Reliability and validity evaluation of the chinese version of the ethical sensitivity questionnaire for nursing students

Instrument choice for assessing ethical sensitivity in nursing students

BackgroundComplex health care environments present moral dilemmas for clinical nurses and nursing students that challenge their professional development as well as their physical and mental health. Ethical sensitivity (ES) is seen as a prerequisite that enables clinical nurses to make appropriate ethical decisions when facing a dilemma; therefore, ES should be a development focus for nursing students.PurposeThe aim of this study is to conduct a systematic evaluation of existing instruments to assess moral sensitivity (MS) or ES in nursing students. We subsequently provide recommendations of the proper research tools that can be used in future studies based on our study results.MethodsA systematic literature search across nine databases from their inception to November 17, 2024 was first conducted. Two researchers then independently screened these studies, which were published in English or Chinese. The studies evaluated were designed to develop or validate a scale used to measure ES or MS among nursing students. The COnsensus-based Standards for the Selection of Health Measurement INstruments (COSMIN) guidelines were followed to evaluate both the methodological quality and the quality of the psychometric properties of the identified tools. Finally, data synthesis was performed.ResultsWe ultimately included 13 assessment tools used for the assessment of ES or MS among nursing students. Only one tool was rated A, and four tools were rated C and not recommended for use. The remaining tools were rated B, and they have potential for assessing MS and ES among nursing students.ConclusionA majority of the tools included in this study still require further revision to enhance their quality prior to their effective use in MS and ES assessments. The COSMIN guidelines indicated that future studies should describe the development and validation of measurement tools in detail and improve their current data analysis methods.

Ethical sensitivity questionnaire for nursing students: psychometric properties of the Persian version

OBJECTIVE

Nursing students' ethical sensitivity is crucial for providing high-quality patient care. Assessing this sensitivity using standardized tools is essential for both students and professional nurses. This study aimed to determine the properties of cultural adaptation and the psychometric evaluation of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS).

RESULTS

This methodological study, conducted between April and November 2023, involved 480 nursing students who were selected through convenience sampling. The ESQ-NS was translated into Persian following the method described by Wild et al. (2005). The data were analyzed using SPSS (version 27) and LISREL (version 8.8) software. The EFA and CFA validated a three-factor, 13-item structure for the assessment tool. The Pearson correlation coefficient demonstrated a positive and significant correlation between the items and their respective subscales of the overall scale. The reliability of the Persian version of the ESQ-NS was confirmed with a Cronbach's alpha of 0.781, a MacDonald's Omega coefficient of 0.78, and an Intraclass Correlation Coefficient (ICC) of 0.78 (CI: 0.743- 0.816). The Persian version of the ESQ-NS demonstrates acceptable reliability and validity, making it a suitable tool for evaluating the ethical sensitivity of nursing students in Iran.

A survey of ethical sensitivity among nursing students and its influencing factors

BACKGROUND

Nurses frequently experience ethical issues in their area of practice. In the challenging reality of today's healthcare environment, nursing students need to be prepared to deal with ethical issues in their future roles. Nevertheless, Chinese nursing students' ethical sensitivity status and the factors influencing it have not been described.

OBJECTIVE

This study aims to explore the level of ethical sensitivity and its influencing factors among Chinese nursing students.

RESEARCH DESIGN

This was a cross-sectional study. We firstly cross-culturally adapted the Japanese version of the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) into a Chinese version. Then, we administered the Chinese version of ESQ-NS, the Caring Ability Inventory (CAI), and general information questionnaire to nursing undergraduates.

PARTICIPANTS AND RESEARCH CONTEXT

The invitations were sent to 600 nursing undergraduates from four universities in Hunan, China.

ETHICAL CONSIDERATIONS

The study was supported by the Institutional Review Board (IRB) of the lead university. The Approval No. was E202092.

RESULTS

A total of 489 undergraduate nursing students participated in the study. The mean score for ethical sensitivity of the samples was 36.34 ± 4.90, and 187.99 ± 22.64 for their humanistic care ability. Pearson's correlation coefficient test indicated a meaningful and positive relationship between the ethical sensitivity and humanistic care ability (r = 0.576 and p < .01). And regression analysis showed that age, school year, experience in studying nursing ethics, how much you like nursing major, and humanistic care ability were of relevance to nursing students' ethical sensitivity.

DISCUSSION

Our findings suggest that the mean ethical sensitivity score of Chinese nursing students is 36.34 (13-52). The humanistic caring ability of Chinese nursing students is still at a low level.

CONCLUSION

Future interventions for improving the ethical sensitivity of the nursing students should consider general information of participants and their humanistic care ability.

Correlation between ethical sensitivity and humanistic care ability among undergraduate nursing students: a cross-sectional study

BACKGROUND

In nursing practice, a high level of ethical sensitivity and humanistic care ability must always be maintained. A limited number of studies have investigated the correlation between the level of ethical sensitivity and humanistic care ability of nursing students.

METHODS

A survey study was conducted from November 2023 to January 2024 among 656 undergraduate nursing students using the General Information Questionnaire, Ethical Sensitivity Questionnaire For Nursing Students, and Humanistic Care Ability Inventory.

RESULTS

The total ethical sensitivity score of nursing students (36.01 ± 6.31) was positively correlated with the total humanistic care ability score (r = 0.426, P < 0.01), and the results of the multivariate linear regression analysis showed that grade, relationship with parents, liking of the nursing major, willingness to work in nursing, experiences in learning nursing ethics, experience of caring for patients, and humanistic care ability are the main influencing factors of nursing students' ethical sensitivity.

CONCLUSION

The ethical sensitivity of undergraduate nursing students is at a moderate level, which shows a moderate and significant correlation with their humanistic care ability. College nursing educators and administrators should focus on integrating humanistic care ability education while increasing ethical education to cultivate excellent nursing students with comprehensive abilities.

The psychometric properties of instruments measuring ethical sensitivity in nursing: a systematic review

BACKGROUND

Recognizing and appropriately responding to ethical considerations is a crucial element of ethical nursing practice. To mitigate instances of ethical incongruity in healthcare and to promote nurses' comprehension of their professional ethical responsibilities, it is imperative for researchers to accurately evaluate ethical sensitivity. Conducting a systematic review of the available instruments would enable practitioners to determine the most suitable instrument for implementation in the field of nursing.

AIM

This review aims to systematically assess the measurement properties of instruments used to measure ethical sensitivity in nursing.

METHODS

A systematic literature search was conducted in July 2022 in the following electronic databases: Scopus, CINAHL, APAPsycINFO, Embase, Web of Science, and PubMed. Two reviewers independently screened and assessed the studies in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The updated criteria for good measurement properties are used to rate the result of measurement properties, and the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to grade the quality of the summarized evidence.

RESULTS

This review encompasses a total of 29 studies that describe 11 different instruments. Neither cross-cultural validity nor responsiveness was examined in any of the included studies. Whereas the majority of the instruments were conducted with at least some type of validity assessment, nearly all of the reliability results rated were indeterminate. Two instruments were recommended, the Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units. It is recommended that new self-administration instruments for special nursing settings be developed in accordance with the item response theory (IRT)/Rasch model.

CONCLUSION

The selection of ethical sensitivity measurement instruments in nursing, and further research on the development, psychometric, and cross-cultural adaptation of these instruments, could be conducted in accordance with the findings and suggestions of this systematic review.

STRENGTHS AND LIMITATIONS

• This review was conducted to assess 11 instruments that were used to measure ethical sensitivity in nursing in 29 studies. • The Ethical Sensitivity Questionnaire for Nursing Students (ESQ-NS) and the Ethical Awareness Scale for nurses in intensive care units can be recommended, but further reliability and cross-cultural validity testing are needed. • The IRT/Rasch model is also recommended to measure ethical sensitivity in nursing. • The potential limitation of utilizing the COSMIN checklist for assessing methodological quality is worth considering. • Test-retest was considered inappropriate; thus, the reliability testing of ethical sensitivity measurement instruments still needs to be explored.

Assessment of ethical sensitivity in nursing students: Tools, trends, and implications

BACKGROUND

Rapid advances in medical technology, changing healthcare policies, and increasing patient diversity have exacerbated the ethical challenges. As nursing students are an integral part of the future nursing workforce, ethical sensitivity has a critical impact on their future careers.

PURPOSE

This study aims to promote research in related fields by systematically reviewing the origin and development of the concept of ethical sensitivity in nursing students, comparing currently available tools for assessing ethical sensitivity in nursing students, and exploring their applicability and reliability.

METHODS

A literature review method was used in this study. A literature search was conducted for assessment tools published between 1995 and 2024. A total of six articles focusing on assessment tools they developed to measure ethical or moral sensitivity were included and analyzed.

RESULTS

Our analysis revealed significant variations in the reliability and applicability of these assessment tools, particularly when used in diverse cultural settings. The study also identified a need for localized modifications of these tools to ensure their accuracy and relevance in different regions.

CONCLUSION

The findings provide valuable guidance for nursing educators in selecting appropriate assessment tools and offer a foundation for developing new tools that are more contextually relevant. This study contributes to the advancement of ethical sensitivity education for nursing students worldwide, ultimately enhancing patient care and professional development.

Cross-cultural adaptation and psychometric properties of the Chinese version of the Intermittent Self-Catheterization Questionnaire (ISC-Q)

Background

The intermittent self-catheterization questionnaire (ISC-Q) is a valid and reliable tool to assess the quality of life (QOL) in patients with neurogenic lower urinary tract dysfunction (NLUTD) who engage in ISC. The aim of this research is to culturally adapt the ISC-Q and evaluate its psychometric properties within the Chinese patient population.

Methods

The cross-sectional research was meticulously conducted in two pivotal stages: initially, the focus was on cross-cultural adaptation, followed by an extensive phase of psychometric testing. This comprehensive analysis involved 405 Chinese patients with NLUTD who use ISC. Various analyses, including evaluations of the floor and ceiling effects, item analysis, content validity, exploratory and confirmatory factor analysis (EFA and CFA), assessments of convergent, discriminant, and criterion validity. Additionally, Cronbach's alpha was utilized to determine internal consistency, and test-retest reliability was measured using the intraclass correlation coefficient (ICC).

Results

No floor and ceiling effects were observed. The content validity index was 0.967. The EFA identified four factors, accounting for 64.953% of the total variance, and this four-factor structure was confirmed by the CFA. The fit indices in CFA were favorable, with χ2/df = 1.999, root mean square error of approximation = 0.070, comparative fit index = 0.916, Tucker-Lewis index = 0.900, goodness-of-fit index = 0.863, and incremental fit index = 0.917. The average variance extracted for the four factors ranged from 0.466 to 0.565, with composite reliability values ranging from 0.776 to 0.859. The ISC-Q showed a positive correlation with the intermittent self-catheterization acceptance questionnaire (r = 0.557, P < 0.001). The ICC overall Cronbach's alpha coefficient for the questionnaire was 0.821, and the for test-retest reliability was 0.951 (95% CI [0.900-0.976] P < 0.001).

Conclusion

The validity and reliability of the Chinese version of the ISC-Q have been verified, making it suitable for measuring the QOL in NLUTD patients who practice ISC.

Psychometric Validation of the Dampness Syndrome Scale of Chinese Medicine for People in China

Background

Dampness syndrome is a basic syndrome of many major and chronic diseases. Early screening and identification of dampness syndrome are important. The Dampness Syndrome Scale of Chinese Medicine (DSSCM) was developed to measure the occurrence and severity of dampness syndrome. The measurement characteristics of the DSSCM should be further validated. The objective of this study is to evaluate the reliability and validity of the DSSCM based on a cross-sectional survey.

Methods

The development of DSSCM was based on the traditional Chinese medicine (TCM) theory, expert consensus and clinical investigations. Participants were recruited from Guangdong Provincial Hospital of Chinese Medicine and Guangzhou Cadre Health Management Center in Guangdong Province, China. All participants completed the baseline questionnaire and DSSCM. The reliability of the DSSCM was evaluated by internal consistency reliability and test-retest reliability. The factor structure was tested with confirmatory factor analysis (CFA), while discriminant validity was evaluated by calculating the difference between the total score of the DSSCM and its four dimensions for participants with or without dampness syndrome. We used a clinician's diagnosis of dampness syndrome as a criterion to evaluate the criterion validity. Multivariate regression analysis was used to analyze the associations among gender, age, height, and weight and dampness syndrome.

Results

A total of 880 participants were enrolled for psychometric validation and 869 participants were included in the final analyses after exclusion. The mean age of the participants was 42.62±12.86 years. The Cronbach's alpha coefficients for the four dimensions of the DSSCM were 0.809, 0.891, 0.816 and 0.780. The ICCs for the four dimensions of the DSSCM were 0.806, 0.674, 0.780 and 0.760. For validity, the results showed that the DSSCM had good content validity, discriminant validity and criterion validity. For the CFA, the root mean square error of approximation (RMSEA) was 0.091; the standardized root mean square residual (SRMR) was 0.074; the comparative fit index (CFI) was 0.766; and the Tucker-Lewis index (TLI) was 0.745. Weight was found to be associated with the total scores of the DSSCM and its three dimensions.

Conclusion

The DSSCM has good reliability and validity to support its use as a tool for assessing the severity of dampness syndrome. This study provides empirical evidence for future updates to the DSSCM.