Development and validation of a novel nursing activities for extracorporeal membrane oxygenation scale in the Netherlands: A nationwide multicentre study

OBJECTIVES: To develop and validate a scale to measure nursing activities in patients receiving extracorporeal membrane oxygenation (ECMO) and to examine its underlying factor structure. METHODS: A multicentre cross-sectional study was conducted among Dutch intensive care unit (ICU) nurses involved in ECMO care. A questionnaire was developed based on the existing and validated Nursing Activities in the Care of Extracorporeal Membrane Oxygenation-Supported Patients Scale, and supplemented with ECMO-specific activities identified through a scoping review and expert input. Exploratory factor analysis was performed to examine the factor structure. Sampling adequacy was assessed using the Kaiser-Meyer-Olkin measure and Bartlett's test of sphericity. Factor retention was based on Eigenvalues >1, scree plot inspection, parallel analysis, and theoretical interpretability. Internal consistency was assessed using Cronbach's α. RESULTS: Out of 866 invited ICU nurses, 486 responded (56.1%); 70.0% were female, with a median age of 38 years [IQR 33-51]. After item reduction and exploratory factor analysis, 31 items were retained. Based on scree plot inspection and parallel analysis, a five-factor structure was identified, explaining 47.8% of the total variance. The final 31-item scale comprised five factors: (1) ECMO-related complications and emergency management (8 items; α = 0.95), (2) ECMO system management and technical skills (11 items; α = 0.83), (3) hemodynamic and pharmacological management (5 items; α = 0.76), (4) transport and procedural support (2 items; α = 0.79), and (5) fundamental nursing care and respiratory management (5 items; α = 0.71). The overall scale demonstrated good internal consistency (Cronbach's α = 0.89). CONCLUSIONS: A Dutch ECMO Nursing Activities Scale was developed, demonstrating a clear five-factor structure and good internal consistency. IMPLICATIONS FOR CLINICAL PRACTICE: This instrument provides a structured, multidimensional framework to assess ECMO nursing activities, with the potential to support the development and international harmonisation of ECMO nursing activity assessment.