Journal of Nursing Education

Major Article 

Development and Psychometric Assessment of the Nursing Competence Self-Efficacy Scale

Evelyn Kennedy, PhD, RN; Gail Tomblin Murphy, PhD, RN; Ruth Martin Misener, PhD, RN-NP; Robert Alder, PhD

Abstract

Background:

The study aim was to develop and psychometrically assess an instrument to measure baccalaureate nursing students’ self-efficacy for practice competence. Social cognitive theory includes the construct of self-efficacy and supports this study.

Method:

Before the Nursing Competence Self-Efficacy Scale (NCSES) was administered to senior nursing students (N = 252), nursing experts in research, practice, instrument development, and psychometrics participated in a two-step validation process consisting of two reviews. Construct validity assessments included content, face, contrasting groups, criterion, and exploratory factor analysis (EFA). The chosen EFA solution consisted of 22 items, each moderately or highly loaded by one of four factors deemed to be interpretable and parsimonious.

Results:

The initial psychometric assessment of the NCSES supported construct validity, internal consistency reliability (.919), and test–retest stability reliability (r = .831).

Conclusion:

With further psychometric assessment, the NCSES can be useful to evaluate new curriculum interventions aimed at increasing students’ self-efficacy for comprehensive practice competence. [J Nurs Educ. 2015;54(10):550–558.]

Abstract

Background:

The study aim was to develop and psychometrically assess an instrument to measure baccalaureate nursing students’ self-efficacy for practice competence. Social cognitive theory includes the construct of self-efficacy and supports this study.

Method:

Before the Nursing Competence Self-Efficacy Scale (NCSES) was administered to senior nursing students (N = 252), nursing experts in research, practice, instrument development, and psychometrics participated in a two-step validation process consisting of two reviews. Construct validity assessments included content, face, contrasting groups, criterion, and exploratory factor analysis (EFA). The chosen EFA solution consisted of 22 items, each moderately or highly loaded by one of four factors deemed to be interpretable and parsimonious.

Results:

The initial psychometric assessment of the NCSES supported construct validity, internal consistency reliability (.919), and test–retest stability reliability (r = .831).

Conclusion:

With further psychometric assessment, the NCSES can be useful to evaluate new curriculum interventions aimed at increasing students’ self-efficacy for comprehensive practice competence. [J Nurs Educ. 2015;54(10):550–558.]

To work and thrive in present and future global health care environments, RNs require complex skill sets (Benner, Sutphen, Leonard, & Day, 2010). RNs require the ability to cope with uncertainty and change, and they must be confident in their ability to do so. The capacity to manage increasingly complex patient conditions, problem solve, seek and use evidence-based information, think critically, and engage with colleagues is essential (Benner et al., 2010; Brown, Kirkpatrick, Mangum, & Avery, 2008).

The purpose of the current study was to develop and psychometrically assess the Nursing Competence Self-Efficacy Scale (NCSES). The construct of self-efficacy is central to social cognitive theory (SCT), the foundation of which supports this study (Bandura, 1986). Self-efficacy is commonly defined as having confidence in one’s capability to succeed in a specific context or a given situation (Pajares & Urdan, 2006). Unfortunately, many RNs may not feel confident in relation to their nursing practice (Jacobs, Fontana, Kehoe, Matarese, & Chinn, 2005; Roche, Diers, Duffield, & Catling-Paull, 2010). RNs may leave the profession due to a lack of confidence in their current and future practice ability (Benner et al., 2010). Attrition from professional nursing practice represents a tremendous loss, both human and financial, to health care systems worldwide (Corpus Sanchez International Consultancy, 2007; O’Brien-Pallas, Murphy, Shamian, Li, & Hayes, 2010). Workplace initiatives aimed at increasing practice self-efficacy and resilience of RNs may provide a cost-effective means to decrease attrition from nursing practice (Gibbons, 2010; Kravits, McAllister-Black, Grant, & Kirk, 2010; Maddalena & Crupi, 2008). Nurse educators can play an important role in enhancing nursing student self-efficacy for future nursing practice (Benner et al., 2010; Duchscher, 2009; Eggertson, 2011).

In the field of general education, it is widely accepted that for classroom strategies to be most effective, students must experience success in the tasks they expect to fail (Bandura, 1994; Margolis & McCabe, 2004; Usher & Pajares, 2006). Many studies report statistically significant findings that demonstrate the effectiveness of interventions designed to enhance student self-efficacy for academic study at all levels of education (van Dinther, Dochy, & Segers, 2011; Gaylon, Blondin, Yaw, Nalls, & Williams, 2012; Sitzmann & Ely, 2011). In their systematic review of factors affecting students’ self-efficacy for academics in higher education, van Dinther et al. (2011) reviewed 39 empirical studies using three inclusion criteria: (a) a focus on self-efficacy, as defined by Albert Bandura; (b) a focus on higher education; and (c) a description of factors influencing self-efficacy. Of the various intervention studies that van Dinther et al. reviewed, 80% reported a significant relationship among interventions designed to increase students’ self-efficacy and students’ reported self-efficacy. Their findings allowed them to confirm that student self-efficacy can be positively influenced by interventions designed to do so; that interventions based on the tenets of SCT are most effective; and that of the factors influencing student self-efficacy, mastery has the strongest influence. On the basis of their systematic literature review, van Dinther et al. stated, “we certainly are convinced after reading all the studies and the presented evidence that self-efficacy is vital to academic performance and that self-efficacy of students can be affected positively” (p. 105).

The general employment literature includes several studies reporting that employees with strong self-efficacy tend to cope effectively with adversity, persist in the face of failure, and are more likely to feel satisfied with the outcomes of their work (Bandura 2004; Pajares, Johnson, & Usher, 2007; Stajkovic, Lee, & Nyberg, 2009). The meta-analysis of 100 studies conducted by Stajkovic et al. (2009) examined relationships among collective efficacy, group potency, and group performance. Collective efficacy was significantly related to group performance, and group potency was positively related to group performance and collective efficacy.

Few studies related to self-efficacy are found in nursing education, nursing practice, or the nursing employment literature. A longitudinal study by McLaughlin, Moutray, and Muldoon (2008) examined the relationship between personality and self-efficacy in predicting students’ academic performance and attrition from nursing programs. An adaptation of the Occupational Self-Efficacy Scale (Betz & Taylor, 1994) was administered to students (n = 384) during their first year of study. Upon completion of the program, the results showed that higher occupational self-efficacy was statistically significant in predicting both higher final marks and lower attrition rates.

Existing studies report that strong self-efficacy in nursing practice has a positive effect on individual nurses and the care they provide, which subsequently impacts the entire nursing unit. Thus, improved outcomes for patients and the health care system may result (Chang, Li, Wu, & Wang, 2010; Lee & Ko, 2010; Townsend & Scalan, 2011). The influence of group contextual factors, such as collective efficacy, on both the individual nurse and the hospital health care team’s performance was considered in a study by Lee and Ko (2010). Their descriptive-correlation design study involved a convenience sample of 1,996 nurses from 182 nursing units in 28 hospitals in Korea. Their results showed that individual-level variables, including self-efficacy, were positively related to nursing performance. Two group-level variables—collective efficacy and the number of in-service sessions provided—were significantly and positively related to higher hospital-level performance.

Townsend and Scalan (2011) reported that “although self-efficacy has been incorporated into the work of many professions, minimal research has been conducted using this concept in clinical nursing education” (p. 1). In fact, published measurement instruments that specifically focus on self-efficacy in nursing practice are rare.

Lauder et al. (2008) compared participants’ (n = 99) observed nursing competence with reported self-efficacy using the 10-item General Perceived Self-Efficacy Scale developed by Schwarzer and Born (1997). They found small-to-moderate correlations between observed nursing competence and self-reported self-efficacy. This result supports the importance of using a self-efficacy scale that is specific to the construct of nursing competence. Self-efficacy measurement is most accurate and predictive when one is asked to measure one’s perceived ability in relation to specifically described tasks and situations (Bandura, 2005; Pajares & Urdan, 2006).

Oetker-Black, Kreye, Underwood, Price, and DeMetro (2014) developed the 14-item Clinical Skills Self-Efficacy Scale. That scale focuses specifically on hands-on nursing skills and tasks. Its focus is on the ability to transfer simulated laboratory practice skills to actual clinical practice. However, it does not provide comprehensive coverage of the RN role in professional nursing practice, as does the NCSES. Oetker-Black et al. supported the development of tools such as the NCSES by stating that “only two studies have examined the effects of incorporating self-efficacy into nursing education” (p. 253).

Stump (2010) measured student self-efficacy specifically related to caring for critically ill patients, using item response theory (IRT). However, a comprehensive scale to assess all areas of RN practice is needed. In addition, several authors suggested that given the increased sophistication, expertise, and complexity of design required for the IRT, they found no real advantage of using the IRT in affective domains (MacDonald & Paunonen, 2002; Sébille et al., 2010; Streiner, 2010).

Finally, Cheraghi, Hassani, Yaghmaei, and Alavi-Majed (2009) stated that they developed a self-efficacy scale specific to Iranian nursing education. In psychometric assessment, their scale demonstrated evidence of content validity, construct validity, concurrent validity, and internal consistency reliability and stability. Those Iranian professors also provided support for the development of a tool, such as the NCSES, by stating, “In the area of nursing education, little attention has been given to assess the contribution of beliefs such as self-efficacy, to clinical practice” (p. 216).

Method

Population

Senior-level undergraduate nursing students (N = 252) in four Canadian universities who agreed to participate in the study were administered the NCSES by one of the researchers (E.K.) within a 6-week period. To better ensure a comparable population and to determine whether educators had developed professional self-efficacy in soon-to-be-graduates, a decision was made to measure students’ level of self-efficacy in the final semester of their education. The decision to use a convenience sampling versus random selection from the target population—all Canadian senior undergraduate nursing students—was based on considerations of finance, distance, and time. The study population is hypothesized to be similar to the target population, as nursing students receive similar preparation to meet required levels of competence. To further enhance the generalizability of results, an environmental scan of randomly selected universities was undertaken. Demographic data were requested and compared with the demographic data in the study sample.

Scale Development Procedures

Construct validation methods included content and face validity assessment (Streiner & Norman, 2008). Initially, multiple items were developed based on the published documents Competencies in the Context of Entry-Level Registered Nurse Practice: A Collaborative Project in Canada (Black et al., 2008) and Entry-Level Competencies for Registered Nurses in Nova Scotia (College of Registered Nurses of Nova Scotia [CRNNS], 2013). It refers to “the knowledge, skills, judgments and attributes required of a registered nurse to practice safely and ethically in a designated role and setting” (Canadian Nurses Association, 2007, p. 11). The document was developed by numerous experts in nursing practice, administration, regulation, and education and currently includes 104 competency statements organized in five domains of professional nursing practice. In 2012, the Competencies document was reviewed and updated, using a jurisdictional collaborative process consisting of a combination of environmental scanning, literature reviews, and numerous stakeholder consultations. The Competencies document informs both education curricula and education practice, indicating, “The competencies aim to ensure that entry-level registered nurses are able to function in today’s realities and are well-equipped with the knowledge and skills to adapt to changes in health care and nursing” (CRNNS, 2013, p. 1).

Given that the aim of the current study was the development of a tool to measure self-efficacy related to the specific competencies considered necessary for entrance to the profession, the Competencies document was an obvious choice as the best resource for item development. Several of the competency statements were worded as items in the first draft of the NCSES. Following initial item development and pruning, a draft 66-item scale was developed and sent to a panel of experts (n = 8) for assessment. Panel members were chosen based on expertise in nursing education theory, scale development, practice competency development, and the mentoring of senior students. The panel was provided with the information required to conduct the content and face validity assessment. Items that 50% or more of the expert panel considered redundant, less relevant, or not having power to discriminate were removed. The NCSES contained 42 items following the initial expert panel review. Items noted by the panel to be unclear were reviewed and revised. A select subset of the expert panel (n = 4) reviewed the instrument 10 weeks later in the two-step process recommended by Polit and Tatano Beck (2008). Those authors further recommended that the second panel be a smaller subset of the first and that it includes individuals with specific expertise in the content area and in the critical appraisal of measurement items. A content validity index (Lynn, 1986) was completed by retaining those items that were scored as a 3 or 4 (based on a Likert scale of 1 to 4) on both relevance and clarity by all four members of the final expert panel.

Finally, a volunteer group of senior nursing students (n = 8), who were not included in the study and were in a different geographic area, completed the scale in the presence of one of the researchers (E.K.). They suggested adding examples to some of the items to relate the item to a specific scenario. For example, the original presentation of item #17 was: “As of today, how confident are you that you can recognize and seek immediate assistance in rapidly changing client conditions that could affect the client’s health or safety?” On the basis of student feedback, the following phrase was added to item #17: “(e.g., potential myocardial infarction or complication of surgery).” The 32 items deemed to be most relevant and clear by the researchers, the two-step expert panel members, and the student readers were included in the final NCSES. In addition to the developed items, basic demographic questions were added to the scale.

Prior to data collection, expert advice was solicited to ensure that the instrument was aesthetically pleasing and that the directions were clear. The items were scrambled on two developed versions of the scale. Participants were made aware of this fact, which added to participant confidentiality, as no participants were able to determine how the others were responding. Permission was obtained from all appropriate ethics review boards (four universities). Permission was requested and granted to visit senior students in their classrooms approximately 4 weeks before the data collection dates. This provided an opportunity to discuss the research topic, objective, and process. It also provided an opportunity to build rapport; answer questions; and read, discuss, and hand out the consent forms. The initial psychometric testing of a scale depends on an appropriate participant-to-item ratio; thus, a good response rate is important. Therefore, a raffle drawing incentive was offered to the students for participating.

The data were collected by using a self-administered pencil-and-paper numerical rating scale (Polit & Tatano Beck, 2008). Bandura (2006) stated that self-efficacy is concerned with perceived capability and not with intention; therefore, the wording in the stem of each item should use the phrase can do versus will do. Both Bandura (2006) and Pajares (2001) recommended that as many options as feasible be used in the response section to increase discrimination. Accordingly, the NCSES consists of a stem that asks a question in the “can you” format, with a 9-point response format.

The NCSES was administered by one of the researchers (E.K.), with the assistance of a faculty member, to groups of senior students in a setting where they normally are together (i.e., the classroom, following class). In a scale development study, many advantages exist to administering the scale personally, rather than using a mailing or electronic process. It was anticipated that further verbal assurances of anonymity would decrease social desirability and enhance candor in the students’ responses. Two separate NCSES administration times per site (spaced at least 1 hour apart and in different rooms) were scheduled to enhance anonymity of participation. This provided the added advantage of allowing for more participants, simply because the students had a greater latitude of when to participate.

One group of students completed the NCSES a second time, 2 weeks after the first administration, allowing for assessment of test–retest stability reliability, as recommended by Frei, Savarin, Steurer-Stey, and Puhan (2009). These senior students were asked to add their mother’s middle name and their favorite pet’s name to the response sheets at both sittings. Frequent reminders were provided to include this information. That process maintained student confidentiality, allowed for the matching of data sets, and reduced the potential risk of students forgetting their identifier.

The NCSES was also administered to a group of students in their second year of a 4-year program, using a known group technique. Because these students are hypothesized to be less efficacious related to entry-to-practice competence, a lower group score would be expected. Known group comparison can contribute to construct validity (by assessing responsiveness and precision) if the results are in the expected direction (Polit & Tatano Beck, 2008). Precision, as defined by Polit and Tatano Beck (2008), is: “An instrument should discriminate between people with different amounts of an attribute as precisely as possible” (p. 467).

No gold standard measure could be found to compare the construct criteria validity testing of the NCSES. Therefore, a second scale, measuring locus of control (an internally held self-belief considered somewhat similar to self-efficacy), was selected. The Internal Control Index developed by Duttweiler (1984) was chosen, as it is a preferred measure of locus of control, is known to have good internal reliability, and is generally considered to be a valid measure (Meyers & Wong, 1988). The Internal Control Index was administered to one group of senior students (n = 46), in addition to the NCSES.

Statistics

The data were appropriately prepared for analyses. An assessment for normal distribution was conducted using the Shapiro-Wilk statistic, the skewness and kurtosis measure, and visualization of the histogram and quantile-quantile plot (Tabachnick & Fidell, 2007). Construct validation and reliability analyses were then conducted.

Construct Validation. Content and face validation began with an in-depth assessment of the documents, Competencies in the Context of Entry-Level Registered Nurse Practice (Black et al., 2008) and Entry-Level Competencies for Registered Nurses in Nova Scotia (CRNNS, 2013), from which initial scale items were developed. This was followed by a two-step assessment by expert panels, as recommended by Polit and Tatano Beck (2008), assessment by student readers, and assessment with the Flesch-Kincaid measure of readability (Flesch, 1948). Contrasting group validity was assessed by using the t test statistic to compare second-year students with senior students (Polit & Tatano Beck, 2008). Construct criterion validity (Streiner & Norman, 2008) was sought between the Internal Control Index measure of internal locus of control and the NCSES by using the Pearson’s product-moment correlation coefficient. An exploratory factor analysis (EFA) was preceded by an assessment of sample size adequacy by the Kaiser-Meyer-Olkin output assessment and Bartlett’s test of sphericity (Burton & Mazerolle, 2011).

Reliability. Cronbach’s alpha statistic (Streiner & Norman, 2008) assessed for reliability of the entire NCSES and the resulting factors. The test–retest stability reliability of the NCSES was assessed by Pearson’s correlation coefficient (Burns & Grove 2009; Polit & Tatano Beck, 2008). Statistical analysis was conducted using SPSS® version 20 software.

Results

Participant Data

Of the potential 301 student participants, 252 (84%) volunteers completed the NCSES. The majority of participants were female (90%), most were aged 29 years and younger (83%), reported no dependents (82%), attained average grades higher than 80% prior to beginning nursing education (68%), and attained average grades higher than 70% in nursing education (89%). The age and gender of participants in this study were compared with the age and gender of senior Canadian undergraduate nursing students (target population) and were found to be consistent (Table 1).

Demographics of Study Sample (N = 252)

Table 1:

Demographics of Study Sample (N = 252)

Item-Derived Data

Given that missing data were random and were less than 1%, the mean response for a given item was substituted. This substitution is termed, cold-deck imputation, which is an overall item mean imputation method considered to be appropriate when missing data are random and comprise less than 5% of the total data set (Aday & Cornelius, 2006).

Administration of the 32-item NCSES to 252 senior nursing students resulted in 8,064 data items. A total of 85 outliers (0.01%) were identified, six of which were considered to be extreme, based on the outlier labeling rule (Hoaglin & Iglewicz, 1987). The outlier labeling rule was applied to the six extreme cases, and all six were found to be valid. Based on the occurrence, validity, strength, and percentage of the outliers, a decision was made to include them as valid data. Following appropriate preparation for analysis, the results obtained are discussed below.

The data in this study are considered approximately normally distributed. The Shapiro-Wilk statistic was measured at 0.982, which demonstrates how correlated the data are with what would be expected if the data were perfectly normally distributed. Skewness and kurtosis statistics and their associated standard errors also suggest a normal distribution (skewness = −0.541 and 0.155; Kurtosis = 0.459 and 0.308, respectively). A visual inspection of the histogram and normal quantile-quantile plot contributes to the assumption of an approximately normally distributed data set.

Construct Validation

The Flesch-Kincaid measure of readability confirmed the reading level of the NCSES to be at grade 11 (Flesch, 1948). An expert panel contributed to content validity by completing a two-step assessment of items for potential inclusion. Student readers evaluated the NCSES for clarity and ease of interpretation. Contrasting group validity was enhanced by t test, which rejected the null hypothesis of no difference in the means (p < .0001) between the scores of a second-year nursing student cohort and a senior nursing student cohort. Construct criteria validity was not supported, as no correlation between the Internal Control Index and the NCSES was obtained (r = .06).

All 32 items in the NCSES were subjected to the initial EFA. Given that the goal of EFA in the current study is to determine whether underlying factors, or latent traits, exist within the 32-item NCSES, a decision was made to use principal axis factoring as the method of factor extraction (Burton & Mazerolle, 2011; Tabachnick & Fidell, 2007). Oblique rotation was chosen because it allows items to correlate with each other if they are truly correlated (Costello & Osborne, 2005; Tabachnick & Fidell, 2007). The following three accepted criteria were considered when deciding how many factors to initially extract: the Kaiser criteria, the scree plot, and prior theory (Burton & Mazerolle, 2011). Several EFA solutions were examined, as recommended in the literature (Tabachnick & Fidell, 2007). The final preferred EFA solution, using principal axis factoring with an oblique rotation, consisted of 22 items, each moderately or highly loaded by one of four factors, with no cross-factor loadings. This four-factor solution (accounting for 57.4% of variance) was deemed to be both interpretable and parsimonious by the researchers (Table 2).

Final Exploratory Factor Analysis of Four-Factor Solution for the 22-Item Nursing Competence Self-Efficacy Scale With CommunalitiesFinal Exploratory Factor Analysis of Four-Factor Solution for the 22-Item Nursing Competence Self-Efficacy Scale With Communalities

Table 2:

Final Exploratory Factor Analysis of Four-Factor Solution for the 22-Item Nursing Competence Self-Efficacy Scale With Communalities

The factors seemed to be reflective of personal self-beliefs that may have resulted in increased student confidence and self-efficacy in specific domains of nursing practice. Factor 1 was labeled Proficiency. All of the items in factor 1 relate to self-efficacy for competence in clinical practice skills and assessment. Factor 2 was labeled Altruism. Factor 2 includes the largest number of items. These items relate to self-efficacy for competence in ethical situations and in caring, with a focus on patient advocacy and patient safety. Factor 3 was labeled Prevention. Factor 3 items relate to self-efficacy in the prevention of complications, the broad determinants of health, primary health care, a global view, and research evidence. Factor 4 was labeled Leadership. Factor 4 items relate to self-efficacy in skills normally associated with nursing leadership, mirroring those competencies currently included in many nursing leadership texts.

Reliability

The estimated Cronbach’s alpha for the revised 22-item NCSES with the study population was high (0.919). Reliability estimates for each of the four factors were found to be acceptable in this study; factor 1 loaded five items (0.789); factor 2 loaded seven items (0.845); factor 3 loaded six items (0.783); and factor 4 loaded four items (0.753). As expected, a moderate positive correlation exists between all four factors (Table 3).

Correlations Among Factors

Table 3:

Correlations Among Factors

The stability of the NCSES is supported by the computed statistic that indicates a positive correlation between the NCSES administration at time 1 and time 2 to paired groups of senior nursing students based on a test–retest stability reliability Pearson’s correlation coefficient (r = .831, 95% confidence interval = 0.774, 0.875). Burns and Grove (2009) suggested that for test–retest analysis, a Pearson correlation of .50 or higher (r > .50) is considered strong. Forty-seven of 57 students participated in the retest.

Discussion

Study Aspects

Nurse educators have the ability to intentionally improve students’ self-efficacy for competent nursing practice; conversely, they also have the potential to unintentionally damage it. However, implementing practice scenarios aimed at increasing nursing students’ self-efficacy for competence cannot replace the requirement of the assessment of nursing students’ actual competence. Existing evidence indicates only a moderate correlation between self-reported efficacy in a given situation and actual competence, as reported by Zell and Krizan (2014) in their meta-synthesis across 23 meta-analyses. It is noteworthy that in vocational areas requiring complex skill sets, the reported correlation is even lower.

Nurse educators have an unquestionable responsibility to ensure that students’ self-assessments are in line with their actual ability so they can become safe, competent practitioners. The NCSES may help determine whether graduates have been provided with a level of education, skill, and knowledge that prepares them to not only become competent and safe practitioners as mandated by regulation but to also thrive, prosper, and become innovators for positive change within the profession. Given that RNs form the largest group of health care providers in the world (Benner et al., 2010; Duchscher, 2009; Eggertson, 2011), ensuring that students’ are prepared to become both competent and confident practitioners is an important goal for nurse educators.

A search of the SCT literature provides evidence of the benefit of collective efficacy within teams. Increasing both individual and collective efficacy may foster independence, resilience, and confidence (Bandura, 1993, 1994). The benefits of collective efficacy in health care teams include improved outcomes for individual nurses, the health care team, and the recipients of the service they provide, as reported in recent studies (Lee & Ko, 2010; Stajkovic et al., 2009).

Limitations

The data in the current study show a slight negative skew, as many students chose answers of 5 and higher (based on a Likert scale of 1 = certain cannot do to 9 = certain can do) on most items. A skew toward the favorable end is commonly seen in scales that measure perceived ability (Streiner & Norman, 2008). This may reflect that participants envision the positive future they anticipate. Also, student scores may have been influenced by the presence of a member of their faculty, resulting in a slight social desirability influence (Polit & Tatano Beck, 2008).

The estimated reliability of the entire NCSES is high for a newly developed scale for the final 22 items (0.919). Although Streiner and Norman (2008) suggested that the current trend in scale development is toward more homogeneity of items and grounding of items in theory, future researchers may consider revising the scale with a view toward adding new items or adding examples to those items that did not discriminate well.

Construct criterion validation of the NCSES was not confirmed by comparing it to locus of control. This was not unexpected, given that although self-efficacy and internal locus of control are similar, they are, in fact, different constructs. It may be more appropriate to compare the NCSES with a self-efficacy–specific measure, such as the New General Self-Efficacy Scale by Chen, Gully, and Eden (2001), as it was assessed by Scherbaum, Cohen-Charash, and Kern (2006) and judged to have adequate psychometric properties. The most meaningful solution to EFA in the current study was achieved by principal axis factoring extraction, with an oblique rotation of 22 of the original items, resulting in four extracted factors. Gorsuch (2003) stated, “one can never state that one number of factors is the only number that can exist, just that it is one of the possible replicable solutions” (p. 161).

Finally, the items in the NCSES are based on published Canadian entry-to-practice competencies. Relevance of the NCSES in other countries has not yet been determined.

Implications for Future Research and Practice

As stated by Streiner and Kottner (2014), “no individual study can establish or prove reliability and validity of an instrument” (p. 7). Therefore, the current authors are conducting a replication of this initial psychometric assessment of the NCSES with a similar but much larger sample. This approach may support the factor structure described in the current study or provide new data to support modifications to the NCSES. If a meaningful and stable factor solution is agreed upon through additional EFA studies, a confirmatory factor analysis would then be appropriate (Gorsuch, 2003). The NCSES could then be utilized to empirically evaluate new or existing curriculum interventions specifically aimed at the enhancement of students’ self-efficacy for competent nursing practice. These interventions should be developed based on the tenets of SCT.

Experts in health and human resources have requested the introduction of unique identifiers for all professional health care providers, including students (Canadian Institution for Health Information, 1999). Unique identifiers would enable researchers to track practitioners without jeopardizing the confidentiality of individuals. If implemented, it may be possible that student scores on the NCSES can be compared over time with outcomes such as movement, attrition, and contribution to the profession.

Given that few studies have examined the construct of self-efficacy in nursing education, qualitative studies are also needed. Such studies conducted in relation to curriculum initiatives or adaptations based on SCT, will increase the current understanding of the construct of self-efficacy in nursing education and, in so doing, enhance, inform, and add meaning to the quantitative data the NCSES provides.

Conclusion

Little attention has been given to the role that nurse educators play in developing nursing students’ self-efficacy for nursing competence (Cheraghi et al., 2009; Oetker-Black et al., 2014; Townsend & Scalan, 2011). The current study contributes to the profession by providing an increased awareness and focus on this important role for nurse educators. This is a valuable contribution. In addition, the current study is the first to develop and assess a scale specifically designed to measure self-efficacy for comprehensive, competent RN practice. Therefore, this study contributes a newly developed measurement scale to the professional nursing literature.

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Demographics of Study Sample (N = 252)

DemographicSampleTarget
Gender90% female85% to 90% female
Age83% < 30 years85% < 30 years

Final Exploratory Factor Analysis of Four-Factor Solution for the 22-Item Nursing Competence Self-Efficacy Scale With Communalities

Question/ItemFactor 1 (Proficiency)Factor 2 (Altruism)Factor 3 (Prevention)Factor 4 (Leadership)Communalities
As of today, how confident are you that you can:
  22 Manage therapeutic interventions safely (e.g., drainage tubes)?.722.104−.086−.031.524
  23 Prepare clients for diagnostic procedures and treatments (e.g., colonoscopy)?.699.136−.071−.034.545
  12 Complete your assessments in a timely manner following agency protocols?.591−.091.130−.199.515
  9 Use the appropriate assessment tools and techniques for each body system (e.g., the neurological system) in consultation with clients and other health care team members?.588−.083.333−.064.608
  16 Manage multiple nursing interventions for clients with complex comorbidities, seeking appropriate consultation when needed?.457.080.159−.153.500
  28 Apply the Code of Ethics to address ethical dilemmas?−.013.706−.046−.134.519
  27 Demonstrate a good understanding of informed consent?−.021.627.083.038.383
  30 Demonstrate respect and knowledge of the unique and shared competencies of various members of the health care team?.166.590.019.093.398
  29 Advocate for clients especially when they are unable to advocate for themselves?−.042.522−.018−.253.429
  24 Provide nursing care to meet hospice, palliative, or end-of-life care needs?.068.443.028−.079.308
  21 Apply safety principles to prevent injury to clients, self, other health care workers, and the public?.295.378.251.131.493
  31 Take action in potentially abusive situations to protect self, clients, and colleagues from injury (e.g., bullying, nurse-to-nurse violence)?.223.349.035−.113.373
  7 Demonstrate awareness about the emerging global health issues?.026−.073.686−.005.426
  11 Demonstrate awareness of the health inequities of people who are affected by various kinds of discrimination?−.025.037.610.035.345
  8 Take part in nursing or health research by identifying research opportunities?.038.055.537−.066.371
  6 Demonstrate the broad knowledge base required for nursing practice?.230−.118.500−.254.546
  18 Assist clients to understand the link between health promotion strategies and health outcomes (e.g., dietary methods to lower cholesterol)?.014.269.441.001.402
  1 Use the Code of Ethics to maximize collaborative interactions within the health care team?−.123.264.356−.269.451
As of today, how confident are you that you can:
  4 Challenge questionable orders, decisions, or actions of other health care team members?.144−.032−.032.760.510
  3 Use conflict resolution strategies when necessary?.031.131.140.482.433
  5 Report a near miss in care (e.g., a narrow escape from a serious complication)?.141.111.068.463.409
  2 Make good practice decisions in the absence of agency policies and procedures?.091.190.065.341366

Correlations Among Factors

Factor1234
11.000.450.465−.505
2.4501.000.441−.455
3.465.4411.000−.457
4−.505−.455−.4571.000
Authors

Dr. Kennedy is Associate Professor, Cape Breton University, Sydney, Dr. Tomblin Murphy is Professor, and Dr. Martin Misener is Professor, Dalhousie University, Halifax, Nova Scotia, and Dr. Alder is Director, Canadian Epidemiology Services, and Adjunct Associate Professor, Department of Epidemiology & Biostatistics, Western University of Canada, London, Ontario, Canada.

This study was supported by Dalhousie University Nursing Research Fund grant 70605 8500.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Evelyn Kennedy, PhD, RN, Associate Professor, Cape Breton University, PO Box, 5300, Sydney, Nova Scotia B1P 6L2, Canada; e-mail: evelyn_kennedy@cbu.ca.

Received: November 13, 2014
Accepted: June 16, 2015

10.3928/01484834-20150916-02

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