Collaboration and Satisfaction About Care Decisions (CSACD)

National Center for Interprofessional Practice and Education's picture
Submitted by National Center... on Sep 28, 2016 - 1:51pm CDT

Baggs, J.G.

The CSACD was originally designed to measure nurse-physician collaboration in intensive care units (ICUs) as they make specific decisions regarding patient transfers. The tool contains a six-item measure of collaboration as well as a global collaboration item, a decision process satisfaction item, and a final decision satisfaction item. The results, which are at the level of a specific patient decision, are meant to support linking nurse-physician collaboration to ICU patient outcomes. The 1994 validity study described below, based on 58 neonatal intensive care unit nurses and resident physicians, demonstrated good factor structure and internal reliability. The six-item collaboration scale was significantly related to the global collaboration and satisfaction measures.  In subsequent research, the author reported some positive association between CSACD scores and patient outcomes.  Since its development in 1994, this instrument has been widely replicated and adapted for other settings, and is suitable for interprofessional education as well as practice environments (see Notes on Content and Access).

Link to Resources
Descriptive Elements
Who is Being Assessed or Evaluated?: 
Instrument Type: 
Self-report (e.g., survey, questionnaire, self-rating)
Source of Data: 
Health care trainees
Health care providers, staff
Notes for Data Sources: 

Neonatal intensive care unit (NICU) nurses and pediatric residents comprised the validation study sample for the 1994 study. 

Instrument Content: 
Reported perceptions, experiences of working relationships, teamwork
Notes for Content: 

The tool focuses on the decision to transfer a patient out of the ICU, and the extent to which this decision is made collaboratively between nurses and physicians.  The tool contains six items targeting separate aspects of nurse-physician collaboration, and one global item measuring collaboration, all for a particular patient.  There are also two items measuring satisfaction with the decision making process for the patient and the final decision for the patient. 

The tool content has applicability for all ICUs (e.g., medical, cardiac, surgical critical care, neonatal) and a wide range of professionals affected by, if not involved with patient decisions: anesthesia, oncology, mental health, rehab, neurology, infectious disease, emergency departments, and community health providers.  In subsequent uses, the instrument as been used to assess unit-level and team-level decision making.

Instrument Length: 

9 items; no time length specified

Item Format: 
7-point likert-type scale ranging from Strongly disagree (1) to Strongly agree (7) for individual collaboration items, No Collaboration (1) to Complete Collaboration (7) for global collaboration item, and Not Satisfied (1) to Very Satisfied (7) for satisfaction items.
In the 1994 study, nurses filled out paper surveys and returned the surveys to a labelled box in the breakroom. Residents filled out a paper survey and mailed it back to the researchers.
The six individual collaboration items are averaged to form a collaboration score. The global item score is used separately as are the two satisfaction item scores.
None described.
Copyrighted (needs permission of author)
Notes on Access: 

Although the items can be found in the article, the author requests that interested colleagues contact her for permission to use the CSACD.  She is happy to provide permission as long as users agree to four things: (1) to share their results with her, (2) to cite her appropriately if they publish, (3) to not publish the instrument, and (4) to check with her before modifying the tool.  In exchange for this agreement, the author will send you three versions of the instrument and a reference list. 

Psychometric Elements: Evidence of Validity
Items were developed from well accepted model for collaboration and the related literature. Items were then reviewed by 12 nursing and medical experts in collaborative practice. All items were judged relevant to nurse-physician collaboration, and the majority of experts agreed that collaboration was adequately measured.
Response Process: 
The items were reviewed by 11 intensive care unit (ICU) nurses, residents, and physicians. All reviewers indicated that the questions were within the ability of respondents to answer, understandable, and differentiating.
Internal Structure: 
Factor analysis revealed a single factor for the six individual items of collaboration with 75% of variance explained. Cronbach’s alpha internal consistency was very high (alpha = 0.93).
Relation to Other Variables: 
The average score for the six individual collaboration items strongly related to the global collaboration item, r = 0.87. The average collaboration score also related moderately to both satisfaction with the decision-making process (r = 0.69) and satisfaction with the final decision (r = 0.50).
None described.