| Course | NR 559 Research Methods and Evidence-Based Practice for Professional Nursing Practice |
|---|---|
| Week | 6 |
| Paper type | Instrument and measurement review |
| Length | About 1,130 words, 2 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NR 559 Week 6
Instrument and Measurement Review: Four Ways of Measuring Whether Older Inpatients Keep Their Mobility, What a Point on Each Scale Means, Who Each Was Built On and Why Two Studies of the Same Outcome May Not Agree
Student Name
College of Nursing, Chamberlain University
NR 559: Research Methods and Evidence-Based Practice for Professional Nursing Practice
Instructor Name
Month Day, Year
Instrument and Measurement Review: Four Ways of Measuring Whether Older Inpatients Keep Their Mobility, What a Point on Each Scale Means, Who Each Was Built On and Why Two Studies of the Same Outcome May Not Agree
Why Measurement Matters Here
The studies reviewed in this course measured mobility in different ways. The randomized trial of a hospital mobility program found no effect on daily activities but a significant effect on community mobility (Brown et al., 2016). Whether a walking program "works" therefore depends on which instrument is used. Before recommending a program for our unit, or deciding how to measure its effect, this review describes four instruments: what each records, what a point of movement represents, who it was built on and whether two studies using different instruments can be compared.
Instrument 1: Katz Index of Activities of Daily Living
What it records. Independence in six basic activities: bathing, dressing, toileting, transferring from bed to chair, continence and feeding. Each is typically scored as independent or dependent, and the total counts the number of activities done independently.
What a point means. One point is the gain or loss of independence in one whole activity, such as becoming unable to dress without help. That is a large, clinically meaningful change, but the scale cannot detect smaller declines, such as walking more slowly or less far.
Who it was built on. It was developed decades ago with older adults and people with chronic illness in institutional settings and has been widely used since.
Implication. In patients who were largely independent before admission, as in the mobility trial, many will score at or near the top of the scale before and after, a ceiling effect. That may explain why the trial found no difference in daily activities: the instrument had little room to show one.
Instrument 2: Life-Space Assessment
What it records. How far a person moved from their bedroom in the preceding four weeks, through five levels from other rooms in the home to beyond the person's town, and how often and with what help. Scores range from 0 to 120.
What a point means. A change of about 10 points reflects a meaningful reduction in how far or how often a person moves in daily life; in the mobility trial, scores in the comparison group dropped roughly ten points after the admission.
Who it was built on. Community-dwelling older adults in Alabama taking part in a study of aging, in whom life-space scores were associated with physical performance and other measures of function (Baker et al., 2003).
Implication. It captures mobility in the community after discharge, which is what patients and families care about, and it is sensitive to changes the Katz index misses. It is not designed for use during the hospital stay, since it asks about the past four weeks of movement in the community.
Instrument 3: Johns Hopkins Highest Level of Mobility
What it records. The highest level of mobility a patient achieved during a shift or day, on an eight-point ordinal scale rising from bed rest at the bottom to a walk of 250 feet at the top.
What a point means. One point is a step up the ladder, such as from sitting at the edge of the bed to standing for a minute. Each step is observable by any clinician.
Who it was built on. Hospitalized adults, with reliability and construct validity tested among nurses and therapists in an academic hospital (Hoyer et al., 2018).
Implication. It is designed for daily use during a hospital stay, can be recorded by nurses in seconds and shows whether patients are walking at all. It does not measure function after discharge.
Instrument 4: AM-PAC Inpatient Basic Mobility Short Form
What it records. Six items about the patient's ability to move in bed, transfer, walk and climb stairs, rated by a clinician on the amount of help needed. Its developers have described it as "6-Clicks."
What a point means. A change on the raw scale reflects a change in the amount of help needed for one or more activities; raw scores can be converted to a standardized scale.
Who it was built on. Hospitalized patients assessed by physical therapists and, in later work, other clinicians, with evidence of validity in acute care (Jette et al., 2014).
Implication. Useful for tracking function during the stay and for discharge planning. Like the mobility ladder, it does not reach beyond the hospital.
Same Outcome, Different Scales
Two studies that both claim to measure mobility may not agree because they measure different things at different times. A study using the Katz index at discharge may find no benefit from walking, while one using the Life-Space Assessment a month later finds a clear benefit, as the mobility trial did internally. A unit project using the mobility ladder may show that patients walked more, without showing whether they kept their mobility after going home. None of these results contradicts the others; they answer different questions. Reading them together requires knowing which instrument each used, when and in whom.
Timing of Measurement
When an instrument is used matters as much as which one. A mobility ladder recorded at the end of each shift shows the highest level reached that shift, which captures whether walking happened. A Katz index at admission often records the patient's state during acute illness rather than before it, which exaggerates later improvement. The Life-Space Assessment at one month captures recovery at home but depends on the patient's memory of the past four weeks. Stating the timing of each measure, and keeping it the same before and after a change, is as important as choosing the instrument.
What to Use on Our Unit
For a walking program on our unit, the review suggests two instruments. The Johns Hopkins mobility ladder, recorded by nurses each shift, would show whether the program is delivered: whether patients who could walk before admission are actually walking. A short telephone Life-Space Assessment one month after discharge, for a sample of patients, would show whether the program achieves the outcome the trial found. The Katz index could be recorded at admission and discharge for comparison with other studies, with the ceiling effect in mind. Choosing instruments before the program starts avoids choosing the one that happens to show the best result afterward, a principle emphasized in evidence-based practice guidance (Melnyk & Fineout-Overholt, 2019).
References
Baker, P. S., Bodner, E. V., & Allman, R. M. (2003). Measuring life-space mobility in community-dwelling older adults. Journal of the American Geriatrics Society, 51(11), 1610-1614. https://doi.org/10.1046/j.1532-5415.2003.51512.x
Brown, C. J., Foley, K. T., Lowman, J. D., MacLennan, P. A., Razjouyan, J., Najafi, B., Locher, J., & Allman, R. M. (2016). Comparison of posthospitalization function and community mobility in hospital mobility program and usual care patients: A randomized clinical trial. JAMA Internal Medicine, 176(7), 921-927. https://doi.org/10.1001/jamainternmed.2016.1870
Hoyer, E. H., Young, D. L., Klein, L. M., Kreif, J., Shumock, K., Hiser, S., Friedman, M., Lavezza, A., Jette, A., Chan, K. S., & Needham, D. M. (2018). Toward a common language for measuring patient mobility in the hospital: Reliability and construct validity of interprofessional mobility measures. Physical Therapy, 98(2), 133-142. https://doi.org/10.1093/ptj/pzx110
Jette, D. U., Stilphen, M., Ranganathan, V. K., Passek, S. D., Frost, F. S., & Jette, A. M. (2014). Validity of the AM-PAC "6-Clicks" inpatient daily activity and basic mobility short forms. Physical Therapy, 94(3), 379-391. https://doi.org/10.2522/ptj.20130199
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer.
Reading the NR 559 Week 6 instructions
This week asks you to review measurement instruments used in research on your topic. The prompt usually wants the instruments, what they measure, their reliability and validity, and their suitability for your question or setting. For each instrument, describe the items, response format and what a single point of change represents before judging it. Say who it was developed and tested on, since that decides how far its scores travel. Consider ceiling or floor effects in your population. Explain why studies using different instruments for the same outcome may reach different conclusions. Address when measurements are taken. Recommend which instruments fit your purpose, choosing before any change is made. Development and validation papers, referenced in APA 7, should back each description.
How the NR 559 Week 6 example is put together
The review opens by noting that a mobility trial found an effect on one instrument and not another. Four sections describe the Katz index with its ceiling effect, the Life-Space Assessment developed in community-dwelling older adults, the Johns Hopkins mobility ladder tested in hospital patients, and the AM-PAC short form, each with items, meaning of a point, origin and implication, citing validation studies. A section explains how studies of the same outcome can disagree. A section addresses timing. The review recommends the mobility ladder each shift for delivery and a one-month Life-Space telephone interview for outcome, chosen in advance. The recommendation explains why both measures are needed.
NR 559 Week 6 rubric: what full points look like
Instrument reviews are commonly weighed on accurate description, understanding of reliability and validity, attention to the populations instruments were built on, and practical recommendations. Describing items and the meaning of a point before judging shows disciplined review. Noting who an instrument was normed on shows awareness of how far scores generalize. Identifying ceiling effects explains puzzling results. Showing why studies of the same outcome disagree demonstrates measurement literacy. Considering timing adds rigor. Recommending instruments for a specific purpose, chosen in advance, shows applied judgment. Development and validation studies cited in APA 7 support the review. Precise, plain descriptions help readers. Consistent terminology for each scale matters too.
NR 559 Week 6 help: mistakes that cost points
Reviews often list instruments with a note that each is valid and reliable, without saying what they measure or in whom. Describe each concretely. Another weakness is overlooking ceiling effects in populations that start near the top of a scale. Check them. Some students recommend instruments without matching them to purpose, such as using a hospital scale to measure recovery at home. Match instrument to question. Avoid mixing instruments before and after a change. Choose before measuring, and state timing, since the same instrument at a different time can give a different picture. Record the instrument version and scoring rules you use, so results can be compared over time.
Get a NR 559 Week 6 example written to your instructions
Send the studies or the instrument your section named, together with the review template if one was issued, and a custom NR 559 Week 6 review lands in 24 to 48 hours, the first one at no cost. Tell us the outcome your unit actually watches and the visibility passage gets written toward that instead of a generic one.
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NR 559 Week 6 questions, answered
What if the study built its own instrument?
Then the review has more to do rather than less. Report what the authors say about how the items were written and whether anything was tested before use, and treat a one study instrument as evidence that travels a shorter distance. That is not the same as calling it wrong. It does make the results harder to place beside anything measured with an established scale.
Does a proxy measure count?
Often it has to, since plenty of things a unit cares about cannot be measured directly. The review's job is to say what the proxy stands in for and where the two come apart. Documentation counts are the standing example: they record that something was written down, which is not the same as recording that it was done.
Do I need reliability figures for this week?
Report what the papers give you and name what is missing rather than hunting for numbers they never published. Where a figure appears, the useful sentence is what it was calculated on and in whom, not the value by itself. A review listing coefficients with no word about which patients produced them has copied a table rather than read one.
Where can I find a free NR 559 Week 6 sample paper?
The four-instrument mobility measurement review is the NR 559 Week 6 sample above, shown whole. If your topic uses other instruments, name them for us and a review can be written.
Why might studies of the same outcome disagree in NR 559 Week 6?
Because they may use different instruments at different times; the Katz index can miss changes the Life-Space Assessment detects in largely independent patients.