title: The Professional Nurse Self-Assessment Scale: Psychometric testing in Norwegian long term and home care contexts.
abstract: BACKGROUND
  Nurses' clinical competence is vital to ensure safe and high quality care, and the continuous assessment of nurses' clinical competence is of major concern. A validated instrument for the self-assessment of nurses' clinical competence at different educational levels across specialties and countries is lacking. The aim of this study was to test the reliability and construct validity of the new Professional Nurse Self-Assessment Scale (ProffNurse SAS) questionnaire in long term and home care contexts in Norway. The questionnaire is based on the Nordic Advanced Practice Nursing model, in which the nurse-patient relationship is central.
  
  
  METHODS
  The study has a cross-sectional survey design. A purposive sample of 357 registered nurses who worked in long term and home care contexts in two geographical regions encompassing eight municipalities and three counties was included. The respondents completed the 74-item ProffNurse SAS questionnaire and demographic background data was collected. Data collection was conducted in two phases: first region autumn 2011 and second region spring 2012. Exploratory factor analyses (EFA) were used to test the psychometric properties of the questionnaire and included the following steps: assessment of the factorality of the data, factor extraction by Principal Component Analysis (PCA), oblimin (oblique) factor rotation, and interpretation. Cronbach's alpha was used to estimate the internal consistency.
  
  
  RESULTS
  The PCA revealed a six-component structure, reducing the number of items in the questionnaire from 74 to 51. Based on the content of the highest-loading items, the six components were named: Direct Clinical Practice, Professional Development, Ethical Decision-Making, Clinical Leadership, Cooperation and Consultation, and Critical Thinking. The Cronbach's alpha values ranged from 0.940 (highest; Direct Clinical Practice) to 0.737 (lowest; Critical Thinking), leading to the estimation that the ProffNurse SAS is reliable.
  
  
  CONCLUSIONS
  The six components support the study's theoretical framework. The ProffNurse SAS showed acceptable reliability and construct validity and may therefore be a promising instrument for the assessment of practicing nurses' clinical competence. However, we recommend further psychometric testing in other countries and contexts and the inclusion of larger samples of nurses at various levels of education, particularly master's level APNs.
authors.affiliation: School of Health and Medical Sciences, Örebro University, Fakultetsgatan 1, Örebro, 702 81 Sweden ; Lovisenberg Diaconal University College, Lovisenberggt. 15 b, Oslo, 0456 Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Finnbakk
authors.affiliation: Faculty of Health, Care and Nursing, Gjövik University College, Postbox 191, Gjövik, 2802 Norway.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Wangensteen
authors.affiliation: Faculty of Health Sciences, Buskerud and Vestfold University College, Postbox 7053, Drammen, 3007 Norway.
authors.forename: Kirsti
authors.initials: K
authors.lastname: Skovdahl
authors.affiliation: School of Health and Medical Sciences, Örebro University, Fakultetsgatan 1, Örebro, 702 81 Sweden ; Faculty of Health Sciences, Buskerud and Vestfold University College, Postbox 7053, Drammen, 3007 Norway ; Åbo Akademi University, Vasa Campus, Postbox 311, Vasa, 65101 Finland.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Fagerström
keywords: Advanced practice nursing; Clinical competence; Factor analysis; Long term care; Professional home nursing; Psychometrics; Questionnaires; Self-assessment