Development and psychometric testing of the safety climate instrument suitable for nurses handling chemotherapy drugs

Aim: To develop and test the psychometric properties of the Taiwanese safety climate instrument suitable for nurses handling chemotherapy drugs. Design: This is an instrument development study. Method: All four stages, including questionnaire design, expert consultation, cognitive testing and psychometric validation, were used in this study. The data were collected between August and December 2018. Nurses with experience in handling chemotherapy drugs (N = 484) at one medical centre and two regional hospitals in Taiwan completed this instrument. Data were randomly split into two groups: one group (N = 237) for exploratory factor analysis and the other (N = 247) for confirmatory factor analysis. Results: The instruments' items were based on qualitative research, and the content validity index levels exceeded the acceptable value. An exploratory factor analysis revealed 43 items remaining in six factors, which accounted for 74.4% of variance. The result of the confirmatory factor analysis verified the acceptability of a 43-item model. The composite reliability values, Cronbach's alpha values, convergent validity and discriminant validity for each factor exceeded the acceptable value. Conclusion: Most climate safety instruments used in the health care sector focus mainly on patient safety outcomes. Furthermore, there is no safety climate instrument for handling chemotherapy drugs, and there is a cultural difference. Through the development and validation process, we have developed a new instrument suitable for nurses handling chemotherapy drugs, which has good psychometric properties. Impact: This instrument is valuable as its development was based on the concept of a safety climate for health care perceptions and qualitative survey findings. Hospital managers can use this instrument regularly to evaluate nurses' perceptions of the safety climate to determine the strengths and weaknesses of their workplace, thereby assisting organizational managers in proposing concrete actions.