Reliability and validity evidence for the revised Caregiver Self-Efficacy Scale for Transfers

The purpose of this study was to develop and test the psychometric properties of an assessment which can be used with paid caregivers of children and adults with mental retardation and developmental disabilities (MR/DD) who reside in long term intensive care facilities (ICF/MR). The scale rates perceived self-efficacy while performing lifting and transferring tasks of nonambulatory or semi-ambulatory residents and clients. Occupational injuries, especially musculoskeletal, are quite common among paid caregivers within the health care sector. High injury rates result in decreased employee productivity and increased workers’ compensation costs. The Paid Caregiver Self-Efficacy Scale for Transfers (PCSEST) can be used by employers to decrease employee injuries incurred during lifting and transferring tasks. The Rasch measurement model was used to determine the reliability, validity, and sensitivity of the PCSEST. Reliability was found for both persons (0.89) and items (0.95). Validity was established through analysis of outfit mean square statistics (0.55-1.31) with only one item falling outside the acceptable parameters. Further validity was established through point biserial correlations (0.47-0.78) and rank hierarchical order based upon caregiver’s self-efficacy responses. Sensitivity was supported through separation of paid caregivers into four distinct levels of self-efficacy (SI=4.093), and separation of items into six categories (SI=6.04). These results established substantial reliability, validity, and sensitivity of the newly developed PCSEST. Occupational therapists can use the PCSEST to assist employers to provide further training to those employees who do not find themselves highly confident in their abilities to safely and efficiently lift and/or transfer clients. Further, the assessment will allow employees to receive the most beneficial training to enable them to perform their job with less risk of injury. Reliability and Validity 3 Reliability and Validity Evidence for the Paid Caregiver Self-Efficacy Scale for Transfers Within the United States, occupational injury rates are remarkably high, especially within the health care sector. One physical demand that is often required of paid caregivers is the task of lifting and transferring clients. While training and lifting equipment is provided, injury rates continue to increase despite these efforts. There is a need for employers to protect employees from the ramifications of the burdens of heavy lifting. Perceived self-efficacy has been shown as a reliable and valid method of rating one’s confidence in ability. This approach can be successful in identifying paid caregivers who may be at risk for neck or back injury. The purpose of this study was to develop and test the psychometric properties of an assessment instrument to be used with paid caregivers of children and adults with mental retardation and developmental disabilities (MR/DD) who reside in long term intensive care facilities for the mentally retarded (ICF/MR). The assessment instrument rates the perceived self-efficacy of paid caregivers who perform lifting and transferring tasks of non-ambulatory or semi-ambulatory clients. This study was conducted in collaboration with Garrett (2009) and was patterned after a previous caregiver study by Thomas, Shuford, Duke and Cipriani (2007). Prior to discussing the details of this assessment instrument, a comprehensive literature review is depicted which describes caregiver and lifting data, common musculoskeletal injuries, the concept of selfefficacy, and the history of a previous self-efficacy scale for lifting. Finally, the Rasch measurement model (RMM) and the role of occupational therapy as it relates to this study are described. This study intends to provide occupational therapists with a valuable tool to assist employers with creating safe work environments. Further, occupational therapists can serve as a resource for increasing staff self-efficacy for lifting and transferring. Reliability and Validity 4 According to the U.S. Department of Labor (2000), the nursing home industry is one of the nation’s fastest growing industries. There are approximately 2.8 million workers (U.S. Department of Labor Bureau of Labor Statistics [BLS], 2006) at over 21,000 nursing homes and long term care facilities throughout the nation (U.S. Department of Labor, 2000). These statistics include long term intensive care facilities for the mentally retarded (ICF/MR) agencies. Throughout the U.S., approximately 129,000 individuals with mental retardation and other conditions are served through ICF/MR programs. Along with mental retardation, many of these individuals are non-ambulatory, have seizure disorders, behavioral problems and/or mental illnesses (Centers for Medicare and Medicaid Services, 2006). The direct care staff at these facilities are required to perform many tasks that require physical strength and endurance. A BLS 2006 report states that the health care and social assistance sector has the second highest rate of occupational injury at 16% in the year 2005; this is second only to the manufacturing sector. According to BLS, the health care sector is composed of four industries: ambulatory health care services, hospitals, nursing and residential care facilities, and social assistance. Nursing and residential care facilities accounted for 209,100 nonfatal occupational injuries and illnesses, second to hospitals (281,500) within the sector (BLS, 2006). Caregiver and Lifting Data For the purposes of this study, a paid caregiver is defined as a non-family member employed through an agency who receives compensation for care given to an individual with a disability. Employees provide assistance with occupations of daily life, instrumental occupations of daily life, educational needs, vocational needs, and leisure and social needs. The physical demands of the job are often quite high; for example, at one facility in Northwest Ohio, the Reliability and Validity 5 caretaker job description states that an employee must be able to lift up to 60 pounds without assistance. Increasingly, employers are providing mechanical lifting assistance for staff. There are several different types of mechanical lifting devices that are available on the market. ARJO, Inc. manufactures several lifting systems which are designed for hospitals and long term care facilities. The floor models are designed for staff to maneuver by pushing the lift to areas where lifting is needed. For example, if a client is positioned in bed, the floor model can be placed to perform the lift at bedside and then can be pushed to an area of destination such as a bathtub. These lifts are not constrained by tracks and can be used anywhere they fit. However, this type of lift system tends to create a strain on a caregiver’s back due to the amount of torque that is required when pushing and turning the systems. Yassi, et al (2001) performed a randomized controlled trial comparing the effectiveness of lifting equipment to reduce musculoskeletal injuries, increase comfort, and reduce physical demands on nursing staff during patient lifting and transferring. Nine wards from an acute care hospital were randomly assigned to one of three arms; control, safe lifting, and no strenuous lifting. Employees were interviewed on self-perceived frequency and intensity of physical discomfort during patient-handling tasks and data were obtained from workers’ compensation files. Results indicated that self-perceived work fatigue, back and shoulder pain, and frequency and intensity of physical discomfort were reduced with the use of mechanical lifting devices. A second type of mechanical lift which is also available through ARJO, Inc. is a ceiling lift system. These models are attached to a track system which runs on the ceiling of the care areas. They are restricted to where the tracks are; however, these systems require much less user strain for the caregiver. Reliability and Validity 6 Chhoker, et al. (2005) conducted a longitudinal case-study at an extended care facility to evaluate the efficacy of overhead lifts in reducing the risk of staff injury. Researchers reviewed workers’ compensation claims for a 3-year period prior to implementation of ceiling lifts and then for 3-years following intervention; only those claims related to lifting, transferring, and repositioning were considered. Results indicated a significant decrease in the number of reported claims in relation to lifting, transferring, and repositioning. Medical claims costs and days lost also demonstrated a significant decrease post-intervention. The study indicated the long-term effectiveness of ceiling lifts in reducing the risk of staff injury. Miller, Engst, Tate, and Yassi (2006) studied the effectiveness of portable ceiling lifts within a long term care facility as compared to other methods of lifting (manual and mechanical). A quasi-experimental, pre-post intervention design with concurrent control was used. Researchers asked nursing staff at two facilities to complete a questionnaire which examined the frequency of handling tasks, preferred method to transfer and reposition residents, discomfort while lifting and transferring, perception of risk of injury, and work organization factors. Results indicated that 75% of the intervention group preferred to use the ceiling lifts. There was a significant decrease in discomfort within the intervention group when using the ceiling lifts versus manual lifting. However, no significant difference in discomfort was found between using the ceiling lift or the mechanical floor lift. Overall, 82% of staff reported using the ceiling lifts had made their jobs easier. Researchers found that within the intervention group there was a perceived lower risk of back injury when using the ceiling lifts versus mechanical lift or manual lift. Facility compensation costs for patient handling also decreased after installation of t