Nursing psychometric testing
This study focused on the development and psychometric testing of the HCAT. The systematic review, qualitative studies and comparisons of core competencies generated a comprehensive pool of items. The sample of participants provided the opportunity for testing the psychometric properties of the instrument. The results indicated that HCAT has a four-factor structure, and satisfied level of internal consistency. In addition, the test-retest reliability reconfirmed the stability of the overall scale and four subscales. This rigorous process of tool development and psychometric testing ensures the validity and reliability of the HCAT.
The four-factor structure of the 36-item HCAT was robust and the domains reflect clinical competence required for nursing undergraduates. In the realm of Professional, Legal and Ethical Nursing Practice, the ten items were all loaded in their original factor. It appears that all these items reflected the expected behaviour of a professional nurse. Interestingly, Item 13, “shows caring attributes towards clients and families”, which was formerly incorporated in the Management of Care subscale, demonstrated the highest loading on the Professional, Legal and Ethical Nursing Practice subscale (.519). This result suggests that caring attributes is also a crucial aspect of professional nursing practice. Indeed, the caring attributes of a nurse has been discussed in the scholarly work of Carper as “the art of nursing”.
The ten items emerged from the Management of Care subscale, and these items typify the knowledge, clinical, communication and critical thinking skills built on clinical exposure and experience . Hassmiller recommends that nurses must develop basic competencies to meet the demands of dynamic clinical situations, with a focus on clinical preparation, emphasising quality and safety, evidence-based practice and leadership. Item 19 and 20, “identifies potential clinical risks through clinical risk assessment tools”, and “identifies risk management strategies to maintain safe care environment”, were cross-loaded on two to three factors. These items were removed from this subscale. However, these items still have face validity, and relevant contents were added to the behavioural cues to illustrate the nursing management of a safe environment. It is interesting to note that certain items were loaded in two factors (Item 5, 7, 17, 25), which reconciles with the fact that nursing practice is complex and requires the combination of knowledge, psychomotor skills, attitudes and critical thinking skills . Allocating the items to a factor according to the higher item loading coefficient could be a reasonable approach .
In this study, the ten items included in the Leadership and Nursing Management subscale focus on managerial and leadership skills, resource utilisation, and a safe working environment. Item 21, “provides a safe care environment for clients”, and was previously included in the subscale of Management of Care. In fact, this item demonstrated the highest loading of .490 on Factor 3. The empirical results suggest that nursing leadership encompasses management of people, resources and environment. It has been acknowledged in the literature that leadership qualities of nurses impact the possibility of sustainable, safe, and high-quality care. Furthermore, highly skilled practice and increasing dependence on the nurse’s role in coordination and management promotes the continuum of care .