Nursing Quality Scale (nqs): Test Development

Nursing Quality Scale

Running Head: Nursing Quality Scale

Nursing Quality Scale (NQS) Test Development

Marife Mamauag Carlo Magno De La Salle – College of Saint Benilde

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Nursing Quality Scale (NQS) Test Development Rationale Measurement of health has been given greater importance over the years in the light of quality assurance because of increasing global changes in health care organizations. Assessing and evaluating effects of changes on organizational and individual well-being require more valid and reliable techniques. More health professionals believe that they have a pretty good idea as to what makes for quality nursing care. Oftentimes they think that competence alone is enough. Recent international nursing standard however, stipulate that quality nursing care requires not only technical skills and critical thinking for sound decision-making but interpersonal skills as well. Unlike in the past, the importance of a global view of work quality and health has now been strongly emphasized. There is a need for more refined and specific assessment tools to measure quality nursing care. Studies have shown strong evidence that aside from aptitude personal attributes have importance implications for nurse selection and training. (March, et al. 1996; Mrayyan, 2004; Bakalis, et al., 2005; Schreiber, 1999; Clark, et al., 1997; Fealy, 2004; Corliss, 1994; Boblin-Cummings, 1996; Kleiman, 2002). According to the country’s standard of quality nursing care, there are four (4) C’s that make a good nurse, namely: Commitment, Caring, Compassion, and Competence. While Competence could be well measured by aptitude and achievement tests, measures for the other three Cs have yet to be defined, refined, and constructed. Qualities of a Nurse Several researches over time have shown evidence of the importance of personal attributes in quality nursing care. Commonly perceived attributes or characteristics by both nurseexperts/practitioners and patients are the following: Compassion, Caring, Commitment, and Connectedness. To validate these findings in the local setting, a personal interview (face-to-face) was conducted in April 2005 among 35 nurses who have been practitioners for at least three years, randomly

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selected from the UP-GH, UST, and MDH. The top ten traits identified a good nurse should possess are the following: competence, dedication and commitment, compassion, T-L-C (tender-loving-care), patience, responsibility over others, trustworthiness, integrity, cheerfulness, and grace under pressure. Compassion. Imogene King’s Interacting Systems model (1981) that supports the need for a baccalaureate degree as entry level for professional nursing, address the question: What are the characteristics of high quality nursing care? Within Fawcett’s (1997) structural hierarchy of contemporary nursing knowledge, the meaning of high quality nursing care is found in the metaparadigm relational proposition: nursing is concerned with the nursing actions in the person’s health status. Quality is seen as an experiential judgment emerging from the nurse patient interaction (Gunther, 2001; Fedorawicz, 2002) as advocated in the King’s model. It requires the nurse’s understanding, self-awareness and perceptual accuracy to guide communication effectively during the nurse-patient interaction. It is further assumed that nurses who are intuitive and empathic provide high quality nursing care (Reynolds, 1999). Dungan model of dynamic integration (DMDI) views humans as possessing synergistic dimensions of body, mind, and spirit. Therapeutic relationships are accomplished through the provision of presence, listening, and communication through “mutuality of concern” which is a construct believed synonymous with empathy. Research findings of Brown (1990) indicated that nurse empathy positively influences patient satisfaction with care. Nurses and patients agreed that the relationship developed between the nurse and patient is very important. Patients identified the most important nursing action as “being there”, and “taking time to sit down and listen” Using a 5-service quality index (tangibles, reliability, responsiveness, assurance, and empathy), Osuna (1998) further contended that there is no significant difference demonstrated in patient’s overall expectations of quality nursing care and patients’ overall perceptions of actual care receive. A closely related construct to empathy is compassion. It means being aware of and sensitive to the feelings, need and well-being of

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others, demonstrating kindness and empathy toward others by taking action to make a difference where one can. Identified by health professionals and consumers alike as the cornerstone of quality nursing care, compassion within the context of nursing education (Peters, 2003) means forming connections with others, walking a mile in their shoes, recognizing needs, burdens, and suffering, embracing the emotional response to suffering, acting to make it better, giving and receiving gifts, and being aware of the boundaries of the professional role. Caring. Patient outcomes are key aspects of quality nursing care. Caring and providing comfort were considered most important outcome to patients, who oftentimes seek health care for relief of physical and psychosocial distress (Yen, 1994; Nandlal, 1995). Patient comfort and care are dimensions of preferred outcome, however, in nursing literature these have long been seen as difficult to define and measure. Using grounded theory approach, Larsen (1998) attempted to identify components of quality nursing care in nursing homes. Findings show that residents, the qualities are: staff who care, personal care and safety, sociality/personal recognition, accommodation, personal choices and family. Commitment. In the State University of West Georgia nursing student handbook, commitment has been defined as the affective ability needed to keep one’s obligations congruent with one’s trust, i.e., a nurse’s obligation to the profession of nursing. It includes attitudes of empowerment, advocacy, assertiveness, courage, selfresponsibility and accountability, and a profound desire to “maintain and elevate the standards of the profession”. Collaborative attitudes include respect for diversity, a positive response to change, and belief in “power with” rather than “power over”. Used as a goal for a standard, commitment occurs whenever goal acceptance increases; there is greater congruence between the assigned and personal goals (Meyer & Gellatly, 1988). In an ethnographic study that examined the attributes of nurses that are important in caring from the relatives’ perspective, process (Ming Ho Loo & Mackenzie, 1996) are the nurses’ competence and commitment to the job, and it was shown that their relationships with the patient and the family were considered important. Quality has

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been judged not only by the patents, but also by the ways in which they work with the family. Closely related construct to commitment is priority setting which has been considered as important skill in nursing. Recent studies, however, suggested that it is a difficult skill for newly qualified nurses to acquire and may not be given sufficient attention in nursing education. Priority setting, according to Hendry & Walker (2004), means the ordering of nursing problems using notions of urgency and/or importance, in order to establish a preferential order for nursing actions. A number of factors that may impact on priority setting include the nurse’s expertise, patient’s condition, availability of resources, ward organization, philosophies and models of care, nursepatient relationship, and the cognitive strategy used by the nurse to set priorities. However, very little empirical work has been conducted along this area. Despite extensive interest in commitment, mainly in the psychological and organizational behavior literature, there has been little empirical research into the meaning of commitment in relationships, the processes that underlie commitment and how they affect the relationship outcome. Connectedness. For the past decade, nurse-client contracting has been used with increased frequency by nurses in many health care settings. Generally, nurse-client contracting is a means of delivery effective nursing care (Sheridad, 1983). From the perspective of patients, high quality nursing comprised of the following: competence, coaching, connection and immediacy (Budgen, 1988). The construct of nurse-patient bonding has been explored several times the early decades of the 20th century. Oftentimes, the concept of nurse empathy has been shown to be manifested within the context of bond variations (Ramos, 1990). There seems to exist an overlapping between the constructs of empathy and bonding. Empathy as commonly described by the nurse-experts oftentimes bear a resemblance of the affective, cognitive, and instrumental types of processing described in most psychology literature. Certain critical incidents describing nurse-patient relationships seemed to exemplify the understood common meaning of

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empathy, particularly those seen with a specific type of relationship characterized by mutuality/reciprocity, resolved control issues, and prolonged or intense contact. According to a study conducted by Yow (1992), nurse-patient interactions are important in the delivery of effective nursing care. The combined effects of role and personal relationships influence the working relationships that develop between nurses and patients. Categories of role relationships are direction and information exchange. The category that describes relationships, on the other hand, is rapport. Moreover, nurses are expected to develop some of the features of what Morse (1991) described as a “connected care relationship”. Person-centered care relies on effective nurse-patient communication. The central tenet of person-centered care is that nurse practitioners work closely with the patients’ perspectives and needs (Clarke et al 2003). Through effective communication skills, nurses need to know how to “say the words” that give shared meaning and respect for dignity to physical care. Conceptual Framework Grounded on the aforementioned research finding as shown in the existing literature about nursing quality care, a conceptual framework was drawn up to serve as the blueprint in the construction of the Nursing Quality Scale of the NQS. The framework embodies the viewpoints commonly expressed by the both the patients and nurses on what quality nursing care is.

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Figure 1. Five Cs – Nursing Quality Scale Framework

NurseExperts’/ Practitioners’

Quality Nursing Care • • • • •

Viewpoints Patients’/ Clients’

Commitment Compassion Caring Connectedness Competence

Method Purpose to be Served by the Test The NQS is part of a battery of tests called Assessment for Nursing Potential (ANP) designed to select and place nursing students to the upper level of college education. The ANP consists of three (3) tests, namely: aptitude test, measuring the “innate-based” learned abilities (verbal reasoning, quantitative reasoning, abstract reasoning); achievement test, measuring the learned abilities in the first two years in nursing (psychology, communication skills, algebra, basic physical sciences, basic life sciences); and the nursing attitudinal inventory, or the NQS which assesses the traits that are essential for a nursing student to contribute to one’s success in the nursing profession. The NQS, therefore, addresses the affective measurement in the ANP. Considered a strong base for selecting students to the upper nursing level, the ANP serves as a good preparation for the nursing board exam and other foreign-based tests like the NCLEX or CGFNS. Scale Content and Specifications The Nursing Quality Scale (NQS) measures an individual’s likelihood of possessing a wide array of personal traits that are desirable for quality nursing care. It consists of four (4) sub-scales, namely: Compassion, Commitment, Caring, and Connectedness, with a total of 150 items each in an agreement scale of 1 (strongly

Nursing Quality Scale

disagree) to 4 (strongly agree). There are two forms of tests constructed (See appendix B and C). The operational definitions of these sub-scales and are shown in the Table of Specifications. Table 1 NQS Table of Specifications Area Scale Compassion

Commitment

Caring

Connected-ness

Definition Being aware of and sensitive to the feelings, needs, and well-being of others, demonstrating kindness and empathy toward others by taking action to make a difference, and ability to work with others for a common goal. This includes attitudes such as respect for diversity, positive response to change, and belief in “power with” rather than “power over”. Affective ability needed to keep one’s obligations congruent with one’s desires and to guide choices related to one’s trust, that is, a nurse’s obligation to the profession of nursing (Meyer & Gellalty, 1988; Meyer & Allen, 1991). It includes attributes of empowerment, advocacy, assertiveness, courage, self-responsibility and accountability, and profound desire to maintain and elevate the standards of the profession. Basic way of being, the essence of nursing and means that people, interpersonal concerns and things matter (Watson, 1979). Caring for self and others involves self-awareness and belief in personal empowerment, maintaining academic and practice standards to ensure the quality of the profession. Fundamental human motivation (Baumeister and Leary, 1995); positive interactions within an ongoing relational connection (Townsend & McWirter, 2005); an increased sense of well-being that comes from feeling connected to others, motivation and the ability to act positively both within and beyond the boundaries of the relationship, increased self-knowledge of the “other” in the relationship, an increased sense of self-worth, and the desire for additional connections (as cited in Riggs & Bright, 1997).

Total

No. of Items 76

79

59

86

300

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Item Writing and Review There are 267 original items across the four (4) subscales that were subjected for review by three (3) experts, one a measurement specialist, a psychologist, and another one who is a teaching faculty in nursing. The item review matrix was made for the reviewers to indicate their comments (see Appendix A). The items were evaluated in terms of their clarity and relevance vis-a-vis their conceptual definitions based on the various subscales. A decision whether to retain, revise or reject an item was done through agreement among the comments of the item reviewers. Pre-test Administration The pre-testing of the NQS was conducted among groups consisting of 167 nursing students in their third year level. The test was administered through group testing to capture a maximum number of target respondents. Permission from school to pre-test the instrument was sought first before conducting the pre-testing proper. Ethical considerations in testing and confidentiality of the test data were ensured prior to and after the test administration. Establishing Validity and Reliability Content validity of the NQS was established through the item review of experts. Its reliability, on the other hand, was be established through item analysis to be processed with the use of both classical (Cronbach’s alpha and factor analysis) and IRT methods (Rasch model). Assembly of the Final Form Based on the results of the item analysis, the final form of the NSQ was assembled to retain good items each of the four subscales, totaling to 150 items. Parallel form was assembled depending on the number of acceptable and good items retained after the item analysis.

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Interpretation of Scores Table 2 presents the interpretative guide for the NQS. It must be noted that reverse scoring was done for the negatively-stated items before final scoring was computed. Mean scores per subscale was finally obtained with corresponding descriptive interpretation. Table 2 Interpretative Guide for the NQS ScalePoints 4 (SA)

Continuum of Values 3.50 – 4.00

3 (A)

2.50 – 3.49

2 (D)

1.50 – 2.49

1 (SD)

1.00 – 1.49

Note: SA=strongly agree,

Interpretation

Most likely to manifest the traits/attributes Likely to manifest the traits/attributes Unlikely to manifest the traits/attributes Least unlikely to manifest the traits/attributes A=agree, D=disagree, SD=strongly disagree

Timelines The test development was undertaken within six (6) months; specific timelines are shown in Table 3. Table 3 Timelines of the NQS Development Activity Item writing and review Pre-testing Item analysis Final Assembly

Duration Three (3) months One (1) month One (1) month One (1) month

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Results Internal Consistency The tests reliability for the two forms was determined using Cronbach’s alpha. The total mean score for form A is 268.46 and a standard deviation of 29.40 with a corresponding mean of 1.902 when divided by the number of items. This shows that the responses of the nursing students are somehow low. The standardized Cronbach’s alpha arrived is .95 which indicates very high internal consistency among the items. For Form B, a mean score of 281 and a standard deviation of 35.16 with a corresponding score of 1.87 which is somehow low. The Cronbach’s alpha derived is .96 which indicates again a high reliability. In determining the reliability, the items for the two forms shows consistency of both having high reliability. Interitem correlation was also conducted top establish the consistency of the items with each other (see Appendix D). Factor Analysis Factor analysis was performed to determine the sources of variation for the two forms of the NQS. In the procedure, the items were extracted in four factors fitting with the hypothesized factors in the study (compassion, commitment, caring, connectedness). The extracted communalities for each item were also determined (See appendix E). The items were clustered into four factors using varimax rotation with the eigenvalues of 26.36 for factor 1, 8.95 for factor 2, 4.09 for factor 3, and 3.81 for factor 4. The total eigenvalues for the extracted factors are shown in table 4. Table 4 Eigenvalues of Form A Rotated Factors Factors 1 2 3 4

Total 26.36 8.924 4.10 3.81

Percentage of Variance Cumulative Percentage 17.57 17.57 5.95 23.52 2.73 26.26 2.54 28.80

In the varimax rotation, items with factor loadings of .3 and above were accepted that composes the final pool of items in the

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instrument. The following items for each factor are shown in Tables 5 7. Table 5 Accepted Items for Factor 1 Item no. 9 11 13 16 23 24 27 28 31 32 33 35 40 41 47 48 49 51 53 56 61 69 93 95 97 99 107 108 112 116 121 128 129 135 136 145 148 149

Item I am able to encourage people get better I am sensitive to the feelings of others To make sure a sick person feel comfortable is something I would like to do I have a sense of connection with the people I meet I react appropriately to others’ facial expressions I treat my friends as my relatives I can guess what others are feeling through their gestures I believe that I am remembered by the good deeds that I do I can feel with people who are hurt I believe I am valued by other people I like entertaining guests I delight in others’ achievements I feel that my friends are close to me I like to accompany lame people to places theya re going I can feel if someone is hurting Other people get along with me I have fun telling stories to young people I can easily detect that someone is feeling bad I enjoy doing errands for my parents I am comfortable others depend on me I love to hug people who are close to me I am able to show affection to persons I care I get along well with others even to people whom I meet for the first time I love to keep good company to people who are hurting. I love to tell jokes to a crowd I find time to listen to the hurt feelings of others I easily feel for the underdog in the movies I feel that there are a lot of qualities that people like in me. I treat my friends as family I have a sense of belongingness in school I enjoy taking care of my pets I feel that I am one with my classmates I make sure that everyone at home is comfortable I never get tired of talking to people who need my help I feel that I share a common career goal with my teachers When doing a task, I often do more than what is demanded I get excited whenever I am able to get through my message in a conversation I readily foresee the actions and consequences of troubled

Factor loading 0.30 0.46 0.32 0.61 0.37 0.46 0.52 0.51 0.68 0.49 0.36 0.32 0.38 0.51 0.62 0.42 0.49 0.64 0.36 0.37 0.36 0.38 0.54 0.39 0.37 0.39 0.32 0.56 0.40 0.61 0.30 0.45 0.40 0.50 0.44 0.33 0.47 0.36

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people I always try to share and suggest improvements on how things are done

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0.54

Table 6 Accepted Items for Factor 2 Item no. 5 21 22 26 42 54 57 66 67 70 75 79 102 114 127 130 134 138

Item I ask my parents the things they need if they are sick I help feed my younger siblings when necessary I know I can reach my career goal I am aware that my career goal of becoming a nurse is worth achieving for I love nursing because I feel that I would be good at it I am willing to volunteer to community projects I love to take care of sick people When given a task, I make sure it is accomplished on time I am happy for people who are able to achieve their goals I am willing to pursue further studies after I graduate from college I am happy for people who become successful I get excited to see others win in their game I will take full responsibility for whatever actions I would take in becoming a good nurse I see myself as a dedicated nurse someday I believe that I need to be kind to others otherwise they will treat me unfairly When given a task, I do it completely and thoroughly I am highly concerned for a sick member of the family I am willing to share similar experiences to others in distress

Factor loading 0.38 0.36 0.55 0.35 0.45 0.51 0.49 0.46 0.62 0.36 0.55 0.31 0.54 0.57 0.31 0.46 0.41 0.33

Table 7 Accepted Items for Factor 3 Item no. 3 8 14 15 19 43 44 55 59 68

Item I find it hard to read facial expressions I can be a good friend to anyone I believe that not much could be gained by pursuing a nursing degree I listen to someone else’s point of view I am concerned when someone is treated unkindly I listen to others who ask for my help I feel secure with my family I hate talking to people who are in pain I do not like to listen to others’ hurts because I easily got carried away by their emotions I get uneasy when someone gets too close to me

Factor loading -0.59 0.45 -0.47 0.38 0.33 0.47 0.54 -0.55 -0.62 -0.59

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76 81 84 89

I am scared getting close to someone I am not able to open up to new acquaintances I do not feel comfortable being intimate with others I do not like to listen attentively to other people’s miseries and sorrows I feel others are reluctant to be close to me I feel people get readily intimidated with me I feel like wining too, when I see my team winning in a game I can easily identify myself with the nursing profession I am willing to share similar experiences to others in distress

92 96 111 120 139

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-0.52 -0.35 -0.37 -0.65 -0.42 -0.55 0.30 0.59 0.30

Table 8 Accepted Items for Factor 4 Item no. 7 18 83 103 104 115

Item I I I I I I

get upset when someone else is sad have a sense of connection with the people I meet take on other people’s problems as if they are my own shrink back when I see the hero hurt in the movies worry if my close friends abandon me cry easily when I see someone crying

Factor loading 0.35 0.36 0.41 0.30 0.40 0.58

Factor analysis was also conducted for Form B extracting four factors through varimax rotation. The extraction of communalities are also conducted (see appendix F). The eigenvalues are 32.51 for factor 1, 9.36 for factor 2, 4.80 for factor 3, and 3.86 for factor 4. The explained variance are high and using the scree test they are above 1. Table 9 Eigenvalues of Form B Rotated Factors Factors 1 2 3 4

Total 32.51 9.36 4.80 3.86

% of Variance 21.67 6.24 3.20 2.57

Cumulative % 21.67 27.91 31.11 33.69

The accepted items for the factors are shown in table 13. The items with factor loadings of .30 and above are accepted.

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Table 13 Accepted Items for Factor 1 Item no. 7 10 16 25 27 28 30 31 36 37 49 51 68 75 78 82 88 93 95 98 108 110 118 121 125 130 132 135 136 140 142 143 144 148 150

Item I can easily identify myself with the nursing profession I spend a lot of time conversing with my family I show my concern when there is someone sick in the family I make sure that everyone in the family eat good healthy meals I enjoy making friends I will take care of my parents when they grow old I enjoy building good relationships with others I am lucky because I have warm and affectionate parents I love to join community projects I believe there is hope for a bright future for my loved ones I enjoy spending time with people I care for I will work hard to become a good burse I trust myself to do right things correctly I love family gatherings The nursing profession has a great deal of meaning to me I would be very happy to spend the rest of my career in the nursing profession I lose my patience with people who are slow I show my real feelings towards other people Whenever a family crisis arises, I have someone whom I trust could give me good advice My chosen career plays a central role in my life I inspire others to work for their goals I believe that I will be a successful nurse I exert more effort in teamwork to attain the goals I always consider what more I can do to advance in my chosen career I can easily forgive and forget other people’s misgivings I pledge to do all things to the fullest as required by my profession I believe that I have a great obligation to society I respect the uniqueness of each individual I give more than one hundred percent of my service I love being a nursing student I enjoy the activities and duties of a nursing student I am determined to finish my nursing course and become a great nurse someday I hate rules and regulations I consider my trials in life as challenges I welcome new experiences

Factor loading 0.61 0.38 0.66 0.51 0.64 0.62 0.60 0.48 0.46 0.59 0.56 0.69 0.58 0.41 0.51 0.59 -0.38 0.49 0.40 0.35 0.49 0.69 0.47 0.45 0.36 0.61 0.54 0.56 0.53 0.71 0.71 0.65 -0.63 0.57 0.52

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Table 14 Accepted Items for Factor 2 Item no. 2 17 20 21 24 29 32 35 38 54 57 63 64 67 70 85 86 111 124 129 134 138

Item I enjoy talking to people I never get tired of talking to people who need my help I am willing to share my similar stories to others in distress I have a strong urge to bond with people whom I feel are good people I love to mingle with people from all walks of life I am happy to know that I am fully understood by others even when I am in trouble I get excited whenever I am able to get my message across in a conversation I readily foresee the actions and consequences of troubled people I admire others’ active self-healing efforts when they are in trouble I can easily see the faults and failures of others I believe that it is okay to commit mistakes I feel I have so much to give to help others in need I feel that people are glad to throw a party form me I am aware I am very capable of helping others I love working long hours because I find personal satisfaction in seeing things get done I accept my friends unconditionally I enjoy discussing about my chosen profession even to others who are not into it When meeting new people, I make sure to call them by name I stay with people who are in critical condition I affirm the positive traits of others I have a sense of pride with what I do I make sure that others come first in everything I do

Factor loading 0.44 0.49 0.37 0.35 0.61 0.44 0.48 0.50 0.62 0.32 0.33 0.48 0.50 0.53 0.34 0.48 0.37 0.33 0.51 0.60 0.51 0.55

Table 15 Accepted Items for Factor 3 Item no. 14 18 64 72 77 90 100 101

Item I can easily sense the pain and sorrow of others I feel that I share a common career goal with my teachers I feel that people are glad to throw a party for me I believe that other people’s needs are more important than mine I feel what other people are feeling I feel I have few options If I leave my chosen career I refrain from saying things that would ridicule others I can easily place myself in the shoes of others

Factor loading 0.46 0.41 0.35 0.49 0.62 -0.40 0.30 0.52

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103 104 107 113 117 119 139

I I I I I I I

think my sense of humor makes me popular show a calm and smiling face to anyone I come across with get along well with people even those I meet for the first time make sure that my friend feels accepted by my peers do all that is necessary for the benefit of my friends am not personally interested in other people’s lives stay out of other people’s personal problems

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0.51 0.31 0.52 0.38 0.42 -0.35 -0.30

Table 16 Accepted Items for Factor 4 Item no. 1 15 43 44 58 71 73 83 91 94 97 102 133 146

Item I do not bother listening to other people’s hurt feelings I believe that my classmates and I have common career goals I do not want getting stressed at doing an assigned task so I perform like everybody else I do not need anyone to fulfill my career goal I find it difficult to commit in a relationship When I have problems, I have nobody whom I feel I will be comfortable to talk with I easily get drained with the bad feelings of others I feel I am often out of place in my circle of friends I find trouble in getting someone whom I can turn to for personal problems I am not afraid of consequences if I quit my schooling in nursing I hate pretentious people I believe that my nursing course is a matter of necessity as much as a desire I make fun of other people who are different I am fond of giving excuses whwnver things go wrong

Factor loading 0.43 0.32 0.32 0.43 0.38 0.43 0.31 0.48 0.43 0.39 -0.31 0.51 0.66 0.46

Item Calibration The items for each factor were calibrated for the qualities that the participants have in the NQS test. For the items for both form A and B, the items that show properly fit with the quality based on the t values which is not significantly different from 0 are accepted in the final form. There are few items that show extreme calibration. Each scale was calibrated for items and by person. As compared in the factor analysis. There are more items that are accepted than in the IRT analysis using the Rasch model.

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Table 17 Item Calibration for Caring Form A item name 5 28 26 4 3,15 8,22 7 23,21,1 0 27 6,20 2 18,12 13 9 16 29 17 11 25 32,14 33 24 1 31 19 30

Item score 166 165 164 163 162 160 159

Item freq. 1 1 1 1 2 2 1

prop. corr. 0.99 0.99 0.98 0.98 0.97 0.96 0.95

Prop. Incur. 0.01 0.01 0.02 0.02 0.03 0.04 0.05

logit incor. -5.11 -4.41 -4.00 -3.71 -3.48 -3.13 -2.99

freq.xlogit -5.11 -4.41 -4.00 -3.71 -6.96 -6.26 -2.99

freq.xlogit^2 26.13 19.47 16.01 13.75 24.20 19.58 8.94

init. delta -2.89 -2.19 -1.78 -1.48 -1.25 -0.91 -0.77

expansion 1.09 1.09 1.09 1.09 1.09 1.09 1.09

delta -3.15 -2.39 -1.94 -1.62 -1.37 -0.99 -0.84

Cal. SE 1.05 0.74 0.61 0.53 0.47 0.40 0.38

157 156 154 153 152 151 149 146 143 142 141 140 137 123 121 120 101 43 32

3 1 2 1 2 1 1 1 1 1 1 1 2 1 1 1 1 1 1

0.94 0.93 0.92 0.92 0.91 0.90 0.89 0.87 0.86 0.85 0.84 0.84 0.82 0.74 0.72 0.72 0.60 0.26 0.19

0.06 0.07 0.08 0.08 0.09 0.10 0.11 0.13 0.14 0.15 0.16 0.16 0.18 0.26 0.28 0.28 0.40 0.74 0.81

-2.75 -2.65 -2.47 -2.39 -2.32 -2.24 -2.11 -1.94 -1.78 -1.74 -1.69 -1.65 -1.52 -1.03 -0.97 -0.94 -0.43 1.06 1.44

-8.26 -2.65 -4.94 -2.39 -4.63 -2.24 -2.11 -1.94 -1.78 -1.74 -1.69 -1.65 -3.04 -1.03 -0.97 -0.94 -0.43 1.06 1.44

22.75 7.03 12.22 5.72 10.73 5.04 4.47 3.76 3.19 3.02 2.86 2.71 4.61 1.06 0.94 0.88 0.18 1.12 2.07

-0.53 -0.43 -0.25 -0.17 -0.09 -0.02 0.11 0.28 0.44 0.49 0.53 0.58 0.70 1.20 1.26 1.29 1.80 3.28 3.66

1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09

-0.58 -0.47 -0.27 -0.18 -0.10 -0.02 0.12 0.31 0.48 0.53 0.58 0.63 0.77 1.30 1.37 1.40 1.96 3.58 3.99

0.34 0.33 0.30 0.29 0.28 0.27 0.26 0.24 0.23 0.23 0.22 0.22 0.21 0.18 0.18 0.18 0.17 0.18 0.21

Table 18 Person Calibration for Caring Form A Possible score Exp. Factor 1 2 3 4 5 6 7 8 9

person freq.

prop. corr.

logit correct

freq.xlogit

freq.xlogit^2

init. ability

Test width

Beta 0 0 0 0 0 0 0 0 0

Cal. SE 0.03 0.06 0.09 0.12 0.15 0.18 0.21 0.24 0.27

-3.47 -2.74 -2.30 -1.98 -1.72 -1.50 -1.31 -1.14 -0.98

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

-3.47 -2.74 -2.30 -1.98 -1.72 -1.50 -1.31 -1.14 -0.98

1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33

-4.60 -3.64 -3.06 -2.63 -2.29 -2.00 -1.74 -1.51 -1.30

1.17 0.84 0.70 0.61 0.56 0.52 0.49 0.47 0.45

Nursing Quality Scale

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

0 0 0 0 0 0 0 1 0 0 1 1 3 2 7 4 13 25 26 37 33 11 3

0.30 0.33 0.36 0.39 0.42 0.45 0.48 0.52 0.55 0.58 0.61 0.64 0.67 0.70 0.73 0.76 0.79 0.82 0.85 0.88 0.91 0.94 0.97

-0.83 -0.69 -0.56 -0.43 -0.31 -0.18 -0.06 0.06 0.18 0.31 0.43 0.56 0.69 0.83 0.98 1.14 1.31 1.50 1.72 1.98 2.30 2.74 3.47

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.06 0.00 0.00 0.43 0.56 2.08 1.67 6.87 4.56 17.06 37.60 44.79 73.30 75.99 30.15 10.40

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.19 0.31 1.44 1.39 6.73 5.19 22.38 56.56 77.17 145.20 174.96 82.63 36.03

-0.83 -0.69 -0.56 -0.43 -0.31 -0.18 -0.06 0.06 0.18 0.31 0.43 0.56 0.69 0.83 0.98 1.14 1.31 1.50 1.72 1.98 2.30 2.74 3.47

1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33

-1.11 -0.92 -0.74 -0.57 -0.41 -0.24 -0.08 0.08 0.24 0.41 0.57 0.74 0.92 1.11 1.30 1.51 1.74 2.00 2.29 2.63 3.06 3.64 4.60

19 0.44 0.43 0.42 0.41 0.41 0.40 0.40 0.40 0.40 0.41 0.41 0.42 0.43 0.44 0.45 0.47 0.49 0.52 0.56 0.61 0.70 0.84 1.17

Table 19 Item Calibration for Caring Form B tem name 22 8 9,19 5,20 4,24 7 23,16 11 14 10 15 1 21,18 12 17 13 6,3 25 2 26

item score 150 148 147 146 145 144 143 142 141 140 136 135 133 130 129 125 124 105 102 50

item freq. 1 1 2 2 2 1 2 1 1 1 1 1 2 1 1 1 2 1 1 1

prop. corr. 0.99 0.98 0.97 0.97 0.96 0.95 0.95 0.94 0.93 0.93 0.90 0.89 0.88 0.86 0.85 0.83 0.82 0.70 0.68 0.33

prop. incor. 0.01 0.02 0.03 0.03 0.04 0.05 0.05 0.06 0.07 0.07 0.10 0.11 0.12 0.14 0.15 0.17 0.18 0.30 0.32 0.67

logit incor. -5.01 -3.90 -3.60 -3.37 -3.18 -3.02 -2.88 -2.76 -2.65 -2.54 -2.20 -2.13 -2.00 -1.82 -1.77 -1.57 -1.52 -0.83 -0.73 0.70

freq.xlogit -5.01 -3.90 -7.21 -6.75 -6.37 -3.02 -5.77 -2.76 -2.65 -2.54 -2.20 -2.13 -4.00 -1.82 -1.77 -1.57 -3.05 -0.83 -0.73 0.70

freq.xlogit^2 25.11 15.20 25.98 22.77 20.29 9.14 16.63 7.61 7.00 6.47 4.86 4.55 8.00 3.32 3.13 2.47 4.65 0.68 0.54 0.49

init. delta -2.57 -1.46 -1.17 -0.94 -0.75 -0.59 -0.45 -0.32 -0.21 -0.11 0.23 0.30 0.44 0.61 0.67 0.87 0.91 1.61 1.70 3.14

expansion 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17 1.17

delta -3.00 -1.70 -1.36 -1.09 -0.87 -0.68 -0.52 -0.37 -0.24 -0.12 0.27 0.36 0.51 0.72 0.78 1.01 1.07 1.88 1.99 3.66

Cal. SE 1.08 0.63 0.55 0.49 0.45 0.42 0.39 0.37 0.35 0.34 0.29 0.29 0.27 0.25 0.25 0.23 0.23 0.19 0.19 0.19

Nursing Quality Scale

20

Table 20 Person Calibration for Caring Form B possible score Exp. Factor 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

person freq. Beta 0 0 0 0 0 0 0 0 0 0 0 0 1 0 2 1 1 2 2 10 17 17 22 34 42

prop. corr. Cal. SE 0.04 0.08 0.12 0.15 0.19 0.23 0.27 0.31 0.35 0.38 0.42 0.46 0.50 0.54 0.58 0.62 0.65 0.69 0.73 0.77 0.81 0.85 0.88 0.92 0.96

logit correct

freq.xlogit

freq.xlogit^2

init. ability

Test width

-3.22 -2.48 -2.04 -1.70 -1.44 -1.20 -1.00 -0.81 -0.64 -0.47 -0.31 -0.15 0.00 0.15 0.31 0.47 0.64 0.81 1.00 1.20 1.44 1.70 2.04 2.48 3.22

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.62 0.47 0.64 1.62 2.00 12.04 24.40 28.98 44.81 84.49 135.19

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.19 0.22 0.40 1.32 1.99 14.50 35.01 49.40 91.28 209.94 435.17

-3.22 -2.48 -2.04 -1.70 -1.44 -1.20 -1.00 -0.81 -0.64 -0.47 -0.31 -0.15 0.00 0.15 0.31 0.47 0.64 0.81 1.00 1.20 1.44 1.70 2.04 2.48 3.22

1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28 1.28

-4.13 -3.19 -2.61 -2.19 -1.84 -1.55 -1.28 -1.04 -0.82 -0.60 -0.40 -0.20 0.00 0.20 0.40 0.60 0.82 1.04 1.28 1.55 1.84 2.19 2.61 3.19 4.13

1.16 0.83 0.70 0.62 0.56 0.53 0.50 0.48 0.47 0.46 0.45 0.45 0.44 0.45 0.45 0.46 0.47 0.48 0.50 0.53 0.56 0.62 0.70 0.83 1.16

Table 21 Item Calibration for Commitment Form A item name 29,1 7,4,30,21 23 9,33,27,2 6 25,10 8,3,2 6,24,13 19,17 22

Item score 164 163 162

Item freq. 2 4 1

prop. corr. 0.99 0.99 0.98

prop. incor. 0.01 0.01 0.02

logit incor. -5.10 -4.40 -3.99

freq.xlogit -10.20 -17.60 -3.99

freq.xlogit^2 52.02 77.46 15.91

init. delta -2.32 -1.62 -1.21

expansion 1.18 1.18 1.18

delta -2.73 -1.91 -1.42

Cal. SE 1.09 0.77 0.63

161 160 159 158 156 155

4 2 3 3 2 1

0.98 0.97 0.96 0.96 0.95 0.94

0.02 0.03 0.04 0.04 0.05 0.06

-3.70 -3.47 -3.28 -3.12 -2.85 -2.74

-14.78 -6.93 -9.83 -9.35 -5.71 -2.74

54.62 24.02 32.22 29.14 16.28 7.51

-0.92 -0.69 -0.50 -0.34 -0.07 0.04

1.18 1.18 1.18 1.18 1.18 1.18

-1.08 -0.81 -0.59 -0.40 -0.09 0.04

0.55 0.49 0.45 0.42 0.37 0.35

Nursing Quality Scale

14 16 28,20,15 31 12,11 37 18 35 34 36 5 32

154 152 148 140 139 135 128 125 119 101 90 64

1 1 3 1 2 1 1 1 1 1 1 1

0.93 0.92 0.90 0.85 0.84 0.82 0.78 0.76 0.72 0.61 0.55 0.39

0.07 0.08 0.10 0.15 0.16 0.18 0.22 0.24 0.28 0.39 0.45 0.61

-2.64 -2.46 -2.16 -1.72 -1.68 -1.50 -1.24 -1.14 -0.95 -0.46 -0.18 0.46

-2.64 -2.46 -6.49 -1.72 -3.35 -1.50 -1.24 -1.14 -0.95 -0.46 -0.18 0.46

6.96 6.05 14.05 2.97 5.62 2.26 1.54 1.30 0.90 0.21 0.03 0.21

0.14 0.32 0.61 1.06 1.10 1.27 1.54 1.64 1.83 2.32 2.60 3.23

1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18

0.16 0.38 0.72 1.24 1.30 1.50 1.81 1.93 2.15 2.73 3.05 3.80

21 0.34 0.31 0.28 0.24 0.23 0.22 0.20 0.20 0.19 0.17 0.17 0.17

Table 22 Person Calibration for Commitment Form A possible score

person freq.

Exp.Factor 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

Beta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 1 2 3 7 5

prop. corr. Cal. SE 0.03 0.05 0.08 0.11 0.14 0.16 0.19 0.22 0.24 0.27 0.30 0.32 0.35 0.38 0.41 0.43 0.46 0.49 0.51 0.54 0.57 0.59 0.62 0.65 0.68 0.70 0.73 0.76 0.78

logit correct

freq.xlogit

Freq.xlogit^2

init. ability

Test width

-3.58 -2.86 -2.43 -2.11 -1.86 -1.64 -1.46 -1.29 -1.13 -0.99 -0.86 -0.73 -0.61 -0.50 -0.38 -0.27 -0.16 -0.05 0.05 0.16 0.27 0.38 0.50 0.61 0.73 0.86 0.99 1.13 1.29

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 1.23 0.73 1.72 2.98 7.94 6.44

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.25 0.75 0.54 1.48 2.96 9.02 8.29

-3.58 -2.86 -2.43 -2.11 -1.86 -1.64 -1.46 -1.29 -1.13 -0.99 -0.86 -0.73 -0.61 -0.50 -0.38 -0.27 -0.16 -0.05 0.05 0.16 0.27 0.38 0.50 0.61 0.73 0.86 0.99 1.13 1.29

1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37

-4.90 -3.91 -3.32 -2.89 -2.54 -2.25 -1.99 -1.76 -1.55 -1.36 -1.18 -1.00 -0.84 -0.68 -0.52 -0.37 -0.22 -0.07 0.07 0.22 0.37 0.52 0.68 0.84 1.00 1.18 1.36 1.55 1.76

1.19 0.85 0.70 0.62 0.56 0.52 0.49 0.47 0.45 0.43 0.42 0.41 0.40 0.40 0.39 0.39 0.39 0.38 0.38 0.39 0.39 0.39 0.40 0.40 0.41 0.42 0.43 0.45 0.47

Nursing Quality Scale

30 31 32 33 34 35 36

3 7 17 28 31 33 25

0.81 0.84 0.86 0.89 0.92 0.95 0.97

1.46 1.64 1.86 2.11 2.43 2.86 3.58

4.37 11.50 31.56 59.09 75.26 94.45 89.59

6.35 18.88 58.58 124.68 182.71 270.34 321.04

1.46 1.64 1.86 2.11 2.43 2.86 3.58

1.37 1.37 1.37 1.37 1.37 1.37 1.37

22

1.99 2.25 2.54 2.89 3.32 3.91 4.90

0.49 0.52 0.56 0.62 0.70 0.85 1.19

Table 23 Item Calibration for Commitment Form B Item name 36,31,1 8,16 8,30,29 ,2 5,34 23,21 35,22 20 6,3,28, 19,17,1 3 33 25 9 4,32 27 7,26 1 41,24 11,10 39 15 14 12 38 40 42 37

Item score

Item freq.

prop. corr.

prop. incor.

Logit incor.

freq.xlogit

freq.xlogit^2

init. delta

expansion

delta

Cal. SE

166

4

0.99

0.01

-5.11

-20.45

104.53

-2.44

1.16

-2.82

1.08

165 164 163 162 161

4 2 2 2 1

0.99 0.98 0.98 0.97 0.96

0.01 0.02 0.02 0.03 0.04

-4.41 -4.00 -3.71 -3.48 -3.29

-17.65 -8.00 -7.41 -6.96 -3.29

77.89 32.02 27.49 24.20 10.82

-1.74 -1.32 -1.03 -0.80 -0.61

1.16 1.16 1.16 1.16 1.16

-2.01 -1.53 -1.19 -0.93 -0.71

0.77 0.63 0.54 0.49 0.45

160 158 157 155 151 145 143 142 138 136 132 123 119 108 100 97 75 65

6 1 1 1 2 1 2 1 2 2 1 1 1 1 1 1 1 1

0.96 0.95 0.94 0.93 0.90 0.87 0.86 0.85 0.83 0.81 0.79 0.74 0.71 0.65 0.60 0.58 0.45 0.39

0.04 0.05 0.06 0.07 0.10 0.13 0.14 0.15 0.17 0.19 0.21 0.26 0.29 0.35 0.40 0.42 0.55 0.61

-3.13 -2.87 -2.75 -2.56 -2.24 -1.89 -1.78 -1.74 -1.56 -1.48 -1.33 -1.03 -0.91 -0.60 -0.40 -0.33 0.20 0.45

-18.78 -2.87 -2.75 -2.56 -4.49 -1.89 -3.57 -1.74 -3.12 -2.96 -1.33 -1.03 -0.91 -0.60 -0.40 -0.33 0.20 0.45

58.75 8.21 7.58 6.55 10.08 3.56 6.37 3.02 4.87 4.37 1.76 1.06 0.82 0.37 0.16 0.11 0.04 0.20

-0.45 -0.19 -0.08 0.12 0.43 0.79 0.89 0.94 1.12 1.20 1.35 1.65 1.77 2.07 2.28 2.35 2.88 3.13

1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16

-0.52 -0.22 -0.09 0.14 0.50 0.92 1.03 1.09 1.29 1.39 1.56 1.91 2.05 2.40 2.63 2.72 3.33 3.62

0.42 0.37 0.35 0.32 0.28 0.25 0.24 0.23 0.22 0.21 0.20 0.19 0.18 0.17 0.17 0.17 0.17 0.17

Nursing Quality Scale

23

Table 24 Person Calibration for Commitment Form B Possible score Exp.Factor 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41

person freq. Beta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 1 1 0 2 0 5 2 3 11 18 14 33 18 28 21 7

prop. corr. Cal. SE 0.02 0.05 0.07 0.10 0.12 0.14 0.17 0.19 0.21 0.24 0.26 0.29 0.31 0.33 0.36 0.38 0.40 0.43 0.45 0.48 0.50 0.52 0.55 0.57 0.60 0.62 0.64 0.67 0.69 0.71 0.74 0.76 0.79 0.81 0.83 0.86 0.88 0.90 0.93 0.95 0.98

logit correct

freq.xlogit

freq.xlogit^2

init. ability

Test width

-3.71 -3.00 -2.56 -2.25 -2.00 -1.79 -1.61 -1.45 -1.30 -1.16 -1.04 -0.92 -0.80 -0.69 -0.59 -0.49 -0.39 -0.29 -0.19 -0.10 0.00 0.10 0.19 0.29 0.39 0.49 0.59 0.69 0.80 0.92 1.04 1.16 1.30 1.45 1.61 1.79 2.00 2.25 2.56 3.00 3.71

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.29 0.77 0.49 0.59 0.00 1.60 0.00 5.18 2.33 3.90 15.92 28.97 25.08 66.05 40.52 71.82 62.91 26.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.08 0.30 0.24 0.35 0.00 1.29 0.00 5.37 2.71 5.06 23.03 46.63 44.95 132.20 91.23 184.21 188.46 96.53

-3.71 -3.00 -2.56 -2.25 -2.00 -1.79 -1.61 -1.45 -1.30 -1.16 -1.04 -0.92 -0.80 -0.69 -0.59 -0.49 -0.39 -0.29 -0.19 -0.10 0.00 0.10 0.19 0.29 0.39 0.49 0.59 0.69 0.80 0.92 1.04 1.16 1.30 1.45 1.61 1.79 2.00 2.25 2.56 3.00 3.71

1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44 1.44

-5.33 -4.30 -3.68 -3.23 -2.87 -2.57 -2.31 -2.08 -1.87 -1.67 -1.49 -1.32 -1.15 -1.00 -0.84 -0.70 -0.55 -0.41 -0.27 -0.14 0.00 0.14 0.27 0.41 0.55 0.70 0.84 1.00 1.15 1.32 1.49 1.67 1.87 2.08 2.31 2.57 2.87 3.23 3.68 4.30 5.33

1.21 0.87 0.72 0.63 0.57 0.53 0.50 0.47 0.45 0.43 0.42 0.41 0.40 0.39 0.39 0.38 0.38 0.37 0.37 0.37 0.37 0.37 0.37 0.37 0.38 0.38 0.39 0.39 0.40 0.41 0.42 0.43 0.45 0.47 0.50 0.53 0.57 0.63 0.72 0.87 1.21

Nursing Quality Scale

24

Table 25 Item Calibration for Compassion Form A item name 27 16,13 35,30,22 15 26 3 12 37,23 33,18 8 4,38 7,21 6 36,10 2 5 14 20 32 11 42 39,34 41,19 31 29 40,1 9 43 25 28 17 24

item score 163 162 161 159 158 156 155 153 152 151 150 149 148 146 145 142 141 140 138 137 136 133 128 127 124 113 107 98 97 90 82 69

Item freq. 1 2 3 1 1 1 1 2 2 1 2 2 1 2 1 1 1 1 1 1 1 2 2 1 1 2 1 1 1 1 1 1

prop. corr. 0.99 0.99 0.98 0.97 0.96 0.95 0.95 0.93 0.93 0.92 0.91 0.91 0.90 0.89 0.88 0.87 0.86 0.85 0.84 0.84 0.83 0.81 0.78 0.77 0.76 0.69 0.65 0.60 0.59 0.55 0.50 0.42

prop. incor. 0.01 0.01 0.02 0.03 0.04 0.05 0.05 0.07 0.07 0.08 0.09 0.09 0.10 0.11 0.12 0.13 0.14 0.15 0.16 0.16 0.17 0.19 0.22 0.23 0.24 0.31 0.35 0.40 0.41 0.45 0.50 0.58

Logit\ incor. -5.09 -4.39 -3.98 -3.46 -3.27 -2.97 -2.85 -2.63 -2.54 -2.45 -2.37 -2.30 -2.22 -2.09 -2.03 -1.86 -1.81 -1.76 -1.67 -1.62 -1.58 -1.46 -1.27 -1.23 -1.13 -0.80 -0.63 -0.40 -0.37 -0.20 0.00 0.32

freq.xlogit -5.09 -8.79 -11.95 -3.46 -3.27 -2.97 -2.85 -5.27 -5.08 -2.45 -4.74 -4.59 -2.22 -4.19 -2.03 -1.86 -1.81 -1.76 -1.67 -1.62 -1.58 -2.91 -2.54 -1.23 -1.13 -1.59 -0.63 -0.40 -0.37 -0.20 0.00 0.32

freq.xlogit^2 25.95 38.62 47.59 11.97 10.70 8.82 8.10 13.86 12.89 6.01 11.25 10.54 4.95 8.76 4.13 3.48 3.29 3.11 2.79 2.64 2.50 4.24 3.22 1.52 1.28 1.27 0.40 0.16 0.14 0.04 0.00 0.10

init. delta -3.00 -2.30 -1.89 -1.37 -1.18 -0.88 -0.75 -0.54 -0.45 -0.36 -0.28 -0.20 -0.13 0.00 0.06 0.23 0.28 0.33 0.42 0.47 0.51 0.64 0.82 0.86 0.96 1.30 1.46 1.70 1.72 1.90 2.09 2.41

expansion 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18 1.18

delta -3.55 -2.72 -2.24 -1.62 -1.39 -1.04 -0.89 -0.64 -0.53 -0.43 -0.33 -0.24 -0.16 0.00 0.07 0.27 0.33 0.39 0.50 0.55 0.60 0.75 0.97 1.01 1.14 1.53 1.73 2.01 2.04 2.24 2.47 2.85

Table 26 Person Calibration for Compassion Form A possible score Exp.Factor 1

person freq. Beta 0

Prop corr. Cal. SE 0.02

logit correct

-3.74

freq.xlogit freq.xlogit^2 init. ability

0.00

0.00

-3.74

Test width

1.33

-4.96

1.17

Cal. SE 1.09 0.77 0.63 0.49 0.45 0.39 0.37 0.34 0.33 0.31 0.30 0.29 0.29 0.27 0.27 0.25 0.24 0.24 0.23 0.23 0.23 0.22 0.21 0.20 0.20 0.18 0.18 0.17 0.17 0.17 0.17 0.17

Nursing Quality Scale

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 2 3 0 2 2 6 6 7 13 13 6 11 14 16 23 17 15 6

0.05 0.07 0.09 0.12 0.14 0.16 0.19 0.21 0.23 0.26 0.28 0.30 0.33 0.35 0.37 0.40 0.42 0.44 0.47 0.49 0.51 0.53 0.56 0.58 0.60 0.63 0.65 0.67 0.70 0.72 0.74 0.77 0.79 0.81 0.84 0.86 0.88 0.91 0.93 0.95 0.98

-3.02 -2.59 -2.28 -2.03 -1.82 -1.64 -1.48 -1.33 -1.19 -1.07 -0.95 -0.84 -0.73 -0.62 -0.52 -0.42 -0.33 -0.23 -0.14 -0.05 0.05 0.14 0.23 0.33 0.42 0.52 0.62 0.73 0.84 0.95 1.07 1.19 1.33 1.48 1.64 1.82 2.03 2.28 2.59 3.02 3.74

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -0.33 0.00 0.00 -0.05 0.00 0.00 0.00 0.66 1.27 0.00 1.25 1.46 5.02 5.69 7.47 15.52 17.28 8.86 18.01 25.47 32.45 52.38 44.03 45.31 22.43

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.11 0.00 0.00 0.00 0.00 0.00 0.00 0.22 0.54 0.00 0.78 1.06 4.20 5.40 7.98 18.53 22.97 13.07 29.50 46.33 65.81 119.28 114.06 136.84 83.82

-3.02 -2.59 -2.28 -2.03 -1.82 -1.64 -1.48 -1.33 -1.19 -1.07 -0.95 -0.84 -0.73 -0.62 -0.52 -0.42 -0.33 -0.23 -0.14 -0.05 0.05 0.14 0.23 0.33 0.42 0.52 0.62 0.73 0.84 0.95 1.07 1.19 1.33 1.48 1.64 1.82 2.03 2.28 2.59 3.02 3.74

1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33 1.33

-4.01 -3.44 -3.02 -2.69 -2.41 -2.17 -1.96 -1.76 -1.58 -1.42 -1.26 -1.11 -0.97 -0.83 -0.69 -0.56 -0.44 -0.31 -0.19 -0.06 0.06 0.19 0.31 0.44 0.56 0.69 0.83 0.97 1.11 1.26 1.42 1.58 1.76 1.96 2.17 2.41 2.69 3.02 3.44 4.01 4.96

25 0.83 0.69 0.60 0.55 0.51 0.48 0.45 0.43 0.42 0.40 0.39 0.38 0.37 0.37 0.36 0.36 0.36 0.35 0.35 0.35 0.35 0.35 0.35 0.36 0.36 0.36 0.37 0.37 0.38 0.39 0.40 0.42 0.43 0.45 0.48 0.51 0.55 0.60 0.69 0.83 1.17

Table 27 Item Calibration for Compassion Form B Item name 32 1 6,19

item score 165 164 163

item freq. 1 1 2

prop. corr. 0.99 0.99 0.98

prop. incor. 0.01 0.01 0.02

Logit incor. -5.11 -4.41 -4.00

freq.xlogit -5.11 -4.41 -7.99

freq.xlogit^2 26.07 19.42 31.92

init. delta -3.04 -2.34 -1.93

expansion 1.16 1.16 1.16

delta -3.53 -2.72 -2.24

Cal. SE 1.08 0.77 0.63

Nursing Quality Scale

21 12 14 11 8,7,16 4,20, 18,10 13 24 28 26 5 9,3 23 29,17 2 30 25 31 15 33 22 27

26

162 161 160 159 158

1 1 1 1 3

0.98 0.97 0.96 0.96 0.95

0.02 0.03 0.04 0.04 0.05

-3.70 -3.47 -3.28 -3.12 -2.98

-3.70 -3.47 -3.28 -3.12 -8.95

13.70 12.05 10.78 9.75 26.70

-1.64 -1.41 -1.22 -1.06 -0.92

1.16 1.16 1.16 1.16 1.16

-1.90 -1.63 -1.42 -1.23 -1.07

0.55 0.49 0.45 0.42 0.39

152 148 144 139 135 134 133 130 129 128 127 126 108 106 97 69 35

4 1 1 1 1 1 2 1 2 1 1 1 1 1 1 1 1

0.92 0.89 0.87 0.84 0.81 0.81 0.80 0.78 0.78 0.77 0.77 0.76 0.65 0.64 0.58 0.42 0.21

0.08 0.11 0.13 0.16 0.19 0.19 0.20 0.22 0.22 0.23 0.23 0.24 0.35 0.36 0.42 0.58 0.79

-2.38 -2.11 -1.88 -1.64 -1.47 -1.43 -1.39 -1.28 -1.25 -1.21 -1.18 -1.15 -0.62 -0.57 -0.34 0.34 1.32

-9.54 -2.11 -1.88 -1.64 -1.47 -1.43 -2.79 -1.28 -2.50 -1.21 -1.18 -1.15 -0.62 -0.57 -0.34 0.34 1.32

22.75 4.44 3.53 2.69 2.16 2.05 3.89 1.65 3.12 1.47 1.39 1.32 0.39 0.32 0.12 0.12 1.74

-0.32 -0.04 0.18 0.42 0.59 0.63 0.67 0.78 0.81 0.85 0.88 0.92 1.44 1.49 1.72 2.40 3.38

1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16 1.16

-0.37 -0.05 0.21 0.49 0.69 0.73 0.78 0.90 0.94 0.98 1.02 1.06 1.67 1.73 2.00 2.79 3.92

0.30 0.27 0.25 0.23 0.21 0.21 0.21 0.20 0.20 0.20 0.20 0.20 0.18 0.17 0.17 0.17 0.20

Table 28 Person Calibration for Compassion Form B possible score Exp.Factor 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

person freq. Beta 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 4

prop. corr. Cal. SE 0.03 0.06 0.09 0.12 0.15 0.18 0.21 0.24 0.27 0.30 0.33 0.36 0.39 0.42 0.45 0.48 0.52 0.55 0.58

logit correct

freq.xlogit

freq.xlogit^2

init. ability

Test width

-3.47 -2.74 -2.30 -1.98 -1.72 -1.50 -1.31 -1.14 -0.98 -0.83 -0.69 -0.56 -0.43 -0.31 -0.18 -0.06 0.06 0.18 0.31

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -0.43 0.00 0.00 0.00 0.00 0.00 1.22

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.19 0.00 0.00 0.00 0.00 0.00 0.37

-3.47 -2.74 -2.30 -1.98 -1.72 -1.50 -1.31 -1.14 -0.98 -0.83 -0.69 -0.56 -0.43 -0.31 -0.18 -0.06 0.06 0.18 0.31

1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38

-4.80 -3.80 -3.19 -2.74 -2.39 -2.08 -1.82 -1.58 -1.36 -1.15 -0.96 -0.77 -0.60 -0.42 -0.25 -0.08 0.08 0.25 0.42

1.19 0.86 0.71 0.63 0.57 0.53 0.50 0.48 0.46 0.45 0.43 0.43 0.42 0.41 0.41 0.41 0.41 0.41 0.41

Nursing Quality Scale

20 21 22 23 24 25 26 27 28 29 30 31 32

2 3 2 7 9 12 22 16 15 25 27 15 6

0.61 0.64 0.67 0.70 0.73 0.76 0.79 0.82 0.85 0.88 0.91 0.94 0.97

0.43 0.56 0.69 0.83 0.98 1.14 1.31 1.50 1.72 1.98 2.30 2.74 3.47

0.86 1.68 1.39 5.83 8.83 13.67 28.87 24.07 25.84 49.53 62.17 41.11 20.79

0.37 0.94 0.96 4.86 8.66 15.58 37.88 36.20 44.52 98.11 143.15 112.68 72.07

0.43 0.56 0.69 0.83 0.98 1.14 1.31 1.50 1.72 1.98 2.30 2.74 3.47

1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38 1.38

27

0.60 0.77 0.96 1.15 1.36 1.58 1.82 2.08 2.39 2.74 3.19 3.80 4.80

0.42 0.43 0.43 0.45 0.46 0.48 0.50 0.53 0.57 0.63 0.71 0.86 1.19

Table 29 Item Calibration for Connectedness Form A item name 23 8,24 31,2 7,6 12 5,14 10 25,22 4,26 11 3 28 1 27 9 29 21 30 18 20 34 35 19 32 17 16 13 36 37 33

Item score 165 160 159 158 157 156 155 153 152 151 149 148 146 145 143 139 136 135 134 131 120 117 110 105 104 102 100 99 90 50

Item freq. 1 2 2 2 1 2 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

prop. corr. 0.99 0.96 0.95 0.95 0.94 0.93 0.93 0.92 0.91 0.90 0.89 0.89 0.87 0.87 0.86 0.83 0.81 0.81 0.80 0.78 0.72 0.70 0.66 0.63 0.62 0.61 0.60 0.59 0.54 0.30

prop. incor. 0.01 0.04 0.05 0.05 0.06 0.07 0.07 0.08 0.09 0.10 0.11 0.11 0.13 0.13 0.14 0.17 0.19 0.19 0.20 0.22 0.28 0.30 0.34 0.37 0.38 0.39 0.40 0.41 0.46 0.70

logit incor. -4.41 -3.13 -2.99 -2.87 -2.75 -2.65 -2.56 -2.39 -2.32 -2.24 -2.11 -2.05 -1.94 -1.89 -1.78 -1.60 -1.48 -1.44 -1.40 -1.29 -0.94 -0.85 -0.66 -0.53 -0.50 -0.45 -0.40 -0.38 -0.16 0.85

freq.xlogit -4.41 -6.26 -5.98 -5.73 -2.75 -5.30 -2.56 -4.78 -4.63 -2.24 -2.11 -2.05 -1.94 -1.89 -1.78 -1.60 -1.48 -1.44 -1.40 -1.29 -0.94 -0.85 -0.66 -0.53 -0.50 -0.45 -0.40 -0.38 -0.16 0.85

freq.xlogit^2 19.47 19.58 17.87 16.42 7.58 14.07 6.55 11.44 10.73 5.04 4.47 4.21 3.76 3.56 3.19 2.57 2.19 2.07 1.96 1.67 0.88 0.72 0.43 0.28 0.25 0.20 0.16 0.14 0.02 0.72

init. delta -2.68 -1.39 -1.25 -1.13 -1.02 -0.92 -0.82 -0.66 -0.58 -0.51 -0.38 -0.32 -0.20 -0.15 -0.05 0.13 0.26 0.30 0.33 0.44 0.80 0.89 1.08 1.21 1.23 1.28 1.33 1.36 1.58 2.59

expansion 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09 1.09

delta -2.92 -1.52 -1.37 -1.23 -1.11 -1.00 -0.90 -0.71 -0.63 -0.56 -0.41 -0.35 -0.22 -0.16 -0.05 0.15 0.28 0.32 0.36 0.48 0.87 0.96 1.17 1.32 1.35 1.40 1.46 1.48 1.72 2.82

Cal. SE 0.74 0.40 0.38 0.36 0.34 0.33 0.31 0.29 0.28 0.27 0.26 0.25 0.24 0.24 0.23 0.22 0.21 0.21 0.20 0.20 0.18 0.18 0.17 0.17 0.17 0.17 0.16 0.16 0.16 0.18

Nursing Quality Scale

15

32

1

0.19

0.81

1.44

1.44

2.07

3.17

28

1.09

3.46

0.21

Table 30 Person Calibration for Connectedness Form A possible score Exp.Factor 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

person freq. Beta 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 2 2 2 4 5 10 8 14 17 31 12 25 23 5 3 1

prop. corr. logit correct freq.xlogit freq.xlogit^2 init. ability Cal. SE 0.03 0.05 0.08 0.11 0.14 0.16 0.19 0.22 0.24 0.27 0.30 0.32 0.35 0.38 0.41 0.43 0.46 0.49 0.51 0.54 0.57 0.59 0.62 0.65 0.68 0.70 0.73 0.76 0.78 0.81 0.84 0.86 0.89 0.92 0.95 0.97

-3.58 -2.86 -2.43 -2.11 -1.86 -1.64 -1.46 -1.29 -1.13 -0.99 -0.86 -0.73 -0.61 -0.50 -0.38 -0.27 -0.16 -0.05 0.05 0.16 0.27 0.38 0.50 0.61 0.73 0.86 0.99 1.13 1.29 1.46 1.64 1.86 2.11 2.43 2.86 3.58

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -0.27 -0.16 0.00 0.00 0.16 0.54 0.77 0.99 2.45 3.67 8.60 7.95 15.89 21.89 45.11 19.71 46.41 48.53 12.14 8.59 3.58

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.07 0.03 0.00 0.00 0.03 0.15 0.29 0.49 1.50 2.69 7.40 7.89 18.03 28.20 65.65 32.36 86.15 102.42 29.47 24.58 12.84

-3.58 -2.86 -2.43 -2.11 -1.86 -1.64 -1.46 -1.29 -1.13 -0.99 -0.86 -0.73 -0.61 -0.50 -0.38 -0.27 -0.16 -0.05 0.05 0.16 0.27 0.38 0.50 0.61 0.73 0.86 0.99 1.13 1.29 1.46 1.64 1.86 2.11 2.43 2.86 3.58

Test width

1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27 1.27

-4.54 -3.62 -3.07 -2.67 -2.35 -2.08 -1.84 -1.63 -1.44 -1.26 -1.09 -0.93 -0.78 -0.63 -0.48 -0.34 -0.21 -0.07 0.07 0.21 0.34 0.48 0.63 0.78 0.93 1.09 1.26 1.44 1.63 1.84 2.08 2.35 2.67 3.07 3.62 4.54

1.14 0.82 0.68 0.60 0.54 0.50 0.47 0.45 0.43 0.42 0.40 0.40 0.39 0.38 0.38 0.37 0.37 0.37 0.37 0.37 0.37 0.38 0.38 0.39 0.40 0.40 0.42 0.43 0.45 0.47 0.50 0.54 0.60 0.68 0.82 1.14

Nursing Quality Scale

29

Table 31 Item Calibration for Connectedness Form B item name

item score

item freq.

prop. prop. logit freq.xlogit freq.xlogit^2 init. expansion delta Cal. corr. incor. incor. delta SE

27 41 36,19 3,26,12 15 29,2 13 9,38,31,24,11

167 165 164 162 161 160 159 158

1 1 2 3 1 2 1 5

0.99 0.98 0.98 0.96 0.96 0.95 0.95 0.94

0.01 0.02 0.02 0.04 0.04 0.05 0.05 0.06

-5.12 -4.01 -3.71 -3.30 -3.14 -3.00 -2.87 -2.76

-5.12 -4.01 -7.43 -9.89 -3.14 -5.99 -2.87 -13.80

26.19 16.06 27.58 32.59 9.83 17.95 8.25 38.09

-3.24 -2.13 -1.84 -1.42 -1.26 -1.12 -1.00 -0.89

1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10

-3.58 -2.35 -2.03 -1.57 -1.39 -1.24 -1.10 -0.98

1.05 0.61 0.53 0.44 0.41 0.38 0.36 0.34

32 1 39,20 17 22,18,16,14

157 156 155 153 152

1 1 2 1 4

0.93 0.93 0.92 0.91 0.90

0.07 0.07 0.08 0.09 0.10

-2.66 -2.56 -2.48 -2.32 -2.25

-2.66 -2.56 -4.96 -2.32 -9.01

7.07 6.58 12.29 5.39 20.27

-0.79 -0.69 -0.61 -0.45 -0.38

1.10 1.10 1.10 1.10 1.10

-0.87 -0.76 -0.67 -0.50 -0.42

0.33 0.31 0.30 0.28 0.28

34 40,4 6 5 45 21 8,35 7 10 42,37 33 23 44 49 25 46,43 30 28 48 47

151 150 149 144 141 136 132 129 128 122 121 117 109 105 96 73 66 43 28 24

1 2 1 1 1 1 2 1 1 2 1 1 1 1 1 2 1 1 1 1

0.90 0.89 0.89 0.86 0.84 0.81 0.79 0.77 0.76 0.73 0.72 0.70 0.65 0.63 0.57 0.43 0.39 0.26 0.17 0.14

0.10 0.11 0.11 0.14 0.16 0.19 0.21 0.23 0.24 0.27 0.28 0.30 0.35 0.38 0.43 0.57 0.61 0.74 0.83 0.86

-2.18 -2.12 -2.06 -1.79 -1.65 -1.45 -1.30 -1.20 -1.16 -0.98 -0.95 -0.83 -0.61 -0.51 -0.29 0.26 0.44 1.07 1.61 1.79

-2.18 -4.24 -2.06 -1.79 -1.65 -1.45 -2.60 -1.20 -1.16 -1.95 -0.95 -0.83 -0.61 -0.51 -0.29 0.53 0.44 1.07 1.61 1.79

4.77 8.99 4.24 3.21 2.73 2.09 3.38 1.43 1.35 1.90 0.89 0.69 0.38 0.26 0.08 0.14 0.19 1.14 2.59 3.21

-0.31 -0.25 -0.19 0.08 0.22 0.43 0.57 0.68 0.71 0.90 0.93 1.04 1.26 1.36 1.59 2.14 2.31 2.94 3.48 3.66

1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10 1.10

-0.34 -0.27 -0.21 0.09 0.24 0.47 0.63 0.75 0.78 0.99 1.02 1.15 1.39 1.50 1.75 2.36 2.55 3.24 3.84 4.04

0.27 0.26 0.26 0.23 0.22 0.21 0.20 0.19 0.19 0.18 0.18 0.18 0.17 0.17 0.16 0.16 0.17 0.19 0.22 0.23

Nursing Quality Scale

30

Table 32 Person Calibration for Connectedness Form B possible score

person freq.

prop. corr.

logit correct

freq.xlogit freq.xlogit^ init. ability 2

Test width

Beta

Cal. SE

-5.30 -4.32 -3.74 -3.32 -2.98 -2.70 -2.45 -2.24 -2.04 -1.86 -1.70 -1.54 -1.40 -1.26 -1.12 -0.99 -0.87 -0.74 -0.63 -0.51 -0.39 -0.28 -0.17 -0.06 0.06 0.17 0.28 0.39 0.51 0.63 0.74 0.87 0.99 1.12 1.26 1.40 1.54 1.70 1.86 2.04 2.24 2.45

1.18 0.84 0.70 0.61 0.55 0.51 0.48 0.45 0.43 0.41 0.40 0.39 0.38 0.37 0.36 0.36 0.35 0.35 0.34 0.34 0.34 0.34 0.34 0.33 0.33 0.34 0.34 0.34 0.34 0.34 0.35 0.35 0.36 0.36 0.37 0.38 0.39 0.40 0.41 0.43 0.45 0.48

Exp.Factor 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 2 1 2 2 3 4 3 5 3 7 6 14 15 12 20 19

0.02 0.04 0.06 0.08 0.10 0.12 0.14 0.16 0.18 0.20 0.22 0.24 0.27 0.29 0.31 0.33 0.35 0.37 0.39 0.41 0.43 0.45 0.47 0.49 0.51 0.53 0.55 0.57 0.59 0.61 0.63 0.65 0.67 0.69 0.71 0.73 0.76 0.78 0.80 0.82 0.84 0.86

-3.87 -3.16 -2.73 -2.42 -2.17 -1.97 -1.79 -1.63 -1.49 -1.36 -1.24 -1.13 -1.02 -0.92 -0.82 -0.72 -0.63 -0.54 -0.46 -0.37 -0.29 -0.20 -0.12 -0.04 0.04 0.12 0.20 0.29 0.37 0.46 0.54 0.63 0.72 0.82 0.92 1.02 1.13 1.24 1.36 1.49 1.63 1.79

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -0.04 0.04 0.25 0.41 0.29 0.74 0.91 1.63 2.53 2.17 4.09 2.75 7.13 6.76 17.36 20.41 17.90 32.68 34.04

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.03 0.08 0.08 0.28 0.42 0.89 1.60 1.57 3.35 2.52 7.26 7.61 21.52 27.78 26.70 53.41 61.00

-3.87 -3.16 -2.73 -2.42 -2.17 -1.97 -1.79 -1.63 -1.49 -1.36 -1.24 -1.13 -1.02 -0.92 -0.82 -0.72 -0.63 -0.54 -0.46 -0.37 -0.29 -0.20 -0.12 -0.04 0.04 0.12 0.20 0.29 0.37 0.46 0.54 0.63 0.72 0.82 0.92 1.02 1.13 1.24 1.36 1.49 1.63 1.79

1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37 1.37

Nursing Quality Scale

43 44 45 46 47 48

19 18 7 2 0 0

0.88 0.90 0.92 0.94 0.96 0.98

1.97 2.17 2.42 2.73 3.16 3.87

37.42 39.15 16.94 5.46 0.00 0.00

73.70 85.13 41.01 14.91 0.00 0.00

1.97 2.17 2.42 2.73 3.16 3.87

1.37 1.37 1.37 1.37 1.37 1.37

31

2.70 2.98 3.32 3.74 4.32 5.30

0.51 0.55 0.61 0.70 0.84 1.18

Final Form The final form of the test is composed of 160 items. There are 40 items for each factor (caring, compassion, commitment, and connectedness). The items that are not significantly different from zero in the Rasch analysis and having high factor loadings are selected to be included in the final form of the NQS test. The content of each item was again reviewed to verify whether each of them are truly composite of the factor they are placed. Table 33 shows the table of specifications of the final form. Table 33 Table of Specifications for the NQS Final Form Factors Caring

5 13 17 21 24

25 29 33 41 45

49 53 57 60 61

63 65 69 80 96

Items 101 104 110 111 113

116* 117 121 125 127

129 133 134 137 151

153 154 155 156 157

Compassion

1 3* 7* 9 11

15 19 23 31 35

39 47 51 55 59

67 71 73 75 79

81 83 85 86 87

88 89* 91 99 103

105 107 119 123 135

142 144 146 149 158

Commitment

2 6 10 14 18

22 26 30 34 38*

42 43 46* 50 54

58 62 66 70 74

78 82 90 94 98

102 106 114 118 122*

126 130 138 141 143

145 147* 150 159 160

4 8 12 16

27 28 32* 36

40 44 48 52

64* 68 72* 76*

84* 92* 93 95

100 108 109 112

120 124 128 131

136 139* 140 148

Connectednes s

Nursing Quality Scale

20

37

56*

77*

97*

115

32

132

* Negative items

Recommendations for Study Based on the initial analysis performed for the NQS test and some encountered procedures that needs to be enhanced, the following recommendations are given: 1. To establish further the reliability of tests, parallel forms of reliability can be conducted. Since the initial form of the test are composed of two forms the scores of each respondent can be correlated to see the consistency of items in a different form that measures the same construct. 2. To establish further the validity of the test, construct validity can be conducted. In the construct validity the scores for each factor can be correlated and theoretically should show positive correlation coefficients. 3. Further studies can be conducted for convergent validation of the test. The Scales of the NQS can be examined with its relationship with different temperament variables like introversion, extraversion, thinking, feeling, sensing, intuiting, and others. The manifestations of each of the factors of the NQS are clearly shown depending on nurse’s temperament. 4. Since the test is part of a battery, the factor on commitment can be related with the cognitive part measuring competency in nursing. Since the content of the items covers academic and skill training it is theoretically related to the outcome of academic skills. 5. Further study can be done using the factor on connectedness. It can be related with communication skills and competency since effectiveness on the factor for connectedness is shown through communication skills. References Bakalis, N. A. (2005). Nurses’s decision-making in clinical practice. Nursing Standard, 19 (23), 33-39.

152

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Boblin-Cummings, S. (1996). An explanation of nursing decisionmaking as a component of nurses’ work: Cognitive process, nurses’ decision, and factors influencing decision-making. Unpublished doctoral dissertation, University of Toronto. Brown, K. A. (1990). The nurse, empathy, and patient satisfaction. Doctoral dissertation, The University of Utah. Budgen, C. M. (1988). Patients’ perspectives on quality of nursing care: Exploring the relationship between process and outcome. Unpublished doctoral dissertation, The University Texas at Austin. Corliss, P. D. (1994). Universals of nursing: consensus and action. Unpublished doctoral dissertation, Boston College. Clark, J. M., Maben, J. & Jones, K. (1997). Project 2000: perception of the philosophy and practice of nursing : shifting perceptions - a new practitioners. Journal of Advanced Nursing. 26 (1), 161168. Fealy, G. M. (2004). The good nurse: visions and values in images of the nurse. Journal of Advanced Nursing 46 (6), 649-656. Federowicz, M. L. 2002. An investigation of clients’ perceptions of what constitutes quality nursing care: A phenomenological approach. Unpublished Masters thesis, D’youville College. Gunther, M. E. (2001). The meaning of high-quality nursing care derived from King’s interacting Systems. Unpublished doctoral dissertation, The University of Tennessee. Hendry. C. (2004). Priority setting in clinical nursing practice: literature review. Journal of Advanced Nursing. 47(4), 427-436. Kleiman, S. (2002). The essences of the lived experiences of nurse practitioners interacting with their patients. Unpublished doctoral dissertation, Adelphi University. Kneafsey, R. (2000). The effect of occupational socialization on nurses’ patient handling practices. Journal of Clinical Nursing . 9(4) 585-593.

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Larsen. B. L. (1998). Quality nursing care: The nursing home residents’ perspective. Unpublished masters thesis, Grand Valley State University. March, P. L. (1996). The important attributes of a nurse from the perspective of qualified and student nurses. Journal of Advanced Nursing. 24(4), 810-816. Ming Ho Lau, V. & Mackenzie, A. (1996). Attributes of nurses that determine the quality of care for mentally handicapped people in an institution. Journal of Advance Nursing, 24(6), 1109-1115. Mrayyan, M. T. (2004). Perceptions of Jordanian head nurses of variables that influence the quality of nursing care. Journal of Nursing Care. 19(3). 276-279. Nandlal, R. (1995). The experience of quality of nursing care among adults recovering from strokes during hospitalization: A phenomenological perspective. Unpublished masters thesis, Southern Connecticut State University. Osuna, E. C. (1998). Quality nursing care: A comparative analysis of patient expectation and perceived actual care. Unpublished masters thesis, California State University. Peters, M. A. (2003). Compassion: An investigation into the experience of nursing faculty. Unpublished doctoral dissertation, Widener University School of Nursing. Ramos, M. C. (1990). Empathy within the nurse-patient relationship. Unpublished doctoral dissertation, University of Virginia. Reynolds, M. 1999. Nurses’ self-perceptions of their intuitiveness an empathy in clinical decision-making. Masteral thesis, Texas Technology University. Sheridan, E. A. (1983). Contracting and client satisfaction: An inquiry into the delivery of effective nursing care. Unpublished doctoral dissertation, University of Massachusetts Amherst. Yen, M. (1994). Patient comfort and its relation to selected process factors: Scaling and model testing. Unpublished doctoral dissertation, University of Minnesota.

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Yow, P. A. (1992). A grounded theory of nurse-patient interactions. Unpublished doctoral dissertation, University of Virginia.

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