Development and psychometric testing of quality nursing care scale in Mongolia

Quality Nursing Care (QNC) is fundamental to the profession of nursing practice. Perception of QNC differ across the globe because of differences in social norms, cultural values and political ambiance and economy. This study aimed to develop a QNC instrument congruent with the Mongolian (QNCS-M) healthcare system and cultural values and societal norms.

Exploratory sequential mixed-method design was implemented to develop and assess performance of QNCS-M. First, we focused on developing the components of QNCS-M and their operational definitions. Second, we dedicated to ascertaining psychometric performance of QNCS-M. The field testing consisted of assessing the construct validity and internal consistency reliability. Correlation between QNCS-M and the criterion tool, Quality of Nursing Care Questionnaire-Registered Nurse was evaluated.

The initial version of QNCS-M contained 66 items of which 7 (I-CVI < .78) were deleted after item-content validity assessment. The total-item correlation analysis yielded to exclusion of another 3 items (<.3). Additional 12 items were excluded after inter-item correlation (<.3, >.7). Results from Spearman rank-order correlation analysis of the remaining 44 items indicated relationship between social desirability and 6 items (r = -.09 to r = .11). These items were excluded to reduce the likelihood of potential information bias. A total of 38 items remained for exploratory factor analysis. Results from exploratory factor analysis yielded eigenvalues > 1.0 for the 9 domains. Three domains contained items fewer than 3. These domains and 2 items (factor loading <.4) were eliminated, yielding to 6 domains with 36-item. Results from internal consistency reliability yielded an overall Cronbach's α = .92; the coefficient values for the 6 domains ranging between .72 and .85 and Pearson correlation for stability reliability yielded an acceptable (r = .82, P < .001).

Improving the quality of healthcare services delivered by nurses is a priority for the Mongolian government. The development of QNCS-M is a major stride in addressing this concern. The final version of QNCS-M which contains 36 items, loaded into 6 domains, was morphed to the specifics of the Mongolian healthcare systems and cultural values and societal norms. QNCS-M demonstrates a high level of content and construct validity with acceptable reliability.