Designing and psychometric evaluation of a Student Identification Scale with Safe Clinical Performance in Undergraduate Nursing: A Sequential Exploratory Study

Abstract

Abstract Background: Maintaining and promoting patient safety is a shared responsibility among all participants in the health care system and is a practical standard for educational institutions during their evaluation. Educators are required to balance the patient's rights to receive safe care and create a suitable and safe environment for nursing students to learn. Therefore, it seems that early identification of students with safe and unsafe clinical practice and intervention against it can be one of the important measures to improve patient safety. However, in the research conducted, a suitable scale for identifying students with safe clinical practice was not found. Therefore, due to the lack of conceptual clarity and knowledge gaps in the field of the concept of nursing students with safe clinical practice and the absence of a specific scale to measure this concept, the present study was conducted with the aim of designing and psychometrically measuring the scale "Measuring safe clinical practice in undergraduate nursing students". Methods: In the first stage, with the aim of explaining the concept of safe clinical practice in undergraduate nursing students, the analysis of the concept was carried out by the hybrid method in three stages (work in the field, theoretical work and integration). In the first stage, qualitative research was conducted with the contractual content analysis approach, with the participation of 19 academic staff members, nursing students, preceptors, supervisors and educational and safety supervisors of hospitals. At this stage, the participants were selected by purposeful sampling and semi-structured interviews were conducted. In the theoretical stage, extensive literature review was conducted with the aim of identifying the characteristics of the concept in previous studies and related scales, the findings of the two stages were integrated and the classes of the concept and their characteristics were determined. Scale items were produced using the findings of the qualitative phase and extensive literature review. Then scale validity with face validity, content validity (determining ratio and content validity index) and construct validity (using exploratory factor analysis on 248 final year nursing students) and convergent validity using Health Professional Education in Patient Safety scale. Survey (H-PEPSS) and its reliability was checked with the reliability method of internal consistency and stability by test-retest method (30 final year nursing students with a two-week interval). Findings: The data analysis in the qualitative part led to the identification of three classes: "readiness for safe clinical practice", "self-presentation" and "personal and professional factors". The draft scale was designed with 77 statements in a five-point Likert spectrum, and after determining the face validity and content validity, the number of items reached 44 items. Reliability analysis of internal consistency in a sample of 30 nursing students led to the elimination of one item. A scale of 43 statements was prepared for construct validity. In the exploratory factor analysis, one item was not loaded in any of the factors. And the analysis indicated the presence of three correlated factors with the explained variance of 36.17. The first factor with 31 items, called "development of knowledge and cognitive capacities" with a percentage of common variance of 25.83, the second factor called "self-expression" with 7 items, with a percentage of common variance of 6.40 and the third factor named " "personal-professional development" with 4 items, with a common variance percentage of 4.48. There was a significant correlation between the safe clinical practice identification scale and the safety competency perception questionnaire (P ≤ 0.001 and r=0.72). In the reliability check for the second time, one item was removed and finally the reliability of the 41-item scale was obtained with Cronbach's alpha coefficient of 0.82 and intraclass correlation coefficient of 0.97.

Conclusion: The findings of this research showed that in order for students to have safe clinical practice, they must reach a necessary stage of development and progress in terms of skills, knowledge, and attitudes. Also, they should have improvements in the field of some personal-professional characteristics. Also, students with unsafe clinical practice may use some tactics to impress their clinical instructors and succeed in getting a passing grade despite not having the skills and qualifications. Also, based on the findings of the quantitative section, the nursing student scale with safe clinical practice has the necessary validity and reliability to measure the different aspects of the concept of nursing students with safe clinical practice.