Development and Psychometric Evaluation of the Nursing Management Capacity Scale for Poststroke Dysphagia Based on the Donabedian Model.

BACKGROUND

Poststroke dysphagia is common and adversely affects patient outcomes, yet no standardised tool exists to assess nursing management capacity in this area.

AIM: To develop and validate the nursing management capacity in poststroke dysphagia (NMC-PSD) Scale, a self-report instrument measuring nurses' perception of unit-level management capacity.

METHODS

The 35-item scale was adapted from an existing checklist and refined through two rounds of Delphi consultation (I-CVI = 0.80-1.00; S-CVI/Ave = 0.93) and pilot testing. A cross-sectional survey provided psychometric validation. The scale uses a mixed model: a formative structure dimension (resource inputs jointly constituting capacity) alongside reflective process and outcome dimensions. Reliability was evaluated using Cronbach's α for the reflective dimensions and test-retest ICC for the total scale and the human resources composite.

RESULTS

In 410 nurses from 12 Chinese provinces, the 26-item reflective core showed adequate internal consistency (process α = 0.97; outcome α = 0.95) and test-retest reliability (ICC = 0.98). Bifactor model fit was good: χ2(348) = 699.11, CFI = 0.958, TLI = 0.951, RMSEA = 0.050, SRMR = 0.027. The 26-item reflective core showed dominant unidimensionality (ECV = 0.869, ωH = 0.963) and is recommended as the primary validated metric (range 26-130). Nine formative structural indicators, supported by content validity (S-CVI/Ave = 0.93), are reported separately as descriptive resource inputs. Six specific factors had low independent reliability (ωHS = 0.05-0.19) and serve as conceptual or descriptive groupings only. Mean reflective total score was 54.71 (SD = 18.40); the exploratory weighted index was 207.87 (SD = 66.41).

CONCLUSIONS

The NMC-PSD Scale demonstrated acceptable psychometric properties as an individual-level measure of nurse-perceived unit capacity. A bifactor re-specification, developed post hoc within the same sample, revealed a dominant general factor underlying the 26 reflective items. Independent cross-validation is warranted. The 26-item reflective total score is recommended as the primary validated metric; nine formative structural indicators are reported separately as descriptive resource inputs. Subscale profiles serve as conceptual or descriptive item groupings only.

IMPLICATIONS FOR NURSING MANAGEMENT: The 26-item reflective total score supports individual-level inference regarding nurses' perceptions of unit management capacity. Organisational-level benchmarking requires further validation of within-unit agreement and aggregation reliability. The nine structural indicators offer descriptive resource profiling, and the exploratory weighted index remains supplementary pending criterion-related validation against objective administrative indicators.