- Email: [email protected]
An exploratory factor analysis for developing and validating a scale of Nursing Students Competence Instrument
An exploratory factor analysis for developing and validating a scale of Nursing Students Competence Instrument Chun-Chih Lin, Chiung-Jung Jo Wu, Ya-Chu Hsiao, Chin-Yen Han, Chang-Chiao Hung PII: DOI: Reference:
S0260-6917(16)30303-3 doi:10.1016/j.nedt.2016.12.007 YNEDT 3453
To appear in:
Nurse Education Today
Received date: Revised date: Accepted date:
22 February 2016 21 November 2016 13 December 2016
Please cite this article as: Lin, Chun-Chih, Wu, Chiung-Jung Jo, Hsiao, Ya-Chu, Han, Chin-Yen, Hung, Chang-Chiao, An exploratory factor analysis for developing and validating a scale of Nursing Students Competence Instrument, Nurse Education Today (2016), doi:10.1016/j.nedt.2016.12.007
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Title page and authors’ information Running head：Measurement on nursing competency of students Title：An exploratory factor analysis for developing and validating a scale of Nursing
IP
SC R
Article word count: 3854 words (including references)
T
Students Competence Instrument
Dr. Chun-Chih Lin
NU
RN, PhD, Assistant Professor, Department of Nursing, Chang Gung University of Science
MA
and Technology; Department of Nursing ,Chang Gung Memorial Hospital at ChiaYi, Taiwan, ROC
D
2, Chia-Pu Rd, West Sec. Pu-tz, ChiaYi, Taiwan 613
TE
Email: [email protected] OR [email protected]
CE P
Dr Chiung-Jung (Jo) Wu5,6,7,8, RN DrHlthSc FACN
5Senior Research Fellow, School of Nursing, Midwifery and Paramedicine,
AC
Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Rd, Banyo, Qld 4014, Australia
6Visiting Fellow, School of Nursing, Queensland University of Technology (QUT) 7Honorary Research Fellow, Royal Brisbane and Women’s Hospital (RBBWH) 8Honorary Research Fellow, Mater Medical Research Institute-University of Queensland (MMRI-UQ) Email: [email protected]; ; [email protected] Phone: + 61 7 3623 7889
Dr. Ya-Chu Hsiao
ACCEPTED MANUSCRIPT EdD, RN, Associate Professor, Department of Nursing, Chang Gung University of Science and Technology; Department of Nursing ,Chang Gung Memorial Hospital at Linkou, Taiwan,
SC R
Dr. Chin-Yen Han
IP
Email: [email protected]
T
ROC261 Wen-Hwa, 1 st Road, Kwei-Shan, Taoyuan 333
RN, PhD, Assistant Professor, Department of Nursing, Chang Gung University of Science
NU
and Technology; Department of Nursing ,Chang Gung Memorial Hospital at Linkou, Taiwan, ROC
MA
261 Wen-Hwa, 1 st Road, Kwei-Shan, Taoyuan 333
D
Email: [email protected]
TE
Dr. Chang-Chiao Hung
CE P
Assistant professor, ChiaYi Campus, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, ROC
AC
2, Chia-Pu Rd, West Sec. Pu-tz, ChiaYi, Taiwan 613 Email: [email protected]
Corresponding author contact details： Chun-Chih Lin ChiaYi Campus, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, ROC Contact details: Address: 2, Chia-Pu Rd, West Sec. Pu-tz, ChiaYi, Taiwan 613 E-mail: [email protected] OR [email protected] Phone number: Work: +886 5 3628800 ext. 2366 Mobile: +886 0978806570
AC
CE P
TE
D
MA
NU
SC R
IP
T
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT An exploratory factor analysis for developing and validating a scale of Nursing Students Competence Instrument
T
1. Background
IP
Nurse education has generally recognized the importance of nursing competency in the provision of professional nursing development. The Taiwan Nursing Accreditation Council
SC R
(TNAC) (TNAC, 2010) set a primary goal for all nursing programs to cultivate and facilitate in nursing graduates safe, competent, and skillful care of patients. These nursing competencies, therefore, are a standard component of the nursing curriculum to guide
NU
education and evaluation of nursing students’ learning outcomes. These nursing competencies define and relate to an individual’s capacity and proficiency in the nursing profession
MA
(Watson, Stimpson, Topping, & Porock, 2001; Australian Nursing and Midwifery Council, 2006). Thus, nursing graduates must meet the responsibilities associated with competence in professional development (Klein, 2006). The assessment of nursing competency becomes a
D
fundamental aspect of nursing students commensurate with achieving learning outcomes to
TE
meet the aims of nursing schools. ―A nurse who can be trusted by patients and their families‖ is generally accepted as a key goal in most nursing schools.
CE P
The TNAC standards have specified eight core values (nursing competencies) within professional nursing for new graduates since 2007. These values aim to guide the continuing improvement of nursing schools. These core values are essential as a standard of nursing
AC
programs for new graduates and are encapsulated as (1) critical thinking and reasoning, (2) general clinical skills, (3) basic biomedical science, (4) communication and team work capability, (5) caring, (6) ethics, (7) accountability, and (8) life-long learning (Chen, 2010; TNAC, 2010). Individual nursing school is based on these core values; however, they are linked with the specific characteristics of each school and their students, and each develops or reforms its own core values in the nursing curriculum. The degree of nursing competency is not only the ability to provide nursing care, but also, involves individual motivation and ability toward professional nursing. Measuring these nursing competencies is challenging because it involves complex dimensions through the process of learning within both classes and daily activities as well as the intrinsic quality of every competence as a whole (Smith, 2012). Furthermore, each nursing competence is imbued with the process of learning within both classes and daily activities, and it is important to monitor how learning goals are achieved (Lee-Hsieh, Kao, Kuo, & Tseng, 2003).
ACCEPTED MANUSCRIPT Although there is evidence to evaluate clinical assessment in undergraduate nursing students (Wu, Enskär, Lee, & Wang, 2015), a systematic review in identifying nursing competency assessment tools has recommended the needs for individual country to develop a validated assessment tool based on the national guidelines (Ličen & Plazar, 2015). There is no
T
specific instrument in Taiwan to assess the relevant nursing competencies. Therefore, this
IP
present study is necessary to address the gaps of the literature to develop an instrument to
SC R
measure the level of nursing competencies among baccalaureate-level nursing students in Taiwan according to the TNAC standards. 2. Aim of study
Students Competence Instrument (NSCI).
MA
3. Methods
NU
The aims of this study were to develop and validate a new scale, namely the Nursing
3.1. Design
D
A descriptive research design with a survey was used (Floyd, 2013) to develop and
TE
evaluate the NSCI. This study consisted of three phases: Phase 1- NSCI items development;
CE P
Phase 2-expert panel review, and Phase 3-evaluation. 3.1.1. Phase 1: NSCI items development The process of development NSCI items were derived from previous qualitative study in
AC
exploring the same level of Taiwanese nursing students’ perceptions in complaining and achieving TANC requirements (Lin, Han, Pan, & Lin, 2016). The instrument contains 30 items with a 10-point Likert response scale (Hinkin, 1998). The highest scores (10) demonstrated the highest level of agreement for the item measured, and a lowest score (1) revealed a lowest level of agreement on the item rated. These items were easy to understand, and the responses were simple to grasp in self-evaluation of nursing competencies as learning outcomes. The 30-item instrument consisted of three items for critical thinking and reasoning component; seven items for care ability involving general clinical skills and basic biomedical science. The communication and teamwork capability comprised four items and caring with five items. In addition, the accountability, stress and coping, and life-long learning sections had four, four, and three items, respectively. The definition of core nursing values from the
ACCEPTED MANUSCRIPT TNAC was discussed and constructed to reflect the outcomes of the nursing curriculum and contributed to the total number of items to be measured for each core value of nursing. 3.1.2. Phase 2: Expert Panel to review NSCI items
T
Five experts from nursing education critiqued and verified it for its relevance, simplicity,
IP
clarity, and ambiguity. Items from the NSCI for experts were in a Likert 4-point scale ranging
SC R
from 1–4, with 4 as the highest, ―very appropriate,‖ 3 for ―appropriate,‖ 2 for ―inappropriate,‖ and 1 for ―very inappropriate.‖ Furthermore, the validity of the NSCI was tested by nursing experts’ comments. According to the experts, all original 30 items were relevant to the research design and the structure of the questionnaire. Item-specific content validity indices
NU
(CVI) were calculated, and six items were revised as suggested. All revised items were worded into meaningful sentences. The mean score of the original 30-item instrument ranged
MA
from 3.6 to 4, and CVI ranged from .93 to .97. In the later progression of instrument development, three items were deleted by considering statistical significance. The CVI with
D
27 items had similar results to 30 items, with scores ranging from .92 to .97.
TE
3.1.3. Phase 3: Evaluation
After NSCI items reviewed by the expert panel, further analysis of the NSCI was
CE P
conducted. The construct validity was identified as the statistics of EFA and correlations. Cronbach’s alpha coefficient, split-half coefficient, and item analysis contributed to the reliability of the instrument. After measuring the reliability and validity of the NSCI, 27 items
AC
were deemed to evaluate the nursing students’ competencies as measurable learning outcomes. A new formation of NSCI with four dimensions was identified and reformed as integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension. 3.2. Sample size considerations The sample size calculation were based on a stable factor structure model, which requires a minimum of 100 and 200 subjects, and a subject variable ratio of at least 2:1 to reduce the standard error (SE) of the correlations to negligible proportions (Kline,1993). Accordingly, the number of subjects in this study was 209 for the 27 variables to meet the exploratory factor analysis requirement with alpha = 0.05. 3.3. Recruitment Nursing students enrolled in participating university were approached for potential participation if they meet the following inclusion criteria: nursing students who held nursing
ACCEPTED MANUSCRIPT diploma and currently enrolled at the baccalaureate-level. Students without holing a diploma in nursing prior to studying in baccalaureate-level were excluded. 3.4. Data collection
T
Nursing students enrolled in the participating university were approached and provided
IP
with a participant information sheet and consent form and the students were required to
SC R
provide written informed consent prior to their participation. All students were assured that neither their results nor their participation in this survey would affect their final marks in any subject In considering external validity and the need to recruit subjects with homogenous characteristics, data were collected from two final semesters of study year: February 2011 and
NU
February 2012.
MA
3.5. Data analysis
Data analysis was performed by using the SPSS 17.0 for Windows statistical software package. Descriptive analysis was used to summarize sample characteristics. An exploratory
D
factor analysis (Hair, Anderson, Tatham, & Black, 1998) was used to determine the construct validity of NSCI.
TE
A content and construct validity was also performed to determine instrument validity. Cronbach’s alpha coefficient, split-half coefficients, and item analysis verified the reliability of the instrument.
CE P
3.6. Ethical considerations
This study received full ethical approval from the university Institutional Review Board
AC
(100-IRB-002). All participating students were volunteers in this study, and no penalty would apply if they withdrew from the study. All data were collected anonymously, and all confidentiality and privacy were maintained. Digital data were stored securely with password protection at the university. 4. Results 4.1. Sample characteristics About 400 students were invited to participate to this study, 209 students have completed with 52% response rate. Majority of students were female (96%) . Students participating in the study were aged 20 to 21 years. 4.2. Validity of the NSCI
ACCEPTED MANUSCRIPT Content and construct validity examined the validity of the NSCI. Findings from a previous qualitative study that explored the perceptions of core nursing values from students’ perspectives confirmed the content validity for the present study of the NSCI.
T
Results from both Kaiser–Meyer–Olkin and Bartlett’s tests demonstrated that samples met
IP
the factor analysis criteria. The Kaiser–Meyer–Olkin measure of sampling adequacy was.92. In addition, Bartlett’s test was statistically significant with χ² (351) = 4576.85 and p < .0001.
SC R
Exploratory factor analysis (EFA) established the construct validity of the NSCI, ensuring that the scale could evaluate interactions genuinely and efficiently. The principal components methods with varimax rotation were conducted to extract common factors. Items with factor
NU
loading greater than .4 were selected to ensure a stable factor structure with adequate sample size and the ratio of participants and variables (Ferguson & Cox, 1993). Three items were
MA
eliminated: ―I can utilize professional nursing knowledge to care‖ stood for the dimension of accountability; ―I understand the influential factors affected the team work, and I can look for possible resources to improve it‖ characterized the communication and teamwork capability;
D
and ―I can accept different thinking points from others‖ corresponded to the aspect of stress
TE
and coping. Twenty-seven residual items were grouped into four factors based on the results of the scree plot.
CE P
Items were arranged into factors based on the size of loading with respect to statistical analysis, a priori conceptual beliefs, and discussion on the issue of the relative items’ interpretability fixed into groups from the research team. The first factor consisted of ten
AC
items and was named integrating care abilities. Items were mostly categorized from the group of care ability origin, and three items from the groups of critical thinking, communication and teamwork, and accountability. The second factor comprised six items that were mostly associated with the factor entitled ―leading humanity concerns.‖ Most items were initially from the group of caring and one item from accountability. The third factor was classified with seven items and labeled as ―advancing career talents.‖ The factor of advancing career talents was integrated with three items from the group of lifelong learning, two items from communication and teamwork, one item from critical thinking, and one item from the former group of stress and coping. The fourth feature was identified with four items, all from the previous stress and coping group; it was named ―dealing with tension.‖ These four factor groups explained 68.08% of the variance. The factors of integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension accounted for 22.29%, 18.59%, 15.99%, and 11.23% of the variable variance, respectively. Twenty-seven items with
ACCEPTED MANUSCRIPT up to four items in a subscale, and item scaling in constructing a scale to approach content validity were achieved in study. 4.3 Reliability of the NSCI
T
Cronbach’s alpha coefficients and split-half coefficients were conducted to express the
IP
internal reliability of the instrument. The Cronbach’s alpha coefficient for the total score
SC R
was .96. The first half of the split-half coefficient with odd-number items had a total of 14 items, and the other half included 13 items with even numbers. These two halves involved unequal lengths of items with the Spearman-Brown coefficients r = .98. The correlation between forms was .95. Both coefficient alpha and split-half coefficients indicated a
NU
satisfactory reliability (Bryman & Cramer, 1997).
MA
Item analysis was conducted to assess the NSCI with 27 items correlated to the total score of the NSCI. The statistical outcome of item analysis identified that the item, ―I satisfy my coping behaviors when facing the stressor,‖ had the lowest corrected item and total
D
correlations with r = .55; item, ―I can reflect the clinical situation of the client, and provide
TE
individual and efficient nursing care to improve client’s health status,‖ had the highest score with r = .77. However, all items were relevant to construct the content of the NSCI; no item
CE P
was reduced based on the results of the item analysis at this stage. Each item was correlated with its own scale and with other scales to assess the convergent and discriminant validity. The results of these analyses are shown in Table 1 and support the measure’s validity. Items were more highly correlated with their own scale than with other scales. The alphas for
AC
integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension scale were .94, .91, .88, and .87, respectively. Coefficient alphas reached the internal consistency estimates of reliability for these four subscales. Insert Table 1 here 5. Discussion Results from this study indicate that the NSCI has high-quality reliability and validity to assess the core values for baccalaureate nursing students. The NSCI assesses four dimensions related to the four nursing competencies for nursing students. Content validity is an important factor in identifying the concept of measurement, and it supports the construct validity of the instrument. In this study, results from a previous qualitative study and factors of core nursing values from the TNAC contributed to the construction of the NSCI in determining the domains and concepts of constructs. Although Yahmale (2003) emphasized that a more
ACCEPTED MANUSCRIPT comprehensive view of content validity than CVI was needed, the content validity in this study was determined by five nursing experts who gave their professional judgment about the instrument construction (Polit, Beck, & Owen 2007). Furthermore, regarding the purpose of identifying the factor structure of a set of variables, EFA offers an opportunity to develop and
T
evaluate scales with a relatively untested population (Hair, Anderson, Taham, & Black, 1998,
IP
pp. 99–109). Thus, the EFA method was used to establish the construct validity of the NSCI.
SC R
Hurley (1997) has advocated that different methods of factor analysis have their strengths and weaknesses, but the choice of which one to use depended on the requirements and context of the study, with some commentators suggesting that EFA may be used in most studies. Internal consistency with Cronbach’s α, split-half reliability, and item analysis is important when
NU
measuring scales of instrument.
MA
By measuring nursing competencies of students, the aim is to prepare future nursing staff for placement in a challenging care environment and possibly reframe the nursing curriculum. This is a way of closing a gap in nursing education between classroom and clinics,
D
because eight core nursing values from the TNAC are the basis of nursing performance. Both
TE
the TNAC and a study from Hsu and Hsieh (2009) asserted that further development of nursing competence for nursing graduates is required, with emphasis on a basis of self-
CE P
government. There is an argument, however, that some nursing competencies for nursing graduates are similar to nursing competencies for staff in clinical areas (Burn & Poster, 2008). Moreover, a competency approach is mainly involved in nursing education as a way of measuring a learning outcome; the cognition and attitude of learning will be difficult to
AC
evaluate when performing care activities with patients (Lofmak, 2006; Renee, 2008). Findings from the present study advocate the importance of nursing abilities in a multidisciplinary health care environment. These nursing competencies lead the expected graduates to effective nursing performance with proficiency in care by integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension. Items originally from integrating care abilities, leading humanity concerns, and advancing career talents of nursing competence for nursing graduates meet the foundation of TNAC’s designation of core values in nursing—professional knowledge and skills, professional humanity, and self-development (Chin, 2010). The four factors of nursing competence from the current study are related as a chain of links connected to each other. It is a responsibility of nursing educators to prepare students well before they are involved in the wider nursing world by cultivating these nursing
ACCEPTED MANUSCRIPT competencies (Klein, 2006). The identification of integrating care abilities demonstrates providing care collaboratively in the work environment. The classification of integrating care abilities emphasizes nursing knowledge and behaviors as part of competent performance toward patients. The naming of leading humanity concerns in nursing demonstrates the
T
nursing care being provided with caring that emphasizes the relationships and interactions
IP
between different parties. Providing nursing care not only involves nursing knowledge and
SC R
technical skills as attributes within integrating care abilities, but also with concern for humanity. This makes nursing care more meaningful. In addition, the discovery of advancing career talents highlights one’s inspiration toward a nursing career as work and dedicates it as an ambitious, life-long occupation. Having high ideals in nursing as final credentials of a
NU
career requires adequate support to continue on the ladder of nursing. Entering a nursing career necessitates dealing with tensions from self-dialogue and interactions with others or
MA
environments when things change rapidly (Marshburn, Engelke, and Swanson, 2009). Kloster, Hoie, and Skar’s (2007) study emphasized that professional challenge underpinned the
D
reasons for nursing students’ career preferences to work in different areas of nursing.
TE
5.1. Limitations
Several limitations are identified for developing an instrument to measure nursing
CE P
graduates’ competencies. First, this study was undertaken in a single institution, and as it is an exploratory study. Second, a previous qualitative study in investigating the same level of
AC
Taiwanese nursing students’ perceptions in core values of nursing according to TNAC (Lin et al., 2016) suggested that the performance of the ethics value should be included in the value of care ability and accountability, it may be advisable to include the value of ethics in the instrument when assessing nursing competence of nursing graduates in a further study. Third, the steps of confirmatory factor analysis and replication are required for the full scale development. 5.2. Implications of the study The results of this study have a significant impact on nursing programs at the baccalaureate level. Its greatest contribution is to provide an opportunity to modify and connect nursing curricula between associate and baccalaureate levels. An evaluation of achieved nursing competencies bridges the completion of students’ learning outcomes and the aims of the nursing curriculum. Furthermore, an efficient teaching–learning strategy achieves
ACCEPTED MANUSCRIPT the aims of learning based on an agreement between teachers and students. Thus, it is recommended that the schools devise a model to identify strategies that assist students in achieving success both in the nursing program and in the national licensure examination (in Taiwan). In this era of serious nursing shortages, identifying strategies to graduate larger
T
numbers of future nurses successfully and guiding them to pass the national nursing board
IP
examination has become imperative to the maintenance of program quality.
SC R
6. Conclusion
This study demonstrates the acceptable level of reliability and validity of the NSCI development for measuring nursing competencies. The NSCI consists of 27 items in four
NU
nursing competencies for graduates according to the TNAC’s eight core values in nursing education. In addition, the dimension of dealing with tensions during nursing school studies
MA
adds to coping with the varied care environment nowadays. The nursing competencies comprise an evaluation of self-care ability as integrating care abilities, with leading humanity concerns making nursing care meaningful, which will motivate future nurses to recognize that
Conflict of Interests
TE
D
nursing is an ambitious occupation through advancing-career talents.
CE P
The author(s) declared no potential conflict of interest with respect to the research authorship and publication of this article.
AC
Authors’ contributions: Attached later
ACCEPTED MANUSCRIPT References 1.
Bryman A. & Cramer D. (1997). Quantitative Data Analysis with SPSS for Windows, Routledge, London. Burn, P. & Poster, EC. (2008). Competence development in new registered nurse
T
2.
IP
graduates: closing the gap between education and practice. The Journal of Continuing
3.
SC R
Education in Nursing 39 (2), 67 – 73
Chen, Y. C. (2010). Essential professional core competencies for nurses. Journal of Nursing 57 (5), 12-17.
Chin, C.C. (2010). A discussion of concepts for promoting nursing core competencies. Journal of Nursing, 57 (5), 24-26.
5.
NU
4.
Ferguson, R.D. & Cox, T. (1993). Exploratory factor analysis: a user’s guide.
MA
International Journal of selection and assessment 1, 84-93. 6.
Floyd, J. F. (2013). Survey research methods (5th ed.), SAGE. Los Angeles
7.
Hair, J. F., Anderson, R. E., Tatham, R. L., & Black, W. C. (1998). Multivariate Data
Hinkin, T. R. (1998). A brief tutorial on the development of measures for use in survey
TE
8.
D
Analysis (5th). Prentice Hall, New Jersey.
questionnaires. Organizational Research Methods, 1, 104-121. Hsu, L.L. & Hsieh, S. I. (2009). Testing of a measurement model for baccalaureate
CE P
9.
nursing students’ self-evaluation of core competencies. Journal of Advanced Nursing 65 (11), 2454-2463.
AC
10. Hurley A.E., Scandura T., Schriesheim C.A., Brannick M., Seers A., Vandenburg R., & William L.J. (1997). Exploratory and confirmatory factor analysis: guidelines, issues and alternatives. Journal of Organisational Behavior 18, 667-683. 11. Klein, C. J. (2006). Linking competency based assessment to successful clinical practice. Journal of Nursing Education, 45 (9), 379-383. 12. Kloster, T., Hoie, M., & Skar, R. (2007). Nursing students’ career preferences: a Norwegian study. Journal of Advanced Nursing, 59 (2), 155- 162. 13. Lee-Hsieh, J., Kao, C. H., Kuo, C.L. & Tseng, H.F. (2003). Clinical nursing competence of RN to BSN students in a nursing concept-Base curriculum in Taiwan. Journal of Nursing Education, 42 (12), 536- 545. 14. Lin, C. C.; Han, C. Y.; Pan, I. J. & Lin, P. L. (2016). Exploring the Perceptions of Core Values of Nursing in Taiwanese Nursing Students at the Baccalaureate Level. The Journal of Nursing Research, 24(2), 126-136. 15. Ličen, S., & Plazar, N. (2015). Identification of nursing competency assessment tools as
ACCEPTED MANUSCRIPT possibility of their use in nursing education in Slovenia —A systematic literature review. Nurse Education Today 35 (2015) 602–608. 16. Lofmark, A., Smide, B., & Wikblad, K. (2006). Competence of newly-graduated nurse – a comparison of the perceptions of qualified nurse and students. Journal of Advanced
T
Nursing 53 (6), 721-728.
IP
17. Marshburn, D.M., Engelke, M.K., & Swanson, M.S. (2009) Relationships of new nurses’
SC R
perceptions and measured performance based clinical competence. The Journal of Continuing Education in Nursing, 40 (9), 426-432.
18. Nursing and Midwifery. Board of Australia. National competency standards for registered nurse. www.nursing midwiferyboard.gov.au accessed date: 18/11/2015
NU
19. Polit, D.F., Beck, C.T., & Owen, S.V. (2007) Is the CVI an acceptable indictor of content validity? Appraisal and recommendations. Research in Nursing & Health 30,
MA
459 – 467.
20. Renee, W., Walker, J.T., Martin, T., Nortington, L.D., Waltman, P., Beacham, T., & Grant, L.V. (2008). Comparing clinical competencies between nursing students with
D
degree and traditional students. Issues in Educational Research, 18 (1), 90-100.
TE
21. Smith, S.A. (2012). Nurse competence: a concept analysis. International journal of nursing knowledge, 23 (3), 172-182. DOI: 10.1111/j.2047-3095.2012.01225.x
CE P
22. Taiwan Nursing Accreditation Council (TNAC). (2010). Evaluation criteria. Retrieved from http://www.heeact.edu.tw/lp.asp?ctNode=352&CtUnit118&BaseDSD=7&mp=5 23. Watson, R., Stimpson, A., Topping, A., & Porock, D. (2001). Clinical competence
AC
assessment in nursing: a systematic review of the literature. Journal of Advanced Nursing 39 (5), 421-431. 24. Yaghmale, F. (2003) Content validity and its estimation. Journal of Medical Education. 3 (1), 25 – 27.
25. Wu, X. V., Enskär, K., Lee, C.S., & Wang, W. (2015). A systematic review of clinical assessment for undergraduate nursing students. Nurse Education Today 35, 347–359.
ACCEPTED MANUSCRIPT Table 1: Correlations of each dimension item with their own scale and with other scales Item
Factors 1
3
4
T
.76
.80
IP
.76
AC
CE P
TE
D
MA
NU
SC R
Integrating care abilities I can integrate the knowledge of basic biomedical science and general clinical skills to care for patients I can completely evaluate and analyze my client’s health problems and its latent factors I can utilize assessment skills in caring for a real-life patient I can analyze a suspicious situation and consider all its possibilities I can use holistic nursing care in caring for patients I can apply concept mapping in investigating a clinical situation I can recognize the role and function of nurses when caring for patients I can have a discussion with others to analyze the patient’s health situation I can reflect on clinical situations and provide individual care for improving a patient’s health status I can distinguish and endorse the role of nursing and non-nursing professionals Leading humanity concerns I can display a general caring behaviors to peers I can present my professional caring behaviors to patients I can reflect my general caring behaviors towards peers I can consider my professional caring behaviors towards patients I can value professional caring behaviors I can demonstrate responsibility towards a professional role and ensure nursing ethics Advancing career talents I can search and use information independently I treasure any learning activities I have confidence in advancing a new idea to another’s hypothesis I can develop effective ways of communication within group interaction I can utilize communication skills in a relationship of collaboration and complete care mission I can apply group dynamics to solve learning problems I can do my job professionally and efficiently Dealing with tension I have satisfactory ways of dealing with pressure I can manage my emotions when I am under stress I can analyze stressors and look for solutions
2
.74 .79 .73 .68 .78 .77 .65
.77 .82 .80 .83 .69 .64
.68 .68 .54 .73 .71 .72 .65 .70 .70 .73
ACCEPTED MANUSCRIPT .65 22.29% 18.59% 15.99% 11.23% 68.09%
AC
CE P
TE
D
MA
NU
SC R
IP
T
I can differentiate any stressors within the learning process sub-total percentage of variance explained Total percentage of the factors explained
ACCEPTED MANUSCRIPT Highlights
An instrument for learning outcome of nursing competency based on the perception of nursing students. Results support the reliability and validity of the NSCI.
Four dimensions of the instrument as Integrating care abilities, Leading humanity
CE P
TE
D
MA
NU
SC R
An indicator bridges students’ learning outcomes and the aims of the nursing curriculum.
AC
IP
concerns, Advancing career talents, and Dealing with tension.
T
S0260-6917(16)30303-3 doi:10.1016/j.nedt.2016.12.007 YNEDT 3453
To appear in:
Nurse Education Today
Received date: Revised date: Accepted date:
22 February 2016 21 November 2016 13 December 2016
Please cite this article as: Lin, Chun-Chih, Wu, Chiung-Jung Jo, Hsiao, Ya-Chu, Han, Chin-Yen, Hung, Chang-Chiao, An exploratory factor analysis for developing and validating a scale of Nursing Students Competence Instrument, Nurse Education Today (2016), doi:10.1016/j.nedt.2016.12.007
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Title page and authors’ information Running head：Measurement on nursing competency of students Title：An exploratory factor analysis for developing and validating a scale of Nursing
IP
SC R
Article word count: 3854 words (including references)
T
Students Competence Instrument
Dr. Chun-Chih Lin
NU
RN, PhD, Assistant Professor, Department of Nursing, Chang Gung University of Science
MA
and Technology; Department of Nursing ,Chang Gung Memorial Hospital at ChiaYi, Taiwan, ROC
D
2, Chia-Pu Rd, West Sec. Pu-tz, ChiaYi, Taiwan 613
TE
Email: [email protected] OR [email protected]
CE P
Dr Chiung-Jung (Jo) Wu5,6,7,8, RN DrHlthSc FACN
5Senior Research Fellow, School of Nursing, Midwifery and Paramedicine,
AC
Faculty of Health Sciences, Australian Catholic University, 1100 Nudgee Rd, Banyo, Qld 4014, Australia
6Visiting Fellow, School of Nursing, Queensland University of Technology (QUT) 7Honorary Research Fellow, Royal Brisbane and Women’s Hospital (RBBWH) 8Honorary Research Fellow, Mater Medical Research Institute-University of Queensland (MMRI-UQ) Email: [email protected]; ; [email protected] Phone: + 61 7 3623 7889
Dr. Ya-Chu Hsiao
ACCEPTED MANUSCRIPT EdD, RN, Associate Professor, Department of Nursing, Chang Gung University of Science and Technology; Department of Nursing ,Chang Gung Memorial Hospital at Linkou, Taiwan,
SC R
Dr. Chin-Yen Han
IP
Email: [email protected]
T
ROC261 Wen-Hwa, 1 st Road, Kwei-Shan, Taoyuan 333
RN, PhD, Assistant Professor, Department of Nursing, Chang Gung University of Science
NU
and Technology; Department of Nursing ,Chang Gung Memorial Hospital at Linkou, Taiwan, ROC
MA
261 Wen-Hwa, 1 st Road, Kwei-Shan, Taoyuan 333
D
Email: [email protected]
TE
Dr. Chang-Chiao Hung
CE P
Assistant professor, ChiaYi Campus, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, ROC
AC
2, Chia-Pu Rd, West Sec. Pu-tz, ChiaYi, Taiwan 613 Email: [email protected]
Corresponding author contact details： Chun-Chih Lin ChiaYi Campus, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, ROC Contact details: Address: 2, Chia-Pu Rd, West Sec. Pu-tz, ChiaYi, Taiwan 613 E-mail: [email protected] OR [email protected] Phone number: Work: +886 5 3628800 ext. 2366 Mobile: +886 0978806570
AC
CE P
TE
D
MA
NU
SC R
IP
T
ACCEPTED MANUSCRIPT
ACCEPTED MANUSCRIPT An exploratory factor analysis for developing and validating a scale of Nursing Students Competence Instrument
T
1. Background
IP
Nurse education has generally recognized the importance of nursing competency in the provision of professional nursing development. The Taiwan Nursing Accreditation Council
SC R
(TNAC) (TNAC, 2010) set a primary goal for all nursing programs to cultivate and facilitate in nursing graduates safe, competent, and skillful care of patients. These nursing competencies, therefore, are a standard component of the nursing curriculum to guide
NU
education and evaluation of nursing students’ learning outcomes. These nursing competencies define and relate to an individual’s capacity and proficiency in the nursing profession
MA
(Watson, Stimpson, Topping, & Porock, 2001; Australian Nursing and Midwifery Council, 2006). Thus, nursing graduates must meet the responsibilities associated with competence in professional development (Klein, 2006). The assessment of nursing competency becomes a
D
fundamental aspect of nursing students commensurate with achieving learning outcomes to
TE
meet the aims of nursing schools. ―A nurse who can be trusted by patients and their families‖ is generally accepted as a key goal in most nursing schools.
CE P
The TNAC standards have specified eight core values (nursing competencies) within professional nursing for new graduates since 2007. These values aim to guide the continuing improvement of nursing schools. These core values are essential as a standard of nursing
AC
programs for new graduates and are encapsulated as (1) critical thinking and reasoning, (2) general clinical skills, (3) basic biomedical science, (4) communication and team work capability, (5) caring, (6) ethics, (7) accountability, and (8) life-long learning (Chen, 2010; TNAC, 2010). Individual nursing school is based on these core values; however, they are linked with the specific characteristics of each school and their students, and each develops or reforms its own core values in the nursing curriculum. The degree of nursing competency is not only the ability to provide nursing care, but also, involves individual motivation and ability toward professional nursing. Measuring these nursing competencies is challenging because it involves complex dimensions through the process of learning within both classes and daily activities as well as the intrinsic quality of every competence as a whole (Smith, 2012). Furthermore, each nursing competence is imbued with the process of learning within both classes and daily activities, and it is important to monitor how learning goals are achieved (Lee-Hsieh, Kao, Kuo, & Tseng, 2003).
ACCEPTED MANUSCRIPT Although there is evidence to evaluate clinical assessment in undergraduate nursing students (Wu, Enskär, Lee, & Wang, 2015), a systematic review in identifying nursing competency assessment tools has recommended the needs for individual country to develop a validated assessment tool based on the national guidelines (Ličen & Plazar, 2015). There is no
T
specific instrument in Taiwan to assess the relevant nursing competencies. Therefore, this
IP
present study is necessary to address the gaps of the literature to develop an instrument to
SC R
measure the level of nursing competencies among baccalaureate-level nursing students in Taiwan according to the TNAC standards. 2. Aim of study
Students Competence Instrument (NSCI).
MA
3. Methods
NU
The aims of this study were to develop and validate a new scale, namely the Nursing
3.1. Design
D
A descriptive research design with a survey was used (Floyd, 2013) to develop and
TE
evaluate the NSCI. This study consisted of three phases: Phase 1- NSCI items development;
CE P
Phase 2-expert panel review, and Phase 3-evaluation. 3.1.1. Phase 1: NSCI items development The process of development NSCI items were derived from previous qualitative study in
AC
exploring the same level of Taiwanese nursing students’ perceptions in complaining and achieving TANC requirements (Lin, Han, Pan, & Lin, 2016). The instrument contains 30 items with a 10-point Likert response scale (Hinkin, 1998). The highest scores (10) demonstrated the highest level of agreement for the item measured, and a lowest score (1) revealed a lowest level of agreement on the item rated. These items were easy to understand, and the responses were simple to grasp in self-evaluation of nursing competencies as learning outcomes. The 30-item instrument consisted of three items for critical thinking and reasoning component; seven items for care ability involving general clinical skills and basic biomedical science. The communication and teamwork capability comprised four items and caring with five items. In addition, the accountability, stress and coping, and life-long learning sections had four, four, and three items, respectively. The definition of core nursing values from the
ACCEPTED MANUSCRIPT TNAC was discussed and constructed to reflect the outcomes of the nursing curriculum and contributed to the total number of items to be measured for each core value of nursing. 3.1.2. Phase 2: Expert Panel to review NSCI items
T
Five experts from nursing education critiqued and verified it for its relevance, simplicity,
IP
clarity, and ambiguity. Items from the NSCI for experts were in a Likert 4-point scale ranging
SC R
from 1–4, with 4 as the highest, ―very appropriate,‖ 3 for ―appropriate,‖ 2 for ―inappropriate,‖ and 1 for ―very inappropriate.‖ Furthermore, the validity of the NSCI was tested by nursing experts’ comments. According to the experts, all original 30 items were relevant to the research design and the structure of the questionnaire. Item-specific content validity indices
NU
(CVI) were calculated, and six items were revised as suggested. All revised items were worded into meaningful sentences. The mean score of the original 30-item instrument ranged
MA
from 3.6 to 4, and CVI ranged from .93 to .97. In the later progression of instrument development, three items were deleted by considering statistical significance. The CVI with
D
27 items had similar results to 30 items, with scores ranging from .92 to .97.
TE
3.1.3. Phase 3: Evaluation
After NSCI items reviewed by the expert panel, further analysis of the NSCI was
CE P
conducted. The construct validity was identified as the statistics of EFA and correlations. Cronbach’s alpha coefficient, split-half coefficient, and item analysis contributed to the reliability of the instrument. After measuring the reliability and validity of the NSCI, 27 items
AC
were deemed to evaluate the nursing students’ competencies as measurable learning outcomes. A new formation of NSCI with four dimensions was identified and reformed as integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension. 3.2. Sample size considerations The sample size calculation were based on a stable factor structure model, which requires a minimum of 100 and 200 subjects, and a subject variable ratio of at least 2:1 to reduce the standard error (SE) of the correlations to negligible proportions (Kline,1993). Accordingly, the number of subjects in this study was 209 for the 27 variables to meet the exploratory factor analysis requirement with alpha = 0.05. 3.3. Recruitment Nursing students enrolled in participating university were approached for potential participation if they meet the following inclusion criteria: nursing students who held nursing
ACCEPTED MANUSCRIPT diploma and currently enrolled at the baccalaureate-level. Students without holing a diploma in nursing prior to studying in baccalaureate-level were excluded. 3.4. Data collection
T
Nursing students enrolled in the participating university were approached and provided
IP
with a participant information sheet and consent form and the students were required to
SC R
provide written informed consent prior to their participation. All students were assured that neither their results nor their participation in this survey would affect their final marks in any subject In considering external validity and the need to recruit subjects with homogenous characteristics, data were collected from two final semesters of study year: February 2011 and
NU
February 2012.
MA
3.5. Data analysis
Data analysis was performed by using the SPSS 17.0 for Windows statistical software package. Descriptive analysis was used to summarize sample characteristics. An exploratory
D
factor analysis (Hair, Anderson, Tatham, & Black, 1998) was used to determine the construct validity of NSCI.
TE
A content and construct validity was also performed to determine instrument validity. Cronbach’s alpha coefficient, split-half coefficients, and item analysis verified the reliability of the instrument.
CE P
3.6. Ethical considerations
This study received full ethical approval from the university Institutional Review Board
AC
(100-IRB-002). All participating students were volunteers in this study, and no penalty would apply if they withdrew from the study. All data were collected anonymously, and all confidentiality and privacy were maintained. Digital data were stored securely with password protection at the university. 4. Results 4.1. Sample characteristics About 400 students were invited to participate to this study, 209 students have completed with 52% response rate. Majority of students were female (96%) . Students participating in the study were aged 20 to 21 years. 4.2. Validity of the NSCI
ACCEPTED MANUSCRIPT Content and construct validity examined the validity of the NSCI. Findings from a previous qualitative study that explored the perceptions of core nursing values from students’ perspectives confirmed the content validity for the present study of the NSCI.
T
Results from both Kaiser–Meyer–Olkin and Bartlett’s tests demonstrated that samples met
IP
the factor analysis criteria. The Kaiser–Meyer–Olkin measure of sampling adequacy was.92. In addition, Bartlett’s test was statistically significant with χ² (351) = 4576.85 and p < .0001.
SC R
Exploratory factor analysis (EFA) established the construct validity of the NSCI, ensuring that the scale could evaluate interactions genuinely and efficiently. The principal components methods with varimax rotation were conducted to extract common factors. Items with factor
NU
loading greater than .4 were selected to ensure a stable factor structure with adequate sample size and the ratio of participants and variables (Ferguson & Cox, 1993). Three items were
MA
eliminated: ―I can utilize professional nursing knowledge to care‖ stood for the dimension of accountability; ―I understand the influential factors affected the team work, and I can look for possible resources to improve it‖ characterized the communication and teamwork capability;
D
and ―I can accept different thinking points from others‖ corresponded to the aspect of stress
TE
and coping. Twenty-seven residual items were grouped into four factors based on the results of the scree plot.
CE P
Items were arranged into factors based on the size of loading with respect to statistical analysis, a priori conceptual beliefs, and discussion on the issue of the relative items’ interpretability fixed into groups from the research team. The first factor consisted of ten
AC
items and was named integrating care abilities. Items were mostly categorized from the group of care ability origin, and three items from the groups of critical thinking, communication and teamwork, and accountability. The second factor comprised six items that were mostly associated with the factor entitled ―leading humanity concerns.‖ Most items were initially from the group of caring and one item from accountability. The third factor was classified with seven items and labeled as ―advancing career talents.‖ The factor of advancing career talents was integrated with three items from the group of lifelong learning, two items from communication and teamwork, one item from critical thinking, and one item from the former group of stress and coping. The fourth feature was identified with four items, all from the previous stress and coping group; it was named ―dealing with tension.‖ These four factor groups explained 68.08% of the variance. The factors of integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension accounted for 22.29%, 18.59%, 15.99%, and 11.23% of the variable variance, respectively. Twenty-seven items with
ACCEPTED MANUSCRIPT up to four items in a subscale, and item scaling in constructing a scale to approach content validity were achieved in study. 4.3 Reliability of the NSCI
T
Cronbach’s alpha coefficients and split-half coefficients were conducted to express the
IP
internal reliability of the instrument. The Cronbach’s alpha coefficient for the total score
SC R
was .96. The first half of the split-half coefficient with odd-number items had a total of 14 items, and the other half included 13 items with even numbers. These two halves involved unequal lengths of items with the Spearman-Brown coefficients r = .98. The correlation between forms was .95. Both coefficient alpha and split-half coefficients indicated a
NU
satisfactory reliability (Bryman & Cramer, 1997).
MA
Item analysis was conducted to assess the NSCI with 27 items correlated to the total score of the NSCI. The statistical outcome of item analysis identified that the item, ―I satisfy my coping behaviors when facing the stressor,‖ had the lowest corrected item and total
D
correlations with r = .55; item, ―I can reflect the clinical situation of the client, and provide
TE
individual and efficient nursing care to improve client’s health status,‖ had the highest score with r = .77. However, all items were relevant to construct the content of the NSCI; no item
CE P
was reduced based on the results of the item analysis at this stage. Each item was correlated with its own scale and with other scales to assess the convergent and discriminant validity. The results of these analyses are shown in Table 1 and support the measure’s validity. Items were more highly correlated with their own scale than with other scales. The alphas for
AC
integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension scale were .94, .91, .88, and .87, respectively. Coefficient alphas reached the internal consistency estimates of reliability for these four subscales. Insert Table 1 here 5. Discussion Results from this study indicate that the NSCI has high-quality reliability and validity to assess the core values for baccalaureate nursing students. The NSCI assesses four dimensions related to the four nursing competencies for nursing students. Content validity is an important factor in identifying the concept of measurement, and it supports the construct validity of the instrument. In this study, results from a previous qualitative study and factors of core nursing values from the TNAC contributed to the construction of the NSCI in determining the domains and concepts of constructs. Although Yahmale (2003) emphasized that a more
ACCEPTED MANUSCRIPT comprehensive view of content validity than CVI was needed, the content validity in this study was determined by five nursing experts who gave their professional judgment about the instrument construction (Polit, Beck, & Owen 2007). Furthermore, regarding the purpose of identifying the factor structure of a set of variables, EFA offers an opportunity to develop and
T
evaluate scales with a relatively untested population (Hair, Anderson, Taham, & Black, 1998,
IP
pp. 99–109). Thus, the EFA method was used to establish the construct validity of the NSCI.
SC R
Hurley (1997) has advocated that different methods of factor analysis have their strengths and weaknesses, but the choice of which one to use depended on the requirements and context of the study, with some commentators suggesting that EFA may be used in most studies. Internal consistency with Cronbach’s α, split-half reliability, and item analysis is important when
NU
measuring scales of instrument.
MA
By measuring nursing competencies of students, the aim is to prepare future nursing staff for placement in a challenging care environment and possibly reframe the nursing curriculum. This is a way of closing a gap in nursing education between classroom and clinics,
D
because eight core nursing values from the TNAC are the basis of nursing performance. Both
TE
the TNAC and a study from Hsu and Hsieh (2009) asserted that further development of nursing competence for nursing graduates is required, with emphasis on a basis of self-
CE P
government. There is an argument, however, that some nursing competencies for nursing graduates are similar to nursing competencies for staff in clinical areas (Burn & Poster, 2008). Moreover, a competency approach is mainly involved in nursing education as a way of measuring a learning outcome; the cognition and attitude of learning will be difficult to
AC
evaluate when performing care activities with patients (Lofmak, 2006; Renee, 2008). Findings from the present study advocate the importance of nursing abilities in a multidisciplinary health care environment. These nursing competencies lead the expected graduates to effective nursing performance with proficiency in care by integrating care abilities, leading humanity concerns, advancing career talents, and dealing with tension. Items originally from integrating care abilities, leading humanity concerns, and advancing career talents of nursing competence for nursing graduates meet the foundation of TNAC’s designation of core values in nursing—professional knowledge and skills, professional humanity, and self-development (Chin, 2010). The four factors of nursing competence from the current study are related as a chain of links connected to each other. It is a responsibility of nursing educators to prepare students well before they are involved in the wider nursing world by cultivating these nursing
ACCEPTED MANUSCRIPT competencies (Klein, 2006). The identification of integrating care abilities demonstrates providing care collaboratively in the work environment. The classification of integrating care abilities emphasizes nursing knowledge and behaviors as part of competent performance toward patients. The naming of leading humanity concerns in nursing demonstrates the
T
nursing care being provided with caring that emphasizes the relationships and interactions
IP
between different parties. Providing nursing care not only involves nursing knowledge and
SC R
technical skills as attributes within integrating care abilities, but also with concern for humanity. This makes nursing care more meaningful. In addition, the discovery of advancing career talents highlights one’s inspiration toward a nursing career as work and dedicates it as an ambitious, life-long occupation. Having high ideals in nursing as final credentials of a
NU
career requires adequate support to continue on the ladder of nursing. Entering a nursing career necessitates dealing with tensions from self-dialogue and interactions with others or
MA
environments when things change rapidly (Marshburn, Engelke, and Swanson, 2009). Kloster, Hoie, and Skar’s (2007) study emphasized that professional challenge underpinned the
D
reasons for nursing students’ career preferences to work in different areas of nursing.
TE
5.1. Limitations
Several limitations are identified for developing an instrument to measure nursing
CE P
graduates’ competencies. First, this study was undertaken in a single institution, and as it is an exploratory study. Second, a previous qualitative study in investigating the same level of
AC
Taiwanese nursing students’ perceptions in core values of nursing according to TNAC (Lin et al., 2016) suggested that the performance of the ethics value should be included in the value of care ability and accountability, it may be advisable to include the value of ethics in the instrument when assessing nursing competence of nursing graduates in a further study. Third, the steps of confirmatory factor analysis and replication are required for the full scale development. 5.2. Implications of the study The results of this study have a significant impact on nursing programs at the baccalaureate level. Its greatest contribution is to provide an opportunity to modify and connect nursing curricula between associate and baccalaureate levels. An evaluation of achieved nursing competencies bridges the completion of students’ learning outcomes and the aims of the nursing curriculum. Furthermore, an efficient teaching–learning strategy achieves
ACCEPTED MANUSCRIPT the aims of learning based on an agreement between teachers and students. Thus, it is recommended that the schools devise a model to identify strategies that assist students in achieving success both in the nursing program and in the national licensure examination (in Taiwan). In this era of serious nursing shortages, identifying strategies to graduate larger
T
numbers of future nurses successfully and guiding them to pass the national nursing board
IP
examination has become imperative to the maintenance of program quality.
SC R
6. Conclusion
This study demonstrates the acceptable level of reliability and validity of the NSCI development for measuring nursing competencies. The NSCI consists of 27 items in four
NU
nursing competencies for graduates according to the TNAC’s eight core values in nursing education. In addition, the dimension of dealing with tensions during nursing school studies
MA
adds to coping with the varied care environment nowadays. The nursing competencies comprise an evaluation of self-care ability as integrating care abilities, with leading humanity concerns making nursing care meaningful, which will motivate future nurses to recognize that
Conflict of Interests
TE
D
nursing is an ambitious occupation through advancing-career talents.
CE P
The author(s) declared no potential conflict of interest with respect to the research authorship and publication of this article.
AC
Authors’ contributions: Attached later
ACCEPTED MANUSCRIPT References 1.
Bryman A. & Cramer D. (1997). Quantitative Data Analysis with SPSS for Windows, Routledge, London. Burn, P. & Poster, EC. (2008). Competence development in new registered nurse
T
2.
IP
graduates: closing the gap between education and practice. The Journal of Continuing
3.
SC R
Education in Nursing 39 (2), 67 – 73
Chen, Y. C. (2010). Essential professional core competencies for nurses. Journal of Nursing 57 (5), 12-17.
Chin, C.C. (2010). A discussion of concepts for promoting nursing core competencies. Journal of Nursing, 57 (5), 24-26.
5.
NU
4.
Ferguson, R.D. & Cox, T. (1993). Exploratory factor analysis: a user’s guide.
MA
International Journal of selection and assessment 1, 84-93. 6.
Floyd, J. F. (2013). Survey research methods (5th ed.), SAGE. Los Angeles
7.
Hair, J. F., Anderson, R. E., Tatham, R. L., & Black, W. C. (1998). Multivariate Data
Hinkin, T. R. (1998). A brief tutorial on the development of measures for use in survey
TE
8.
D
Analysis (5th). Prentice Hall, New Jersey.
questionnaires. Organizational Research Methods, 1, 104-121. Hsu, L.L. & Hsieh, S. I. (2009). Testing of a measurement model for baccalaureate
CE P
9.
nursing students’ self-evaluation of core competencies. Journal of Advanced Nursing 65 (11), 2454-2463.
AC
10. Hurley A.E., Scandura T., Schriesheim C.A., Brannick M., Seers A., Vandenburg R., & William L.J. (1997). Exploratory and confirmatory factor analysis: guidelines, issues and alternatives. Journal of Organisational Behavior 18, 667-683. 11. Klein, C. J. (2006). Linking competency based assessment to successful clinical practice. Journal of Nursing Education, 45 (9), 379-383. 12. Kloster, T., Hoie, M., & Skar, R. (2007). Nursing students’ career preferences: a Norwegian study. Journal of Advanced Nursing, 59 (2), 155- 162. 13. Lee-Hsieh, J., Kao, C. H., Kuo, C.L. & Tseng, H.F. (2003). Clinical nursing competence of RN to BSN students in a nursing concept-Base curriculum in Taiwan. Journal of Nursing Education, 42 (12), 536- 545. 14. Lin, C. C.; Han, C. Y.; Pan, I. J. & Lin, P. L. (2016). Exploring the Perceptions of Core Values of Nursing in Taiwanese Nursing Students at the Baccalaureate Level. The Journal of Nursing Research, 24(2), 126-136. 15. Ličen, S., & Plazar, N. (2015). Identification of nursing competency assessment tools as
ACCEPTED MANUSCRIPT possibility of their use in nursing education in Slovenia —A systematic literature review. Nurse Education Today 35 (2015) 602–608. 16. Lofmark, A., Smide, B., & Wikblad, K. (2006). Competence of newly-graduated nurse – a comparison of the perceptions of qualified nurse and students. Journal of Advanced
T
Nursing 53 (6), 721-728.
IP
17. Marshburn, D.M., Engelke, M.K., & Swanson, M.S. (2009) Relationships of new nurses’
SC R
perceptions and measured performance based clinical competence. The Journal of Continuing Education in Nursing, 40 (9), 426-432.
18. Nursing and Midwifery. Board of Australia. National competency standards for registered nurse. www.nursing midwiferyboard.gov.au accessed date: 18/11/2015
NU
19. Polit, D.F., Beck, C.T., & Owen, S.V. (2007) Is the CVI an acceptable indictor of content validity? Appraisal and recommendations. Research in Nursing & Health 30,
MA
459 – 467.
20. Renee, W., Walker, J.T., Martin, T., Nortington, L.D., Waltman, P., Beacham, T., & Grant, L.V. (2008). Comparing clinical competencies between nursing students with
D
degree and traditional students. Issues in Educational Research, 18 (1), 90-100.
TE
21. Smith, S.A. (2012). Nurse competence: a concept analysis. International journal of nursing knowledge, 23 (3), 172-182. DOI: 10.1111/j.2047-3095.2012.01225.x
CE P
22. Taiwan Nursing Accreditation Council (TNAC). (2010). Evaluation criteria. Retrieved from http://www.heeact.edu.tw/lp.asp?ctNode=352&CtUnit118&BaseDSD=7&mp=5 23. Watson, R., Stimpson, A., Topping, A., & Porock, D. (2001). Clinical competence
AC
assessment in nursing: a systematic review of the literature. Journal of Advanced Nursing 39 (5), 421-431. 24. Yaghmale, F. (2003) Content validity and its estimation. Journal of Medical Education. 3 (1), 25 – 27.
25. Wu, X. V., Enskär, K., Lee, C.S., & Wang, W. (2015). A systematic review of clinical assessment for undergraduate nursing students. Nurse Education Today 35, 347–359.
ACCEPTED MANUSCRIPT Table 1: Correlations of each dimension item with their own scale and with other scales Item
Factors 1
3
4
T
.76
.80
IP
.76
AC
CE P
TE
D
MA
NU
SC R
Integrating care abilities I can integrate the knowledge of basic biomedical science and general clinical skills to care for patients I can completely evaluate and analyze my client’s health problems and its latent factors I can utilize assessment skills in caring for a real-life patient I can analyze a suspicious situation and consider all its possibilities I can use holistic nursing care in caring for patients I can apply concept mapping in investigating a clinical situation I can recognize the role and function of nurses when caring for patients I can have a discussion with others to analyze the patient’s health situation I can reflect on clinical situations and provide individual care for improving a patient’s health status I can distinguish and endorse the role of nursing and non-nursing professionals Leading humanity concerns I can display a general caring behaviors to peers I can present my professional caring behaviors to patients I can reflect my general caring behaviors towards peers I can consider my professional caring behaviors towards patients I can value professional caring behaviors I can demonstrate responsibility towards a professional role and ensure nursing ethics Advancing career talents I can search and use information independently I treasure any learning activities I have confidence in advancing a new idea to another’s hypothesis I can develop effective ways of communication within group interaction I can utilize communication skills in a relationship of collaboration and complete care mission I can apply group dynamics to solve learning problems I can do my job professionally and efficiently Dealing with tension I have satisfactory ways of dealing with pressure I can manage my emotions when I am under stress I can analyze stressors and look for solutions
2
.74 .79 .73 .68 .78 .77 .65
.77 .82 .80 .83 .69 .64
.68 .68 .54 .73 .71 .72 .65 .70 .70 .73
ACCEPTED MANUSCRIPT .65 22.29% 18.59% 15.99% 11.23% 68.09%
AC
CE P
TE
D
MA
NU
SC R
IP
T
I can differentiate any stressors within the learning process sub-total percentage of variance explained Total percentage of the factors explained
ACCEPTED MANUSCRIPT Highlights
An instrument for learning outcome of nursing competency based on the perception of nursing students. Results support the reliability and validity of the NSCI.
Four dimensions of the instrument as Integrating care abilities, Leading humanity
CE P
TE
D
MA
NU
SC R
An indicator bridges students’ learning outcomes and the aims of the nursing curriculum.
AC
IP
concerns, Advancing career talents, and Dealing with tension.
T