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

doi:10.21203/rs.3.rs-4854387/v1

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

https://doi.org/10.21203/rs.3.rs-4854387/v1

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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.

professionalism

nursing

questionnaire

psychometric properties

mixed-method study

Today, the shortage of professional nurses in the healthcare system is a significant challenge for nursing managers. This need has escalated with the advancement of care technologies (1). Despite efforts such as promoting university education, providing independent work opportunities, defining ethical codes, and establishing legal responsibilities to professionalize nursing, the outcomes remain unsatisfactory (2). Nurses often exhibit weaknesses in areas like scientific knowledge and autonomy, and there are considerable barriers to establishing a robust professional identity (3).

Professionalism in nursing is a fundamental, complex, and multidimensional concept. A professional nurse possesses specialized academic knowledge, continually strives to enhance competence, adheres to professional ethical codes, and respects cultural, and spiritual values, laws, and standards. Additionally, by being an active member of professional organizations and delivering independent, high-quality care, a nurse projects a positive identity of the nursing profession to society and remains committed to the profession and its people. Other essential characteristics of a professional nurse include responsibility, accountability, and professional self-awareness (1). The American Nurses Association emphasizes the importance of professional nurses adhering to ethical codes, and professional standards, and receiving specialized and academic training (4).

In certain countries, the low average scores of nurses’ professionalism and the increasing inadequacy of care quality have led to criticism. Studies have pointed to nurses' lack of knowledge and skills, autonomy, and participation in career-related decisions as significant issues. Nurses, however, identify the main problems as the scarcity of professional nurses and the absence of clearly defined professionalism indicators by academic nurses (1–3, 5, 6). This raises the question: if the average scores of nurses' professionalism were low, is the tool used to measure this concept valid and reliable across various experiences? The availability of valid and reliable tools to accurately measure deficiencies in nurses' professional behavior is essential for the proper planning of corrective actions (3).

Despite numerous efforts over the past fifty years to develop suitable tools for measuring professionalism, many of these tools are not specific to the nursing profession (7), fail to assess new characteristics of the concept (5, 8–10), and lack adequate psychometric properties (7–9). Some tools assess multiple dimensions of professionalism, such as education, ethics, leadership, competence, and communication, while others focus on only one dimension (11–13). Table 1 lists several instruments used to measure nurses’ professionalism.

The first professional tool for nursing was designed by Miller in 1988, comprising five dimensions and 16 items (14). This tool was developed further in 1993 to include nine characteristics and 48 items (α = 0.686), though no construct validity was performed (8). Other tools, such as those by Hall (7) and Kramer (9), are general, with one designed for doctors and nurses (10), and another for nurses and midwives (15). Commonly used tools like Hall's (16), Miller's (8), and Kramer's (9) have been updated repeatedly by their designers or others over time and in different societies due to the evolving concept of professionalism and cultural influences. These researchers have acknowledged that their tools were not perfect and recommended content review and development before use (5, 16–18).

Recent studies have shown that the concept of professionalism in nursing has evolved, with new characteristics added. These include spiritual care, holistic nursing, creating a safe care environment, risk management, time management, establishing job standards, and supporting oneself and colleagues, as well as professional self-awareness, Effective professional communication with nursing colleagues and the healthcare team, (1, 2, 11, 19–21) yet they are not addressed in any of the currently available tools. Sociologists like Freidson and Hall have suggested that every profession should establish a model for evaluating professional behavior based on the consensus of experts in the field (8). Additionally, the culture of each society significantly influences professional attitudes and behaviors (22), necessitating the consideration of societal culture when developing such tools (18).

Developing valid and reliable tools to measure nursing professionalism offers numerous benefits, including improvements in the quality and quantity of care, individual and community health, patient satisfaction, and nurse satisfaction (22–24). These tools also enhance responsibility, research, autonomy, critical thinking, clinical reasoning (23), stress management (6), evidence-based practice, competence, and working relationships within the healthcare team (25). Furthermore, they help prevent nurse burnout, job attrition, and career changes (3, 24).

Currently, there is no appropriate, up-to-date, and culturally specific tool to investigate the professional behaviors of Iranian nurses. Designing a valid and reliable tool that is specific to the nursing profession and evaluates the new characteristics of professionalism is a significant challenge (3) and the first step toward enhancing nursing professionalism (8, 26). The absence of such a tool is a critical gap that needs to be addressed.

With the results from valid tools, nursing managers and policymakers can develop necessary policies in educational, managerial, and clinical fields, and plan strategies to improve nurses' professional behavior. Additionally, using this tool can help increase the knowledge, attitude, and performance of nurses in acquiring, improving, and promoting professional behaviors. Therefore, this study aims to develop and conduct psychometric testing of the Iranian Nurses’ Professionalism Questionnaire.

Study Design and Setting

This study employed a sequential exploratory mixed-method design, consisting of two phases: qualitative (item generation) and quantitative (item reduction and psychometric properties testing) (27).

Phase 1: Item Generation

Item generation is a pivotal stage in developing an instrument and involves a deductive-inductive approach where data are collected through qualitative research methods (28). The qualitative phase was executed in two steps: a literature review and interviews with nursing experts to identify attributes of professionalism in nursing and subsequently generate items.

1. Literature Review

An integrative review of the literature was conducted following the method outlined by Whittemore and Knafl. This systematic review method synthesizes evidence from diverse theoretical and empirical studies to better understand a phenomenon (29, 30). Studies published between 1985 and 2021 in English or Persian were searched across various international and national databases, including CINAHL, EBSCO, PubMed, ProQuest, The Cochrane Library, EMBASE, SAGE, ScienceDirect, Google Scholar, SID, Magiran, Irandoc, and medical sciences theses search engines. Inclusion criteria encompassed studies on nursing staff written in Persian or English with available full texts. Out of 90 accepted studies, critical evaluation and data extraction were performed by two authors using qualitative and quantitative checklists (31). Data analysis was conducted on 54 eligible studies (47 articles, 5 theses, 2 guidelines) using qualitative content analysis as per Graneheim and Lundman’s method (32).

2. Interviews with Nursing Experts

Semi-structured interviews were conducted with 25 nursing experts from medical sciences universities in Tehran and Rasht to assess their views on the dimensions and attributes of nursing professionalism. Participants were selected using purposive and snowball sampling methods and were interviewed until data saturation was achieved. Informed consent was obtained after explaining the study's purpose. Interviews were recorded digitally, transcribed verbatim, and reviewed multiple times by two researchers. Each interview lasted between 21 and 86 minutes. Data were analyzed using the directed content analysis method of Elo and Kyngas, comprising preparation, organization, and reporting phases (33).

Phase 2: NPQ Item Reduction and Psychometric Properties Testing

Psychometric quality is critical when designing or utilizing a tool. This includes validity, reliability, and the tool’s responsiveness to changes (34). In the quantitative phase, the initial questionnaire from the previous stages was evaluated for validity, reliability, responsiveness, interpretability, ceiling and floor effects, weighting, and scoring. The questionnaire utilized a five-point Likert scale: Always (score 5), Often (score 4), Sometimes (score 3), Rarely (score 2), and Never (score 1).

1. Validity

Validity consists of content validity, face validity, and construct validity. Content validity was assessed by obtaining expert opinions on grammar, appropriate wording, item placement, and scoring.

Face validity, concerning the appropriateness of items from the respondents' perspective, was tested qualitatively(35). Given the nurses' unfamiliarity with professionalism characteristics, 10 nurses (8 staff nurses, 1 supervisor, and 1 head nurse) from both general and specialized hospitals were consulted. Cognitive interviews were conducted to identify ambiguities and improve clarity, leading to revisions of the NPQ.

Quantitative content validity was assessed using the content validity ratio (CVR) and content validity index (CVI). Fifteen nursing experts were purposively selected and sent the NPQ (79 items) along with explanations of the study's general and specific objectives. They rated the necessity (for CVI) and relevance (for CVI) of each item. Items with a CVR greater than 0.49 and CVI greater than 0.78, with an S-CVI/Average greater than 0.9, were deemed acceptable and retained (34).

2. Reliability

The reliability of the NPQ was evaluated through internal consistency, stability, standard error of measurement (SEM), and reproducibility (36). Internal consistency and homogeneity were assessed using the Item-Total correlation method, with a Cronbach's alpha coefficient greater than 0.7 indicating strong internal consistency (37).

The construct validity of the NPQ was tested through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). EFA, conducted with varimax rotation on data from 310 nurses, identified the dimensions of nursing professionalism and item placement. Kaiser-Meyer-Olkin (≥ 0.6) and Bartlett’s test (< 0.05) were used to assess sample adequacy and factor analysis suitability. Eigenvalues greater than one and factor loadings of at least 0.3 were considered acceptable (27, 36).

Following EFA, the four-factor model was confirmed by CFA with a new electronic questionnaire containing 47 items. Data from 203 nurses were analyzed using LISREL v 8.8. Test-retest reliability was assessed by having 30 nurses complete the NPQ twice with a two-week interval, using the intraclass correlation coefficient (ICC) to measure relative stability. ICC values above 0.7 were deemed acceptable (31). Weighted kappa statistics (WK > 0.4) were applied for each item.

3. Absolute Reliability

Absolute reliability was measured using SEM and Minimal Detectable Changes (MDC). SEM was calculated using the formula (38):

$$\:{SEM}_{agreement=\text{S}\text{D}\times\:\surd\:(1-\text{I}\text{C}\text{C}agreement)}$$

MDC indicates the validity and realness of score changes. MDC% below 30% is acceptable, and below 10% is excellent, calculated using the formula (39):

$$\:MDC\text{\%}=(MDC÷MEAN)\times\:100$$

Ceiling and floor effects were analyzed to confirm interpretability. If more than 15% of participants achieved the highest or lowest possible score, it suggested the questionnaire might be missing items that capture the extreme ends of the phenomenon (27).

Additionally, score distribution, mean, and standard deviation in nurse groups were analyzed for interpretability.

Scoring used a five-point Likert scale, with reversed items scored inversely. Each item's score was calculated by multiplying the item score by its weight, and factors were converted to a zero-to-one-hundred scale for clarity and comparability.

Item Generation

Analysis of 54 articles and interviews with 25 nursing experts yielded 954 codes, 25 subcategories, and 9 categories defining professionalism in nursing. These include Specialized Knowledge, Continuous Competence Pursuit, Adherence to Ethical Principles and Values, Professional Commitment, Accountability, Autonomy, Advocacy, Professional Interaction, and Professional Self-awareness. The latter included two subcategories: Personal and Professional Self-awareness, an innovative finding added to the data matrix. These 9 categories formed the domains of the NPQ, resulting in a 132-item initial pool.

Primary Qualitative Content Validity

A panel of nursing experts selected the most appropriate items for assessing nursing professionalism in two steps. After removing 51 items, the questionnaire with 81 items entered the face validity phase, ensuring proper grammar, word choice, question significance, and placement.

Face Validity

Cognitive interviews with 10 nurses led to the removal of 2 redundant or ambiguous items, resulting in a final pool of 79 items.

Content Validity Findings

The initial NPQ version had 79 items, with 9 items removed due to CVR values < 0.49. The remaining 70 items had CVI values > 0.89, with an SCVI/average of 0.96. Four items were combined due to similar meanings, resulting in 68 items for the NPQ.

Initial Reliability

The electronic questionnaire was completed by 64 participants, and Corrected Item-Total correlation analysis retained items with scores > 0.3. Four items were eliminated, resulting in a 64-item NPQ with a Cronbach's alpha coefficient of 0.942.

Construct Validity

a. Exploratory Factor Analysis (EFA)

EFA on 310 nurses revealed four main factors. The Kaiser-Meyer-Olkin test value of 0.922 confirmed sample adequacy, and Bartlett's sphericity test was significant (p < 0.000) (Table 2). Factor analysis with varimax rotation identified four factors: accountability & advocacy, professional commitment & interaction, professional competence, and professional self-awareness (Table 3). Fifteen items with factor loadings < 0.4 were removed, resulting in a 47-item instrument for CFA. Pearson correlation analysis showed significant correlations between factors and the overall questionnaire. The correlation of three factors with the total score of the questionnaire is above 80% and significant. The correlation between the second factor and the whole questionnaire is moderate, but significant (0.354, p<0.000) (Table 4).

b. Confirmatory Factor Analysis (CFA)

CFA confirmed the four-factor model obtained from EFA. Figure 1 illustrates the structure of the NPQ, where the latent factors 1 to 4 are confidence in accountability & advocacy, professional Commitment& interaction, professional competence, and Professional self-awareness. The goodness-of-fit index indicated a well-fitting model, with a chi-square value of 2068.67 (p = 0.000) and a chi-square to degrees of freedom ratio of 1.05. Factor loadings for items were above 0.3, except for item 13 (0.16). The four-factor model was validated, demonstrating good structural validity (Table 5).

Reliability

Test-retest was used to evaluate the stability of the instrument. The relative stability of the overall tool was indicated by an ICC of 0.87, and Cronbach's alpha of 0.93 confirmed the good reliability of the NPQ. For absolute stability, the results of the standard error of measurement (SEM) and minimal detectable changes (MDC) showed that the MDCpercentage for the factors of professional commitment & interaction and professional self-awareness was below 30%, which is considered acceptable. For the factors of accountability & advocacy and professional competence, the MDC was below 10%, indicating excellence. Additionally, the MDC for the entire questionnaire was below 10% (2.69), also indicating excellence. The results of relative and absolute stability are shown in Table 6.

Interpretability of the tool

Interpretability of the tool was done by evaluating the percentage of unanswered items, the adequacy of the sample size, calculating the minimum significant change, determining the ceiling and floor effect, and describing the distribution of total scores in the samples. Due to the electronic nature of the questionnaire, the number of unanswered questions was zero.

Minimal Detectable Changes

The results showed that the Minimal Important Changes are more than the Minimal Detectable Changes. That is, the questionnaire can detect the minimum significant change in the level of professionalism of nurses, on the other hand, the change is reliable and the scores are not caused by measurement error (Table 6).

ceiling and floor effects

The ceiling and floor effects for the questionnaire and its factors were found to be below 15%, indicating favorable reliability and content validity (Table 7). Interpreting questionnaire scores can help differentiate nurses with minimum and maximum levels of professionalism.

The Distribution of Professionalism Scores Based on Demographic Characteristics

The results of examining the distribution of nurses' professionalism scores about demographic variables showed significance only concerning their work experience, with no significant associations with other demographic variables (Table 8). Scheffe's post hoc test results revealed notable variances in professionalism scores among nurses with different years of working experience. Significant differences were found between nurses with 6-10 years and 16-20 years (P = 0.03) and between 6-10 years and 21-30 years (P = 0.04). Additionally, significant differences were observed between nurses with 11-15 years and 16-20 years of experience (P = 0.04). These findings indicate a significant increase in professionalism after 16 years of working experience (Table 9).

This study aimed to design a standardized self-report questionnaire for assessing professionalism in nursing and to evaluate its psychometric properties. The Nurses' Professionalism Questionnaire (NPQ) was developed based on an integrated literature review and directed content analysis (1), resulting in a final version with 47 items across four domains: Accountability & Advocacy, Professional Commitment & Interaction, Professional Competence, and Professional Self-Awareness.

Existing tools for measuring nursing professionalism often address characteristics such as communication, professional competence, responsibility, support, and commitment (8, 9, 18). These align with the findings of this study, yet none specifically include the new characteristic of Professional Self-Awareness identified in our research.

The reliability and validity of the NPQ were assessed by expert nurses. The Cronbach’s alpha coefficient was 0.942, indicating high reliability, while content validity was confirmed with a Content Validity Index (CVI) of 0.89 and a Scale Content Validity Index (S-CVI) average of 0.96. Construct validity was demonstrated through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), which supported the four-factor model of the NPQ.

Previous instruments, such as that by Baumann & Kolotylo, did not aim to specifically measure professionalism, and some existing tools lacked sufficient psychometric properties (18). For example, Hall's revised instrument had a Cronbach’s alpha of 0.66, deemed unacceptable (16), and Miller's tool did not adequately detail face and content validity nor perform construct validity testing (8). Similarly, Kramer's revised tool did not include CFA or evaluate the reliability of stability (9).

The first dimension of the NPQ, Accountability & Advocacy, comprises 20 items. The highest variance was observed in the item "I participate in social welfare activities (serving in crises, health stations, and free visits)." regarding participation in social welfare activities, reflecting the nurse’s commitment to caring responsibilities and accountability (1). This finding is consistent with other tools that emphasize community service & cooperation (8), and professional responsibility & support (9, 10, 18), and accountability(40).

The second dimension, Professional Commitment & Interaction, includes 11 items. The highest variance was noted in the item "I establish proper professional communication with nursing colleagues", highlighting the importance of maintaining a positive professional reputation and quality interactions with patients, nurses, and other team members. This dimension correlates with tools focusing on professional commitment and collaboration (7, 16, 18), and membership in professional organizations (8, 41).

The third dimension, Professional Competence, also includes 11 items, with the highest variance found in the item "I use the findings of new research in the field of nursing for patient care”. This underscores the importance of ongoing education and evidence-based practice in nursing. Consistent with previous studies, this dimension aligns with tools that assess continuing education and clinical competence (8, 9, 10, 18). Continuous participation in in-service training programs, consistent study, and knowledge updating contribute to developing nursing's professional identity and professionalism (42, 43).

The fourth dimension, Professional Self-Awareness, consists of 5 items, with the highest variance found in the item "Having a source of income and a job market is the reason for my employment in the nursing profession”. A professional nurse has sufficient knowledge of the individual and professional qualities necessary to enter the nursing profession such as honesty, optimism, and adaptability (44), duties, ability to work in unusual shifts, and adaptability to various working conditions. self-awareness which is critical for professional development, is not addressed by existing tools. This dimension represents an innovative aspect of the NPQ.

The assessment of professionalism scores based on demographic characteristics revealed a significant correlation with work experience, consistent with findings from studies by Dickman and Kim-Goodwin (3, 45). However, no significant differences were found concerning other demographic variables. Differences noted in previous studies, such as those by Dikmen and Shohani (3, 46), may be attributed to variations in sample characteristics, such as educational level and gender distribution.

Study Limitations

One limitation of this study was the use of a non-randomized sampling method due to the constraints imposed by the COVID-19 crisis, except for the phases involving face validity and test-retest reliability. Despite our efforts to encourage nurses to complete the electronic questionnaire honestly—by clearly explaining the study's objectives and ensuring the confidentiality of their responses—there may still be concerns about the representativeness and reliability of the collected data.

The absence of a suitable tool to assess nursing professionalism in Iran prompted the development and evaluation of the NPQ, which is tailored to the specific needs of Iranian nurses. Existing tools were found to be culturally unsuitable or inadequate in measuring all dimensions of professionalism. The NPQ, comprising 47 items across four dimensions and 14 demographic questions, was developed using a mixed-method approach. It is a valid and reliable measure that can be completed in approximately 25 minutes, making it practical for hospital settings. The NPQ’s development, grounded in expert opinions, literature, and empirical data, ensures its generalizability. Nursing policymakers can utilize this tool to enhance educational, managerial, and clinical policies, improving nursing professionalism and ultimately the quality of care.

NPQ: Nursing Professionalism Questionnaire

EFA Exploratory Factor Analysis

CFA Confirmatory Factor Analysis

SPSS Statistical Package for the Social Sciences

LISREL Linear Structural Relations

CVR Content Validity Ratio

CVI Content Validity Index

I-CVI= Item Content Validity Index

S-CVI= Scale Content Validity Index

ICC Intraclass Correlation Coefficient

PAF Principal Axis Factoring

RMSEA Root Mean Square Error of Approximation

GFI Goodness of Fit Index

CFI Comparative Fit Index

NFI, Normed Fit Index

IFI Incremental Fit Index

AGFI Adjusted Goodness of Fit Index

PNFI Parsimonious Normed Fit Index (PNFI)

ICC Intraclass Correlation Coefficient

The online version contains supplementary material available at: https://drive.google.com/file/d/1nJ4CK8T8IPYkjiNwEcdWp8bWyxV1hFVz

Acknowledgments

This study is part of the PhD Dissertation in nursing that has been approved by the ethics committee, University of Social Welfare and Rehabilitation Sciences, Tehran (IR.GUMS.REC.1402.264). We thank all of the nurses and experts who participated in this study and the research team who accompanied us in all stages of the research..

Author Contributions

Literature search, conducting interviews, distributing questionnaires, data collection, and data entry into statistical software: Sakineh Parastesh.

Study conception and design, analysis and interpretation of results, manuscript writing, editing, and final approval: All authors.

Funding

This study received no external funding.

Data Availability

Data are available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

After obtaining permission from the Ethics Committee of Social Welfare and Rehabilitation Sciences University, Tehran, Iran (Code: IR.USWR.REC.1397.118) and before starting the interview and distribution of the questionnaire, Participants were informed about the research purpose, voluntary participation, data use exclusively for the study, and the publication of the results. also, written informed consent was obtained for interviews, Content validity, Face validity, and the test-retest reliability phases. completion of the questionnaire electronically in the initial reliability, and construct reliability indicated consent to participate. The study followed ethical considerations, guidelines, and regulations throughout all stages.

Consent for publication

Not applicable.

Competing interests

None declared.

Parastesh S, Hosseini MA, Mohammadi-Shahbolaghi F, Seyyed Maddah BS, A. E. Professionalism in Nursing: An Integrative Review of the Literature. J Holist Nurs Midwifery. 2024;34(1):93-106. 34. 2024;1:93-106.
Habibzadeh H Af. Nursing Professionalization Process: Designing a Career: Pattern.2010. Available from: https://elmnet.ir/doc/10517116-59127.
Dikmen Y KH, Arslan GG, Ak B. The level of professionalism of nurses working in a hospital in Turkey. J Caring Sci. 2016;5(2):95-102.
Gurney D GG, McMahon MP, Kolbuk ME. Nursing code of ethics: provisions and interpretative statements for emer gency nurses. J Emerg Nurs. 2017;43(6):497-503.
Fantahun A DA, Gebrekirstos K, Zemene A, Yetayeh GA. A cross-sectional study on factors influencing professionalism in nursing among nurses in Mekelle Public Hospitals, North Ethiopia, 2012. BMC Nurs. 2014;13(1):10.
Akabarbegloo M ZV, Valizadeh L. . Challengus of Professional Nursing. Nursing & Professionalism in Iran and the World Urmia. Iran2017. p. 138.
Hall R. Professionalization And Bureaucratization. American Sociological Review. 1968;33(1):92-104.
Miller BK AD, Beck L. A behavioral inventory for professionalism in nursing. J Prof Nurs. 1993;9(5):290-5.
Kramer M BB, Halfer D, Hnatiuk CN, MacPhee M, Schmalenberg C. The evolution and development of an instrument to measure essential professional nursing practices. J Nurs Adm. 2014;44(11):569-76.
lombarts K PT, Thompson C, Arah O, . Measuring Professionalism in Medicine and Nursing: Results of a European Survey. PLoS ONE. 2014;9(5):e97069.
Dehghani A ML, Dehghan-Nayeri N. Factors affecting professional ethics in nursing practice in Iran: a qualitative study.. 2015;16(61. BMC Medical Ethics. 2015;16(61).
Jafaraghaee F EA, Negarandeh R, Mehrdad N. Professional commitment scale for clinical nurses: A study protocol. Med J Islam Repub Iran. 2017;31(123):106.
Varjus SL ST, Leino-Kilpi H. . Autonomy among intensive care nurses in Finland. 2003;19:3 1–4 0. Intensive and Critical Care Nursing. 2003;19(3):1-40.
Miller B. A model for professionalism in nursing. Today's OR Nurse. 1988;10(9):18-23.
Erbil N, Baker A. Development of a professional attitude inventory in the profession. International Journal of Human Sciences. 2009;6(1):290-302.
Snizek WE. Hall's Professionalism Scale: An Empirical Reassessment. American Sociological Review. 1972;37(1):109-14.
Chan ATS CE, Scott D. . Evaluation of Hall’s Professionalism Scale for Professionals in the Construction Industry. Psychological Reports. 2007;100(3):1201-217.
Baumann A KC. The Professionalism and Environmental Factors in the Workplace Questionnaire: development and psychometric evaluation. . 2009;65(10):2216–28. Journal of Advanced Nursing. 2009;65(10):2216-28.
RNAO. Professionalism in Nursing: Healthy Work Environments Best Practice Guidelines. 2007. Toronto, Canada: In: Ontario RNAo editor. Available from: https://rnao.ca/bpg/guidelines/professionalism-nursing.
Ghadirian F SM, Cheraghi M. Nursing professionalism: An evolutionary concept analysis. Iranian Journal of Nursing and Midwifery Research. 2014;19:1-10.
Li H DN, Zhang Y, Liu Y, Wen D. . Assessing medical professionalism: A systematic review of instruments and their measurement properties.. 2017;12(5):1-28. PLOS ONE. 2017;12(5):1-28.
Hwang JI LF, Han SS, Cao F, Kim WO, Li P. Professionalism: The major factor influencing satisfaction among Korean and Chinese nurses Int Nurs Rev. 2009;56(3):313-8.
Bragnanca AVeD, Nirmala R. Professionalism among Nursies: A concept analysis. IJBMI. 2017;6(7):60-6.
Aldina K. Professionalism in post-licensure nurses in developed countries J Nurs Educ Pract. 2013;3(5):128-37.
Abd ElAzim Ibrahim S AQS. Relationship between faculty staff professionalism and nursing students’ values. Journal of Nursing Education and Practice. 2016;6(9):38-45.
Hasan Doost F, Moghadas T, Momeni M, Rafiei H. Factors Influencing Professionalism: A Cross-Sectional Study among Iranian Registered Nurses. IOSR Journal of Nursing and Health Sciences. 2016;5(3): 47-9.
Ebadi A ZL, Rakhshan M, Zareiyan A, Sharifnia H, Mojahedi M. Principles of Scale Development in Health Science. 1nd edition ed. Tehran: Jame-e-Negar; 2017. 264 p.
Sinclair Sh Ha, Jaggi P K, McClement S. A Practical Guide for Item Generation in Measure Development: Insights From the Development of a Patient-Reported Experience Measure of Compassion. Journal of Nursing Measurement. 2020;28(1).
Whittemore R KK. The integrative review: updated methodology. Journal of Advanced Nursing. 2005;52(5):546-53.
Gifford W DB, Edwards N, Griffin P, Lybanon V. . Managerial leadership for nurses’ use of research evidence: An integrative review of the literature. Worldviews Evid Based Nurs. 2007;4(3):126-45.
Greenhalgh T RG, Bate P, Kyriakidou O, Macfarlane F, Peacock R. . How to spread good ideas: A systematic review of the literature on diffusion, dissemination, and sustainability of innovations in health service delivery and organization. London School of Hygiene & Tropical Medicine: National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO); 2004.
Graneheim UH LB. Qualitative content analysis in nursing research: Concepts, procedures, and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105-12.
Elo S, Kyngas H. The qualitative content analysis process. Journal of Advanced Nursing. 2008;62:107-15.
Taghizadeh Z EA, Montazeri A, Shahvari Z, Tavousi M, Bagherzadeh R. . Psychometric properties of health-related measures. Part 1: Translation, development, and content and face validity Journal of the Iranian Institute for Health Sciences Research. 2017;16(3):343-57.
Moores K JG, Radley S. Development of an instrument to measure face validity, feasibility and utility of patient questionnaire use during health care: the QQ-10. International J Qual Health Care. 2012;24(5):517-24.
Ebadi A TZ, Montazeri A, Shahvari Z, Tavousi M, Bagherzadeh R. Translation, development and psychometric properties of health-related measures-Part 2: construct validity, reliability, and responsiveness. Journal of the Iranian Institute for Health Sciences Research. 2017;4:445-55.
Polit DF BC. Nursing Research: Generating and Assessing Evidence for Nursing Practice. Philadelphia,: Wolters Kluwer; 2017.
JAWORSKI J AT, LECH G, SPIESZNY M, BUJAS P, ZAK M, CHWAŁA W. . Absolute and relative reliability of several measures of static postural stability calculated using a GYKO inertial sensor system. Acta of Bioengineering and Biomechanics 2020;22(2).
Azadi F PM, Shakeri H, Kazemnejad A, Akbari Kamrani AA, Arab AM, et al. . Relative and Absolute Reliability of Timed Up and Go Test in Community-Dwelling Older Adult and Healthy Young People. Iran J Ageing. 2014;8(4):56-66.
Boozaripour M AA, Shahriari M, Almasi Hashiani A, Borhani F. The first priority of professional values from the perspective of Iranian. Annals of Tropical Medicine and Public Health. 2017;10(3):678-83.
Hisar F KA. Determining the professional behavior of nurse executives. Int J Nurs Pract. 2010;16(4):335-4
L. W. The influence of leadership on nursing professionalism: Minneapolis: Walden University; 2017.
Elksas EI AERR, Hassan Ali N. Developing an Instrument for Measuring Bachelor’s Degree Nursing Professionalism. J Nov Res in Health Nurs. 2021;8(1):376-89.
Azemian A EA, Afshar L. Redefining the concept of professionalism in nursing: An integrative review. Front Nurs. 2021;8(4):327-40.
Kim-Godwin YS BH, Wynd CA. Factors influencing professionalism in nursing among Korean American registered nurses. J Prof Nurs. 2010;426:242-9.
Shohani M, Zamanzadeh V. Nurses' Attitude towards Professionalization and Factors Influencing It. J Caring Sci. 2017;6(4):345-57.

Tables 1 to 9 are available in the Supplementary Files section.

No competing interests reported.

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09 Aug, 2024
Submission checks completed at journal
08 Aug, 2024
First submitted to journal
03 Aug, 2024

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

Status:

Version 1

Abstract

Introduction

Methods

Study Design and Setting

Phase 1: Item Generation

1. Literature Review

2. Interviews with Nursing Experts

Phase 2: NPQ Item Reduction and Psychometric Properties Testing

1. Validity

2. Reliability

3. Absolute Reliability

Results

Discussion

Study Limitations

Conclusion

Abbreviations

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1