Items: Accuracy of Ratings Across Different Reporting Periods

This study examined the ecological validity of sleep experience reports across different lengths of reporting periods. The accuracy of item responses on the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) across 3-, 7-, and 28-day reporting periods was examined in relation to electronic daily item ratings. Primary care clinic patients (N = 119) were recruited, and were not required to have sleep problems to participate. Analyses found few differences in item scores when electronic daily ratings were compared with recall ratings, regardless of the length of the reporting period. However, within-subjects analyses indicated low levels of accuracy in recall of sleep items for specific days in the last week. Thus, for the purpose of between-subject comparisons, patients generally can provide accurate recall of sleep experiences; studies requiring finer-grained analysis across time and within-subjects require daily diary methodology.

Re-examining Test Item Issues in the TIMSS Mathematics and Science Assessments

As the largest international study ever taken in history, the Trend in Mathematics and Science Study (TIMSS) has been held as a benchmark to measure U.S. student performance in the global context. In-depth analyses of the TIMSS project are conducted in this study to examine key issues of the comparative investigation: (1) item flaws in mathematics and science; (2) inability to reflect item score differences between adjacent grades; (3) ambiguity of the test items behind nonrandom guessing; and (4) unfair comparisons resulted from inconsistent item difficulties across the nations. The TIMSS item checking could help education stakeholders understand more profound assessment issues through the information triangulation.

Measurement Instruments in Behavioral Medicine

Measurements is the cornerstone of science. Measurement instruments (e.g., questionnaires, observational methods, and assessment of physiological parameters) are used to gather data: these data are used to test hypotheses (deductive approach) or to generate new hypotheses (inductive approach). In both approaches, a high-quality measurement instrument is an essential requirement for good science. This applies to behavioral medicine as well. It is therefore highly appropriate for the International Journal of Behavioral Medicine to publish the special series on ‘measurement instruments in behavioral medicine’. One of the challenges facing behavioral medicine is the bewildering variety of measurement instruments. Several years ago, 31 questionnaires and 26 performance-based tests were identified to measure pain and activity limitations in osteoarthritis [1, 2]. And this is osteoarthritis only: in other areas an equally wide range of instruments is available for measuring functioning and quality of life. This wide range of measurement instruments constitutes a huge impediment to scientific communication. Results of studies using different instruments cannot be fully compared. Are questionnaire X and questionnaire Y really measuring the same construct or do they measure different concepts? How does a 15-point improvement on questionnaire X compare to a nine-point improvement on questionnaire Y? In a way, the situation in measuring health resembles the pre-Napoleonic era, when cities and even villages had their own measures of length, volume, and weight: this created confusion and impediments to science and trade [3]. It is high time for the field of behavioral medicine to reach consensus on preferred measurement instruments. In the natural sciences, consensus on the International System of Units was reached a little bit more than 150 years ago. Behavioral medicine should aim for a similar consensus. At least one step into the direction of reaching consensus on preferred measurement instruments is the translation of existing questionnaires into other languages, instead of developing fully new questionnaires. Six papers in the present special series concern translation of an existing questionnaire. Ng et al. [4] evaluated a Chinese translation of the Daily Spiritual Experience Scale. Spindler et al. [5] and Pedersen et al. [6] translated the questionnaire for assessing Type D personality into the Danish and Ukrainian language, respectively. Canavarro et al. [7] translated the World Health Organization Quality of Life scale into the Portuguese language, while Maiano et al. [8] translated the Body Image Avoidance Questionnaire into the French language. In all cases, the psychometric properties of the translated questionnaires were satisfactory: translating existing instruments is an excellent alternative to developing new instruments. However, translation might introduce subtle differences in various language versions of the same questionnaire. Even if the measurement properties of the various versions of the questionnaire are good, there is no guarantee for full measurement equivalence across cultures. In a carefully designed study, Choi et al. [9] demonstrated differences in item scores of the Job Content Questionnaire between European cultures. To reduce cross-language differences in the future, the authors argue in favor of a stricter translation process and studies using only items which have been shown not to suffer from cross-cultural differences. Three other papers in the special series concern the further validation of measurement instruments. Lee et al. [10] validated the Life Control Scale in a new population. Guo et al. [11] and Weck et al. [12] evaluated the factor structure of the Decisional Balance Scale and the Illness Attitude Scales, respectively. Cross-validation and evaluation of the factor structure of existing instruments are highly relevant objectives: in the context of reaching consensus on measurement instruments thorough information on measurement properties of measurement instruments is highly desirable. The present special series is intended to contribute to information on properties of measurement instruments, in the context of reaching consensus on preferred measurements in behavioral medicine.

Parental beliefs and attitudes towards child caries prevention: assessing consistency and validity in a longitudinal design

BackgroundExploring the stability of self-reports over time in observational studies may give valuable information for the planning of future interventions. The aims of the present study were: 1) to explore the consistency of parental self-reports of oral health habits, beliefs and attitudes towards child oral health care over a two-year period; 2) to evaluate possible differences in item scores and consistency between parents with different immigrant status; and 3) to assess the construct validity of items measuring parental beliefs and attitudes towards child oral health care.MethodsThe sample (S1, n = 304) included parents of 3-year-old children in Oslo, Norway; 273 mothers of western origin (WN-group) and 31 of non-western origin (IM-group). They were surveyed in 2002 (child age 3 years) and in 2004 (child age 5 years). Two additional samples of parents were also included; one with 5-year old children in 2002 (S2, n = 382) and one with 3-year-old children in 2004 (S3, n = 427). The questionnaire included items measuring child oral health habits and parental beliefs and attitudes towards child oral health care.ResultsIn 2002, 76.8% of the parents reported that they started to brush their child's teeth before the age of 1 year. Eighty-five percent of them reported the same in 2004; 87.0% of the WN-group and 33.3% of the IM-group (P < 0.001). For 17 of 39 items measuring beliefs and attitudes the responses were more positive for the WN-compared to the IM-group. Parents of caries-free children in 2004 reported significantly more positive beliefs and attitudes towards child oral health care in 2002 compared to parents of children with caries in 2004 (P < 0.05, P < 0.01 and P < 0.001). No differences in mean item scores were found between the three samples S1, S2 and S3.ConclusionThe results showed a fair to good consistency of parental self-reports from 2002 to 2004. They also indicate that parents with different cultural backgrounds should be evaluated separately and in a cultural context.

Spanish-Language Version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS): Preliminary Validation

An instrument that provides valid measurements of satisfaction with physical therapy care for Spanish-speaking patients will enhance communication and ensure their representation in quality assurance analyses and research on health care disparities. The purpose of this investigation was to provide preliminary information on the factor structure, group- and individual-level reliability, and criterion-referenced validity of measurements obtained from a Spanish-language version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS). A total of 203 Spanish-speaking patients in the New York City area participated in this study. Consenting subjects completed a 20-item MRPS after discharge from outpatient physical therapy care. Several translators performed "forward" and "backward" translation of the MRPS, followed by consensus agreement on item structure. Factor structure was investigated using item-correlation and exploratory factor analysis. Group-level reliability for single test administration was assessed using the Cronbach alpha, and individual-level reliability was assessed by calculating the standard error of the measure (SEM). Concurrent validity was tested by comparing the item scores and mean scores of factors to global measures of satisfaction. The means of individual item scores (1-5) ranged from 3.22 for "I did not wait too long" to 4.80 for "My therapist treated me respectfully." There were no sex-based differences in item scores. Exploratory factor analysis suggested a 2-factor solution: a 7-item "external" factor and a 3-item "internal" factor. The correlations (r) of the mean scores from these factors with the 2 global measures ranged from .59 to .82. The SEM was 0.16 for the internal factor and 0.25 for the external factor. The underlying factor structure of the Spanish-language version of the MRPS was identical to the English-language version. Our findings provide preliminary support for the reliability and validity of measurements obtained from the Spanish-language version of the MRPS. Further study is needed to assess the stability of these findings in other samples. As with English-speaking patients, Spanish-speaking patient's satisfaction with physical therapy care is most strongly linked to the professional behavior of the clinician.

Symptoms of post-traumatic stress disorder after non-traumatic events: evidence from an open population study

Post-traumatic stress disorder (PTSD) is the only psychiatric condition that requires a specific event to have occurred for its diagnosis. To gather evidence from the adult general population on whether life events (e.g. divorce, unemployment) generate as many symptoms of post-traumatic stress as traumatic events (e.g. accidents, abuse). Data on demographic characteristics and history of stressful events were collected through a written questionnaire sent to a random sample of 2997 adults. Respondents also filled out a PTSD symptom checklist, keeping in mind their worst event. Mean PTSD scores were compared, controlling for differences between the two groups. Differences in item scores and in the distribution of the total PTSD scores were analysed. Of the 1498 respondents, 832 were eligible for inclusion in our analysis. For events from the past 30 years the PTSD scores were higher after life events than after traumatic events; for earlier events the scores were the same for both types of events. These findings could not be explained by differences in demographics, history of stressful events, individual item scores, or the distribution of the total PTSD scores. Life events can generate at least as many PTSD symptoms as traumatic events. Our findings call for further studies on the specificity of traumatic events as a cause of PTSD.

Testing of an audit instrument for the nursing discharge note in the patient record.

This study validates and tests the reliability of an audit instrument constructed to evaluate the content of nursing discharge notes. Instrument validation and reliability testing. Factor analysis identifying structure through data summarization of the instrument, association between scores in test-retest, and interrater reliability between auditors. Three factors emerged in the factor analysis: 'General information', 'Planning', and 'Assessment', accounting for 76% of the variance regarding the quantitative aspect and 79% of the variance regarding the qualitative aspect, confirming the distinctiveness. Reliability: The Spearman rank-order correlation coefficient calculated per item in the test-retest ranged from 0.72 to 1.0 (p=0.01). The correlation coefficient for the total score was 0.98 (p=0.01). There were no differences in item scores between the test and retest in 93% of the comparisons (n=486). Between the two auditors, the Spearman rank-order correlation coefficient in each item ranged from 0.83 to 1.00 (p=0.01) and weighted kappa values from 0.70 to 1.00 with the exception of one item in both calculations. The correlation coefficient for the auditors' total score was 0.99 (p=0.01). The Student's paired t-test comparing the two auditors' mean values in five different parts of the instrument showed no significant differences in score. The Cat-ch-Ing EPI instrument shows a high reliability and validity as an audit instrument to evaluate the content of nursing discharge notes.