Developing the KAMA instrument (knowledge and management of abuse)

to develop and validate an instrument which measures applied knowledge and practice regarding identification and management of potentially abusive situations in staff who work with older vulnerable inpatients. One of the anticipated uses will be to measure any change produced by attending an educational intervention designed to improve management of abuse. A vignette-based instrument was chosen to measure applied knowledge and practice over other methods of assessments which were felt not to be practical or provide too much cueing for the volunteering staff.

a parallel form vignette-based instrument was developed so that not only baseline knowledge but also change in knowledge could be measured. Abusive scenarios were adapted from researchers' clinical practice and from the literature. Advice from senior nurses about the suitability of the vignettes for ward and community based staff was obtained and the instrument was piloted. Staff working with older people and employed by health or social services working in inner London completed the questionnaire.

79 (92%) of the eligible staff took part in this study. All completed the instrument. Version A of the Knowledge and Management instrument was answered by 39 staff, whilst 40 answered version B. The proportion of qualified and unqualified staff as well as the proportion employed by health or social services was similar for each parallel version of the instrument. The measure of internal consistency Cronbach's alpha was 0.89 for version A and 0.79 for version B. Parallel form reliability coefficient was calculated as 0.82, indicating that the two versions of the Knowledge and Management instrument perform similarly. Measures for concurrent validity according to years of experience and professional education also proved significant. Inter-rater reliability was calculated at 0.98 (P=0.01). Test-retest reliability at 0.69 (P=0.01) indicated that the instrument is stable yet sensitive to change.

this instrument is a valid assessment tool that can be used to identify gaps in applied knowledge and management in potentially abusive situations in older people and allow knowledge in this field to be built on.