心理测量学：护理学应用

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The phenomena evaluated by nurses in their professional or scientific practice have become complex and require multiplicity of diverse information for the formation of critical thinking and clinical reasoning. The health evaluation paradigms have changed, imposing the need for an evolution in the evaluation processes and methods, for measuring both objective and subjective phenomena.

Evaluating subjective and indirectly observable phenomena can be a challenge, as it depends on an objective measurement that serves as evidence to strengthen nurses’ clinical impression during the assessment. Measuring instruments (tests, scales, inventories and indices, among others)((1)) render measurements objective. In this way, such instruments can be used to detect, quantify, describe, inform, explain and predict different phenomena, in addition to guiding courses of action.

In Nursing, instruments support the teaching and learning process in nurses’ initial, continuing and permanent training; they subsidize the clinical evaluation inherent to the Nursing Process and advanced practice; and they direct care management and measure phenomena in scientific research studies. However, for them to fulfill their measuring role, they should have their metric properties analyzed.

The measuring science must be employed to analyze such properties. Psychometrics is concerned with measuring and predicting psychological, attitudinal and behavioral phenomena((2)). It can also be used from a clinimetric perspective. When understood as a research method, it is concerned with evaluating the attributes of an instrument with regard to the type of information generated, data validity and reliability, relating to the procedures used to evaluate such attributes((1)), but it is not restricted to using statistical techniques to analyze data related to the application of instruments((3)). It uses its own theoretical framework to ground and direct the way to analyze the data, in a quantitative and qualitative combined perspective related to the intended type of evidence.

Psychometrics is guided by two theoretical models: the Classical Test Theory (CTT) and the Item Response Theory (IRT)((1)). Each of these models will direct the application of psychometric procedures from different perspectives. CTT addresses an instrument from the perspective of the set of items that comprise it and IRT does so from the perspective of each item individually((1)). In both models, a set of procedures and combined techniques assess the validity and reliability evidence, which in turn represent the necessary attributes to demonstrate the metric quality of an instrument.

Validity and reliability are different but interrelated attributes. Validity represents to which extent an instrument evaluates what it is intended to measure, from different perspectives related to the type of validity under analysis, being considered the most important evidence of the metric quality of an instrument((1)). Without its analysis, measurements are potentially dangerous, especially when they support courses of action in health. Reliability relates to constancy of the assessment product at different times or situations((1)). Both should be based on solid empirical evidence.

In fact, the psychometric science has evolved in such a way that, currently, its theoretical models are understood as complementary and equally important. They differ in the analysis objective and in the type of inference to be presented. What contemporary Psychometrics requires is the use of combined procedures for data analysis and the validity types have also been changing in this evolution. Currently, there are five types of validity evidence (test content, response process, internal structure, association with other variables, and consequences of use)((1)), each with a set of specific techniques to be employed in a chained fashion. Techniques were improved, new indices were incorporated and software were developed((1),(4)). The major challenge for researchers is to know when to use one technique or another, according to the analysis objective and to the theoretical model that should be based on the guiding principles of Psychometric science((4)). There is no more room for using techniques that have proved to be outdated for decades((5)). Employing outdated procedures violates the principles of integrity and good scientific practices and represents a disservice to society, in addition to constituting a major ethical problem((1),(5)).

Herein understood here as a measuring science and not merely as a set of statistical techniques used to analyze instrument evaluation data, Psychometrics has much to contribute to Nursing. It can be used to create, adapt and/or analyze diverse validity and reliability evidence of instruments that support nurses’ scientific and professional practice. As it is based on a contemporary and well-applied theoretical framework, it contributes to the design of studies with high methodological rigor and to the development of Nursing knowledge.

The availability of measuring instruments that really evaluate the phenomena of interest in the Nursing and Health areas with validity and precision is essential for care quality and patient safety. It is the duty of all nurses to ground their professional practice on the best evidence available. It is the duty of all researchers to produce knowledge derived from research guided by the best scientific practices. More than a scientific duty, it is a social obligation.

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护士在其专业或科学实践中评价的现象已变得复杂，需要多种多样的信息来形成批判性思维和临床推理。健康评价模式已经发生变化，因此需要改进评价过程和方法，以衡量客观和主观现象。

评估主观和间接观察到的现象可能是一个挑战，因为它取决于一个客观的测量，作为证据，以加强护士的临床印象在评估期间。计量工具（测试、量表、清单和指数等）（（1））使计量客观。这样，除了指导行动方针外，这些工具还可用于检测、量化、描述、通报、解释和预测不同的现象。

在护理学中，仪器支持护士初始、继续和永久培训中的教学过程;他们资助护理过程和高级实践中固有的临床评估;他们指导护理管理和测量科学研究中的现象。然而，为了使它们履行其测量角色，它们应该对其度量属性进行分析。

必须采用测量科学来分析这些性质。心理测量学涉及测量和预测心理，态度和行为现象（2）。它也可以从临床角度使用。当被理解为一种研究方法时，它涉及评估工具的属性，涉及生成的信息类型，数据有效性和可靠性，涉及用于评估这些属性的程序（（1）），但它不限于使用统计技术来分析与工具应用相关的数据（3））。它使用自己的理论框架，以与预期证据类型相关的定量和定性相结合的角度，为分析数据提供基础和指导。

心理测量学由两个理论模型指导：经典测验理论（CTT）和项目反应理论（IRT）（（1））。这些模型将从不同的角度指导心理测量程序的应用。CTT从组成工具的一组项目的角度处理工具，IRT从每个项目的角度单独处理工具（（1））。在这两种模型中，一组程序和组合技术评估的有效性和可靠性的证据，这反过来又代表了必要的属性，以证明一个工具的度量质量。

有效性和可靠性是不同但相互关联的属性。有效性表示工具从与分析中的有效性类型相关的不同角度评估其意图测量的内容的程度，被认为是工具的度量质量的最重要证据（（1））。如果没有分析，测量是潜在的危险，特别是当它们支持健康方面的行动时。可靠性涉及评估产品在不同时间或情况下的恒定性（（1））。两者都应基于坚实的经验证据。

事实上，心理测量学已经发展到这样一种方式，目前，它的理论模型被理解为互补的，同样重要的。它们在分析目标和要呈现的推理类型方面有所不同。当代心理测量学要求的是使用组合程序进行数据分析，有效性类型也在这一演变中发生了变化。目前，有五种类型的有效性证据（测试内容，反应过程，内部结构，与其他变量的关联，以及使用的后果）（（1）），每一种都有一套具体的技术，以连锁的方式使用。改进了技术，纳入了新的指标，并开发了软件（（1），（4））。研究人员面临的主要挑战是知道何时使用一种技术或另一种，根据分析目标和理论模型，应该基于心理测量科学的指导原则（（4））。没有更多的空间来使用已经被证明过时了几十年的技术（（5））。采用过时的程序违反了诚信和良好科学实践的原则，除了构成重大的伦理问题外，还对社会造成损害（（1），（5））。

在这里被理解为一门测量科学，而不仅仅是一套用于分析仪器评估数据的统计技术，心理测量学对护理有很大的贡献。它可以用来创建，适应和/或分析支持护士的科学和专业实践的仪器的各种有效性和可靠性证据。由于它是基于一个当代的和应用良好的理论框架，它有助于设计的研究与高方法的严谨性和护理知识的发展。

测量仪器的可用性，真正评估感兴趣的现象，在护理和健康领域的有效性和精度是必不可少的护理质量和病人的安全。所有护士都有责任将其专业实践建立在现有的最佳证据之上。所有研究人员都有责任在最佳科学实践的指导下，从研究中产生知识。这不仅仅是一种科学责任，更是一种社会义务。

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