الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Quality and patient safety have been issues in health care nationally and
internationally. Over the last ten years several international and national
commissions have reported and documented multiple problems related to quality
and safety within the health care system. These commissions have also
concluded that to improve health care, the providers need to be equipped with a
different set of competencies than those which currently included. Consequently,
the competencies attributes must be updating over the times to coping with the
rapidly change and technology advancement in health care system. In this
respect the current study aims to develop a measuring instrument to measure
nurses’ quality-safety practice competencies )QSPC ( measurement can be used
to assess and evaluate the quality of practice of nurses to determine the area of
weakness to improve. Also, it can be used to assess the practice of new hiring
nurses.
The results of this study can provide nursing educators with information
they can use to update and revitalize course content and curricula to integrate
between nursing education and practice. Furthermore, QSPC instrument can be
used by health care policy makers or quality and safety committees to improve
the quality- safety practice competencies for health care providers. In addition, it
can be used at all nursing administrative levels in different health care sitting and
also, can be used as an assessment and benchmarking tool to evaluate nurses’
quality-safety practice competencies to make sure that an organization is
delivering the desired nursing care services and having competitive advantage
for raising the community confidence in health care services, increasing
customer satisfaction, improve marketing, reputation, nationally and
internationally
Summary
134
Aim of the study
This study aims to develop an instrument to measure nurses’ quality-
safety practice competencies.
Research Design
Methodological research design was utilized to conduct this study.
Setting
This study was conducted at all hospitals that are affiliated to Ministry of
Health and Population (MOHP) at El-Beheira Governorate. The hospital
numbers (n=20), are named as follows: Kafr EL-Dawar General Hospital;
Kafr EL-Dawar Central Hospital; Kafr EL-Dawar Fever Hospital; Damanhour
Fever Hospital; Damanhour Chest Hospital; Damanhour Ophthalmology
Hospital; Hamdy El-Tabakh (previously, Abu Hommus Central Hospital)
Central Hospital; Rashid central Hospital; Edfina Central Hospital; Idku
Central Hospital; Badr Central Hospital; Kom Hamada Central Hospital;
Housh Eisssa Central Hospital; Abu AL-Matamir Central Hospital; El
Rahmaneya Central Hospital; El Delengat Central Hospital; El Mahmoudeya
Central Hospital; Itai Elbaroud Central Hospital; Shubrakhit Central Hospital;
and El Noubareya Central Hospital .
Subjects
The subjects of the study were divided into two groups, as follows:
1- Panel of experts:
They were selected to assess the content and face validity of the
developed
instrument
for
measuring
quality-safety
practice
nurses
Summary
135
competencies by electing their opinions. They were divided into two
categories a follow:
They will be divided into two groups:
a- Academic experts in the field of the study (n= 10): they include
Academic staff members, as follow: one professor and one assistant
professor of nursing administration faculty of nursing Damanhour
university (n=2), one professor of nursing administration faculty of
nursing Helwan university (n=1), one professor and one assistant
professor of nursing administration faculty of nursing Alexandria
university (n=2), three professor and one assistant professor of nursing
administration faculty of nursing Tanta university (n=4), and one
professor from public health institute Alexandria university (n=1).
b- Clinical Professional Experts group (n=80): They include the directors
of nursing services and their assistants, directors of Quality and safety
committees in the selected hospitals (n=60) and the director of nursing
administration at El Beheira Directorate of Health Affairs and their
assistants (n=7) and three from El Beheira Nursing Syndicate (n=3).
2- Study subjects:
A systematic random sample, the estimated sample size = 350 at
confidence level 95% by using Thompson equation, (45) since the total
number of head nurses and their assistants, and members of quality and safety
team committees, who are working in the previously mentioned settings, are
1890. Thus a list of all members of a population was made for each hospital,
and randomly generate a number for each element. Since each element has an
equal chance of being selected in the study.
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Since the population size (N) and the required sample size (n), the
calculation was done as follows: Divide the size of the population (N) by the
required sample size (n) to get the index number (k). Then every kth element
was chosen from the population list to create the required sample.
Index Number (k) = N/ n
For example, if population number is (N= 42) and the required sample
size is (n=7), the Index Number (k) = 42/ 7= 6, then the selected numbers
are: number (6, 12, 18, 24, 30, 36, 42).
Tools of the Study
Two tools was utilized to conduct this study
Tool (I): Quality-Safety Practice Competencies Instrument (QSPCI):
It was developed by the researcher based on thorough review of related
literature (6-21,23,28-132) to determine components of the instrument that measure
quality-safety practice competencies. This instrument will include ten
dimensions as follows: (1) Patient-Centered Care, (2) Safety, (3) Teamwork
And Collaboration, (4) Communication, (5) Informatics And Technology, (6)
Nursing Documentation (7) Evidence-Based Practice (8) Knowledge Based
Practice (9) System Based Practice (10) Quality Improvement. Responses will
be measured on 5-point Likert scale ranging from (1) rarely to (5) always. The
higher score (70 % or more) that will indicate higher level of quality-safety
practice competencies.
Tool (II): Opinionnaire Sheet
It was developed by the researcher to measure both the experts’ group
and study subjects’ group opinions based on the following form:
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A- Content Validity was tested through indicating panel of experts
opinions’ for each item of the developed instrument, responses were
measured on 4-point ordinal rating scale ranged from 1(irrelevant ) to
4(very relevant).
B- Face Validity was tested through eliciting the panel of experts’
opinions regarding the general form of the developed instrument. Their
responses were measured dichotomously, as: agree or disagree.
(Appendix II)
In addition, demographic data sheet of the study subjects was developed
by the researcher for two study groups as follow: (A) the panel of experts; it
included questions related to: age, educational qualifications position, years of
experience and (B) the study subjects, it contained data related to: age,
gender, educational qualifications, years of experience, years of unit
experience and working unit.
II-Methods
An approval to carry out the study was obtained from the Dean, Faculty
of Nursing – Damanhour University and the responsible authorities after
explanation of the purpose of the study.
Development of the instrument:
According to Alkena and Mateja (2012) (29) the process of instrument
development instrument included ten steps grouped into three phases that
were executed as follows:
Phase I: Theoretical Importance and Existence of the Construct:
This phase consists of the following three steps:
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Step1 : Content Domain Specification:
A content domain for measuring quality-safety nurses ’practice
competencies( QSPC) was decided after extensive review of related literature (6-
21,23,28-132) these domains( attributes) included : (1) Patient-Centered Care,
(2) Safety , (3) Teamwork And Collaboration, (4) Communication, (5)
Informatics And Technology, (6) Nursing Documentation(7) Evidence-Based
Practice (8) Knowledge Based Practice (9) System Based Practice (10) Quality
Improvement.
Step2: Item Pool Generation:
The aim of this step is to generate statements/questions items for measuring
nurses’ quality-safety practice competencies. This was conducted Through
individualized semi- structured face to face interviews, with ten clinical
professional experts, who are working at ten hospitals, affiliated to El-Beheira to
MOHP, namely Kafr EL-Dawar General hospital ; Damanhour Chest Hospital; ;
Abu Hommus Central Hospital; Rashid Central Hospital; Edfina Central
Hospital; Idku Central Hospital; Badr Central Hospital; Kom Hamada Central
Hospital; Housh Eisssa Central Hospital; Abu AL-Matamir Central Hospital.
They were selected randomly based on their willingness to participate in the
study. After explanation of its purpose, in order to gather information from their
working environment and to determine their points of view in relation to nursing
professionalism. (Appendix III)
Afterwards, constant comparative analysis was carried out to confirm that
the attributes and its underlying items of QSPC were in accordance between
through review of related literature and those extracted from the individualized
semi- structured interviews. Collected, analyzed and categorized with the data
which will be revealed from literature review, to find the main domains of the
instrument. The resulting product of this step was the first version of the
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developed instrument for measuring QSPC, which include (101) Items grounded
in ten domains (attributes). (Appendix IV)
Step 3: Content and Face Validity Evaluation:
The goal of this step is to determine the content and face validity of the
proposed instrument. The first version of the instrument was measured
through asking the panel of experts to read and evaluate the relevance of each
item to the main domain using four point ordinal scale, where: 1= not
relevant, 2=somewhat relevant, 3= quite relevant and 4= very relevant. This
step took a period of four months ranged from the beginning of October 2020
to the end of January 2021.
The content validity index (I- CVI), was calculated as the proportion of
the content giving a relevance rating to the item in each domain, its values
range from 0 to 1. If I-CVI was <0.70, the item was omitted. Furthermore, for
the whole instrument, Scale –content validity index (S-CVI) was calculated
as: the proportion of items relevancy, with values range from 0 to 1.
Furthermore, the opinionaire sheet contained number of questions
designed for the panel of experts to determine their opinions regarding the
general form of the developed instrument, their responses were measured
dichotomously, as: agree or disagree, to evaluate the face validity. At the end
of this step, all items approved by the panel of experts were retained and
formed the second version of the developed instrument.
Phase II: Representativeness and Appropriateness of the Data
Collection.
This phase consist of the following four steps.
Step 4: Questionnaire Development and Evaluation
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Based on the results of content and face validity evaluation of the
developed instrument, 17 items out of 101 items were omitted as they got I
CVI < 0.70. The result of this study yielded the second version of the
developed instrument for measuring QSPC, which comprised of (84) items
grounded in the pre-mentioned ten domains (Attributes).
Step 5: Instrument Translation
The second version of the instrument was translated into Arabic language.
It was tested by five experts from the field of the study (two professors of
nursing administration, Alexandria University, and two professors of Tanta
University and one professor of Damanhur University to test the translation and
its feasibility between the two languages, based on this step, no modification
was executed .
Step 6: Pilot Study
A pilot study was conducted on (10%) from study subjects (n=35), rather
than the study subjects to test the applicability of the second version of the
developed instrument and to determine the difficulties in using it.