Validation of the Psychometric Properties of the Nursing Culture Assessment Tool for Use in Long-Term Care

Monday, 22 July 2013: 1:30 PM

Susan M. Kennerly, PhD, RN
School of Nursing, College of Health and Human Services, University of North Carolina Charlotte, Charlotte, NC
Tracey L. Yap, PhD, RN, WCC, CNE
School of Nursing, Duke University, Durham, NC

Learning Objective 1: The learner will be able to describe the psychometric properties of the Nursing Culture Assessment Tool.

Learning Objective 2: The learner will be able to discuss the NCATís potential use for baseline assessment of nursing culture in order to guide changes in occupational culture.

Purpose: Nursing’s occupational subculture encompasses beliefs, attitudes, and values that impact cultural norms supporting patterns of behavior and care practices that can consistently produce quality care outcomes. The Nursing Culture Assessment Tool (NCAT), previously determined to be valid and reliable, aims to capture general aspects of nursing culture in diverse healthcare settings. We will present the NCAT’s revalidation for use in long-term care (LTC) settings.  

Methods: The sample (n=318) was composed of 211 individuals working in Kentucky LTC facilities combined with participants from a prior cross-sectional study of 107 individuals working in LTC in Kentucky or Ohio. Using a survey approach, participants were asked to rate their perceptions (Strongly Disagree=1, Disagree=2, Agree=3, Strongly Agree=4) of 19 declarative statements about culture in their work setting. Data analysis was conducted to reconfirm the NCAT’s dimensionality, reliability, and empirical construct validity with this larger LTC sample. Empirical construct validity was tested using confirmatory factor analysis. Analysis of variance (ANOVA) was used to test for differences in item responses by nurses' licensure status or primary/secondary sub-groups.

Results: The NCAT’s six previously determined subscales (behavior, expectations, teamwork, communication, satisfaction, professional commitment) of the 19 item questionnaire were validated by calculating the comparative fit index and the standardized root mean-square residual (CFI=0.94, SRMR=0.05). Standardized loadings ranged from 0.65 to 0.94. Cronbach’s alpha coefficients for subscales were medium to high (0.72 to 0.92). ANOVA results revealed paired differences among nursing licensure categories for the professional commitment subscale. 

Conclusion: The NCAT provides LTC leaders a reliable means for measuring individual and group nursing staff perceptions about attitudes and behaviors associated with their work and work relationships. The NCAT can be used for baseline assessment of clinical unit or a facility’s nursing culture to guide changes in occupational culture that can potentially lead to improved care outcomes.