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Shin and Yoon: Development of the Patient-Centered Nursing Culture Scale for Hospitals
Original Article

J Korean Acad Nurs 2019;49(5):613-630.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.5.613

Development of the Patient-Centered Nursing Culture Scale for Hospitals

Esther Shin1, Sook-Hee Yoon1, 2,

1Department of Nursing, Inje University, Busan

2Institute for Health Science Research, Inje University, Busan, Korea

Address reprint requests to : Yoon, Sook-Hee Department of Nursing, Institute for Health Science Research, Inje University, 75 Bokji-ro, Busanjin-gu, Busan 47395, Korea Tel: +82-51-890-6826 Fax: +82-51-896-9840 E-mail: nurysh@inje.ac.kr

Received 19 March 2019       Revised 26 July 2019       Accepted 26 July 2019

Copyright © 2019 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to develop a scale measuring the Patient-Centered Nursing Culture (PCNC) and provide a basic tool to improve PCNC in Korea.

Methods

A conceptual framework and construct factors were extracted through extensive literature review and in-depth interviews with nursing professionals. In total, 59 items were derived based on the pilot survey. Data were collected from 357 nurses working at general hospitals and analyzed for verifying the reliability and validity of the scale.

Results

Nine factors containing 54 items were extracted from the exploratory factor analysis to verify the construct validity. The nine factors were top management leadership, policy and procedure, education and training, middle management leadership, supportive teamwork, nursing workplace environment, professional competence, patient-centered nursing activity, and nurses’ values. These items were verified by convergent, discriminant, and concurrent validity testing. The internal consistency reliability was acceptable (Cronbach's α=.96).

Conclusion

The developed PCNC scale is expected to be used as the tool for the development of theory and improvement of PCNC, the empirical testing for cause and effect of PCNC, the development of interventions, education and training programs for improving PCNC, and indicators for evaluation or accreditation of hospital service quality.

Keywords: Patient-Centered Nursing, Culture, Reliability and Validity, Hospitals

References

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Figure 1.
Flow of the study.
jkan-49-613f1.tif
Table 1.
Socio-Demographic Characteristics of Participants
Variable Category n % M SD
 Gender Male 29 8.1
Female 328 91.9
 Age (yr) 29.69 6.73
 Marital status Unmarried 265 74.2
Married 91 25.5
Others 1 0.3
 Working unit Internal medicine ward 90 25.2
Surgery ward 38 10.6
Emergency room 31 8.7
Integrated ward 54 15.1
Orthopedic ward 34 9.5
Hemodialysis unit 11 3.1
Intensive care unit 67 18.8
Others 32 9.0
 Position Staff nurse 298 83.5
Charge nurse 38 10.6
Head nurse 15 4.2
Others 6 1.7
 Total clinical career (yrs) 6.80 6.24
 Clinical career at present hospital (yrs) 5.31 5.44
 Total 357 100.0

M=Mean; SD=Standard deviation.

Table 2.
Item Analysis (N=357)
Item M SD Skewness Kurtosis Item-Total correlation Floor effect (%) C Ceilling effect (%)
1 3.36 0.75 -0.33 0.24 .58 (<.001) 1.1 3.6
2 2.89 0.87 -0.15 -0.42 .61 (<.001) 5.6 1.4
3 3.30 0.74 -0.33 0.14 .60 (<.001) 1.1 2.5
4 3.16 0.73 0.03 0.33 .61 (<.001) 1.1 3.1
5 3.29 0.80 -0.31 0.18 .61 (<.001) 2.0 4.2
6 2.94 0.89 -0.16 -0.31 .60 (<.001) 5.6 2.2
7 3.22 0.78 -0.19 -0.26 .61 (<.001) 1.1 2.8
8 3.23 0.81 -0.23 -0.15 .62 (<.001) 1.7 3.6
9 3.07 0.83 -0.28 -0.15 .65 (<.001) 3.4 2.0
10 3.37 0.73 -0.14 -0.43 .55 (<.001) 11.5 3.6
11 3.37 0.76 -0.20 -0.12 .58 (<.001) 0.6 4.5
12 3.54 0.92 -0.46 0.10 .48 (<.001) 2.5 13.2
13 3.04 0.86 -0.06 -0.52 .61 (<.001) 2.5 2.8
14 3.14 0.86 -0.25 -0.33 .62 (<.001) 2.8 3.1
15 2.83 0.87 0.04 -0.36 .60 (<.001) 5.3 2.0
16 2.87 0.87 -0.07 -0.35 .62 (<.001) 5.3 1.7
17 3.59 0.86 -0.47 0.10 .61 (<.001) 1.4 12.0
18 3.63 0.84 -0.47 0.35 .65 (<.001) 1.4 12.6
19 3.53 0.88 -0.43 -0.01 .61 (<.001) 1.7 11.2
20 3.71 0.84 -0.48 0.15 .54 (<.001) 0.8 15.1
21 3.62 0.86 -0.36 0.01 .60 (<.001) 1.1 14.0
22 3.61 0.87 -0.49 0.35 .59 (<.001) 2.0 13.2
23 3.53 0.85 -0.31 -0.04 .61 (<.001) 1.1 10.6
24 3.66 0.85 -0.43 0.26 .56 (<.001) 1.4 14.6
25 3.57 0.70 -0.55 1.06 .65 (<.001) 1.1 5.6
26 3.73 0.71 -0.32 0.29 .60 (<.001) 0.3 11.2
27 3.62 0.78 -0.22 -0.13 .59 (<.001) 0.3 11.2
28 3.66 0.80 -0.48 0.53 .56 (<.001) 1.1 12.0
29 2.47 1.06 0.29 -0.82 .56 (<.001) 19.9 2.0
30 2.69 0.98 0.11 -0.57 .68 (<.001) 11.2 2.5
31 2.85 1.06 0.01 -0.67 .63 (<.001) 10.9 5.0
32 2.70 0.99 0.12 -0.49 .57 (<.001) 11.2 3.1
33 3.14 0.89 -0.26 0.01 .67 (<.001) 4.5 4.8
34 2.92 0.91 -0.14 -0.37 .59 (<.001) 6.4 2.5
35 3.29 0.82 -0.39 0.44 .71 (<.001) 2.8 4.5
36 3.50 0.87 -0.59 0.47 .59 (<.001) 2.8 9.0
37 3.34 0.81 -0.48 0.44 .63 (<.001) 2.5 4.5
38 3.53 0.87 -0.54 0.34 .61 (<.001) 2.2 10.1
39 3.41 0.62 -0.05 -0.29 .46 (<.001) 5.3 2.2
40 3.48 0.62 0.09 -0.27 .47 (<.001) 3.4 3.6
41 3.46 0.63 0.01 0.17 .54 (<.001) 0.3 3.6
42 3.53 0.70 -0.19 0.34 .46 (<.001) 0.6 6.4
43 3.57 0.62 -0.21 -0.17 .61 (<.001) 3.4 3.9
44 3.56 0.66 -0.24 -0.13 .48 (<.001) 5.0 4.8
45 3.59 0.70 -0.29 0.18 .52 (<.001) 0.3 7.0
46 3.59 0.65 -0.19 -0.11 .53 (<.001) 3.9 5.3
47 3.70 0.64 -0.28 0.12 .49 (<.001) 2.8 7.3
48 3.61 0.73 -0.22 0.05 .50 (<.001) 0.3 8.7
49 3.58 0.67 -0.21 -0.11 .52 (<.001) 4.8 5.6
50 3.50 0.69 -0.32 0.37 .54 (<.001) 0.6 4.5
51 3.66 0.69 -0.23 -0.06 .53 (<.001) 4.5 8.4
52 3.25 0.78 -0.22 0.15 .53 (<.001) 1.7 3.6
53 3.55 0.67 -0.14 -0.17 .52 (<.001) 5.0 5.3
54 3.60 0.70 -0.13 -0.18 .55 (<.001) 5.0 7.6
55 3.89 0.63 -0.09 -0.10 .45 (<.001) 0.8 14.6
56 3.73 0.69 -0.21 -0.03 .47 (<.001) 3.4 10.6
57 3.62 0.68 -0.34 0.32 .53 (<.001) 0.3 6.7
58 3.72 0.71 -0.04 -0.33 .56 (<.001) 3.1 12.6
59 3.70 0.68 0.14 -0.44 .50 (<.001) 1.7 10.9

M=Mean; SD=Standard deviation.

Table 3.
Exploratory Factor Analysis (Final Stage) (N=357)
Item No. Communality Factors
1 2 3 4 5 6 7 8 9
1 .70 .22 .15 .10 .05 .74 .08 .08 .08 .22
2 .67 .15 .07 .34 .11 .64 .27 .06 .00 .17
3 .65 .14 .17 .22 .13 .70 .08 .09 .12 .14
4 .72 .23 .19 .14 .12 .75 .10 .04 .09 .10
5 .57 .23 .05 .31 .10 .54 .23 .09 -.03 .25
6 .57 .19 .20 .23 .13 .28 .20 .00 .09 .55
7 .59 .20 .07 .21 .05 .36 .16 .26 .23 .48
8 .59 .08 .16 .12 .14 .33 .16 .12 .10 .60
9 .56 .13 .02 .13 .15 .34 .28 .24 .24 .44
10 .59 .13 .13 .12 .12 .11 .12 .02 .03 .71
11 .72 .21 .10 .27 .10 .13 .72 .05 .13 .17
12 .66 .17 .15 .22 .16 .13 .65 .11 .10 .26
13 .73 .24 .12 .29 .10 .14 .72 .11 .02 .09
14 .77 .24 .11 .27 .06 .24 .74 .09 .05 .10
15 .75 .79 .15 .12 .04 .17 .21 .00 .07 .03
16 .79 .82 .09 .11 .16 .14 .11 .08 .16 .09
17 .71 .75 .05 .12 .14 .13 .13 .07 .26 .05
18 .65 .77 .15 .06 .09 .04 .06 .07 .09 .08
19 .71 .78 .08 .12 .13 .14 .12 .07 .13 .03
20 .79 .84 .07 .12 .01 .17 .06 .10 .11 .07
21 .76 .82 .09 .13 .03 .17 .13 .07 .10 .06
22 .77 .83 .08 .11 .05 .00 .05 .07 .14 .16
23 .69 .34 .22 .22 .15 .16 .09 .03 .62 .17
24 .73 .34 .25 .11 .16 .14 .01 .05 .69 .13
25 .77 .30 .20 .19 .09 .05 .16 .11 .74 .02
26 .66 .34 .24 .10 .09 .04 .04 .12 .66 .08
27 .63 .14 .07 .71 .06 .12 .26 .01 -.01 .12
28 .79 .16 .10 .79 .14 .16 .21 .08 .08 .14
29 .72 .12 .17 .78 .09 .16 .12 .06 .07 .12
30 .67 .11 .10 .77 .09 .15 .15 .08 .02 .03
31 .69 .15 .27 .69 .06 .05 .07 .12 .22 .20
32 .66 .08 .16 .72 .14 .18 .10 .15 .14 -.06
33 .62 .19 .33 .58 .11 .15 .08 .11 .25 .13
34 .58 .12 .22 .02 .13 .13 .10 .67 .10 .08
35 .73 .07 .27 .12 .12 .06 .06 .78 .05 .07
36 .76 .14 .26 .17 .09 .15 .03 .77 .08 .09
37 .59 .11 .32 .14 .08 -.01 .10 .67 .02 .01
38 .54 .18 .59 .10 .24 .13 .11 .20 .10 .10
39 .51 .17 .61 .16 .05 .07 .02 -.08 -.05 .26
40 .58 .11 .68 .07 .10 -.04 .14 .19 .14 .11
41 .56 .11 .67 .14 .25 .03 .05 .07 .07 .09
42 .54 .02 .62 .12 .25 .06 -.10 .17 .08 .16
43 .59 .01 .70 .08 .10 .03 .13 .18 .15 .08
44 .51 .16 .64 .05 .13 .17 .05 .10 .08 .02
45 .57 .06 .68 .13 .16 .17 .05 .14 .11 .01
46 .59 .03 .65 .16 .18 .00 .06 .30 .12 .01
47 .55 .05 .51 .28 .16 .24 .16 .15 .12 -.25
48 .47 .09 .48 .11 .28 .32 .00 .17 .08 -.06
49 .55 .09 .39 .12 .53 .18 .08 .12 .20 -.03
50 .60 .06 .27 .05 .67 .02 .02 .12 -.01 .24
51 .66 .12 .25 .10 .73 .12 -.02 .12 .00 -.01
52 .66 .06 .19 .22 .73 .11 .11 .05 .09 .08
53 .72 .14 .19 .17 .76 .07 .11 .08 .18 .06
54 .68 .14 .25 .01 .74 .06 .14 .04 .07 .13
Eigen value 17.68 4.53 3.40 2.14 1.96 1.56 1.41 1.36 1.11
Explained variance (%) 32.7 8.4 6.3 3.9 3.6 2.8 2.6 2.5 2.0
Cumulative explained variance (%) 32.7 41.1 47.4 51.4 55.0 57.9 60.5 63.0 65.1
KMO=.93, Bartlett’s test: χ2=12667.96 (p<.001)
Table 4.
Multi-Trait/Multi-Item Matrix for Item Convergent and Item Discriminant (N=357)
Factor Item No. Correlation between each item and total scores of sub-factor 2*S.E
F1 F2 F3 F4 F5 F6 F7 F8 F9
 Top management leadership 1 .81 .51 .40 .38 .34 .37 .28 .28 .28 .27
2 .84 .50 .53 .34 .31 .53 .27 .32 .32 .21
3 .79 .46 .41 .34 .35 .45 .30 .35 .35 .28
4 .82 .48 .41 .41 .37 .40 .38 .35 .35 .27
5 .79 .53 .50 .40 .30 .48 .28 .30 .30 .24
 Policy & procedure 6 .52 .75 .48 .37 .38 .44 .24 .38 .35 .33
7 .55 .72 .46 .40 .43 .44 .37 .34 .30 .03
8 .51 .71 .41 .29 .31 .36 .29 .35 .34 .38
9 .51 .69 .49 .36 .38 .39 .34 .32 .34 .38
10 .37 .82 .36 .25 .27 .30 .21 .26 .27 .24
 Education & training 11 .46 .49 .85 .41 .38 .51 .27 .31 .31 .19
12 .47 .52 .82 .37 .37 .48 .33 .36 .37 .21
13 .46 .42 .86 .41 .32 .51 .30 .33 .31 .18
14 .52 .46 .86 .43 .34 .52 .29 .33 .28 .17
 Middle management leadership 15 .42 .36 .47 .87 .47 .36 .22 .32 .26 .37
16 .43 .40 .43 .89 .55 .36 .28 .32 .35 .34
17 .40 .36 .41 .84 .58 .35 .27 .29 .32 .38
18 .32 .32 .35 .80 .47 .27 .26 .30 .37 .44
19 .40 .34 .42 .85 .50 .35 .25 .30 .31 .39
20 .43 .35 .39 .88 .50 .34 .26 .26 .23 .34
21 .44 .36 .43 .87 .50 .35 .26 .29 .25 .36
22 .32 .35 .36 .86 .52 .32 .24 .26 .25 .38
 Supportive teamwork 23 .44 .44 .40 .53 .83 .45 .30 .44 .40 .21
24 .37 .39 .31 .51 .85 .36 .30 .45 .39 .20
25 .32 .33 .40 .49 .87 .42 .32 .41 .34 .17
26 .28 .36 .29 .49 .83 .33 .32 .43 .32 .19
 Nursing workplace environment 27 .43 .39 .50 .30 .27 .78 .21 .28 .25 .34
28 .51 .45 .56 .36 .39 .88 .31 .38 .37 .03
29 .47 .41 .48 .31 .36 .85 .29 .50 .32 .29
30 .43 .32 .47 .27 .31 .81 .27 .33 .28 .34
31 .41 .43 .45 .35 .45 .80 .35 .48 .34 .39
32 .42 .61 .42 .27 .36 .78 .33 .40 .34 .39
33 .47 .44 .46 .39 .50 .75 .37 .53 .40 .47
 Professional competence 34 .28 .32 .30 .25 .31 .25 .77 .41 .32 .23
35 .26 .28 .29 .21 .28 .31 .85 .48 .34 .19
36 .36 .65 .30 .30 .34 .37 .86 .51 .34 .18
37 .24 .42 .27 .23 .27 .30 .79 .48 .30 .20
 Patient-centered nursing activity 38 .35 .37 .35 .33 .42 .37 .49 .71 .51 .47
39 .30 .32 .26 .26 .29 .33 .25 .61 .33 .48
40 .25 .27 .30 .25 .40 .30 .44 .72 .41 .44
41 .28 .28 .28 .25 .38 .34 .38 .72 .50 .46
42 .28 .28 .18 .17 .34 .30 .41 .70 .48 .47
43 .26 .28 .27 .18 .36 .31 .43 .75 .41 .43
44 .32 .27 .28 .29 .36 .30 .39 .68 .40 .47
45 .30 .30 .27 .23 .37 .36 .43 .75 .44 .44
46 .24 .26 .26 .20 .36 .35 .51 .75 .45 .44
47 .34 .23 .31 .23 .34 .44 .39 .66 .40 .40
48 .35 .33 .25 .25 .32 .33 .39 .65 .47 .45
 Values of nurses 49 .35 .30 .29 .27 .41 .35 .36 .57 .73 .33
50 .25 .34 .24 .20 .25 .24 .30 .45 .74 .36
51 .30 .25 .23 .24 .30 .28 .33 .48 .79 .31
52 .34 .34 .34 .23 .33 .39 .29 .46 .79 .31
53 .32 .33 .35 .31 .40 .38 .31 .47 .84 .26
54 .29 .35 .31 .29 .32 .25 .28 .47 .81 .29

S.E=Standard Error.

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