The present study examined the validity and reliability of the Nurses’ Professional Values Scale (Nurses’ PVS) by adapting it to Turkish.
Methods
This methodological study was conducted with 297 nurses who agreed to participate in the study by using the Snowball Sampling Method. The study data were collected using the Descriptive Data Form and Nurses’ PVS. The data were evaluated using the Content Validity Index, Confirmatory Factor Analysis, Cronbach’s Alpha, McDonald’s Omega Reliability, and test–retest analysis.
Results
Factor load values of the scale items were found to vary between 0.590 and 0.960. The fit index values were found to be X2 = 102.87, df = 398 (p < 0.05), X2/df = 2.77, RMSEA = 0.077, CFI = 0.99, RMR = 0.045, SRMR = 0.051 and TLI = 0.97. It was also found that the Cronbach’s Alpha Coefficients of the sub-dimensions of the scale varied between 0.896 and 0.977, and the total Cronbach’s Alpha Coefficient was 0.958. The total McDonald’s Omega Coefficient was .958, and the McDonald’s Omega Coefficients of the sub-dimensions varied between .896-.977. The Turkish form of the 30-item and 4-subdimensional scale was confirmed without any changes in the original scale form.
Conclusion
The Turkish version of the Nurses’ PVS is a valid and reliable tool for measuring the values that nurses care about.
Clinical trial number
Not applicable.
Hinweise
Publisher’s Note
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Introduction
It is accepted that nursing started with Florence Nightingale in the modern sense [1, 2]. The nurse is responsible for providing patient care in the traditional role. However, many factors, such as the changes in science and technology, demographic changes, health promotion approach, migration, and awareness of disease prevention, have enabled the transition of nursing from its traditional role into the contemporary nursing model [2]. All these changes and transitions have brought with them new values and judgments. Values change depending on time, culture, society, and historical conditions that affect the internal dynamics of society, culture, and profession, bringing new values [3]. The shift to contemporary models of care, such as evidence-based practice and patient-centered care, has redefined nurses' professional values by emphasizing collaboration, critical thinking, and respect for patient autonomy, which are now integral components of quality nursing care [2]. In addition to these advancements, professional values in nursing continue to evolve in response to systemic healthcare changes and challenges such as burnout. Understanding these changes provides crucial insights for fostering resilience and maintaining quality care. Cultural differences play a vital role in shaping professional values in nursing, as healthcare systems, ethical norms, and societal expectations vary widely across regions. Studies from diverse contexts have shown that while Western healthcare systems often emphasize individual autonomy and evidence-based practices, Eastern systems prioritize community-oriented care and collective decision-making [6, 14]. These differences highlight the importance of context-specific approaches in understanding and fostering professional values, ensuring that nursing practices align with global standards and local cultural norms [6, 14]. Professional values are fundamental to nursing practice and directly impact patient health outcomes. These values serve as a framework for ethical decision-making, collaboration, and accountability, collectively enhancing the quality of care and patient satisfaction [6, 12, 19]. Psychometric tools are crucial in evaluating these values, providing reliable insights into areas that require improvement [20, 22]. By systematically measuring professional values, interventions can be designed to address gaps and strengthen these values, ultimately benefiting both nurses and patients [6, 19, 22].
Value means “how useful and important something is” [4]. Occupation is “a type of work that requires special training or skills, especially a high level of education/training, in which a person has a main field of work and does a permanent job to make a living” [5]. Professional values are “the result individuals desire and expect from their professions.” Professional values involve more than one individual's emphasis or expectation of [6]. It can be argued that there are many professional values because values consist of essential concepts for individuals [6‐8]. According to Liptak, professional values involve the characteristics an individual seeks in their profession, such as cooperation, teamwork, respect, security, freedom, creativity, promotion, diversity, money, and health [9].
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Professional values make up the ideal behaviors individuals must exhibit when performing their profession and the beliefs and guiding principles needed to exhibit such behaviors [10]. Professional values show the standard of behavior in a professional group or a professional member [11]. Professional values in nursing are defined as the principles and standards that guide nurses' actions and decisions, reflecting the core ideals of the profession [11]. These values are intrinsically linked to patient care, as they shape the ethical framework, quality standards, and interpersonal relationships that underpin nursing practice. Furthermore, the evolution of the nursing profession—transitioning from a task-oriented role to a holistic, patient-centered approach—has further emphasized the importance of these values in promoting professional identity, accountability, and advocacy [11]. Hara and Asakura defined nurses’ professional values as “enduring beliefs about the preferable conditions and outcomes that nurses desire in their profession, the principles and standards that give importance to the work and guide their attitudes, judgments, and behaviors” [6].
Value, which involves more than one concept, affects the nurse-patient relationship, nurse-nurse relationship, and nurse-society relationship [12, 13]. In nursing, professional values are an essential source of motivation in increasing the quality of care, ensuring professional satisfaction, increasing commitment to the profession, ensuring continuity in the profession, reducing the level of nursing burnout, and strengthening the professional identity and performance of the individual [14‐16]. Professional values, at the center of nursing practice, constitute the basis of determining priorities in healthcare and patient-nurse relationships and, therefore, appear as an essential predictor of nurses’ job satisfaction, quality nursing care, and the patient-nurse relationship [12, 17]. Burnout has been identified as a significant factor influencing nurses’ re-prioritization of professional values. During high stress, values such as resilience and teamwork become more prominent, reflecting the need for organizational and educational strategies to support nurses in maintaining their professional identity [17].
In determining the status of a profession, establishing professional discipline, and ensuring social acceptance, professional value is the most critical factor [18]. Measuring professional values makes it easier to determine how individuals want to work and what they desire in their work [19]. For this reason, measuring the professional values of nurses is essential for determining the problems associated with the subject. Measuring a concept for individuals can only be achieved with a valid and reliable measurement tool [20]. It has been stated in the literature that there are few valid and reliable measurement tools to measure the concept of professional values and the professional values of nurses. The existing measurement tools are inadequate for this purpose [19]. Professional values need to be researched and measured in a way specific to professions because each profession has its values [21]. The present study aimed to ensure the validity and reliability of the “Nurses’ Professional Values Scale” developed by Hara et al. in 2023 for the Turkish language [19]. With this measurement tool, nurses’ professional value levels can be determined. The scale can also identify new problems and shed light on future studies to increase nurses’ professional value levels.
Research question:
Can the Turkish version of the 'Nurses’ Professional Values Scale' measure nurses' professional values validly and reliably?
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Method
Study design
The present study had a methodological design.
Setting
The Snowball Sampling Method was used to collect study data. The snowball sampling method was implemented by initially contacting nurses who met the inclusion criteria (nursing graduates over 18). These participants were asked to share the survey link with colleagues who met the criteria. This method allowed the recruitment of diverse participants from various institutions and clinical settings. However, as snowball sampling relies on personal networks, it introduces a selection bias and limits the generalizability of the results to the broader nursing population. Despite this limitation, the method was deemed suitable for accessing a hard-to-reach population within the study's time constraints. The data were collected by creating a link over Google Forms. The link was shared on nursing platforms, and nurses were asked to fill it out. Pilot implementation data were collected between 5.10.23 and 15.10.23, and primary implementation data were collected between 16.10.23 and 23.11.23.
Addressing response bias
The use of online data collection through Google Forms may have introduced response bias, as participation was limited to nurses with internet access and the willingness to complete an online survey. This could affect the representativeness of the sample, potentially excluding nurses from regions with limited internet connectivity or those less inclined to participate in online studies. To mitigate such biases, the survey link was distributed widely across various nursing platforms and professional networks to ensure a diverse range of participants. Additionally, the study ensured anonymity and emphasized the voluntary nature of participation to encourage honest and unbiased responses.
Population and sample of the study
The population of the study consisted of individuals who were over the age of 18 and nursing graduates. The literature states that the number of samples for pilot implementation must be at least 50 [20]. In the present study, 50 nurses were contacted during the pilot implementation. A sufficient number of samples for the primary implementation was calculated based on the number of items used. It is also stated in the literature that 5–10 times the number of items must be contacted for scale development or adaptation studies [20, 22]. The main form of the “Nurses’ Professional Values Scale” consists of 30 items. Therefore, it was determined that a sufficient number of samples must be between 150 and 300 for the study. In the present study, 265 nurses constituted the sample during the main implementation stage.
Data collection tools
The study’s data collection tools were the “Personal Data Form” and the draft “Nurses’ Professional Values Scale.”
Personal data form
The form consisted of questions asking the nurses’ ages, genders, education levels, marital status, working years, shift work, and the clinic they worked in.
Nurses’ professional values scale
The Nurses’ Professional Values Scale was developed by Hara et al. in 2023 to determine how critical specific values are for nurses and to measure the set of values that nurses care about [19]. The scale consists of 30 items and four sub-dimensions (“Intrinsic Professional Values (F1)”, “Extrinsic Professional Values (F2)”, “Social Professional Values (F3)”, and “Prestige Professional Values (F4)”. The “Intrinsic Professional Values” sub-dimension of the scale consists of 9 items and is scored between 9 and 45. The “Extrinsic Professional Values” subscale consists of 5 items and is scored between 5–25 points. The “Social Professional Values” subscale consists of 10 items and is scored between 10–50. The “Prestige Professional Values” subscale consists of 6 items and is scored between 6–30. The scale consists of 30 items, divided into four sub-dimensions, and is scored between 30–150. The scale was developed on a 5-point Likert style (1=not at all important, and 5=very important). In the initial study, Cronbach's alpha for the dimensions 'F1,' 'F2,' 'F3,' and 'F4' were 0.92, 0.83, 0.94, and 0.92, respectively, and the total instrument was calculated as 0.95 [19] The scale was adapted to Turkish within the scope of our study and its validity and reliability study was conducted.
This tool, the "Nurses’ Professional Values Scale," was chosen for psychometric testing due to its comprehensive structure and alignment with the core professional values identified in nursing practice. Developed by Hara et al. (2023), the scale uniquely integrates ethical, social, and professional dimensions, making it a robust instrument for evaluating professional values across diverse healthcare settings [19]. Its conceptual framework is grounded in the principles of nursing ethics, patient-centered care, and professional identity development, which are pivotal in ensuring high-quality nursing care and enhancing patient outcomes.The tool has been validated in its original language, Japanese, and translated into English and Turkish for cross-cultural validation [19, 22]. Its adaptability to different cultural contexts demonstrates its practical utility and relevance in global nursing research. The existence of this tool contributes significantly to the field by addressing the lack of valid and reliable instruments that can systematically evaluate professional values in nursing. Practically, it provides nursing educators and administrators with a mechanism to assess and strengthen these values, which are essential for fostering professional development and improving patient care quality [22].
Adaptation process
The adaptation of the scale was performed in 3 stages.
In the first stage, two English language experts translated The scale items from English into Turkish
The translated items were then sent to 10 experts, including 4 nurses specialized in nursing principles, 4 nurses specialized in internal medicine and care, and 2 Turkish language experts, for content validation. Each expert evaluated the items using a 4-point Content Validity Index (CVI) scale (1 = not relevant, 4 = highly relevant). All items scored between 0.90 and 1.00, indicating strong expert consensus. The content validity of the scale and each item was assessed to ensure they adequately measured the intended concepts. This process confirmed the equivalence of the items in terms of language and culture, as well as their content validity, using numerical values and expert evaluations. This approach provided a systematic and robust evaluation of the scale’s content validity (e.g., assessing linguistic and cultural equivalence using expert evaluations). Based on the feedback, minor revisions were made to enhance clarity, and the revised items were translated back into English by two foreign language experts to ensure semantic equivalence. A comparison of the initial and final versions confirmed no semantic differences. The finalized scale was then uploaded to “Google Forms” to prepare for pilot implementation.
The Second stage (Pilot implementation)
The pilot study played a critical role in shaping the final version of the scale by ensuring its reliability and content validity. During the pilot phase, the item correlation values were thoroughly evaluated, and all items demonstrated values above 0.30, confirming their alignment with the scale's construct [20, 22, 23]. The Cronbach's Alpha value of the scale exceeded 0.70, which indicated strong internal consistency across the scale items [20, 22, 23]. These findings validated and included all 30 items in the final version without modifications, ensuring that the scale effectively captured the intended dimensions of nurses' professional values. Furthermore, the insights gained during the pilot implementation phase helped refine the methodology for the main implementation stage by confirming the feasibility and robustness of the scale’s structure.
Third stage (Main implementation)
The items were uploaded to “Google Forms” to collect the study data, and a link was created. The link was distributed on nursing platforms, and nurses were asked to complete the form. A total of 297 nurses participated in the study at this stage. Confirmatory Factor Analysis and Reliability Analysis of the scale were performed. The fit indices obtained were examined in line with the literature data in the Confirmatory Factor Analysis [24, 25]. The obtained values showed that the scale structure was valid.
Statistical analysis
The data was collected using Google Forms. The items were uploaded to “Google Forms,” with required fields activated for each item to prevent data loss. The link was shared on nursing platforms, accompanied by information about the study’s purpose, to invite participants. The data were then exported from “Google Forms” into an Excel file and subsequently imported into the SPSS package program for analysis. To begin, item-total correlation values and Cronbach’s Alpha values for the scale items were evaluated. The suitability of the dataset and sample size for factor analysis was assessed using the Kaiser Meyer Olkin (KMO) and Bartlett’s Sphericity Test. The KMO test verified the adequacy of the sample size, while Bartlett’s Sphericity Test determined whether sufficient correlation existed between variables. These preliminary tests confirmed the dataset’s suitability for analysis, particularly as the scale was adapted to a different language and cultural context. Including these steps enhanced the methodological rigor and transparency of the Turkish adaptation process and supported the robustness and reproducibility of the findings. When the KMO value exceeds 0.60 and Bartlett’s Sphericity Test result is significant, the sample size and dataset are considered adequate for factor analysis [20]. Factor analysis is a widely used method to test construct validity. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) are the two primary approaches for this purpose. While EFA explores the underlying structure and subdimensions of items, CFA verifies the validity of a pre-determined structure. According to the literature, CFA can be performed without EFA to validate an existing structure [20, 26]. In this study, CFA was conducted to confirm the validity of the 30-item, 4-factor structure. The data were then transferred to the Lisrel Package Program to evaluate the construct validity of the scale through fit indices. The following fit indices were examined: Relative Chi-Square Index (CMIN/DF), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), Root Mean Square Residual (RMR), Standardized Root Mean Square Residual (SRMR), and Tucker-Lewis Index (TLI). Acceptable fit was indicated by CMIN/DF values below 5, RMSEA and RMR values below 0.08, SRMR values below 0.08, and CFI and TLI values above 0.90 [24, 27, 28]. To assess reliability, Cronbach’s Alpha Coefficients, McDonald Omega Reliability Analysis, and the test–retest method were employed. Cronbach's Alpha measured internal consistency across scale items, while McDonald's Omega provided a modern alternative, particularly useful for items with varying weights or multidimensional structures. The test–retest method assessed the scale's stability and invariance over time [20, 29]. Additionally, item-total correlation coefficients were analyzed to determine the reliability of individual items. A reliability coefficient above 0.70 indicated that the scale was reliable [20, 30].
Ethical considerations and permissions
The Ethics Committee Approval was received from the Fırat University Non-Interventional Research Ethics Committee on 02.10.2023 with decision number 18653. This study was conducted in full accordance with the ethical principles of the Declaration of Helsinki and relevant institutional and national guidelines and regulations. Information about the purpose and method of the study was given with the link because “Google Forms” was used to collect the study data. The participant’s consent was obtained by informing them that the study was based on voluntariness and confidentiality.
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Permission to use the "Nurses’ Professional Values Scale" was obtained from its original developers. Two English language experts familiar with healthcare terminology translated the scale into Turkish. Subsequently, two independent bilingual experts performed a back-translation, and the original and back-translated versions were compared to ensure semantic and conceptual equivalence. Adjustments were made to resolve discrepancies, ensuring the Turkish version accurately reflected the original scale's content.
Findings
The mean age of the 297 nurses who participated in the study was 30.88 ± 7.35, 68.7% were women, 61.3% had an associate degree, 51.9% were single, 49.8% had a working year between 1 and 5 years, 64.3% were shift nurses, and 71.4% were working in Internal Diseases Clinics. (Table 1).
Table 1
Descriptive characteristics of the participants
Characteristics
Number (n = 297)
%
Gender
Female
204
68.7
Male
93
31.3
Marital status
Married
143
58.1
Single
154
51.9
Educational status
Vocational high school
8
2.7
High school
21
7.1
Associate degree
182
61.3
Bachelor's degree
86
29.0
Years of employment
1–5 years
148
49.8
5–10 years
51
17.2
10 years and above
98
33.0
Working style
Shift
191
64.3
Daytime
106
35.7
Workplace
Internal medicine clinics
212
71.4
Surgical clinics
38
12.8
Internal medicine intensive care
24
8.1
Surgical intensive care
23
7.7
Mean ± SD
Min–Max
Age (yr)
30.88 ± 7.35
19–59
Findings on validity
Content validity
According to expert opinions, the Item-Based Content Validity Index (I-CVI) ranged between 0.90 and 1.00, and the Scale-Based Content Validity Index (S-CVI) was 0.97.
Construct validity
The KMO and Bartlett’s Sphericity Tests were performed to check the suitability of the sample size and the suitability of the dataset for analysis before construct validity. The KMO value was found to be 0.944. The Bartlett’s Test of Sphericity was significant (x2 = 9493.302; p = 0.000). CFA analysis was performed without EFA to demonstrate the validity of the 30-item and 4-subdimensional structure. As a result of CFA analysis, factor loading values were found to be over 30 (between 0.590 and 0.960) and the 4 sub-dimensional structure was confirmed (Table 2).
Table 2
Mean, item correlation coefficient, and CFA factor load results
Scale Items
Mean ± SD
Corrected Item-total Correlations
Factor Load Value
F1
F2
F3
F4
Item 1
4.61 ± .58
.492
.640
Item 2
4.58 ± .60
.506
.630
Item 3
4.73 ± .53
.512
.800
Item 4
4.72 ± .52
.569
.790
Item 5
4.70 ± .63
.451
.670
Item 6
4.65 ± .58
.473
.710
Item 7
4.54 ± .66
.467
.590
Item 8
4.72 ± .55
.524
.810
Item 9
4.70 ± .61
.497
.740
Item 10
4.40 ± 1.11
.636
.960
Item 11
4.38 ± 1.08
.577
.940
Item 12
3.72 ± 1.12
.442
.630
Item 13
4.15 ± 1.16
.538
.800
Item 14
4.18 ± 1.12
.589
.780
Item 15
4.41 ± 1.06
.718
.890
Item 16
4.40 ± 1.01
.835
.820
Item 17
4.41 ± 1.03
.828
.940
Item 18
4.45 ± .97
.829
.910
Item 19
4.24 ± 1.00
.779
.870
Item 20
4.45 ± .98
.836
.950
Item 21
4.44 ± .95
.813
.910
Item 22
4.35 ± 1.01
.826
.910
Item 23
4.38 ± .99
.831
.920
Item 24
4.31 ± 1.00
.809
.880
Item 25
4.15 ± 1.12
.722
.790
Item 26
4.06 ± 1.10
.673
.820
Item 27
4.20 ± 1.10
.662
.870
Item 28
4.42 ± 1.13
.654
.930
Item 29
4.44 ± 1.08
.652
.900
Item 30
4.39 ± 1.05
.675
.910
F1: Intrinsic professional values;F2: Extrinsic professional values; F3: Social professional values; F4: Prestige professional values
Confirmatory factor analysis
According to the results, CFA fit index values were obtained as follows; X2 = 102.87, df = 398 (p < 0.05) (Table 3), and the PATH diagram created during Confirmatory Factor Analysis is given in Fig. 1.
Fig. 1
PATH diagram
Table 3
Confirmatory factor analysis results
Fit criteria
Found
Appropriate
Acceptable
Result
x2/df (CMIN/DF)
2.77
< 2
< 5
Acceptable fit
RMSEA
0.077
< 0.05
< 0.08
Acceptable fit
CFI
0.98
> 0.95
> 0.90
Perfect fit
RMR
0.045
< 0.05
< 0.08
Perfect fit
SRMR
0.051
< 0.05
< 0.08
Acceptable fit
TLI
0.97
> 0.95
> 0.90
Perfect fit
CFI Comparative Fit Index, RMSEA Root Mean Square Error of Approximation, RMR Root Mean Square Residual, SRMR Standardized Root Mean Square Residual, TLI Tucker Lewis Index
×
When Table 3 is evaluated, it is seen that a significant relationship was detected between the sub-dimensions of the scale. The moderate correlations obtained show that there was no multicollinearity problem between the sub-dimensions.
Findings regarding reliability
Cronbach’s Alpha Coefficient of the scale was calculated and was determined that it was 0.896 for the “F1” sub-dimension, 0.934 for the “F2” sub-dimension, 0.977 for the “F3” sub-dimension, 0.949 for the F4” sub-dimension, and the Cronbach’s Alpha Value for the entire scale was 0.958. Also, the Omega Reliability Values of the scale were determined to be 0.896 for the “F1” sub-dimension, 0.935 for the “F2” sub-dimension, 0.977 for the “F3″ sub-dimension, 0.958 for the F4″ sub-dimension, and the Omega Reliability Value for the entire scale was 0.958 (Table 4). When the item-total correlation coefficients of the scale were evaluated, it was found that the item-total correlation coefficient was above 0.30 (0.442–0.836) (Table 2).
Table 4
Correlation values, score means, and reliability results
Scale and sub-dimensions
F1
F2
F3
F4
Number of items
Min–Max
X ± SD
α
Ω
F1
1
9
27–45
41.99 ± 3.92
.896
.896
F2
.430**
1
6
7–30
25.25 ± 5.79
.934
.935
F3
.540**
.468**
1
10
11–50
43.62 ± 9.22
.977
.977
F4
.385**
.354**
.648**
1
5
5–25
21.53 ± 4.98
.949
.958
Total Nurses' WVS
.690**
.686**
.918**
.776**
30
49–140
123.98 ± 18,22
.958
.958
F Factor, Nurses' WVS Nurses' Work Values Scale, X Mean, SD Standart devaisyon, a Cronbach’s alpha coefficients, Ω McDonald omega coefficient
**Correlation is significant at the 0.01 level (2-tailed)
During the study process, the correlation values observed between test–retest measurements applied to 31 people at 20-day intervals to evaluate the consistency of the scale over time were found to be r = 0.947 for Nurses’ PVS total, r = 0.773 for “F1” sub-dimension, r = 0.773 for “F2”. r = 0.893, r = 0.824 for “F3” and r = 0.924 for “F4”. These correlation values were statistically significant (p < 0.05). Also, no statistically significant differences were found between the test–retest measurement results (Table 5) (p > 0.05). At the same time, Intraclass correlation coefficients (ICC) values for measuring test–retest reliability were found to be between 0.728 and 0.957.
Table 5
Test–retest results and score means (n = 31)
Scale and sub-dimensions
Scale Score Means
Analysis Results
ICC
First
Implementation
X ± SD
Second
Implementation
X ± SD
r
p
t
p
F1
41.35 ± 3.84
41.19 ± 3.19
.773**
.000
.343
.734
.728
F2
22.96 ± 6.40
23.96 ± 5.61
.893**
.000
−1.929
.063
.939
F3
42.41 ± 9.48
42.64 ± 7.29
.824**
.000
-.233
.818
.887
F4
20.54 ± 5.58
20.64 ± 4.77
.924**
.000
-.256
.800
.957
Total Nurses' WVS
127.29 ± 19.66
128.45 ± 16.83
.947**
.000
−1.095
.282
.941
F Factor, p < 0.05, r Pearson Correlation Coefficient; t: t Paired sample t test, ICC Intraclass Correlation Coefficient
**Correlation is significant at the 0.01 level (2-tailed)
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Discussion
The present study was conducted to ensure the validity and reliability of the “Nurses’ Professional Values Scale,” which consisted of 30 items and 4 sub-dimensions for the Turkish language. The findings obtained in the study were discussed in line with the literature data.
The draft form of the scale was sent to 10 experts to ensure content validity. When the CVI of the items above is 0.80, it is considered to be an indication that the item is appropriate to the subject and that there is a consensus among experts on this subject [20, 31]. As a result of expert opinions, it was determined that the items had a value between 0.90–1.00 in the present study (I-CVI) and the content validity on a scale basis was 0.97 (S-CVI). These values show that there is a very high agreement among expert opinions and that the scale items are sufficient to measure the subject.
The suitability of the scale for factor analysis and the adequacy of the sample must be tested with KMO and Bartlett’s Sphericity Tests before starting factor analysis. The fact that the KMO value is above 0.60 and Bartlett’s Sphericity Test is significant shows that the data are suitable for factor analysis and the number of samples is sufficient [22, 31]. It was found in this study that the KMO value was 0.944 and Bartlett’s Test of Sphericity was significant (p = 0.000). These values show that the number of samples and datasets is suitable for analysis [22, 30]. Also, the KMO value being over 0.90 shows that the sample size is perfect [20].
Confirmatory Factor Analysis is needed to verify a constructed or predetermined model. For this reason, Confirmatory Factor Analysis must be preferred instead of Exploratory Factor Analysis in scale adaptation studies and the resulting fit indices must be evaluated accordingly [20]. If the factor loads of the items are above 0.30 in the factor analysis, this shows that the scale has a solid factor structure [20]. In the present study, it was found that the factor loads of the items varied between 0.590 and 0.960. These values showed that the scale had a solid factor structure (Table 1) [20].
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The fit indices that are obtained as a result of Confirmatory Factor Analysis must be at or above acceptable levels. When the CMIN/DF value is less than 5, the RMSEA value is less than 0.08, the CFI value is greater than 0.90, the RMR value is less than 0.08, the SRMR value is less than 0.08, and the TLI value is greater than 0.90, it is deemed that the fit indices are acceptable [24, 27, 28, 32]. In the present study, it was found that the fit indices were above acceptable values with X2 = 102.87, df = 398 (p < 0.05), X2/df = 2.77, RMSEA = 0.077, CFI = 0.99, RMR = 0.045, SRMR = 0.051 and TLI = 0.97. The obtained values show that the scale, which consisted of 30 items and 4 factors, was associated with the factors, the factors were associated with the scale, and the scale was structurally confirmed [24, 27, 28, 32]. The results obtained in the Confirmatory Factor Analysis show that the Turkish validity of the scale was achieved. Hara et al. (2023) reported in their study that the fit indices obtained in the Confirmatory Factor Analysis were χ2 = 2074.5, df = 384, p < 0.001, RMSEA = 0.053, CFI = 0.955 [19]. It can be argued that the values obtained in this study and those reported by Hara et al. are similar.
The findings of this study align with similar research conducted in different cultural contexts. For example, Poorchangizi et al. (2017) highlighted that Iranian nurses emphasized social and ethical values, such as community-oriented care and collective decision-making, which are consistent with the findings of this study [14]. In contrast, Hara & Asakura (2021) observed that Japanese nurses prioritized intrinsic professional values like respect and empathy [6]. On the other hand, studies from Western countries often emphasize individual autonomy and evidence-based practice as dominant professional values, reflecting differences in healthcare systems and cultural expectations [19]. These comparisons illustrate the significance of considering cultural and regional factors in understanding and fostering professional values.
Different methods can be employed to determine the reliability of a measurement tool [30, 33]. The Test–Retest Method, Cronbach Alpha Coefficient, and McDonald Omega Coefficient are among the methods that can be used to determine the reliability of a scale [29, 30, 33]. The Test–Retest Method, Cronbach Alpha Coefficient, and McDonald Omega Coefficient were used in the present study to determine the reliability of the scale.
The item-total correlation coefficients of the scale items were above 0.30, which indicated that the items were associated with the subject of the scale. For this reason, the items below 0.30 had to be removed from the scale [20, 30]. It was found in the present study that the item-total correlation coefficients of the items varied between 0.442 and 0.836. These values show that the scale items were reliable for the scale [30]. For this reason, no items were removed from the scale.
The most preferred method to determine the reliability of a scale is the Cronbach Alpha Value. As the Cronbach Alpha Value approaches “1”, the reliability of the scale increases. Also, for a measurement tool to be reliable, the Cronbach Alpha Coefficient and McDonald Omega Coefficient are expected to be above 0.70 [20, 30]. In the present study, the score was 0.896 for the “Intrinsic Professional Values (F1)” sub-dimension of the scale, 0.934 for the “Extrinsic Professional Values (F2)” sub-dimension, 0.977 for the “Social Professional Values (F3)” sub-dimension, 0.949 for the “Prestige Professional Values (F4)” sub-dimension, and Cronbach’s Alpha Value of the entire scale was 0.958. It was also found that the McDonald Omega Coefficient varied between 0.896 and 0.977. These values showed that the scale was quite reliable [20, 30]. In their study, Hara et al. (2023) determined that Cronbach Alpha Values were 0.92 for the “Intrinsic Professional Values” sub-dimension, 0.83 for the “Extrinsic Professional Values” sub-dimension, 0.94 for the “Social Professional Values”, and 0.92 for “Prestige Professional Values” [19]. It was seen that the values obtained from the present study and the study of Hara et al. were similar.
The Test–Retest Method is based on a measurement tool maintaining the same stability over time and finding a relationship between the measurements obtained [30, 33]. The higher the correlation value obtained, the more reliable the scale is [30]. In the present study, it was found that the correlation value obtained from the test–retest data regarding the scale and its sub-dimensions varied between 0.773 and 0.947. At the same time, ICC values were found to be between 0.728 and 0.957. These values showed that the scale was reliable [22, 30]. Also, the results obtained from “the t-test in dependent groups” performed to determine the difference between the two measurements showed that there were no statistically significant differences between the two measurements regarding the scale and its sub-dimensions. These results showed that the scale proved its invariance over time [30, 34]. The values obtained as a result of the study showed that the Turkish form of the scale was reliable.
Measurement tools associated with the subject were reviewed in the national literature and it was found that these measurement tools were developed by Weis and Schank. The scale was developed to measure the values of nurses, demonstrating the ethical rules of the American Nurses Association (ANA). Weis and Schank developed the 44-item version of the scale in 2000 and revised it in 2001 because of some changes made in the ethical code statements and the resulting scale had a 26-item structure [13, 35, 36]. It was determined that the revised scale consisted of 26 items and 5 sub-dimensions (“caregiving”, “professionalism”, “activism”, “justice”, and “loyalty”. It was found that the sub-dimensions of the scale developed by Weis and Schank whose Turkish validity and reliability studies were conducted were not similar in terms of names to the sub-dimensions in this study. The items of the scale, which Weis and Schank developed, were compared with the items of the scale in this study, and no similar items were detected. The fact that the scale developed by Weis and Schank and the scale in this study were not similar in terms of items and factors showed the originality of the scale.
Study limitations
This study has several limitations that should be considered when interpreting the results. First, the sample size, although adequate for the statistical analyses conducted, may not fully represent the broader population of nurses, potentially limiting the generalizability of the findings. Second, the use of online data collection may have introduced response bias, as participation was limited to individuals with internet access and a willingness to complete the survey. Finally, the snowball sampling method, while effective for reaching a diverse nursing population, relies on participant networks and may inadvertently exclude some groups, further affecting the representativeness of the sample. Despite these limitations, the study provides valuable insights into nursing professional values and their influencing factors.
Conclusion
As a result of the study, it was found that the Turkish version consisted of 30 items and 4 subscales, similar to the original scale. Cronbach’s Alpha Values and fit indices were high in the Turkish version, similar to the original scale. As a result of the present study, it was found that the Turkish version of the scale was the same as the original scale, ensuring cultural equivalence. The results of the present study show that the Turkish version of Nurses’ Professional Values is a valid and appropriate tool that can be used in the Turkish population.
Use of results in practice
The small number of items on the scale will facilitate its implementation and evaluation, making it an accessible tool for researchers and practitioners. The scale can be easily applied to nurses to assess their importance on specific professional values and identify areas for improvement. Using this tool, researchers and healthcare managers can measure and analyze the value priorities of nursing staff, providing a basis for tailored interventions. For instance, in-service training programs that enhance professional values can be designed and implemented where gaps are identified. Additionally, integrating this scale into nursing education programs can help students internalize essential values early in their training, fostering a strong professional identity and improving patient care quality in the long term.
Acknowledgements
We thank the nurses for taking part in the study.
Authorship statement
All listed authors meet the authorship criteria, and all authors agree with the manuscript’s content.
Declarations
Ethics approval and consent to participate
The Ethics Committee Approval was received from the Fırat University Non-Interventional Research Ethics Committee on 02.10.2023 with decision number 18653. This study was conducted in full accordance with the ethical principles of the Declaration of Helsinki and relevant institutional and national guidelines and regulations. Information about the purpose and method of the study was given with the link because “Google Forms” was used to collect the study data. The participant’s consent was obtained by informing them that the study was based on voluntariness and confidentiality.
Competing interests
The authors declare no competing interests.
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