Nurses’ attitudes towards physical health care of psychiatric patients scale

Authors

Purpose

The primary objective of the NATPHCPPS is to offer a psychometrically robust method for evaluating how prepared and willing psychiatric Nurses are to incorporate physical healthcare into their daily practice. While an older measurement tool existed in the literature, it suffered from weak explanatory power, accounting for only 42% of the variance in Nurses' attitudes. This falls short of modern psychometric standards, which generally require a scale to explain at least 50% of the variance to be considered adequately representative of the construct.

This newly developed scale fills a significant methodological gap by providing a highly reliable, theoretically grounded alternative. For clinical supervisors and researchers, having an accurate measure of these attitudes is essential. Because attitudes strongly predict future behavior, understanding where Nurses stand on this issue allows institutions to design targeted educational interventions, ultimately improving the physical health outcomes of a highly vulnerable patient population.

Construct

The NATPHCPPS is deeply rooted in the Tripartite Model of Attitudes, a foundational psychological framework which posits that human attitudes are constructed from three distinct but interacting components: cognitive (beliefs and thoughts), affective (feelings and emotions), and behavioral (actions and intentions). During the initial item generation phase, the researchers carefully mapped statements to these three theoretical domains to ensure comprehensive coverage of the construct.

Following empirical testing and factor analysis, this theoretical foundation naturally distilled into three specific, measurable sub-dimensions: Motivation, Emotional Challenge, and Responsibility Awareness. The Motivation and Responsibility Awareness facets capture the proactive, cognitive, and behavioral readiness of Nurses to take charge of physical health monitoring. Conversely, the Emotional Challenge facet captures the affective difficulties and negative emotional responses that Nurses might experience when tasked with duties outside their traditional psychiatric scope.

Validity

To establish the validity of the NATPHCPPS, the research team employed a rigorous, multi-stage validation protocol. Initially, content validity was secured through an expert panel review comprising specialists in both psychiatric nursing and psychometrics. Utilizing the Davis technique, the panel evaluated the initial 45-item pool, ensuring that all retained items achieved a Content Validity Index exceeding the strict 0.80 threshold, which indicates excellent expert consensus.

Construct validity was subsequently evaluated through advanced factor analytic techniques, ensuring the items mapped correctly to their intended theoretical dimensions. Furthermore, the researchers established convergent validity for the final model by calculating composite reliability and average variance extracted. By ensuring that composite reliability exceeded 0.70 and average variance extracted surpassed 0.50, the developers provided strong evidence that the items within each subscale are meaningfully and strongly related to their underlying latent constructs.

Reliability

The instrument demonstrates exceptional internal consistency, making it a highly dependable tool for both cross-sectional research and longitudinal clinical evaluation. The overall 16-item scale yielded a remarkable Cronbach's alpha of 0.94, indicating excellent cohesion among the items. The individual sub-dimensions also performed exceptionally well, with alpha coefficients of 0.93 for Motivation, 0.91 for Responsibility Awareness, and 0.86 for Emotional Challenge.

Beyond internal consistency, the researchers also established the temporal stability of the scale. A subset of 100 participants completed the assessment a second time after a two-week interval. The resulting intraclass correlation coefficients were evaluated against strict criteria, where values above 0.80 are considered good and those above 0.90 are excellent. This test-retest reliability confirms that the attitudes measured by the NATPHCPPS represent stable psychological traits rather than transient moods, ensuring the tool's utility in evaluating long-term educational interventions.

Factor Analysis

The underlying structure of the scale was investigated using a combination of Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). The dataset demonstrated excellent suitability for factor reduction, evidenced by a highly significant Bartlett’s Test of Sphericity and a robust Kaiser-Meyer-Olkin measure of 0.93. The EFA, utilizing Varimax rotation, successfully reduced the initial item pool down to a clean, 16-item model distributed across three distinct factors.

To rigorously test this newly discovered structure, a CFA was subsequently performed. The researchers evaluated the model against a comprehensive suite of goodness-of-fit indices, looking for a Normed Chi-Square ratio below 5, CFI and IFI values at or above 0.95, and an RMSEA below 0.08. It is important to note that the researchers used the same sample for both the EFA and CFA phases. While this is acknowledged as a methodological limitation in psychometrics, the team justified the approach through their robust sample size and the strict adherence to multiple, stringent fit indices during the confirmatory phase.

Subscales

Subscale	Items	Description
Motivation		Measures the proactive drive and willingness of psychiatric Nurses to engage in the physical health care of their patients.
Emotional Challenge		Assesses the negative affective responses, difficulties, and emotional barriers Nurses face when addressing physical health needs.
Responsibility Awareness		Evaluates the cognitive recognition and acceptance of physical health monitoring as a core component of the psychiatric nursing role.

Instrument

Test Type	Self-report questionnaire
Format	16 items, 5-point Likert scale
Scoring	Total scores range from 16 to 80. Items in the Motivation and Responsibility Awareness sub-dimensions are scored from 1 (Strongly Disagree) to 5 (Strongly Agree). Items in the Emotional Challenge sub-dimension are negatively worded and reverse-scored (5 to 1). Higher total scores indicate more positive attitudes toward providing physical health care.
Language	Turkish
Population	Nurses, Healthcare professionals
Age Group	Adults
Administration	Self-administered

Scoring & Interpretation Guidelines

Scoring Instructions

Reverse score all items belonging to the Emotional Challenge sub-dimension.

Nurses' attitudes towards physical health care of psychiatric patients scale Items

Sample

The validation sample consisted of 225 psychiatric Nurses employed at a psychiatric hospital in Türkiye, all of whom had at least six months of experience in the setting. The cohort was predominantly female (76.9%) and highly educated, with 79.1% holding a bachelor's degree. Participants had a mean age of 34.45 years (SD = 10.28) and an average of 7.49 years (SD = 8.87) of clinical experience working directly with psychiatric patients.