Systems Thinking for Transitions of Care: Reliability Testing for a Standardized Rubric

Janet M. Phillips, Ann M. Stalter, Jeanne S. Ruggiero, Pamela L. Bonnett, Josette Brodhead, Deborah H. Merriam, Debra L. Scardaville, Carol M. Wiggs, Sherri Winegardner

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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 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 ( = 0.99), and sections of the rubric showed a strong degree of reliability with '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.

Original languageEnglish (US)
Pages (from-to)128-135
Number of pages8
JournalClinical Nurse Specialist
Issue number3
StatePublished - May 1 2019


  • clinical nurse specialist
  • standardized rubric
  • systems thinking
  • transitions of care

ASJC Scopus subject areas

  • Leadership and Management
  • Assessment and Diagnosis
  • Advanced and Specialized Nursing
  • LPN and LVN


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