Developing a Fidelity Assessment Instrument for Nurse Home Visitors

• Published in: Research in nursing & health Vol. 38; no. 3; pp. 232 - 240
• Main Authors: Black, Kirsten J., Wenger, Mary Beth, O' Fallon, Molly
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.06.2015; Wiley Subscription Services, Inc
• Subjects: Advisory Committees; Clinical Competence; Family - psychology; Humans; instrument development; Intervention; intervention fidelity; Models, Psychological; nurse home visiting; nurse-family partnership; Nurse-Patient Relations; Nurses, Community Health - psychology; Nurses, Community Health - standards; Nurses, Community Health - statistics & numerical data; Nursing; Professional development; quality improvement; Skill development; Surveys and Questionnaires; translational research; Visiting nurses; nurse home visiting; nurse-family partnership; instrument development; intervention fidelity; translational research; quality improvement
• ISSN: 0160-6891; 1098-240X
• DOI: 10.1002/nur.21652

Fidelity monitoring is a core component for successful translation of evidence‐based interventions, yet little guidance is available on developing tools to assess intervention fidelity that are valid and feasible for use in community settings. We partnered with nurses in the field to develop a fidelity monitoring instrument that would capture the essential elements of the nursing intervention that is the core of Nurse‐Family Partnership, a prenatal and early childhood home visitation program. Using a grounded approach, we employed concept mapping to identify the salient behavioral characteristics associated with the program, and then, adapting Dreyfus’ model of skill development, created a tool to assess nurse home visitors (NHVs) according to their stage of growth. In a pilot, the Nursing Practice Assessment (NPA) form was used to assess 188 NHVs. The average time to complete the tool was 1 hour, and skill development stage was concordant with years of NHV experience. According to surveys of supervisors and NHVs, the tool captured the essential elements of the program model. Articulating the essential elements of each skill development stage can provide a foundation for professional development for NHVs. In response to feedback, online training modules were developed prior to large‐scale implementation in the field. The grounded methods used to develop the NPA enhanced its internal consistency and implementation feasibility and could be utilized by other public health nursing programs. © 2015 Wiley Periodicals, Inc.