Date of Award

Spring 5-2025

Document Type

Dissertation

Selected Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Degree Name

Doctor of Philosophy (Ph.D.) Nursing

Department

Nursing

School

School of Nursing and Health Sciences

First Advisor

Jennifer E. Mannino

Abstract

Background

Acute care facilities are seeing an increased demand for critical care resources, given the increasing aging population with more complex health problems, retiring healthcare professionals, and subsequent decreasing supply of new expertise (Shahpori et al., 2011). Telehealth in the ICU is a valuable resource that some hospitals have employed to bridge this gap. The use of the teleICU has been associated with improved outcomes for patients (Williams et al., 2019), and reduction in failure to rescue (FTR) events. Despite the increasing availability of teleICU programs and the associated potential benefits, there continue to be inconsistencies in terms of usage by bedside critical care nurses. The reasons for the inconsistencies must be understood so that interventions can be developed to increase the use of eICU® technology, which has been shown to improve patient quality of care outcomes (Beasley et al., 2020).

Purpose

The purpose of this study is to evaluate the psychometric properties of a researcher-modified version of the Nurses’ Attitudes Toward eICU® Scale (NATES) (Kowitlawakul et al., 2011) in a population of critical care nurses with access to teleICU technology. The NATES instrument was initially developed to assess attitudes toward teleICU technology among critical care nurses. The instrument has been previously tested by registered nurses working in critical care units that have not yet implemented teleICU technology. However, it has yet to be tested with registered nurses working in critical care units with access to teleICU technology. This instrument can be used to understand nurses' inconsistencies in the utilization of teleICU.

Methods

This study used a non-experimental, cross-sectional study design to evaluate the psychometric properties of Nurses’ Attitudes Toward eICU® Scale (NATES) in a population of critical care nurses with access to teleICU technology.

Results

This study found a 3-factor solution explaining 62.85% of the total variance. An additional EFA with four items deleted was also completed, yielding a 2-factor solution explaining 64.77% of the total variance. The data showed positive correlations existed between prior use of teleICU and prior teleICU training, the amount of continuing education provided, and the number of teleICU interactions per shift, which indicates that prior use of teleICU, prior training, and the amount of continuing education provided will increase usage of teleICU. There were also positive correlations between the amount of continuing education provided and the number of teleICU interactions per shift, indicating that the provision of ongoing teleICU continuing education will increase the usage of teleICU. The study’s high Cronbach’s alpha (α=.895) demonstrates the reliability of the NATES to assess nurses’ attitudes towards teleICU in bedside critical care nurses who currently utilize teleICU. Deletion of four items was shown to improve the overall performance of the NATES in the population studied.

Conclusion

Further research is recommended to confirm the instrument’s psychometric properties using the 17 items recommended in this study. Knowledge gained from this research will help guide continuing education related to teleICU and interventions to improve the usage of teleICU, which has been shown to improve patient outcomes (Armaignac et al., 2018; Udeh et al., 2024; Williams et al., 2019; Goran, 2012; Lilly et al., 2011; Trombley et al., 2018).

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