Development of the ECMO nursing self-efficacy Perception scale: A validity and reliability study

Caring for patients receiving ECMO in the ICU is a complex process that requires advanced knowledge, technical skills, and confident clinical decision-making from nurses. Despite the increasing use of ECMO in Türkiye, no comprehensive, validated tool exists to measure ICU nurses' self-efficacy in ECMO care. This methodological study aimed to develop the ECMO Nursing Self-Efficacy Perception Scale (ECMO-SEPS) and evaluate its psychometric properties. The scale was developed in two stages. In the first stage, an item pool was generated through an extensive literature review and qualitative interviews with seven ICU nurses experienced in ECMO care. In the second stage, the scale's content and construct validity were assessed using confirmatory factor analysis, including convergent and discriminant validity evaluations. Reliability analyses included internal consistency, evaluated by Cronbach's alpha coefficients, and test-retest reliability, assessed with intraclass correlation coefficients. The final scale consists of 37 items across three subscales: cognitive, affective, and psychomotor, collectively explaining 70.5% of the total variance. Confirmatory factor analysis supported the three-factor structure with acceptable to good model fit indices. The overall Cronbach's alpha was 0.97, with 0.97, 0.81, and 0.96 for the cognitive, affective, and psychomotor subscales, respectively, indicating high internal consistency. Test-retest results demonstrated excellent stability over time. In conclusion, the ECMO-SEPS is a valid and reliable instrument for objectively assessing ICU nurses' self-efficacy in ECMO care. Its use may facilitate standardized evaluations and inform evidence-based education, workforce planning, and clinical practice in ECMO programs.