Design and Psychometric Evaluation of the Nurses’ Professionalism Questionnaire (NPQ): A Sequential Exploratory Mixed-Method Study

Abstract Background: With advancements in nursing tasks and technologies, the demand for professional nurses has increased, highlighting issues such as the low average of nurses' professional skills and the lack of a reliable tool to assess nurses' professional status. This study aimed to develop and psychometrically evaluate the Nurses’ Professionalism Questionnaire. Methods: This study employed a mixed-method approach in two stages: item generation and psychometric testing. Initially, a 79-item questionnaire was developed through an integrated review of the literature and expert opinions using a directed content analysis approach. Psychometric testing included content and construct validity, reliability, interpretability, and scoring. A total of 310 nurses participated in the exploratory factor analysis phase, and 203 nurses participated in the confirmatory factor analysis phase. Data were analyzed using SPSS 21.0 and LISREL 8.8, with a significance level set at 0.05. Results: In the primary validity assessment, 79 items were included in the initial tool. Following content and construct validity analyses, 32 items were removed, resulting in 47 items loaded onto four factors: professional competence, professional self-awareness, professional commitment and interaction, and accountability and advocacy. These factors explained 45% of the variance in professionalism. The confirmatory factor analysis model of the NPQ demonstrated a good fit. The Cronbach’s alpha and intraclass correlation coefficient (ICC) for the NPQ were 0.94 and 0.93, respectively, and the scale content validity index (S-CVI) was 0.96. Conclusion: The NPQ is valid and reliable for evaluating nurses’ professionalism. Nursing managers and policymakers can utilize it to plan and improve nurses' professional behavior.