Psychometric properties of the ethical conflict in nursing questionnaire critical care version among Chinese nurses: a cross-sectional study

Abstract

Background Ethical conflicts are common in the critical care setting, and have compromised job satisfaction and nursing care quality. Using reliable and valid instruments to measure the ethical conflict is essential. This study aimed to translate the Ethical Conflict in Nursing Questionnaire — Critical Care Version into Chinese and determine the reliability and validity in the population of Chinese nurses. Methods Researchers obtained permission and followed the translation-backward method to develop the Chinese version of the Ethical Conflict in Nursing Questionnaire — Critical Care Version (ECNQ-CCV-C). Relevant psychometric properties were selected according to the Consensus-based standards for the selection of health status measurement instruments checklist. Critical care nurses were recruited from two tertiary public hospitals in Hangzhou, Zhejiang Province, and Kunming, Yunnan Province. Of the 264 nurses we approached, 248 gave their consent and completed the study. Results The ECNQ-CCV-C achieved Cronbach’s alphas 0.902 and McDonald’s omega coefficient 0.903. The test-retest reliability was satisfactory within a 2-week interval (intraclass correlation coefficient = 0.757). A unidimensional structure of the ECNQ-CCV-C was determined. Confirmatory factor analysis supported acceptable structure validity. Concurrent validity was confirmed by a moderate relation with a measure for hospital ethical climate (r = − 0.33, p < 0.01). The model structure was invariant across different gender groups, with no floor/ceiling effect. Conclusions The ECNQ-CCV-C demonstrated acceptable reliability and validity among Chinese nurses and had great clinical utility in critical care nursing.

Development of ethical conflict scale for nurses in extraordinary circumstances and psychometric testing

“…Higher scores of nurses in the context of these three dimensions indicate that they experience high levels of ethical conflict in extraordinary circumstances. Some measurement instruments that have been developed in this field focus on whether the ethical conflicts experienced by nurses would differ during routine nursing care (Tosun, 2018), in specific cases such as adult's desire to die and the adaptation of a new nurse (Cerit, 2010), and among nurses working in specialized units such as intensive care units (Liu et al, 2021). The developed measurement instrument focuses on the ethical conflict that nurses have experienced during the implementation of decisions that threaten public health and aim to save a large number of patients and injured.…”

“…For this, the concept to be measured is defined, and the theoretical structure is created (Boateng et al, 2018; DeVellis & Thorpe, 2021). In this context, the researchers conducted a literature review by searching the keywords “extraordinary circumstances,” “emergency preparedness,” “disaster,” “nurse,” “nursing,” “ethics conflict,” “ethical dilemma,” and “ethical sensitivity.” Twelve studies reached as a result of the search were reviewed (Barsky, 2008; Cerit, 2010; Crisham, 1981; Edelstein et al, 2009; Ferrell & Skinner, 1988; Gaudine & Thorne, 2012; Khanal et al, 2022; Liu et al, 2021; McAndrew et al, 2018; Sperling, 2021; Tosun, 2018; Turale et al, 2020). As a result of the review, the concept of “ethical conflict for extraordinary circumstances” was defined.…”

“…In this study, an item pool was created by utilizing the method of deduction that involves reviewing the relevant literature and assessing other scales and indicators in that field (Barsky, 2008; Cerit, 2010; Crisham, 1981; Edelstein et al, 2009; Ferrell & Skinner, 1988; Gaudine & Thorne, 2012; Khanal et al, 2022; Liu et al, 2021; McAndrew et al, 2018; Sperling, 2021; Tosun, 2018; Turale et al, 2020). This is a valid method that has been described in the literature and is used to create item pools (Boateng et al, 2018).…”

“…In the review of the relevant literature, we find the “Moral Sensitivity Questionnaire” developed by Lutzen et al in 1994 and adapted for Turkish by Tosun (2018) to analyse the ethical sensitivities of nurses in decision‐making, the “Nursing Dilemma Test” Crisham created in 1981 that was adapted to Turkish by Cerit (2010) to identify the ethical decision‐making statuses of nursing staff, the “Scale of Ethical Conflict with Hospitals” created by Gaudine and Thorne (2012), and the “Ethical Conflict in Nursing Questionnaire‐Critical Care Version (ECNQ‐CCV)” that was developed by Falcó‐Pegueroles et al (2013) and adapted to Chinese by Liu et al (2021) to measure ethical conflicts experienced by intensive care nurses.…”

The relationships of ethical climate, physician–nurse collaboration and psychological empowerment with critical care nurses' ethical conflict in China: A structural equation model

“…Higher scores indicate a greater level of ethical conflict. The Chinese version of ECNQ‐CCV demonstrated good internal consistency (Cronbach's α = .902 and test‐retest reliability = .757) (Liu et al, 2021). The Cronbach's α in our study was .936.…”