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Measuring the qualities of nurses: development and testing of the qualities of nurses scale.

ABSTRACT

Aim. This paper reports on the creation, development and testing of a new instrument to measure qualities of nurses, known as the Qualities of Nurses (QON) scale, applicable to student nurses.

Background. High attrition rates within nursing programs and during early postgraduate years are an international phenomena. Mismatches between idealized perceptions of nursing and the realities of education and clinical experiences have been identified as contributing factors.

Method. A survey method was used to elicit responses to scale items from 678 first-year nursing students at a large university.

Results. A one-factor 12-item solution explaining 47 percent of variance in the construct was demonstrated.

Conclusion. The QON can assist in the initial assessment and ongoing monitoring of changes in students' perceptions of nurses. Using the QON, researchers and educators can identify initial student nurses' perceptions and any changes associated in educational or other events that ultimately could be manipulated to reduce attrition.

Key Words Attrition--Nursing Career--Perceptions of Nursing--Qualities of Nursing--Nurse Recruitment--Nurse Self-Image

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A SUSTAINABLE NURSING WORKFORCE IS FUNDAMENTAL TO THE HEALTH CARE SYSTEM (O'BRIEN-PALLAS & HAYES, 2008) AS WELL AS THE QUALITY OF PATIENT CARE (JOHNSTONE & KANITSAKI, 2006). The aging of populations from developed countries (Buchan, 2001) coupled with the aging of the nursing workforce (Duffield, Roche & Merrick, 2006; Gabrielle, Jackson, & Mannix, 2008; Palumbo, McIntosh, Rambur, & Naud, 2009) have resulted in an increasing demand for nurses. Other factors such as the high rate of attrition from nursing baccalaureate programs, which ranges from 10 percent to 25 percent in Australia (Andrew et al., 2008), up to 18 percent in the United States (Sadler 2003), and up to 40 percent in the United Kingdom (O'Brien-Pallas & Hayes, 2008), is of concern. In addition, the early departure of new graduates to other careers continues to compound the problem. Gaynor, Gallasch, Yorkston, Stewart, and Turner (2007) reviewed the results of four studies that utilized graduate attrition as a research outcome, finding attrition to be at 19 percent to 27 percent at the end of 12 months. Mismatches between idealized perceptions of nursing and the realities of education and clinical experiences have been identified as major factors in these attrition rates (Pitt, Powis, Levett-Jones, & Hunter, 2012; Wilson, Chur-Hansen, Marshall, & Air, 2011).

This article reports on the development and psychometric testing of the Qualities of Nurses (QON) scale. The instrument is designed to identify mismatches between perceived and real understandings of nurses and nursing and provide insights into recruiting suitable students for schools of nursing.

Background A number of researchers have provided ideas about why students do not complete nursing school (Bolan & Grainger, 2009; Sadler, 2003), noting that those with idealized views of nursing upon entering nursing school are more likely to leave when they have clinical experiences. Conversely, students with views of nursing consistent with the reality of nursing usually complete nursing school and subsequently are more likely to join the workforce (Bolan & Grainger). Using comparative and longitudinal designs, researchers have examined student perceptions and how they are altered over time (Bolan & Grainger; Grainger & Bolan, 2006; O'Brien, Mooney, & Glacken, 2008).

Images and perceptions of nurses are often derived from the media and the Internet (Kalisch, Begeny, & Neumann, 2007). Some are positive images that portray nurses as caring, compassionate individuals who require a high level of technical skills, while others depict nurses as requiring direction and "dependent on doctors" (Stanley, 2008, p. 85). Brodie et al. (2004) summarized the literature about perceptions of young people in relation to nursing as: nursing would be easy to get into with lower academic requirements (although ethnic minorities identified the entry requirements as high for nursing), and nursing is a job with little opportunity to use intellectual abilities or a mainly physical job. The perception of nursing as a career was examined in a group of high academic achieving British students who derived their concepts of nursing from television (Neilson & Lauder, 2008). They did not believe that by entering a nursing program, students used their grades to the "maximum benefit." They believed that doctors cured, nurses cared, and that nursing was a practical and routine occupation.

Another key issue is that real-world nursing experience may result in increased attrition within schooling. In the United Kingdom, student attrition was related to lack of support during placement, traveling difficulties, financial hardship, personal or family problems, and a disparity in perceptions of nursing and disillusionment with the health care industry (Brodie et al., 2004). Changes in perceptions of nursing following experience were related to the amount of education and clinical experiences of the student (Brodie et al.). More concerning was the finding that the perceptions were negatively altered, confirming the presence of misconceptions about nursing.

A United States study by Sadler (2003) identified differences between students who completed a nursing program (completers) and those who dropped out (noncompleters) and explored different aspects of nursing roles. Completers more frequently described a long-held wish to become a nurse, while noncompleters discussed nursing as something "to do" rather than "to be" (p. 626). The author suggests that certain questions be used to identify completers, such as personal experience with a nurse, caregiving for relatives or in paid positions, or whether the student describes wanting "to be" a nurse (p. 627). These findings suggest that there are qualities of a nurse that potential students want to or do have that are important to attrition and recruitment.

A Canadian study also examined the perceptions of nursing students in a BSN program. Grainger and Bolan (2006) reported a positive image of nursing from first- and fourth-year groups; however, fourth-year students had more knowledge of the roles of nurses and had "a realistic perception of the multiple roles and opportunities within nursing" (p. 42). First-year students saw nurses as "kind, compassionate people in an exciting career and feeling good about what they are doing" (p. 42), while more experienced students believed nurses should be paid more and required advanced education. Grainger and Bolan further emphasized the need for a "realistic image" of nursing once students enter nursing programs.

Many authors have confirmed the importance of realistic perceptions for nursing students. As can be seen from the literature, broad imagery about nursing could be used as an instrument to measure qualities of nurses among students who have completed nursing school ("leavers") and those who have just started the program. Surprisingly, only a small number of instruments have been used to determine perceptions of nurses and nursing among nursing school students.

The Nursing Attitude Questionnaire (NAQ) is among one of the earliest tools in the literature (Toth, Dobratz, & Boni, 1998) and has been used in contemporary research (Bolan & Grainger, 2009; Grainger & Bolan, 2006), measuring nursing roles, values, responsibilities, characteristics of nurses, nursing, professionalism, and stereotypes of society. It included what nurses do, e.g., "Nurses are patient advocates" (Bolan & Grainger, p. 778), and other aspects, such as "Nurses should have a baccalaureate degree for entrance to practice." No construct validity testing using factor analysis was undertaken; however, several factors may exist within the tool. Reliability was demonstrated and construct validity using contrasted groups was reported (Grainger & Bolan).

The Nursing Orientation Tool (NOT) developed by Vanhanen and Janhonen (2000) is a widely used instrument developed from qualitative research methods and is designed to focus on student orientation to nursing within caring, nursing expertise, and life orientation (Grainger & Bolan, 2006), including "student's nursing experiences, feelings towards nursing and expectations of nursing as a career" (Bolan & Grainger, 2009, p. 777). Law and Arthur (2003) reported on an 11-item scale used in a sample of Hong Kong students to determine their perceptions of nursing as a career. The scale considers aspects of pay, status, gender (as a social construct), job characteristics, irregular time (shiftwork), and working with the sick. The Nursing Dimensions Inventory, containing 35 items within five factors, examined perceptions of nursing and items related to an understanding of the answer to the question, "As a nurse it will be important for me to ..." (Watson et al., 2003, p. 142). Most items in the scale required considerable knowledge and understanding of a nurse's role, for example, "Observe the effects of a medication on a patient" (p. 142).

Other instruments focus on specific aspects such as caring behaviors (Khademian & Vizeshfar, 2008). The Perceptions of Professional Nursing Tool (PPNT) measures perceptions of nursing among nurses, health care professionals, and health care consumers within 27 items and was modified for nursing students (Sand-Jecklin & Schaffer, 2006). What is evident from the literature is that there are instruments measuring nursing as a role (Sand-Jecklin & Schaffer; Watson et al., 2003) and aspects of career and life (Law & Arthur, 2003; Toth et al., 1998; Vanhanen & Janhonen, 2000), but no instrument uniquely measured qualities of nurses.

Method DESIGN A longitudinal, cross-sectional survey of beginning nursing students was used to conduct psychometric testing of the QoN. The QoN contained 21 items relating to qualities of nurses. A five-point Likert-type scale, ranging from 1 (not important) to 5 (very important) was used to assess participant responses. Demographic data such as age, sex, country of birth, prior health care industry experience, and university entry score were collected from existing student databases.

PARTICIPANTS We recruited a sample of beginning nursing students in 2009. All 780 students starting a baccalaureate-degree nursing program at a large metropolitan university in Sydney, Australia, were invited to participate. Of these, 676 students responded, representing an 87 percent response rate. It is worth noting that Australia has had entry to practice education at the degree level for approximately 20 years, so researchers from other countries with newly developed programs may find differing results.

Ethical approval was obtained from the university's Ethics Committee, Human Research Division. Details of the study aims and purpose were included on a website ("Becoming a Nurse") for participants. Written consent was obtained from all participants.

DEVELOPMENT OF THE QON The QoN instrument used a compilation of the most common themes from a content analysis of statements made by nursing students. During the previous year, in a course exploring professional issues in nursing, 700 new students were asked, "What qualities do you think are essential for professional nurses?" More than one half of the cohort claimed to have experience working in the health care setting; therefore, these responses to the item provided a realistic cross-section of perceptions.

Responses were entered into a database (NVivo 7, QSR International, Melbourne, Australia) to assist in sorting, classifying, and organizing the descriptors into nodes and clusters. References to some nodes were more common: caring (296 times), knowledgeable (290 times), professional (228 times), and helpful (180 times). The most frequently occurring 21 terms relating to qualities were drawn from these analyses, with the frequency of items greatly decreasing after 21 (47 to 11 responses). The final list of 21 terms was critiqued by a panel of 11 experts (nurses who were also academicians and researchers) for content validity. The expert panel rated each term for use in a short and succinct measure of the contemporary qualities of nurses on a scale of 1 (not a quality of nurses) to 4 (a definite quality of nurses). All 21 items scored highly in this assessment and were consequently retained in the instrument.

DATA ANALYSIS The 21 items were entered into a database (SPSS 17) and versions of the data were used in AMOS 17.0 (SPSS Inc., Chicago, IL). The data were treated as continuous rather than discrete, although there is a somewhat "ambiguous" nature to the data collected using Likert-type scales (Tabachnick & Fidell, 2007, p. 7). Analyses of the 676 responses included communality, Principal Component Analysis (PCA), using varimax rotations until one factor was generated. Although exploratory factor analysis (EFA) can explore possible underlying factor structures, confirmatory factor analysis, using structural equation modeling in LISREL (Joreskog & Sorbom, 2006), can verify the factor structure (Todman & Dugard, 2007). Once we identified the best solution (loading to one factor only), we undertook further reliability assessment and testing using Cronbach's alpha estimations and Pearson's correlations for item and scale relations to examine internal consistency. Correlation values of 0.2 indicated a weak positive linear relationship through to a strong positive relationship of 0.8. Values beyond 0.8 should were questioned to determine whether the same construct was measured (Tabachnick & Fidell).

Results DESCRIPTION OF SAMPLE AND DEMOGRAPHICS Most of the available population participated in the survey (676/780; 87 percent). Most students were women (80 percent), many of whom had previous health care experience (40 percent). (See Table 1.)

MEAN SCORES, INTER-ITEM CORRELATIONS, AND FACTOR ANALYSES Mean scores and correlations were reviewed for the 21-item model. The mean score of all items was in a narrow range from 4.35 to 4.80 (1-5). The results of item- and total-scale correlations revealed that most items in the 21-item model were significantly related (p < .01, two-tailed), ranging from .12 (competence and caring) to .69 (helpful and hard working). The weakest correlations included competence and, to a lesser extent, good team worker, empathetic, and ethical. PCA with varimax rotation was conducted on the initial 21 items. The Kaiser-Meyer-Olkin measure of sampling was .922 and Bartlett's test of sphericity was significant (> .001). The analysis revealed an unclear four-factor model with considerable cross-loading of items and a variance of 59 percent (Table 2).

QUALITIES OF NURSING MODEL RESPECIFICATION In a series of EFAs and reliability analyses (internal consistency assessment), items were removed based on whether the item cross loaded on to more than one factor or was only loaded on to a different factor (see Table 2 for a comparison of the original 21 items and the final 12 items). Item removal was followed by confirmatory factor analysis and model estimation. Once it was clear that the best solution in factor analysis was a one-factor congeneric model, the aim of construct validity was to create, test, and refine a one-factor global or unidimensional measure of the qualities of nurses (Tables 3 and 4). Internal consistency was examined using Cronbach's alpha procedures: The 21-item solution achieved .93 and the 12-item one-factor solution achieved .89.

Discussion This study sought to establish the validity and reliability of the QoN instrument, capturing qualities of nurses rather than the tasks or roles of nursing or the profession. The instrument was used for more than four years and a large student cohort was recruited in 2009. Because we received a very good response rate to the survey (87 percent), the sample was valid for testing of the instrument.

As in other studies, a sizable proportion of participants in this student cohort had experience in the health care industry (40 percent), suggesting that an important subgroup may exist within beginning students that warrants separate analysis (Cowin & Johnson, 2011), or, indeed, an oversampling to capture this group. A more homogeneous group of nursing students may be better described as students with no prior health care experience.

VALIDITY AND SCOPE OF ITEMS Face and content validity have been demonstrated through the methods used to identify the qualities; characteristics were developed from responses to open-ended questions from previous surveys of beginning students, similar to an instrument based on open-ended responses by Vanhanen and Janhonen (2000). The qualities selected--caring, compassionate, and professional attributes--reflect qualities or characteristics identified by other Canadian (Grainger & Bolan, 2006) and Swedish researchers (Lyckhage & Pilhammar, 2008). Bolan and Grainger (2009) used a combination of the Toth et al. (1998) NAQ and the NOT by Vanhanen and Janhonen (2000) to conduct a longitudinal study of student perceptions of nursing. The NAQ was a modified, 30-item tool with demonstrated content, construct validity, and internal consistency. The NOT measures aspects of caring, nursing expertise, and life orientation, with three factors reported as explaining a 35 percent variance using principal axis factoring in 17 items (Vanhanen & Janhonen). These instruments measure differing constructs and use more items than the 12-item QoN. We believe this is the first instrument that focuses solely on qualities of nurses.

The qualities identified in the QoN reflect similar images of nursing reported by Lyckhage and Pilhammar (2008) derived from short narratives of beginning students. This qualitative study identified three sets of student motives for choosing nursing: the idealistic helper (wants to work with people, is helping, caring, wishes to be needed), the realistic developer {is experienced as a health care professional, has personal growth, makes a good salary, makes a difference), and the young seeker (works in exciting places, easily finds various types of employment). The intent of the study was motive, although some aspects are similar to the QoN, particularly in relation to the idealistic helper.

The prominence of the aspects of caring is evident in the QoN, which is similar to other studies (nurses are kind, compassionate, empathetic, and sympathetic) (Bolan & Grainger, 2009). Khademian and Vizeshfar (2008) comprehensively examined the importance of caring behaviors of nursing students. Similarly, professional aspects were evident in the NAQ and QoN, such as nursing as a respected profession; by contrast,

some aspects were dissimilar, such as nurses should wear a white uniform to be identified. It is clear that the intention of the NAQ--attitudes toward nursing, including roles, values, responsibilities, characteristics of nurses/nursing, professionalism, and stereotypes of society (Grainger & Bolan, 2006)--was much broader than the constrained focus of the QoN on the qualities of nurses.

The PPNT uses 27 items to measure perceptions with practice, value, and public-valuing subscales. Items covered in valuing are similar to the QoN (e.g., hard working, professional). Although an extensive, direct comparison is not possible due to varying proposes of the instruments, some comparison is informative. The QoN reflects a predominance of aspects of caring and professional attributes, the major dilemma of occupational identity outlined by Apesoa-Varano (2007).

Construct validity, examined using varimax rotation, initially resulted in a four-factor solution using 21 items, explaining 59 percent of the variance in the construct and a model fit below the accepted level of .90 (goodness of fit [GFI] = .866). However, the first factor captured most of the variance (42 percent) with some cross loading on characteristics such as being dedicated, empathetic, good attitude, and hardworking. Because a short, simple instrument was sought, a one-factor solution was analyzed; it explained 47 percent of the variances in the 12 items and fit an acceptable model.

A global or one-factor congeneric scale (Ten Berge & Socan, 2007) has a number of advantages that may be appealing if a unidimensional approach is theoretically defensible. For example, a global scale is generally short, fast to complete, and, thus, more attractive to respondents. A global scale is often easy to manage and analyze, lends itself to smaller samples, and can have high face validity. Finally, this type of scale finesses issues that may arise from a longer multidimensional scale, such as determining factors critical to the measurement as well as those that are more peripheral. The disadvantages of creating and utilizing a global scale include the concept that information may be lost from the global scale and that it may not pick up critical factors because it is not sensitive enough (Bentler, 2007). Social desirability effects also are an important issue for any social research (De Vaus, 2002) and should be considered here because the respondents of the QoN aspired to develop the qualities they were asked to consider, as evidenced by their high scores. However, high scores were evident for most qualities, and, in large sample sizes, minor differences are usually detectable and can provide important information.

Based on the results, the one-factor solution is recommended for use with beginning students. We support a simple, short instrument to measure student nurses' perceptions of the qualities of nurses and favor the one-factor solution. Nonetheless, both solutions of the QoN are well short of the ideal of 65 percent of the variance being explained by the underlying items. Tinsley and Tinsley (1987) suggest that many scales only explain 50 percent of the variance of the underlying construct, even though 100 percent is the optimum sought, yet rarely achieved. Instruments vary based on the number of items and sample size, although the standard variance of 65 percent is the ideal. We propose that further items to capture aspects of nurses, perhaps derived from aspects of the "realistic developer" (Lyckhage & Pilhammar, 2008), may improve the explained variance. There was also a high proportion of participants with experience in the health care field (40 percent). To further isolate this impact, we analyzed those students with such experience and determined there was little variation; therefore, no justification existed for an alternative experienced health care professional instrument. The QoN demonstrated modest construct validity as well as content and face validity. However, a known group analysis was not conducted on the QoN nor was an examination of changes over time possible. Further research is required into the stability of the instrument over shorter time periods.

RELIABILITY-INTERNAL CONSISTENCY Internal consistency was examined using Cronbach's alpha procedures. The 12-item, one-factor solution achieved .89. The QoN demonstrated internal consistency with a minimum number of items. Vanhanen and Janhonen (2000) reported a coefficient of .84 for their 17-item NOT. The NAQ reported internal consistency from .77 to .80, whereas the PPNT instrument subscale coefficients ranged from .89 to .96 (Sand-Jecklin & Schaffer, 2006). Although the QoN four-factor solution demonstrated an increased overall scale coefficient of .92, this was not a favored solution given the number of items required.

The QoN and other instruments to measure perceptions of nurses, nursing, or similar aspects of a career path are important tools because they may provide quantitative evidence that unrealistic perceptions lead to later disenchantment with a student's chosen profession. For example, unrealistic perceptions may lead to attrition during the nursing program or within the first two years following graduation. Instruments such as the QoN must measure change for their utility to be fully developed; therefore, the ability to measure change will be the focus of further studies during subsequent waves of data collection. Additional studies utilizing the QoN with samples of students preparing for work at an enrolled, diploma-level and an associate's degree-level nursing program may provide important information on variation and diversity. In the future, researchers should examine the QoN, the NAQ, NOT, and the PPNT to consider which aspects of nurses' perceptions are important. Further research into interventions to manipulate perceptions of nurses has yet to be explored, but is an area for further research endeavors.

Conclusion The QoN may assist in the initial assessment and monitoring of ongoing changes in nursing students' perceptions of nurses. Changing perceptions of the qualities or characteristics of nurses may be influenced by many factors, including educational and clinical or socialization experiences. The availability of a valid and reliable instrument to measure such perceptions provides a valuable tool for career advisers, educators, managers, and researchers. By using the QoN as well as other instruments, researchers and educators may identify initial interpretations, changes in perceptions as they occur, and the temporal events likely attributable to such change and open to manipulation or intervention. High attrition rates in some Australian and international nursing baccalaureate programs coupled with high losses of nursing graduates is an issue of international concern, and tools and interventions to reduce these rates may be the keys to minimizing nursing workforce turnover.

References

Andrew, S., Salamonson, Y., Weaver, R., Smith, A., O'Reilly, R., & Taylor, C. (2008). Hate the course or hate to go: Semester differences in first year nursing attrition. Nurse Education Today, 28(7), 865-872.

Apesoa-Varano, E. C. (2007). Educated caring: The emergence of professional identity among nurses. Qualitative Sociology, 30, 249-274.

Bentler, P. M. (2007). Covariance structure models for maximal reliability of unit-weighted composites. In S.-Y. Lee (Ed.), Handbook of latent variable and related models (pp. 1-19), Boston: Elsevier/North-Holland.

Bolan, C., & Grainger, P. (2009). Students in the BN program: Do their perceptions change? Nurse Education Today, 29, 775-779.

Brodie, D.A., Andrews, G. J., Andrews, J. P., Thomas, G.A., Wong J., & Rixon, L. (2004). Perceptions of nursing: Confirmation, change and student experience. International Journal of Nursing Studies, 41, 721-733.

Buchan, J. (2001). Nurse migration and international recruitment. Nursing Inquiry, 4, 203-204.

Cowin L. S., & Johnson, M. (2011). Many paths lead to nursing: Factors influencing students' perceptions of nursing. International Nursing Review, 58, 413-419.

De Vaus, D.A. (2002). Surveys in social research. Sydney: Allen & Unwin.

Duffield, C., Roche, M., & Merrick, E.T. (2006). Methods of measuring nursing workload in Australia. Collegian, 13, 16-22.

Gabrielle, S., Jackson, D., & Mannix, J. (2008). Older women nurses: Health, ageing concerns and self-care strategies. Journal of Advanced Nursing, 61, 316-325. doi:10.1111/j.1365-2648.2007.04530.x

Gaynor, L., Gallasch, T., Yorkston, E., Stewart S., & Turner, C. (2007). Where do all the undergraduate and new graduate nurses go and why? A search for empirical research evidence. Australian Journal of Advanced Nursing, 24, 26-32.

Grainger, P., & Bolan, C. (2006). Perceptions of nursing as a career choice of students in the baccalaureate nursing program. Nurse Education Today, 26, 38-44.

Johnstone, M., & Kanitsaki, O. (2006).The moral imperative of designating patient safety and quality care as a national nursing research priority. Collegian, 13, 5-9.

Joreskog, K. G., & Sorbom, D. (2006). LISREL for Windows. Lincolnwood, IL: Scientific Software International.

Kalisch, B.J., Begeny, S., & Neumann B. (2007). The image of the nurse on the Internet. Nursing Outlook, 55, 182-188.

Khademian, K., & Vizeshfar, F. (2008). Nursing students' perceptions of the importance of caring behaviors. Journal of Advanced Nursing, 61, 456-462.

Law, W., & Arthur, D. (2003).What factors influence Hong Kong school students in their choice of a career in nursing? International Journal of Nursing Studies, 40, 23-32.

Lyckhage, D. E, & Pilhammar, E. (2008). The importance of awareness of nursing students' denotative images of nursing. Journal of Nursing Education, 47, 537-543.

Neilson, G. R., & Lauder, W. (2008). What do high academic achieving school pupils really think about a career in nursing: Analysis of the narrative from paradigmatic case interviews. Nurse Education Today, 28, 680-690.

O'Brien, F., Mooney, M., & Glacken, M. (2008). Impressions of nursing before exposure to the field perceptions of the nursing profession. Journal of Clinical Nursing, 17(14), 1843-1850.

O'Brien-Pallas, L., & Hayes L. (2008). Challenges in getting workforce research in nursing used for decision-making in policy and practice: A Canadian perspective. Journal of Clinical Nursing, 17, 3338-3346.

Palumbo, M.V., McIntosh, B., Rambur, B., & Naud, S. (2009). Retaining an aging nurse workforce: Perceptions of human resource practices. Nursing Economics, 27, 221-227, 232.

Pitt, V., Powis, D., Levett-Jones, T., & Hunter, S. (2012). Factors influencing nursing students' academic and clinical performance and attrition: An integrative literature review. Nurse Education Today, 32(8), 903-913.

Sadler, J. (2003). Effectiveness of student admission essays in identifying attrition. Nurse Education Today, 23, 620-627.

Sand-Jecklin, K. E., & Schaffer, A. J. (2006). Nursing students' perceptions of their chosen profession. Nursing Education Perspectives, 2 7, 130-135.

Stanley, D.J. (2008). Celluloid angels: A research study of nurses in feature films 1900-2007.Journal of Advanced Nursing, 64, 84-95. doi: 10.1111/j.1365-2648.2008.04793.x

Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics. Boston, MA: Pearson International.

Ten Berge, J. M. F. & Socan, G. (2007). The set of feasible solutions for reliability and factor analysis. In S.-Y. Lee (Ed.), Handbook of computing and statistics with applications, Vol. I (pp. 303-319).Amsterdam: Elsevier.

Tinsley, H. E.A., & Tinsley, D.J. (1987). Uses of factor analysis in counseling psychology research. Journal of Counseling Psychology, 34, 414-424.

Todman, J., & Dugard, P. (2007). Approaching multivariate analysis: An introduction for psychology. New York, NY: Psychology Press.

Toth, J. C., Dobratz, M.A., & Boni, M. S. (1998). Attitude toward nursing of students earning a second degree and traditional baccalaureate students: Are they different? Nursing Outlook, 46, 273-278. Vanhanen, L., & Janhonen, S. (2000). Factors associated with students' orientations to nursing. Journal of Advanced Nursing, 31, 1054-1062.

Watson, R., Deary, I. J., Hoogbruin, A. L., Vermeijden, W., Rumeu, C., Beunza, M., ... McCready, T. (2003). Perceptions of nursing: A study involving nurses, nursing students, patients and non-nursing students. International Journal of Nursing Studies, 40, 133-144.

Wilson, A, Chur-Hansen, A., Marshall, A., & Air, T. (2011). Should nursing-related work experience be a prerequisite for acceptance into a nursing programme? A study of students' reasons for withdrawing from undergraduate nursing at an Australian university. Nurse Education Today, 31 (5), 456-460.

Maree Johnson, PhD, RN, is professor, University of Western Sydney School of Nursing and Midwifery, Sydney, New South Wales, Australia. Leanne Cowin, PhD, RN, is head of the Master of Nursing Program, University of Western Sydney School of Nursing and Midwifery. The authors would also like to express their thanks and appreciation to the nursing students who gave their time, effort, and enthusiasm to help formulate and conduct this study. Contact Dr. Cowin at l.cowin@uws.edu.au for more information.
Table 1. Participant Demographics (N = 676)

Variable Category n Percent Missing

Course entry UAI 195 28.9 18
 International student 108 16
 Unitrack 50 7.4
 SAT and mature entry 305 45.1

Sex Men 132 19.6 2
 Women 542 80.3

Age (y) [less than or equal to] 18 152 22.5 1
 19-22 191 28.2
 23-31 164 24.3
 32-60 168 24.9

Working in Yes 268 39.7 18
health care No 390 57.7
field

Country Australia 313 46.3 42
of birth Philippines 60 8.8
 China 55 8.1
 Fiji 24 3.6
 India 20 3
 Vietnam 14 2.1
 South Korea 12 1.8
 Sierra Leone 10 1.5
 Other countries (52) 116 17.2

School leaver 18 + below 152 22.5 1
 19 + above 523 77.4

Note. UAI = Universities Admission Index (score out of possible 100);
Unitrack = pre-admission trial study unit; SAT = Scholastic Aptitude
Test score; mature entry = entry pathway based on age > 21

Table 2. Initial Exploratory Factor Analysis (21 Items) and
Final Analysis (12 Items) (N = 676)

Variable Factor

 1 2 3 4

Caring .33 .71
Compassionate .76 .32
Competent .83
Dedicated .33 .32 .35 .46
Empathetic .41 .57 .37
Ethical .68
Good attitude .41 .39 .38
Good communicator .77
Good listener .79
Good team worker .67
Hard working .59 .36
Helpful .70
Honest .62
Knowledgeable .65
Patient .62 .32
Professional .48 .45
Respectful .60
Sense of enjoyment .55 .44
Sympathetic .59 .53
Trustworthy .60 .36
Understanding .623 .32

12-Item Component Matrix (b)

Variable Component

Caring .52
Dedicated .71
Empathetic .64
Good communicator .62
Hard working .73
Helpful .81
Honest .73
Knowledgeable .66
Professional .62
Respectful .70
Trustworthy .70
Understanding .73

Note. Only loadings over 0.30 listed.

(a) Four components extracted, 58.95% of variance explained.

(b) One component extracted, 46.72% of variance explained.

Table 3. Mean, Standard Deviations, and Correlations for Final 12-Item
Qualities of Nursing Scale (N = 676

 Mean SD Caring Dedicated Empathetic

Caring 4.74 .57 1
Dedicated 4.63 .65 .35 1
Empathetic 4.46 .78 .23 .45 1
Good communicator 4.77 .46 .26 .39 .28
Hard working 4.66 .57 .24 .52 .37
Helpful 4.67 .55 .30 .53 .46
Honest 4.69 .61 .22 .48 .37
Knowledgeable 4.75 .54 .20 .40 .36
Professional 4.77 .49 .23 .32 .26
Respectful 4.70 .62 .23 .41 .39
Trustworthy 4.76 .53 .22 .37 .34
Understanding 4.74 .52 .30 .46 .42

 Good Hard
 Communicator Working Helpful Honest

Caring
Dedicated
Empathetic
Good communicator 1
Hard working .41 1
Helpful .45 .69 1
Honest .37 .49 .59 1
Knowledgeable .32 .48 .49 .54
Professional .37 .41 .36 .33
Respectful .39 .43 .54 .47
Trustworthy .31 .39 .42 .43
Understanding .42 .50 .62 .51

 Knowledgeable Professional Respectful

Caring
Dedicated
Empathetic
Good communicator
Hard working
Helpful
Honest
Knowledgeable 1
Professional .41 1
Respectful .45 .39 1
Trustworthy .30 .37 .48
Understanding .46 .33 .48

 Trustworthy Understanding

Caring
Dedicated
Empathetic
Good communicator
Hard working
Helpful
Honest
Knowledgeable
Professional
Respectful
Trustworthy 1
Understanding .48 1

Note. Correlation is significant at the 0.01 level (two-tailed), > .20.

Table 4. Respecified Model of 12 Items, Including Goodness of Fit and
Path Loadings

 Standardized Squared Model Fit Statistics
 Regression Multiple
 Weights Correlations

Dedication .71 .49 Chi-square 502.181
Empathy .64 .42 Degrees of freedom 108
Good
 communicator .62 .35 Probability .001
Hard worker .72 .49 RMR .01
Helpful .91 .62 GFI .94
Honest .73 .44 AGFI .91
Knowledgeable .66 .40 PGFI .65
Professional .62 .28
Respectful .70 .41
Trustworthy .70 .47
Understanding .73 .56
Caring .52 .28

Note: RMR = Root mean square residual; GFI = Goodness of Fit;
AGFI = Adjusted Goodness of Fit; PGFI = Parsimony Goodness-of-Fit
Index
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Title Annotation:NURSING EDUCATION RESEARCH / NURSE QUALITIES SCALE
Author:Johnson, Maree; Cowin, Leanne
Publication:Nursing Education Perspectives
Geographic Code:8AUST
Date:Mar 1, 2013
Words:5388
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