Development and Evaluation of Psychometric Properties of a Chinese Version Questionnaire for Measuring Emergency Nursing Interruptions

Abstract

Nursing interruptions occur frequently and often have adverse outcomes, threatening patient safety. Emergency departments have a high incidence of nursing interruptions owing to the concentration of critically ill patients and frequent emergencies. Current research mainly focuses on large hospitals and uses observation and interview methods. Therefore, there is a need to develop tools for measuring emergency nursing interruptions. This study develops a survey questionnaire on emergency nursing interruptions. It tests its validity and reliability by building on the conceptual framework of emergency nursing interruption proposed in the literature. Specifically, we develop a test version of the emergency nursing interruption survey questionnaire using a Delphi expert inquiry and preinvestigation. We selected 1047 emergency nurses in 22 provinces and autonomous regions of China to participate in the survey by completing the questionnaire between June and July 2023 to evaluate the validity and reliability of the questionnaire. The final questionnaire comprised 26 items across 5 dimensions-sources, types, interrupted nursing activities, consequences of interrupted nursing activities, and management of nursing interruptions. The content validity indexes were 0.948 at scale level and 0.842-1.000 at item level. We used exploratory factor analysis (EFA) to extract five common factors with a cumulative variance contribution rate of 66.550%. The results of the confirmatory factor analysis (CFA) demonstrated a good model fit. Cronbach's α coefficient of the questionnaire was 0.912, split-half reliability was 0.846, and the retest reliability calculated using the intraclass correlation coefficient was 0.915. To ensure the structural validity of the scales, EFA and CFA were conducted using two different datasets. Thus, the questionnaire showed good validity and reliability and can be used to evaluate how nurses understand emergency nursing interruptions.

Keywords: emergency department; nursing interruptions; patient safety; questionnaire; reliability; validity.

Figure 1

Theoretical framework. Note: (1) Breaks are planned or spontaneous recesses taken during work from a task that interrupts the flow and continuity of the task. (2) Negative type refers to interruption events that temporarily interrupt the nursing process and produces one of the following results: (i) extends the completion time of a certain job/operation; (ii) increases the workload; (iii) affects the quality of nursing work; (iv) causes adverse nursing events. (3) Positive type implies that temporary interruption has a positive impact on nursing procedures and results and that timely termination can prevent or avoid adverse consequences—such as when medical staff find potential medical errors and take the initiative to interrupt, correct, and remind each other. (4) Missing consequences: the primary reason for this is that the observers failed to monitor the entire interruption process as well as the interruption results. This occurred when two interruptions overlapped, which hindered the observer's ability to capture the results of the previous interruption.

Figure 2

Standardized path coefficient diagram of the confirmatory factor analysis model for the survey questionnaire on emergency nursing interruptions.