The Development and Psychometric Validation of the Ethical Awareness Scale

Abstract

Background: As established in professional codes of ethics, critical care nurses must be equipped to provide good (ethical) patient care. This requires ethical awareness, which involves recognizing the ethical implications of all nursing actions (ranging from the mundane to the dilemmatic). Ethical awareness is imperative in successfully addressing patient needs, however, evidence suggests that the ethical import of everyday issues may often go unnoticed by nurses in practice. Assessing nurses’ ethical awareness is a necessary first step in preparing nurses to identify and manage ethical issues in the highly dynamic critical care environment. Purpose: To use Rasch principles to develop a psychometrically sound instrument to assess the nature and extent of critical care nurses’ ethical awareness in the context of everyday nursing practice, and to assess the success of scale development using a Rasch model. Method: An item bank representing nursing actions was developed (33 items). Content validity testing with nursing ethics experts (n = 5) was performed (CVI-I = 1). Eighteen items were selected for face validity testing with graduate nursing students (n = 7). After revisions, two full-scale pilot administrations were performed to run item analyses. Sample: Critical care nurses (n = 116) at a large academic teaching hospital in New England. Results: Pilot test analyses suggest sufficient item invariance across samples and sufficient construct validity. Final analyses demonstrate a progression of items uniformly along a hierarchical continuum; items that match respondent ability levels; response categories that are sufficiently used; a Principle Components Analysis demonstrating randomness of residuals, and adequate internal consistency (Cronbach’s α = 0.83). Mean ethical awareness scores were in the low/moderate range (M = 34.9/54; logit = -0.21). Conclusion: The results of this study suggest the Ethical Awareness Scale (EAS) is a psychometrically sound, reliable, and valid measure of ethical awareness in critical care nurses.