The assessment of safe nursing care: development and psychometric evaluation

AIM: To develop an instrument for the assessment of safe nursing care (ASNC) within the Iranian context and psychometrically evaluate its reliability and validity. BACKGROUND: There is a need for a valid and reliable instrument to assess how nurses employ the components of safe nursing care in clinical practice in non-Western countries. METHOD: This methodological study was conducted in two phases: (1) a qualitative phase of instrument development, and (2) a quantitative phase of psychometric evaluation of the assessment of safe nursing care (ASNC). The instrument's content validity was assessed by experts in the field of safe nursing care. The reliability of this instrument was examined using internal consistency reliability and intra-rater reliability analysis. Exploratory factor analysis was then conducted to establish the instrument's initial construct validity. RESULTS: The instrument developed was a questionnaire with 32 items. The Cronbach's alpha of the scale was 0.92, and Intra-class Correlation Coefficient for intra-rater reliability was 0.78. Exploratory factor analysis resulted in a four-factor solution: (1) evaluation of nursing skills, (2) assessing the patient's psychological needs, (3) assessing the patient's physical need, and (4) Assessing nurses' teamwork. The four factors accounted for 63.54% of the observed variance. CONCLUSION: The ASNC can be applied to a wide variety of settings because of the broad range of methods utilised to generate items and domains, its comprehensive consideration of the principles of safe care, and its initial reliability and validity. IMPLICATIONS FOR NURSING MANAGEMENT: The ASNC can help nurse managers assess whether clinical nurses are prepared to apply their safe care skills in clinical practice. It can also be used by clinical nurses to assess their own and peers' practice to detect potential areas for improvement in nursing care and help nurse managers with planning appropriate quality improvement programmes.