Development and Psychometric Testing of the Cambodian Nursing Care Quality Scale

Main Article Content

Virya Koy
Jintana Yunibhand
Yupin Angsuroch
Sue Turale


              The evaluation of nursing care quality as a patient outcome is critical to improving practice, and requires appropriate instruments that have been validated and are reliable. Although a number of such instruments have been developed in the west, there are few in Asia and none in Cambodia where nursing quality needs vast improvement. The aim of this study was to develop the Cambodian Nursing Care Quality Scale and assess its validity and reliability.
            The design of this study was instrument development and psychometric testing. This methodological study had seven steps in instrument development, including content validity assessment by 5 experts. It was then tested with 240 registered nurses in 12 hospitals from five geographic areas of Cambodia who had undergone a multistage random sampling procedure. The analysis involved exploratory factor analysis and internal consistency testing. The instrument was developed as a questionnaire which had six factors: patient outcomes; physical environment; ethics-oriented activities; nurses’ characteristics; nurses’ task activities; and progress of the nursing process. Only 35 items were kept after exploratory factor analysis. The instrument had an acceptable level of construct validity and good internal consistency, indicating its usefulness to measure nursing care quality in Cambodia. It needs further testing with different samples. Nursing and health leaders need to find ways of improving nursing care and developing nursing quality, and instruments used for measuring nursing care quality must be reliable and valid.

Article Details

How to Cite
Koy V, Yunibhand J, Angsuroch Y, Turale S. Development and Psychometric Testing of the Cambodian Nursing Care Quality Scale. PRIJNR [Internet]. 2017 Aug. 7 [cited 2022 Oct. 5];21(4):267-79. Available from:
Original paper
Author Biography

Jintana Yunibhand, RN, PhD, Associate Professor, Faculty of Nursing, Chulalongkorn University, Thailand




1. Cline DD, Rosenberg MC, Kovner CT, Brewer C. Early career RNs’ perceptions of quality care in the hospital setting. QHR [Internet]. 2011 [cited 2014 Aug 11]; 21: 673-682. Available from 10.1111/jan.12503.

2. Koy V, Yunibhand J, Angsuroch Y. The quantitative measurement of nursing care quality: a systematic review of available instruments. International Nursing Review [Internet]. 2016 [cited 2017 Jan 15]; 63: 490–8. Available from https://www. pubmed/2729314.

3. Burhans LM, Alligood MR. Quality nursing care in the words of nurses. JOAN [Internet]. 2010 [cited 2015 Sept 10]; 66: 1689-97. Available from https://www. ncbi.

4. Lindgren M, Andersson IS. The Karen instruments for measuring quality of nursing care: construct validity and internal consistency. IJQHC [Internet]. 2011 [cited 2015 Nov 8]; 23: 292-01. Available from https://www.ncbi. pubmed/21242159.

5. Leinonen T, Leino-Kilpi H, Ståhlberg MR, Lertola K. Comparing patient and nurse perceptions of perioperative care quality. ANursRes [Internet]. 2003 [cited 2016 Jun 12]; 16: 29-37. Available from https://www.ncbi.nlm. pubmed/12624860.

6. Van Bogaert P, Kowalski C, Weeks SM, Clarke SP. The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: a cross-sectional survey. IJNS [Internet]. 2013 [cited 2015 Dec 9]; 50: 1667-77. Available from pubmed/23777786.

7. Aiken LH, Sermeus W, Van den Heede K, Sloane DM, Busse R, McKee M, Bruyneel L, Rafferty AM, Griffiths P, Moreno-Casbas MT, Tishelman C. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ [Internet]. 2012 [cited 2015 Feb 27]; 20: 344:e1717. Available from https://www. 344/bmj.e1717.short.

8. Lindqvist R, Smeds Alenius L, Griffiths P, Runesdotter S, Tishelman C. Structural characteristics of hospitals and nurse-reported care quality, work environment, burnout and leaving intentions. JONM [Internet]. 2015 [cited 2017 Jan 15]; 23: 263-74. Available from https://onlinelibrary. wiley. com/doi/10.1111 /jonm.12123/full.

9. Lu M, Ruan H, Xing W, Hu Y. Nurse burnout in China: a questionnaire survey on staffing, job satisfaction, and quality of care. JONM [Internet]. 2015 [cited 2016 Dec 18]; 23: 440-7. Available from https://www.ncbi.nlm. /24024567.

10. You LM, Aiken LH, Sloane DM, Liu K, He GP, Hu Y, Jiang XL, Li XH, Li XM, Liu HP, Shang SM. Hospital nursing, care quality, and patient satisfaction: cross-sectional surveys of nurses and patients in hospitals in China and Europe. IJNS [Internet]. 2013 [cited 2015 Dec 9]; 50: 154-61. Available from https://www.ncbi. pubmed/22658468.

11. Nantsupawat A, Srisuphan W, Kunaviktikul W, Wichaikhum OA, Aungsuroch Y, Aiken LH. Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand. JONS [Internet]. 2011 [cited 2015 Mar 21]; 43: 426-32. Available from https://www.ncbi.

12. Lee B. Identifying outcomes from the nursing outcomes classification as indicators of quality of care in Korea: A modified delphi study. IJNS [Internet]. 2007 [cited 2017 Jan/Mar]; 44: 1021-8. Available from https://www. ncbi.nlm.nih. gov/pubmed/16712852.

13. Senarat U, Gunawardena NS. Development of an instrument to measure patient perception of the quality of nursing care and related hospital services at the National Hospital of Sri Lanka. ANursRes [Internet]. 2011 [cited 2016 Jun 10]; 5: 71-80. Available from kor/sub3/filedata_anr/ 201102/71.pdf.

14. Mrayyan MT. Jordanian nurses’ job satisfaction, patients’ satisfaction and quality of nursing care. INR [Internet]. 2006 [cited 2015 Dec 10; 53: 224-30. Available from https://

15. Pazargadi M, Tafreshi MZ, Abedsaeedi Z, Majd HA, Lankshear AJ. Proposing indicators for the development of nursing care quality in Iran. INR [Internet]. 2008 [cited 2017 Jan/Mar]; 55: 399-06. Available from https:// 2008.00642.

16. Ministry of Health (MoH). Personnel Department: Government Health Staff Statistics, Cambodia. 2016; (Unpublished manuscript).

17. Bureau of Nursing and Midwifery. Nursing Workforce, Cambodia. 2017; (Unpublished).

18. Donabedian A. Evaluating the quality of medical care. The MMFQ [Internet]. 1966 [cited 2017 Jun 27]; 44(3): 166-206. Available from 10.2307/3348969.

19. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA [Internet]. 2002 [cited 2017 Jan 18]; 288: 1987-93. Available from 10.1001/ jama. 288. 16.1987.

20. Sochalski J. Is more better?: the relationship between nurse staffing and the quality of nursing care in hospitals. Medical care [Internet]. 2004 [cited 2016 Jun 12]; 42:II-67. Available from 14734944.

21. Zhao SH, Akkadechanunt T, Xue XL. Quality nursing care as perceived by nurses and patients in a Chinese hospital. JOCN [Internet]. 2009 [cited 2016 Jun 22]; 18: 17228. Available from 10.1111/j.1365-2702.2008.02315.

22. Lynn MR, McMillen BJ, Sidani S. Including the provider in the assessment of quality care: Development and testing of the nurses’ assessment of quality scale-acute care version. JNCQ [Internet]. 2007 [cited 2014 Jan 1]; 22: 328-36. Available from 0.1097/01.NCQ.0000290414.42640.

23. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins. [Internet]. 2010 [cited 2017 Jan 18]. Available from https://

24. DeVellis RF. Scale development: Theory and applications. Sage publications [Internet]. 2016 [cited 2016 Dec 18]. Available from author/robert-f-devellis.

25. Kline RB. Principles and Practice of Structural Equation Modeling, 3rd ed. Guilford Press. New York [Internet]. 2011 [cited 2017 Feb 17]. Available from https://www.

26. Nunnally JC, Bernstein IH. Psychometric Theory. 3rd ed. New York: McGraw-Hill, Inc; 1994.

27. Hair JF, Anderson RE, Babin BJ, Black WC. Multivariate Data Analysis: A Global Perspective. 6th ed. New Jersey: Pearson 2010.

28. Strickland OL. Using factor analysis for validity assessment: practical considerations. JNM [Internet]. 2003 [cited 2012 Jun 13]. Available from https://www.ncbi.

29. Higgins PA, Straub AJ. Understanding the error of our ways: Mapping the concepts of validity and reliability. Nursing Outlook [Internet]. 2006 [cited 2015 Dec 18]; 54: 23-9. Available from https://www.ncbi.nlm.nih. gov/: pubmed/16487776.

30. Burston S, Chaboyer W, Gillespie B. Nurse-sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues. JCN [Internet]. 2014 [cited 2016 April 6]; 49: 1785-1795. Available from 10.1111/jocn.12337.

31. Agyeman-Yeboah J, Korsah KA, Okrah J. Factors that influence the clinical utilization of the nursing process at a hospital in Accra, Ghana. BMC Nursing [Internet]. 2017; 16: 1-7. Available from 10.1186/s12912-0170228-0.

32. Oliveira AC, Kovner CT, Silva RS. Nosocomial infection in an intensive care unit in a Brazilian university hospital. Revista Latino-Americana de Enfermagem [Internet]. 2010 [cited 2017 July 15]; 18(2): 233-9. Available from 10.1590/: S0104-11692010000200014.

33. Lachman VD. Applying the ethics of care to your nursing practice. MedSurg Nurs [Internet]. 2012 [cited 2015 April 18]; 21(2): 112-120.

34. Armstrong SJ, Rispel LC, Penn-Kekana L. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox? GHA [Internet]. 2015 [cited 2017 Feb 19]; 8: 1-9. Available from

35. Cho E, Lee NJ, Kim EY, Kim S, Lee K, Park KO, Sung YH. Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: a cross-sectional study. IJNS [Internet]. 2016 [cited 2017 July 9]; 60: 263-71. Available from 10.1016/j.ijnurstu.2016.05.009.

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