Design and Psychometric Evaluation of a Nursing Care Rationing Instrument

The present study aimed to design and validate an instrument for measuring nursing care rationing based on the limitations of existing instruments.

This study employed an instrument design and psychometric evaluation methodology.

In the initial item generation phase, an exploratory qualitative study using conventional content analysis was conducted through individual semi-structured interviews with 15 clinical nurses to extract rationing dimensions and formulate an initial item pool alongside literature reviews. Following face and content validity assessments, the psychometric properties of the instrument were evaluated among 220 clinical nurses recruited from educational hospitals. Construct validity and dimensionality were examined using exploratory factor analysis (EFA), Exploratory Graph Analysis (EGA) and Mokken Scale Analysis (MSA). Stability was further assessed via a Monte Carlo simulation (1000 replications), and reliability was evaluated using internal consistency indices and test-retest reliability (n = 30).

The final instrument comprises 12 items accounting for 71.97% of the total variance in exploratory factor analysis. A single-factor dimensionality was supported by EGA (with 100% item stability across 500 bootstrap iterations) and Mokken Scale Analysis (overall scalability coefficient $H=0.762$ ). Monte Carlo simulation (1000 replications) demonstrated high structural replicability (mean Tucker's congruence coefficient $=1.00$ , statistical power $=100\%$ ). Reliability assessments demonstrated high internal consistency (Cronbach's $\alpha =0.953$ , McDonald's $\omega =0.968$ ) and test-retest stability ( $\mathrm{ICC}=0.969$ , 95% CI: 0.953-0.985).

Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.