Development and psychometric evaluation of the arterial puncture self-efficacy scale

Highlights

• The APSES shows evidence of high reliability, very good criterion validity and excellent content and construct validity.

• The APSES can be used to assess healthcare professionals' confidence before attempting to perform arterial puncture on patients.

• The APSES can provide healthcare educators with valuable information about the effectiveness of their teaching methods.

Abstract

Background

Arterial puncture for arterial blood gases (ABG) analysis can be a risky, painful, difficult-to-perform procedure that is often insufficiently practised and generates stress and discomfort amongst patients and healthcare professionals. Self-efficacy is a key component in the acquisition of procedural skills. Therefore, professionals' self-efficacy in arterial puncture should be measured before attempting the procedure on real patients.

Objective

To develop and psychometrically assess a self-efficacy scale in arterial puncture.

Design

An observational cross-sectional design was used in this study.

Setting

Faculty of Education Sciences, Nursing and Physiotherapy in a higher education institution in the south of Spain.

Participants

A convenience sample of 342 nursing students entered and completed the study. All participants met the following inclusion criteria: (1) ≥ 18 years old and (2) enrolled in a nursing degree programme during the 2014/2015 academic year. Participants were 74% female (n = 254) and their age ranged from 18 to 50, with a mean age of 21.74 years (SD = 5.14).

Method

The Arterial Puncture Self-Efficacy Scale (APSES) was developed and psychometrically tested. Reliability and content validity were studied. Predictive validity and concurrent validity assessed criterion validity. In addition, principal component analysis and known-group analysis evaluated construct validity.

Results

Principal component analysis revealed the two-subscale structure of the final 22-item version of the Arterial Puncture Self-Efficacy Scale (APSES). A total Cronbach's alpha coefficient of 0.97 showed its high reliability. The APSES' content validity index was excellent (S-CVI/Ave = 0.95). Predictive and concurrent validity analysis demonstrated the good criterion validity of the tool. Supporting the APSES' sensitivity and specificity, known-groups analysis evidenced significant differences (p < 0.001) in self-efficacy levels between groups.

Conclusion

The APSES showed good psychometric properties for measuring self-efficacy in arterial puncture for ABG analysis.

Introduction

In acutely ill patients, the respiratory function must be closely monitored and the most frequently ordered laboratory test amongst those needing critical care is arterial blood gases (ABG) analysis (Andrews and Waterman, 2010). Arterial puncture is, therefore, a regularly performed invasive procedure within critical care units, emergency departments and some medical wards (Bobbia et al., 2013, Crawford, 2004). The radial artery is the most commonly chosen blood vessel to obtain a sample for ABG analysis (Dev et al., 2011). However, the radial artery puncture is not a totally safe procedure despite its accessibility, the presence of collateral circulation and the possibility to easily promote haemostasis by applying direct pressure on the area (Baskin et al., 2014, Masoorli, 2007). Indeed, arterial puncture has been associated with a risk of arteriospasm, nerve injury, pseudoaneurysm and acute compartment syndrome (Baskin et al., 2014, Bisarya et al., 2013, Dev et al., 2011, Leone et al., 2009, Masoorli, 2007). In addition, radial artery puncture is described as a very painful and difficult-to-perform procedure in which more than one attempt is usually needed to be successful (Bobbia et al., 2013, Crawford, 2004, Haynes and Mitchell, 2010, Matheson et al., 2014, Valero Marco et al., 2008), thus generating discomfort and stress in both patients and healthcare professionals (Baskin et al., 2014, Matheson et al., 2014).