Ying Zou, Yiwen Chen, Lingyi Liao, Hongyu Chen, Changyue Gao, Changyan Yuan
The NMC-PSD Scale demonstrated acceptable psychometric properties as an individual-level measure of nurse-perceived unit capacity. A bifactor re-specification, developed post hoc within the same sample, revealed a dominant general factor underlying the 26 reflective items. Independent cross-validation is warranted. The 26-item reflective total score is recommended as the primary validated metric; nine formative structural indicators are reported separately as descriptive resource inputs. Subscale profiles serve as conceptual or descriptive item groupings only.
BACKGROUND: Poststroke dysphagia is common and adversely affects patient outcomes, yet no standardised tool exists to assess nursing management capacity in this area.
AIM: To develop and validate the nursing management capacity in poststroke dysphagia (NMC-PSD) Scale, a self-report instrument measuring nurses' perception of unit-level management capacity.
METHODS: The 35-item scale was adapted from an existing checklist and refined through two rounds of Delphi consultation (I-CVI = 0.80-1.00; S-CVI/Ave = 0.93) and pilot testing. A cross-sectional survey provided psychometric validation. The scale uses a mixed model: a formative structure dimension (resource inputs jointly constituting capacity) alongside reflective process and outcome dimensions. Reliability was evaluated using Cronbach's α for the reflective dimensions and test-retest ICC for the total scale and the human resources composite.
RESULTS: In 410 nurses from 12 Chinese provinces, the 26-item reflective core showed adequate internal consistency (process α = 0.97; outcome α = 0.95) and test-retest reliability (ICC = 0.98). Bifactor model fit was good: χ2(348) = 699.11, CFI = 0.958, TLI = 0.951, RMSEA = 0.050, SRMR = 0.027. The 26-item reflective core showed dominant unidimensionality (ECV = 0.869, ωH = 0.963) and is recommended as the primary validated metric (range 26-130). Nine formative structural indicators, supported by content validity (S-CVI/Ave = 0.93), are reported separately as descriptive resource inputs. Six specific factors had low independent reliability (ωHS = 0.05-0.19) and serve as conceptual or descriptive groupings only. Mean reflective total score was 54.71 (SD = 18.40); the exploratory weighted index was 207.87 (SD = 66.41).
CONCLUSIONS: The NMC-PSD Scale demonstrated acceptable psychometric properties as an individual-level measure of nurse-perceived unit capacity. A bifactor re-specification, developed post hoc within the same sample, revealed a dominant general factor underlying the 26 reflective items. Independent cross-validation is warranted. The 26-item reflective total score is recommended as the primary validated metric; nine formative structural indicators are reported separately as descriptive resource inputs. Subscale profiles serve as conceptual or descriptive item groupings only.
IMPLICATIONS FOR NURSING MANAGEMENT: The 26-item reflective total score supports individual-level inference regarding nurses' perceptions of unit management capacity. Organisational-level benchmarking requires further validation of within-unit agreement and aggregation reliability. The nine structural indicators offer descriptive resource profiling, and the exploratory weighted index remains supplementary pending criterion-related validation against objective administrative indicators.