Measuring Restorative Care Provided by Nursing Assistants: Reliability and Validity of the Restorative Care Behavior Checklist

BACKGROUND: Most prior research on the outcomes of restorative care programs has been focused on resident outcomes including such things as functional performance, behavior, and quality of life. Treatment fidelity issues and compliance with the programs were not addressed in these studies. Without such an evaluation, it is impossible to evaluate the effectiveness of restorative care activities. PURPOSE: To test the reliability and validity of the Restorative Care Behavior Checklist (RCBC), which is an observed measure of restorative care activities performed by nursing assistants (NAs). METHODS: The study involved a single observation of care activities and completion of survey data among NAs working in nursing homes. A total of 386 participants from eight nursing homes were included in the study. In addition to completion of the RCBC during a 15-minute observation of care activities, demographic data were obtained, and participants completed a paper-and-pencil survey that included assessments of self-efficacy, outcome expectations, knowledge of restorative care, and job attitude. Reliability testing was based on person separation reliability and interrater reliability. Validity testing was based on evidence of the unidimensionality of the measure, the fit of the items using Rasch analysis, and evidence of convergent validity. RESULTS: There was support for the reliability of the RCBC with a person separation reliability of .77 and interrater reliability, with 83% to 100% agreement on each of the care activities. Support for validity was provided based on evidence of unidimensionality and a good fit of the items. There was minimal support for convergent validity. DISCUSSION: The development and psychometric testing of the RCBC are an important first step in the observational assessment of restorative care activities performed by NAs, or other caregivers of older adults, living in long-term care settings.