Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Systems Thinking for Transitions of Care

Reliability Testing for a Standardized Rubric

Phillips, Janet M. PhD, RN, ANEF; Stalter, Ann M. PhD, RN; Ruggiero, Jeanne S. PhD, RN, CNE; Bonnett, Pamela L. DNP, RN, CNE; Brodhead, Josette PhD, MSHS, RN, RNC-MNN, CNE; Merriam, Deborah H. DNS, RN, CNE; Scardaville, Debra L. PhD, RN, CPNP-PC; Wiggs, Carol M. PhD, RN CNM, AHN-BC; Winegardner, Sherri DNP, RN, MSN, MHA

doi: 10.1097/NUR.0000000000000443
Feature Article

Purpose: The purpose of this study was to develop a standardized rubric for systems thinking across transitions of care for clinical nurse specialists.

Design: The design was a mixed-methods study using the Systems Awareness Model as a framework for bridging theory to practice.

Methods: Content validity was determined using a content validity index. Reliability was established using statistical analysis with Cronbach’s α and intraclass correlation coefficient. Usability of the rubric was established using content analysis from focus group discussions about their experiences in using the rubric.

Results: Content validity was established with a content validity ratio of 1.0. Statistical analysis showed a high interrater reliability (α = 0.99), and sections of the rubric showed a strong degree of reliability with α’s ranging from 0.88 to 1.00. Content analysis revealed several overall themes for usability of the rubric: clarity, objectivity, and detail. The area for improvement included adding more detail in the scholarly writing section.

Conclusion: The research team recommends using the rubric to reflect application of systems thinking across transitions of care.

Author Affiliations: Clinical Associate Professor (Dr Phillips), Indiana University School of Nursing, Indianapolis; Associate Professor (Dr Stalter), Wright State University, Dayton, Ohio; Associate Professor (Dr Ruggiero), New Jersey City University; Director (Dr Bonnett), RN-BSN Program, The University of Akron, Ohio; Full-Time Faculty and Assistant Professor of Nursing (Dr Brodhead) and Assistant Professor (Dr Merriam), Daemen College, Amherst, New York; Professor and Graduate Program Coordinator (Dr Scardaville), Department of Nursing, New Jersey City University; Associate Professor and RN-BSN Track Administrator (Dr Wiggs), The University of Texas Medical Branch, Galveston; and Director of Nursing and Associate Professor (Dr Winegardner), Bluffton University, Ohio.

The authors report no conflicts of interest.

Correspondence: Janet M. Phillips, PhD, RN, ANEF, 4002 Tolbert Place, Carmel, IN 46074 (;

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved