Psychometric evaluation of the Vietnamese version of nurses’ ethical behaviors for protecting patient rights scale (V-NEBPPRS): a methodological study

The NEBPPR was translated into Vietnamese, and exhibited validity and reliability for evaluating the ethical behavior of nursing staff in Vietnam regarding the protection of patients’ rights. The Vietnamese version of NEBPPR consists of 24 items divided into five dimensions: respect for the right to information and decision-making, providing fair care, providing benefits not harming, respect for patient values and choices, and attention to privacy. This instrument holds the potential to facilitate future research to enhance nurses’ awareness of patients’ rights, thereby promoting ethical behaviour in safeguarding those rights. A valid and reliable measurement scale can offer insights into how well nurses who have been trained in specific patients’ rights and the corresponding protective behaviours have assimilated this knowledge. This information can be instrumental in designing initiatives to enhance nurses’ ethical practices in safeguarding patients’ rights [21].

The results for content validity indicated that both the S-CVI and I-CVI indexes met the criteria [31], without changes recommended by the committee. Therefore, the instrument was appropriately translated for the target population.

The CFA conducted in this study demonstrated that the V-NEBPPRS achieved structural validity within the Vietnamese nursing context. The tool’s five-factor structure was not only verified but also found to be consistent with the original NEBPPR’s five-factor structure [21]. This consistency extends to the recently translated Indonesian version (I-NEBPPR) [22] and Korean version [32]. The scale effectively reflects the adequate dimensions of the measured construct, thereby providing substantial support for the structural validity of the V-NEBPPRS.

There were differences in the number of items among the original 28-item Turkish, 23-item Indonesian, and 24-item Vietnamese versions. This variation may be attributed to exploratory factor analysis (EFA), used in the original Turkish version, while CFA was employed in the three translated versions to support the instrument’s structure and items. The EFA is typically used in the initial stages to explore the possible underlying factor structure of a dataset without imposing a preconceived structure [26], which aligns with the development stage of the original instrument in Turkey. CFA was subsequently employed in the translated versions to rigorously test the stability and applicability of the factor structure identified through EFA in the Turkish version in new cultural contexts. This approach helps to ensure the validity and reliability of the instrument across different languages and settings [26]. Additionally, cultural differences could have affected the unequal number of items among the three versions [33]. For instance, a distinct cultural concept called ‘Siri na passe,’ prevalent among the Bugis population in Indonesia, significantly influences daily behaviors including diligence, integrity, teamwork, and conscientiousness. Bugis descent nurses often rigorously follow this ethical paradigm [22]. In Vietnam, the concept of ‘hiếu’—a fundamental element of Confucianism—emphasizes filial piety and ethical behaviors dealing with family members, community and society [34]. This principle plays a significant role in shaping ethical behaviors and is deeply ingrained in Vietnamese culture, influencing professional conduct across various fields, including healthcare. Guided by ‘hiếu,’ Vietnamese nurses show heightened respect towards patients and demonstrate a meticulous approach to patient care.

The V-NEBPPRS eliminated four items (items 6, 9, 14, and 20) with standardized factor loadings below 0.5. Item 6, which expressed that nurses do not need to explain the care plan to patients who have lost their decision-making ability, conflicted with the practice of nurses providing relevant information to patients before implementing nursing interventions, even if the patients are unconscious. This practice is in line with the ethical standards of the Vietnamese nursing profession [35] and is commonly observed among Vietnamese nurses. Item 9, ‘I create an opportunity for the patient to take part in care and treatment decisions,’ was removed because it focuses on the nurse’s role in facilitating patient autonomy. This role primarily involves ensuring that patients have the opportunities and necessary information to make informed decisions themselves. It reflects the respect nurses have for patients’ participation in care and decision-making. Practically, the content of item 9 was already covered under the ‘respect the patient’s right to self-determination in providing care’ subdimension of the ‘respect patient and their family member’ dimension in Vietnamese ethical standards [35]. Items 14 and 20 were also removed because their standardized factor loadings were less than 0.5. Both items focus on improper curiosity about the patient’s life, a topic also addressed in the ethical standards of the Vietnamese nursing profession [35]. Vietnamese nurses are likely highly familiar with and adhere to these standards. This finding is consistent with the results reported in Susmarini’s studies in 2023, which noted that the fundamental elements covered by these items are thoroughly examined by item 15, which assesses nurses’ respect for patients with diverse values.

The final model includes 24 items and was confirmed through an appropriate model confirmation process. Although four items were removed from the original instrument, the V-NEBPPRS still aligned with the overall concept of nurses’ ethical behaviour in protecting patients’ rights. Additionally, this model’s suitability was similar to that reported in previous studies [22, 32]. Moreover, in the relationships among factors of Model II, the significance (C.R) values ranged from 6.9 to 12.3; constituent variables significantly explained all factors at a significance level of 0.05. Therefore, the V-NEBPPRS with 24 items was accepted as the final instrument.

Convergent validity pertains to the alignment of indicators measuring the same construct [36]. The findings of this study affirm the fulfilment of the criteria, with CR, standardized factor loadings and AVE values spanning from 0.73 to 0.81, 0.5 to 0.8, and 0.54 to 0.67, respectively. Consequently, the convergent validity of the V-NEBPPS was confirmed. Discriminant validity is generally described as “two distinct constructs” and is evaluated by the correlation between the two constructs [37]. The study results showed that none of the AVE values were found to be significantly lower than the square of the correlation coefficient between two subfactors. Hence, the discriminant validity of the V-NEBPP instrument was successfully established. This study’s convergent and discriminant validity results were consistent with studies of Susmarini et al. [22] and Yun [32]. However, it is impossible to compare to the original version by Egyboglu [21], which did not report convergent and discriminant validity.

In this study, the V_NEBPPRS’s Cronbach’s coefficient was 0.85, with subscales ranging between 0.73 and 0.79, indicating good internal consistency and homogeneity. Notably, these Cronbach’s α values were higher than those reported in the original study, possibly due to cultural differences.

The final version of the 24-item V-NEBPPRS included five factors (Table 5) and utilized a five-point Likert scale ranging from “never” to “always”, with scores from one to five. Factor 1, “Respect for the right to information and decision-making” consists of seven items. Factor 2, “Providing fair care” comprises five items requiring reverse coding. Factor 3, “Providing benefit - not harming” includes four items, and both Factor 4, “Respect for patient values and choices” and Factor 5, “Attention to privacy” each include four items.