|Year : 2020 | Volume
| Issue : 3 | Page : 171-177
Development and validation of the social responsibility questionnaire for Iranian nurses
Mohsen Faseleh Jahromi
, Ali Dehghani
Department of Nursing, Jahrom University of Medical Sciences, Jahrom, Iran
|Date of Web Publication||17-Jul-2020|
Jahrom University of Medical Sciences, School of Nursing and Paramedical, Motahari St., Jahrom
Source of Support: None, Conflict of Interest: None
Background: Assessment of nurses' social responsibility is necessary for improving their social responsibility and accountability. Valid and reliable culturally appropriate instruments are needed for such an assessment. Objectives: This study aimed to develop and validate the Nurse Social Responsibility Questionnaire (NSRQ) for Iranian nurses. Methods: This methodological study was conducted in a qualitative and a quantitative phase. In the qualitative phase, the concept of social responsibility was explored using a grounded theory study and the item pool of NSRQ was generated. In the quantitative phase, the psychometric properties of the questionnaire (namely face, content, and construct validity and reliability) were evaluated. Results: Exploratory factor analysis revealed that NSRQ consisted of four factors which were labeled ethical commitment, clinical care management, professional competence, and divine satisfaction. The Cronbach's alpha and the test–retest intraclass correlation coefficients of NSRQ were 0.92 and 0.95, respectively. Conclusion: The 27-item NSRQ is a valid and reliable instrument for social responsibility measurement among nurses.
Keywords: Nurse, Questionnaire, Self-report, Social responsibility, Validation
|How to cite this article:|
Jahromi MF, Dehghani A. Development and validation of the social responsibility questionnaire for Iranian nurses. Nurs Midwifery Stud 2020;9:171-7
|How to cite this URL:|
Jahromi MF, Dehghani A. Development and validation of the social responsibility questionnaire for Iranian nurses. Nurs Midwifery Stud [serial online] 2020 [cited 2020 Aug 3];9:171-7. Available from: http://www.nmsjournal.com/text.asp?2020/9/3/171/289984
| Introduction|| |
Social responsibility (SR) is a key concept in professional nursing which directly relates to the values of professional nursing. Frey states that nurses have a common responsibility for the development of individual and community health. According to Spitzer, SR is the essence of nursing leadership and entails the commitment of nurses, either staff nurses or nursing leaders, to their communities. She also notes that SR and emergency service provision to communities are the core of nurses' professional practice. Accordingly, nurses need to be aware of their SRs and develop their social commitment.
The results of our literature search showed that there are few studies on SR in the area of global nursing.,, Moreover, studies on SR among nurses reported contradictory results about dimensions and examples of SR and failed to address some aspects of SR such as ethical principles and commitment to the belief principles etc., In addition, the results of these studies are context specific. Therefore, studies on SR in different contexts are needed to determine nurses' adherence to their SRs. Valid and reliable questionnaires are needed for such studies.
There are several SR-related questionnaires. Most of these questionnaires are appropriate for the assessment of SR among the general public and also among the staff of professions other than nursing. Most of these questionnaires are not appropriate for SR assessment among nurses due to the unique conditions of nurses' work and workplace. In addition, most of them were developed based on the results of literature reviews, and are not based on nurses' own experiences and viewpoints. Experts highlighted the importance of developing instruments based on the experiences of the target population., Besides, most of the existing SR-related questionnaires were developed in Western countries and may provide no reliable data about Iranian nurses' SR even in case of accurate translation and cross-cultural adaptation., The present study was conducted to address these gaps by developing a nursing-specific SR questionnaire for Iranian nurses.
This study aimed to develop and validate the Nurse SR Questionnaire (NSRQ) for Iranian nurses.
| Methods|| |
This methodological study was conducted in a qualitative and a quantitative phase. In the qualitative phase, the concept of SR among nurses was analyzed through a grounded theory study, and in the quantitative phase, a methodological study was conducted for NSRQ validation.
The qualitative phase
In this phase, the Strauss and Corbin's grounded theory method was used to determine the definitions and the dimensions of the concept of nurses' SR. Participants were 19 nurses purposively and theoretically recruited from health-care centers affiliated to Shiraz and Jahrom Universities of Medical Sciences, Shiraz and Jahrom, Iran. Inclusion criteria were a work experience of more than 1 year in nursing, the ability to share personal experiences, and willingness to participate in the study. The exclusion criterion was a refusal to stay in the study during data collection.
Data collection was done through in-depth semi-structured face-to-face interviews held at participants' preferred place which was mainly their workplace. The duration of each interview varied from 45 to 60 min. Interviews were conducted by the first author and started and continued using open-ended questions. Data collection was continued up to data saturation and the full development of the intended theory. Besides interviews, the existing SR-related questionnaires were retrieved and evaluated for item generation.
Data were analyzed concurrently with data collection through constant comparison and the three main steps, namely open, axial, and selective coding. Initially, each interview transcript was read several times to obtain a general understanding about its whole content. Then, meaning units were identified and coded and the generated codes were constantly compared and revised. In axial coding, the generated codes were categorized based on their similarities and differences. Consequently, the main dimensions of nurses' SR were identified and used for the generation of NSRQ items.
The quantitative phase
In this phase, we evaluated the psychometric properties of NSRQ, namely face, content, and construct validity, as well as reliability.
The face validity of NSRQ was evaluated using qualitative and quantitative methods. In qualitative face validity assessment, ten nurses were invited to give comments on the difficulty, ambiguity, and appropriateness of NSRQ items. In quantitative face validity assessment, the importance of each item was evaluated on a Likert scale with five points, namely “Absolutely important” (scored 5), “Somewhat important” (scored 4), “Moderately important” (scored 3), “Mildly important” (scored 2), and “Not important” (scored 1). Then, the impact score was calculated for each item and items with impact scores more than 1.5 were considered appropriate.
The content validity of NSRQ was assessed both qualitatively and quantitatively. In qualitative content validity assessment, several experts commented on the grammar, placement, wording, and scoring of NSRQ items. In quantitative content validity assessment, content validity ratio (CVR) and content validity index (CVI) were calculated. For CVR calculation, nine experts in instrument development and nursing were asked to rate items on the following 3-point scale: “Essential” (scored 3), “Useful but not essential” (scored 2), and “Not essential” (scored 1). According to the Lawshe's table of CVR critical values, items with CVR values more than 0.77 were considered appropriate. For CVI calculation, experts commented on the relevance of NSRQ items on the following 4-point scale: “Irrelevant” (scored 1), “Slightly relevant” (scored 2), “Somewhat relevant” (scored 3), and “Completely relevant” (scored 4). Based on the Waltz and Basel criteria,, items with CVI values >0.79 were considered appropriate.
For construct validity assessment, five nurses per NSRQ item were nonrandomly recruited from private and public hospitals in Iran to complete the questionnaire. Then, construct validity assessment was performed through exploratory factor analysis (EFA). In EFA, Kaiser-Meyer-Olkin test was used to check sampling adequacy, Bartlett's test was used to check factor analysis model appropriateness, principal component analysis with varimax rotation was used for factor extraction, and eigenvalues and scree plot were used to determine the number of factors., Eigenvalues >1 and factor loading values equal to or >0.5 were considered acceptable.
NSRQ reliability was assessed through the internal consistency and the stability assessment methods. For internal consistency assessment, twenty nurses completed the questionnaire and their data were used to calculate Cronbach's alpha. A Cronbach's alpha of >0.7 was interpreted as acceptable internal consistency. For test–retest stability assessment, twenty nurses completed the questionnaire twice with a 3-week interval and their data were used to calculate test–retest intraclass correlation coefficient.
All statistical analyses were carried out using the SPSS program (version 16, IBM Company, Chicago, United States). Normal distribution of the data was evaluated through the Kolmogorov–Smirnov test. EFA was done for factor extraction and Cronbach's alpha and intraclass correlation coefficients were calculated for reliability assessment.
This study was approved by the Ethics Committee of Jahrom University of Medical Sciences, Jahrom, Iran (code: IR. JUMS. REC.1396.010). Verbal and written informed consents were obtained from all participants, and they were ensured of the confidential management of their data, anonymity, privacy, and voluntary participation. Furthermore, the participants were informed of the research purposes.
| Results|| |
The results of the qualitative phase
SR was determined to be a multidimensional concept with subjective and objective aspects. In total, 84 items for NSRQ were generated and included in five main SR dimensions, namely acquiring divine satisfaction (14 items), achieving professional competence (20 items), management of clinical care (16 items), ethical commitment (17 items), and personality traits (17 items). Further revisions of the items reduced item number to 78, and six items were excluded due to their overlapping. Item scoring was performed on a 5-point scale with the following points: “Very lowly,” “Lowly,” “Moderately,” “Highly,” and “Very highly.”
The results of the quantitative phase
In the quantitative phase, the psychometric properties of the 78-item NSRQ were assessed.
In qualitative face validity assessment, five items were revised based on nurses' comments. For example, the item “I strive to preserve the values of the nursing profession” was revised to “I preserve the values of the nursing profession.” In quantitative face validity assessment, ten items were deleted due to item impact scores <1.5.
In qualitative content validity assessment, none of the items were removed, but some of them were revised based on the experts' comments. For example, the item “Clients are respected” was revised to “I respect patients.” In quantitative content validity assessment, 19 items were removed due to CVR values <0.77 and nine items were removed due to CVI values <0.79., The average scale-level CVI (Ave) of NSRQ was 0.91.
The 40-item NSRQ was completed by 200 nurses [Table 1]. The Kaiser-Meyer-Olkin test value was 0.872 and the Bartlett's test showed a significant correlation among items (P = 0.001). In EFA, four factors with eigenvalues >1 were extracted. Principal component analysis with a varimax rotation also showed that NSRQ had a four-factor structure. Thirteen items were removed due to factor loading values <0.5, and hence, the number of NSRQ items reduced to 27. The four extracted factors of NSRQ were labeled ethical commitment (nine items), clinical care management (eight items), professional competence (seven items), and divine satisfaction (three items). These four factors accounted for 49.59% of the total variance of NSRQ total score. The amount of the variance explained by each of the four factors of NSRQ was 18%, 14%, 10.495%, and 7.20%, respectively [Table 2]. The scree plot also confirmed the four-factor structure of NSRQ [Figure 1].
|Table 1: Demographic characteristics of the participants in the quantitative section (n=200)|
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|Table 2: The eigenvalues of Nurse Social Responsibility Questionnaire items and the percentage of the variance explained by the Nurse Social Responsibility Questionnaire dimensions|
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The Cronbach's alpha and the test–retest intraclass correlation coefficients of the 27-item NSRQ were 0.92 and 0.95, respectively. The Cronbach alpha coefficient and intraclass correlation coefficient for the four factors are also presented separately in [Table 3].
|Table 3: The Cronbach's alpha and the intraclass correlation coefficient values of the Nurse Social Responsibility Questionnaire scale|
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| Discussion|| |
This study was conducted to develop and validate NSRQ. The final questionnaire had 27 items in four main dimensions, namely ethical commitment, clinical care management, professional competence, and divine satisfaction. NSRQ has acceptable validity and reliability with a Cronbach's alpha of 0.92 and a test–retest intraclass correlation coefficient of 0.95.
The first dimension of NSRQ was ethical commitment. This dimension included the biggest number of items (nine items), indicating the importance of adherence to ethical principles among nurses. The items of the ethical commitment dimension are based on the moral obligations of nursing practice. Therefore, this dimension highlights that ethical commitment is the most important aspect of SR in nursing. Nursing is an ethical practice, professional ethics are inherent in the profession, and professional and ethical performance is considered as the most important responsibility of nurses. Respect for human rights and commitment to ethical practice are considered as the key components of nursing, and thereby, the extraction of the ethical commitment dimension from NSRQ is justified.
Management of clinical care was the second dimension of NSRQ. This dimension had eight items. Participants considered the management of clinical care as nurses' accountability to patients. Nurses need to be accountable to their patients due to their pivotal roles in health-care systems. Therefore, nurses' accountability can be considered as their management of clinical care. Nurses' SR can lead to the delivery of more comprehensive clinical care to patients. Thus, nursing managers should strive to promote the nurses' accountability to improve nursing care quality and clinical care management. In line with our findings, a former study showed that nurses' SR was equivalent to the provision of nursing care services such as clinical care, social justice advocacy, and community knowledge consultation.
The third dimension of NSRQ was professional competence and had seven items. Participants considered clinical competence as a requirement for SR and a key characteristic of socially responsible nurses. Previous studies also reported the same findings and considered professional competence as a professional value of nurses., To provide quality care in their humanitarian missions, nurses need to have professional characteristics, skills, and abilities such as clinical experience, ability to provide care to patients of all ages, ability to resolve conflicts, and ability to employ individuals in appropriate positions for which they have been trained., Another study introduced four main competencies for nurses, namely technical competence, critical thinking, organizational thinking, and communication skills.
The fourth dimension of NSRQ was divine satisfaction and consisted of three items. Our participants considered that the most important outcome of their services is divine satisfaction, implying that performing nursing tasks and helping others are religious duties. They also equated professional accountability with working for God. As they believed that God observes and rewards all things, they considered divine satisfaction as the ultimate goal of nursing care. An explanation for these findings is the fact that religious beliefs have significant effects on Iranians' and Muslims' thoughts, behaviors,, culture, and life. A study reported that the patient's satisfaction is not separate from God's satisfaction, and therefore, patient care is actually a service to God. Nursing participants in another study also sought job satisfaction in patient and divine satisfaction.
One of the strengths of the present study was the assessment of the most important psychometric properties of NSRQ. Moreover, the questionnaire has a limited number of items and its completion takes a short amount of time. Future studies are recommended to evaluate the construct validity of NSRQ through confirmatory factor analysis on the data collected from a larger sample of nurses. Moreover, the NSRQ is a self-report questionnaire that might expose the studies to social desirability bias.
| Conclusion|| |
This study suggests that NSRQ is a valid and reliable questionnaire for SR assessment among nurses. Health-care managers can use this questionnaire to periodically review nurses' SR, develop interventions for its promotion, and thereby, improve nursing care quality.
This research was funded by the research department at Jahrom University of Medical Sciences of Iran. The authors would like to gratefully thank all nurses and a panel of experts who participated in this study.
Financial support and sponsorship
This research was funded by the Research Department at Jahrom University of Medical Sciences of Iran.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]