Development and Validation of a Multidimensional Nursing Empowerment Scale (NES)

Empowerment in nurses is a multidimensional construct that has favorable results for both the patient and the employee and is emphasized in order to provide high-quality healthcare. For this concept to be translated into practice, measurement tools developed in this field are of critical importance. Although several validated instruments assess structural, psychological, or behavioral empowerment separately, each having been validated independently, using distinct samples, scoring frameworks, and item structures, no instrument evaluating all three dimensions simultaneously within a single scale has been identified. This gap limits nurse managers in comprehensively diagnosing empowerment and in evaluating the effectiveness of empowerment interventions.

The study was conducted to develop a valid and reliable measurement tool aiming to determine the empowerment levels of nurses in a multidimensional manner in terms of structural, psychological, and behavioral dimensions.

In this methodological study, the standard scale development and validation procedures required for instruments to be psychometrically sound were employed. An initial 256-item pool was generated based on a comprehensive literature review and an autoethnographic approach involving 36 nurses. Subsequently, face and content validity (Lawshe's technique) were evaluated. Data were collected between May and September 2017 from nurses (N = 1992) working across 10 hospitals affiliated with a regional health group in Istanbul; the study was completed with a final sample of 743 nurses (37.3%). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to determine the construct validity of the scale. Cronbach's alpha, item analyses, and test-retest analyses were employed to assess reliability.

The draft nursing empowerment scale (NES), developed as a result of the face and content validity studies, consisted of 136 items and was administered to the sample group. The EFA conducted resulted in a NES consisting of 103 items and three factors (structural, psychological, and behavioral), explaining 49.95% of the total variance (KMO = 0.97; Bartlett χ² = 58,144.65, p < 0.001). The scale factor structure was supported by supplementary CFA. The goodness-of-fit indicators (χ²/df = 3.75; RMSEA = 0.06; CFI = 0.92; NFI = 0.90; GFI = 0.90; AGFI = 0.88) were favorable. Internal consistency was observed (Cronbach's α = 0.98 overall; subscale α = 0.91-0.98) and 15-day test-retest correlation was r = 0.86 (subscale r = 0.73-0.83).

The NES demonstrates good psychometric properties as a comprehensive, multidimensional research instrument. Future research should test the scale on independent and diverse samples. Its considerable length (103 items) is acknowledged as a practical limitation, and the development of a shorter, practice-oriented form is planned.

The NES enables the simultaneous, multidimensional measurement of structural, psychological, and behavioral empowerment within a single instrument. It could be useful in determining empowerment levels and evaluating the effectiveness of targeted empowerment strategies.