Development and testing of four instruments to assess prior conditions that influence nurses' adoption of evidence-based pain management practices

This paper is a report of the development and testing of the psychometric properties of a set of four instruments measuring prior conditions influencing nurses' decisions to adopt evidence-based pain management practices. Nurses do not use evidence-based pain management practices consistently. Their adoption of pain management practices depends on several prior conditions. Prior conditions are factors that influence the need to learn more about an innovation and begin the adoption process. Four instruments were developed, collectively known as Carlson's Prior Conditions Instruments, to assess the four theoretically-derived prior conditions of previous practice, felt needs/problems, innovativeness and norms of the social system that influence nurses' decisions to adopt evidence-based pain management practices. Item-to-total correlations and Cronbach's alpha were used to determine internal consistency reliability. Construct validity was examined through principal components factor analysis with varimax rotation. Data were collected as part of a larger study in 2005. Content validity of the four instruments was supported through review by experts. The instruments were distributed to nurses (n = 187). Each instrument demonstrated internal consistency (alpha range = 0.731-0.825). Factor analysis demonstrated that the Felt Needs/Problems and Norms of the Social System Instruments were unidimensional, with six and seven items respectively. The Previous Practice Instrument (11 items, three factors) and Innovativeness Instrument (six items, two factors) were multidimensional. Initial psychometric testing revealed adequate estimates of reliability and validity for Carlson's Prior Conditions Instruments. Further research is needed using the tools with nurses in different countries and cultures to test and confirm the constructs.