Psychometric Testing of the Evidence-Based Practice Nursing Leadership Scale and the Work Environment Scale After Cross-Cultural Adaptation in Mainland China

Abstract

Implementation and sustainability of the evidence-based practice (EBP) approach within systems of health-care delivery require leadership and organizational support, yet few instruments have been developed specifically in Mainland China. The purpose of this study was to adapt the EBP Nursing Leadership Scale and the EBP Work Environment Scale to Mainland China’s cultural context and to evaluate the psychometric properties of the newly adapted Chinese version. A pilot study was conducted in Mainland China with 25 clinical nurses. A subsequent validation study was conducted with 419 nurses from Mainland China. A content validity index of .985 and .982 was achieved. The split-half coefficient was .890 for the EBP Nursing Leadership Scale and .892 for the EBP Work Environment Scale. Test–retest reliability was .871 and .855, respectively. Principal component analysis resulted in a one-factor structure explaining 62.069% of the total variance for the EBP Nursing Leadership Scale and 62.242% of the total variance for the EBP Work Environment Scale. Both of the newly cross-culturally adapted scales possess adequate internal consistency and test–retest reliability and validity and therefore may be utilized in health-care environments to assess leadership and organizational support for EBP in Mainland China.

Keywords

evidence-based practice reliability validity health-care organizations nursing leadership

Evidence-based practice (EBP) is a problem-solving approach to the delivery of care that incorporates the best evidence from well-designed studies in combination with a clinician’s expertise and patients’ preferences within a context of caring (Melnyk, Fineout-Overholt, Stetler, & Allan, 2005). EBP has gained increasing popularity worldwide. The approach entails the uptake of the best available evidence by health professionals when making care decisions. Evidence in the form of robust research findings in addition to individual patient contexts and preferences will enable best practice behaviors and optimize patient outcomes (Wallen et al., 2010). Moreover, it is becoming the norm that health professionals are expected to demonstrate evidence-informed practice behaviors on a daily basis (Upton, Upton, & Scurlock-Evans, 2014). Nurses are the health professionals in hospitals who engage with patients more frequently and for longer periods of time. Hence, it is of paramount importance that clinical nurses are equipped with both the abilities and opportunities to implement an EBP approach. EBP ensures clinical nurses make care decisions at the bedside drawn from rigorous research reports, clinical expertise, and patient perspectives (Murphy, 2011). Original models for EBP implementation reflect a systematic process. Increasingly, it is becoming evident that contextual factors, including nursing leadership and work environments, are instrumental to the process (Kueny, Shever, Mackin, & Titler, 2015).

Nursing leadership is vital to the process of implementing EBP (Kueny et al., 2015; Sandstrom, Borglin, Nilsson, & Willman, 2011). Transformational leaders are well suited to lead organizations in creating cultures that more effectively promote, support, and sustain EBP (Gallagher-Ford, 2014). Among the facilitators and barriers of EBP implementation reported in the literature, leadership resistance and lack of support can negatively impact fulfilling EBP expectations (Hutchinson & Johnston, 2006). In contrast, respected and influential nursing leaders can support and guide EBP initiatives (Moser, Deluca, Bond, & Rollins, 2004). Leaders may put up barriers to the EBP implementation process because they lack advanced academic degrees (Sandstrom et al., 2011) and do not have the necessary critical appraisal skills. In addition, they may lack the authority and mandate to prioritize the time for EBP implementation. The organizational structure has been repeatedly perceived as presenting considerable obstacles to EBP (Brown, Wickline, Ecoff, & Glaser, 2009; Hutchinson & Johnston, 2006). Given leadership and organizational structures may emerge as barriers (or facilitators) to EBP implementation, it is important to have the means to assess levels of support; in particular, the extent to which nurses are afforded opportunities to access and utilize research reports.

Several instruments have been developed for EBP evaluation relevant to nursing practice in recent years (Filippini, Sessa, Giuseppe, & Angelillo, 2011; Tucker, Olson, & Frusti, 2009; Williams, Perillo, & Brown, 2015). However, only a few instruments are designed to focus on leadership dynamics and workplace organizational structures. The instruments developed to assess leadership regarding EBP for managers/leaders include the Nurse Manager EBP Competency Scale and the Implementation Leadership Scale (Finn, Torres, Ehrhart, Roesch, & Aarons, 2016; Shuman, Ploutz-Snyder, & Titler, 2018). The former scale was designed to investigate nurse manager competencies regarding EBP. And the Implementation Leadership Scale was originally developed for mental health clinicians. The newly developed and accurate instruments that we located in the extant literature are the EBP Nursing Leadership and Work Environment Scales, which measure leadership and organizational support regarding EBP of nurses (Pryse, McDaniel, & Schafer, 2014). Although nurses in Mainland China are motivated to adopt EBP, no instruments have been developed to evaluate the extent to which nursing leadership and workplace organizational structures are conducive to successful implementation of EBP. Therefore, we cross-culturally adapted and tested the EBP Nursing Leadership Scale and the EBP Work Environment Scale to measure organizational influences in Chinese clinical nurses.

Method

Translation Procedure

After obtaining original author approval, translation and cross-cultural adaptation of the original scales were performed according to a clear and user-friendly guideline (Sousa & Rojjanasrirat, 2011). The EBP Nursing Leadership Scale and the EBP Work Environment Scale were translated into Chinese by three independent translators who worked in clinical nursing, evidence-based nursing education, and English-language teaching in the university, respectively. Each version of translation was completed. The differences in between were resolved after comprehensive discussion with the participation of a fourth translator. The differences were resolved and the original scales were achieved. The scales were then back translated independently by another team, including two independent translators (i.e., bilingual experts fluent in English and Chinese), who were blind to the original English version. A multidisciplinary consensus committee, comprised of one methodologist (a member of the research team), one health-care professional (head nurse, associate professor), and all five bilingual and bicultural translators, was held to consolidate all the translated and back-translated versions of the questionnaires, verify any controversial or ambiguous wording, ensure cross-cultural equivalence, and develop the prefinal version of the scales for field testing.

The Pilot Study

In our study, one of the five tertiary hospitals was randomly selected as the pilot study setting. Twenty-five clinical nurses were recruited through convenience sampling from this hospital to test the Chinese versions of the scales. All volunteers were asked to complete the questionnaires. The pilot study enabled us to detect problems with wording, terminology, instructions, and clarity of response options. A structured interview was followed to explore their perception and understanding of each item and the suggestions for improvement of the scales. For example, nurses were asked whether they found some question statements in the scales too difficult to understand or to answer and whether they would recommend phrasing questions differently for improvement of the given scale. Some phrases were changed according to participant recommendations. This process ensured that the adapted versions were still retaining the equivalence and linguistically appropriate when applied in practice. After this process, the final Chinese version was developed. The 25 nurses were recruited to complete the same scales to measure the test–retest reliability values 2 weeks later.

The Validation Study

Using a cross-sectional validation design, 437 clinical nurses were recruited through convenience sampling to validate the scales. Nurses were recruited from five accessible tertiary hospitals in Mainland China. The hospitals were selected because they have well-established nursing protocols, and their provisions of nursing care services demonstrate current practice standards. Nurses were recruited if they (1) were involved in direct nursing care, (2) had worked 6 months or more on the current unit, and (3) were willing to give their consent to participate in the study. Written consent forms were signed by all participants after full explanation of the study. Anonymity and confidentiality were assured, and participants were told that they could withdraw at any point without consequences. Data were collected by the researcher and one of the research team members after connecting with the head nurse of each department. Data collectors distributed questionnaires combining questions from both scales to each participant and provided instructions according to predefined protocols. Among the 437 nurses recruited, 4 nurses declined, 5 nurses were missed, and 9 nurses’ questionnaires were not so complete in some items. The final number of nurses who participated and who had completed a questionnaire in full was 419 of the 437 recruited, yielding a response rate of 95.9%. The characteristics of the nurses not included in the analysis were not different from the 419 participants. Approval was obtained from the Ethics Committees of Xi’an Jiaotong University. All procedures followed were in accordance with the ethical standards of the Declaration of Helsinki.

Participant Characteristics

As mentioned above, 419 clinical nurses completed the questionnaire. Table 1 lists the sociodemographic and evidence-based relevant characteristics of the participants. The mean age was 28.01 years (standard deviation [SD] = 4.22). About 80.7% of participants were between the ages of 20 and 30. Slightly over half (54.9%) were married. Regarding first academic qualifications, more than half had obtained an associate degree (62.5%), followed by technical nursing education (18.9%) and a bachelor’s degree (18.6%). The highest academic qualification was the bachelor’s degree (75.4%), earned through continuing education. Over half (70.9%) received EBP courses or training, and 64.4% of participants had interests in EBP. About 39.6% of the participants read Chinese literature sometimes. A total of 180 participants (43.0%) strongly agreed that it was necessary to implement EBP in clinical settings.

Table 1.

Sociodemographic and Evidence-Based Relevant Characteristics of the Nurses.

Characteristics		n (%)
Age	20–30	338 (80.7)
	31–40	74 (17.6)
	41–50	7 (1.7)
Gender	Female	403 (96.2)
Gender	Male	16 (3.8)
Ethnicity	Han	414 (98.8)
Ethnicity	Minorities	5 (1.2)
Marital status	Unmarried	189 (45.1)
Marital status	Married	230 (54.9)
First academic qualifications	Technical nursing education	79 (18.9)
	Associate degree	262 (62.5)
	Bachelor’s degree	78 (18.6)
Highest academic qualifications	Associate degree	83 (19.8)
	Bachelor’s degree	316 (75.4)
	Master’s degree	20 (4.8)
Professional title	Registered nurse	201 (48.0)
	Senior nurse	189 (45.1)
	Supervisor nurse or above	29 (6.9)
Attitude to nursing	Like	202 (48.2)
	Neutral	183 (43.7)
	Dislike	34 (8.1)
Received EBP courses or training	Yes	297 (70.9)
Received EBP courses or training	No	122 (29.1)
Chinese literature reading	Often	37 (8.8)
	Sometimes	166 (39.6)
	Seldom	216 (51.6)
Interests in EBP	Yes	270 (64.4)
Interests in EBP	No	149 (35.6)
Necessary to implement EBP	Strongly agree	180 (43.0)
	Neutral	207 (49.4)
	Strongly disagree	32 (7.6)

Note. n = 419. EBP = evidence-based practice.

Measures

The EBP Nursing Leadership Scale and the EBP Work Environment Scale

The Chinese versions were developed based on the original EBP Nursing Leadership Scale and EBP Work Environment Scale (Pryse et al., 2014). The two original tools were developed from a meta-synthesis of research (Funk, Champagne, Wiese, & Tornquist, 1991; Pryse et al., 2014). The EBP Nursing Leadership Scale consists of 10 items that examine the staff nurses’ perception of support provided by the nurse manager for EBP. And the EBP Work Environment Scale comprises 8 items that examine organizational support for EBP. Both of the original scales had demonstrated good psychometric properties. The content validity index (CVI) computed from expert rankings was 0.78–1.0 with an average of 0.96. Factor analysis confirmed that each scale measured a unidimensional construct (p < .001). Examination of the scree plot revealed that the primary factor explained 71.25% of the variance for the EBP Nursing Leadership Scale and 51.06% of the variance for the EBP Work Environment Scale. Descriptive statistics and correlation coefficients estimates demonstrated sufficient item facility and discrimination for the original instruments (Pryse et al., 2014).

Nurse General Information Questionnaire

Sociodemographic and evidence-based relevant data were obtained with the Nurse General Information Questionnaire developed by the research group. The questionnaire included age, gender, marital status, first academic qualifications, professional title, EBP courses, literature reading, interests in EBP, and so forth.

Statistical Analysis

Data were entered into the database using Epi Data Version 3.1 (The EpiData Association, Odense, Denmark; www.epidata.dk). Calculations were performed using the Statistical Package for the Social Sciences (SPSS Version 19.0). The statistical descriptions of the demographic variables were illustrated in frequency tables, depicting the means and the SDs. CVI was performed to quantify scores for each item and the whole scales. CVI had been computed by asking experts to rate the relevance of each item on a 4-point scale from 1 (very invalid) to 4 (very valid). Items rated at a 3 or 4 on the 4-point relevance scale suggested expert consensus regarding relevance. The CVI of each item was calculated, and a CVI of more than .8 was interpreted as indicating the validity (Polit, Beck, & Owen, 2007). The internal consistency was calculated with Cronbach’s α coefficient. Cronbach’s α value of .7 or greater was considered satisfactory (Osburn, 2000). Split-half coefficient reliability was assessed by using half of odd and even items. Test–retest reliability was assessed by using the intraclass correlation coefficient (ICC) for items and Bland–Altman methods for scales (Giavarina, 2015). ICC values of .60–.80 were deemed good reliability, and ICC values above .80 were regarded as excellent reliability (Mancini et al., 2012).

Validity of each item was determined through item analysis. We considered unfavorable floor or ceiling effects to be present if more than 15% of the individuals reached the highest or lowest score (Wamper, Sierevelt, Poolman, Bhandari, & Haverkamp, 2010). The known-group validation was used to evaluate the extent to which the Chinese versions of the EBP Nursing Leadership Scale and the EBP Work Environment Scale were able to discriminate between nurse subgroups representing different characteristics (Cicolini, Della Pelle, Cerratti, Franza, & Flacco, 2016). One-way analysis of variance was performed. A p value of <.05 was considered to be statistically significant. Exploratory factor analysis using principal component analysis with varimax rotation was conducted to determine the factor structure of each scale (Harman, 1960). The scree plot, the Kaiser criterion (eigenvalue), and clinical interpretability were used to identify the factor solution. Items were deemed relevant if factor-loading coefficients exceeded .40 and extracted factors achieved an eigenvalue ≥1.0 (Sapountzi-Krepia et al., 2017). A confirmatory factor analysis (CFA) was also performed to verify the results. The expected values of indices recommended were as follows (Batista-Foguet, Coenders, & Alonso, 2004): (1) χ² divided by the degrees of freedom ≤3, (2) the root mean squared error of approximation (RMSEA) < .08, (3) the comparative fit index (CFI) > .90, and (4) goodness-of-fit index (GFI) > .90.

Results

Content Validity

The CVI was calculated to determine the content validity of a total of 18 items by asking seven experts to agree or disagree with item statements (Polit et al., 2007). Experts specialized in nursing education, evidence-based nursing, clinical nursing, and nursing management were selected from Mainland of China. All seven experts responded. The overall CVI for the EBP Nursing Leadership Scale was .985, and each item CVI was above the .857 level of agreement. For the EBP Work Environment Scale, the overall CVI was .982, and each individual item CVI was above the .857 level of agreement. The results suggested an acceptable and good content validity for the scales (Polit et al., 2007).

Reliability

Cronbach’s α was .931 for the EBP Nursing Leadership Scale and .909 for the EBP Work Environment Scale. The split-half coefficient for the EBP Nursing Leadership Scale and the EBP Work Environment Scale was .890 and .892, respectively. In the Bland–Altman agreement analysis, the mean differences between test and retest for the EBP Nursing Leadership Scale and the EBP Work Environment Scale were values of .8 and −.4, respectively. The Bland–Altman 95% limits of agreement of differences were observed to be from −2.4 to 4.0 for the EBP Nursing Leadership Scale and from −4.8 to 3.9 for the EBP Work Environment Scale. Test–retest reliability by intraclass correlation was .871 and .855 for the EBP Nursing Leadership Scale and the EBP Work Environment Scale, respectively.

Item Analysis

Item analysis was performed on all items in both scales. The EBP Nursing Leadership Scale items and the EBP Work Environment Scale items were first sorted into high and low scoring groups, respectively. The top 27% of the highest scoring items comprised the high group and the lower 27% of the lowest scoring items comprised the low group (Andersson & Lindgren, 2008; Berk & Griesemer, 1976; Reynolds, Perkins, & Brutten, 1994). Then, the mean score of each item in the two groups was compared. Item analysis was also performed by comparing total scale scores. For the high group, the mean score for the EBP Nursing Leadership Scale was 45.42 (2.97) and 34.92 (2.99) was the mean score for the EBP Work Environment Scale. For the low group, the mean scores for the EBP Nursing Leadership Scale and the EBP Work Environment Scale were 28.90 (4.35) and 20.70 (3.69), respectively. Item analysis verified that the two groups were significantly different (p < .001) and indicated that the items had good discrimination. Hence, all 18 items were retained. The floor effect was 5.0% and the ceiling effect was 0.2% for the EBP Nursing Leadership Scale. For the EBP Work Environment Scale, the floor effect was 3.8% and the ceiling effect was 0.7%. A good discriminative effect of the items was indicated since both scales showed no floor or ceiling effects (Wamper et al., 2010).

Construct Validity of the EBP Nursing Leadership Scale

Exploratory factor analysis

Exploratory factor analysis was used to assess construct validity. The correlation matrix showed ample adequacy of the sample size (Kaiser–Meyer–Olkin [KMO] = .949) and the Bartlett Test of Sphericity results (χ² = 2,633.943 [45], p < .001) rejected the hypothesis of zero correlations. Therefore, the matrix was considered appropriate for factor analysis. Examination of the scree plot, which graphed the eigenvalues against the factors, revealed that the primary factor explained 62.069% of the total variance, suggesting unidimensionality. The loadings for the 10 items ranged from .743 to .817 (see Table 2). In all cases, the benchmark of .40 was exceeded. The one-factor structure is validated as identical to the original structure.

Table 2.

Percentage Endorsement and Factor Loadings on Items of the EBP Nursing Leadership Scale and the EBP Work Environment Scale.

Item	Strongly Agree or Agree (%)	Loading
EBP Nursing Leadership Scale
1. My manager is able to communicate how EBP is important for improving patient outcomes on my unit	65.6	.766
2. My manager encourages me to examine evidence to guide clinical decision-making	67.5	.776
3. My manager has a vision for EBP on my unit	66.3	.807
4. My manager can explain EBP in terms that are easy to understand	64.9	.817
5. My manager helps me resolve conflicts between nursing research and clinical practice	64.7	.789
6. My manager supports my efforts to change practice in response to new knowledge/evidence	69.2	.798
7. My manager is able to influence others to engage in EBP	63.0	.766
8. My manager facilitates my use of resources for EBP (e.g., data bases, experts, literature)	59.4	.743
9. My manager facilitates practice change based on relevant nursing research	64.4	.806
10. My manager provides time for me to engage in EBP	55.6	.808
EBP Work Environment Scale
1. Experts in EBP are available in my work setting	37.5	.796
2. In my organization, I have access to databases that have full length nursing research articles	50.6	.656
3. I believe my organization values evidence-based nursing practice	53.5	.825
4. The nurses on my unit discuss research relevant to our clinical practice	55.6	.807
5. The physicians I work with support EBP changes based on nursing research	56.1	.806
6. The nurses on my unit base their practice on the best evidence	52.3	.825
7. My manager makes sure that I have access to relevant research on my unit	53.2	.848
8. My organization pays for me to attend educational offerings about EBP	45.8	.731

Note. n = 419. EBP = evidence-based practice.

CFA

In the one-factor model, the CFA produced: a CFI value of .953, a GFI of .919, an RMSEA of .090, and the χ² divided by the degrees of freedom was 4.38, which was more than the benchmark of 3. In the modified model, the fit indices assessed were in the acceptable range: (1) The χ² test was 2.260, less than the benchmark of 3; (2) the RMSEA was .055, less than .08; (3) the CFI was .985; and GFI was .968, exceeding the benchmark of .90.

Construct Validity of the EBP Work Environment Scale

Exploratory factor analysis

The results of the Barlett Test of Sphericity (χ² = 1,918.186 [28], p < .001) and of the KMO, .925, indicated a strong basis for factor analysis. Exploratory factor analysis of the 8 items in this scale produced factor loadings ranging from .656 to .848 (see Table 2). Examination of the scree plot revealed that the primary factor explained 62.242% of the total variance, suggesting unidimensionality.

CFA

In the one-factor model, the CFA produced the following fit indices values: a CFI of .966, a GFI of .951, an RMSEA of .089, and the χ² divided by the degrees of freedom was 4.27 (which was more than the benchmark of 3). In the modified model, the fit indices values were in the acceptable range: (1) the χ² test was 1.750, less than the benchmark of 3; (2) the RMSEA was .042, less than .08; (3) the CFI was .994; and GFI was .985, exceeding the benchmark of .90.

Known-Group Validation

Known-group validity of the EBP Nursing Leadership Scale and the EBP Work Environment Scale were demonstrated. Differences in grouped scores formed by sociodemographic and EBP characteristics were detected in both scales. Significant differences were found in mean scores of both scales by professional title, attitude to nursing, EBP courses or training, Chinese literature reading, interests in EBP, and perceived necessity to implement EBP. The EBP Work Environment Scale demonstrated statistically significant differences in mean scores with first academic qualifications (see Table 3).

Table 3.

Differences in the EBP Nursing Leadership Scale and the EBP Work Environment Scale by Nurse Characteristics.

Characteristics		The EBP Nursing Leadership Scale	The EBP Work Environment Scale
First academic qualifications	Technical nursing education	37.24 ± 6.04	28.04 ± 5.43
	Associate degree	37.73 ± 6.86	28.20 ± 5.99
	Bachelor’s degree	36.64 ± 7.55	26.32 ± 6.13*
Professional title	Registered Nurse	38.28 ± 5.92	28.99 ± 5.37
	Senior nurse	37.11 ± 7.39	26.90 ± 6.22
	Supervisor or above	33.69 ± 7.84*	25.66 ± 6.46**
Attitude to nursing	Like	38.84 ± 6.03	28.85 ± 5.48
	Neutral	36.52 ± 6.85	26.80 ± 6.02
	Dislike	34.12 ± 9.28**	27.24 ± 7.35**
Received EBP courses or training	Yes	38.64 ± 6.72	29.13 ± 5.64
Received EBP courses or training	No	36.99 ± 6.90*	27.29 ± 6.05**
Chinese literature reading	Often	38.49 ± 7.94	29.95 ± 5.94
	Sometimes	38.35 ± 6.89	28.16 ± 6.25
	Seldom	36.55 ± 6.53*	27.19 ± 5.63*
Interests in EBP	Yes	38.58 ± 6.31	28.60 ± 5.79
Interests in EBP	No	35.38 ± 7.32**	26.42 ± 6.00**
Necessary to implement EBP	Strongly agree	39.31 ± 6.28	29.01 ± 6.04
	Neutral	36.56 ± 6.29	27.29 ± 5.19
	Strongly disagree	32.50 ± 9.60**	24.44 ± 8.14**

Note. n = 419. EBP = evidence-based practice.

*p < .05. **p < .01.

Discussion

The EBP Nursing Leadership Scale and the EBP Work Environment Scale are psychometrically sound instruments that can be used to identify the relationship between EBP implementation activities and the workplace environment and nursing leadership (Pryse et al., 2014). The attributes of a transformational leadership style are a particularly good fit for leading a hospital organization in implementing meaningful changes to promote and sustain EBP as the foundation of all nursing practice behaviors and decision-making. A nursing leader, for example, must be intentional, determined, and use critical reasoning when carefully preparing a systematic process to introduce, execute, monitor, and evaluate implementation of EBP within health-care organizations that are more often than not complex and even chaotic (Gallagher-Ford, 2014).

The EBP Nursing Leadership Scale and the EBP Work Environment Scale were initially developed in the United States by Pryse, McDaniel, and Schafer (2014) to identify and assess organizational influences from the standpoint of the American cultural lens and perspectives, and thus may be ineffectual in other cultural contexts such as Mainland China. We culturally adapted both scales to the Chinese nursing context, and then the Chinese versions underwent psychometric testing that produced robust results. We believe the Chinese versions of the EBP Nursing Leadership Scale and the EBP Work Environment Scale are both reliable and feasible options for EBP implementation by clinical nurses.

Cronbach’s α of original versions was .96 for the EBP Nursing Leadership Scale and .86 for the EBP Work Environment Scale. We were able to attain similar Cronbach’s α values for the Chinese versions of the scales involving a sample of 419 nurses. Moreover, test–retest assessment resulted in high ICC values and then, again, we reported high ICC values in the 2-week retest indicating strong reliability. Exploratory factor analysis revealed that the extracted one principal component was theoretically comparable with the original structures of the two scales. As a further contribution of our study, CFA was conducted for investigating the fit of the one factor with the general structures of the EBP Nursing Leadership Scale and the EBP Work Environment Scale. CFA indicated that the modification model with one-factor structure was considered a good fit. Moreover, the two scales could be completed in 10 min and, therefore, fulfill the goal of brevity sought in clinical research and application.

Despite successful cross-cultural adaptation of the EBP Nursing Leadership Scale and the EBP Work Environment Scale, several limitations should be mentioned. First, participants were recruited using convenience sampling in northwest China, so that widespread generalization and application of these instruments may be limited. Second, we did not carry out further consultations with the original authors since the back-translated versions were almost completely consistent with the original versions of both the EBP Nursing Leadership Scale and the EBP Work Environment Scale. Usually, such consultation might increase validity of the translated version and eliminate inaccuracies. Finally, predictive validity was not directly determined since a gold standard does not exist. And a psychometric assessment of the EBP Nursing Leadership Scale and the EBP Work Environment Scale with respect to convergent validity should be considered in the future validation study.

Conclusion

This study supports the Chinese versions of the EBP Nursing Leadership Scale and the EBP Work Environment Scale as the psychometrically robust measures of organizational influences on EBP. We have demonstrated that our newly adapted Chinese versions are reliable and valid to serve as instruments to assess leadership and organizational support for EBP and identify those factors that may negatively impact EBP implementation by clinical nurses in Mainland China.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Yin-Ping Zhang

References

Andersson

I. S.

Lindgren

(2008). The Karen instruments for measuring quality of nursing care. Item analysis. Vård i Norden, 28, 14–18.

Batista-Foguet

J. M.

Coenders

Alonso

(2004). Confirmatory factor analysis. Its role on the validation of health related questionnaires. Medicina Clínica, 122, 21–27.

Berk

R. A.

Griesemer

H. A.

(1976). Iteman: An item analysis program for tests, questionnaires, and scales. Educational and Psychological Measurement, 36, 189–191.

Brown

C. E.

Wickline

M. A.

Ecoff

Glaser

(2009). Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing, 65, 371.

Cicolini

Della Pelle

Cerratti

Franza

Flacco

M. E.

(2016). Validation of the italian version of the stanford presenteeism scale in nurses. Journal of Nursing Management, 24, 598–604.

Filippini

Sessa

Giuseppe

G. D.

Angelillo

I. F.

(2011). Evidence-based practice among nurses in Italy. Evaluation & the Health Professions, 34, 371–382.

Finn

N. K.

Torres

E. M.

Ehrhart

M. G.

Roesch

S. C.

Aarons

G. A.

(2016). Cross-validation of the Implementation Leadership Scale (ILS) in child welfare service organizations. Child Maltreatment, 21, 250–255.

Funk

S. G.

Champagne

M. T.

Wiese

R. A.

Tornquist

E. M.

(1991). BARRIERS: The barriers to research utilization scale. Applied Nursing Research, 4, 39–45.

Gallagher-Ford

(2014). Implementing and sustaining EBP in real world healthcare settings: Transformational evidence-based leadership: Redesigning traditional roles to promote and sustain a culture of EBP. Worldviews on Evidence-Based Nursing, 11, 140–142.

10.

Giavarina

(2015). Understanding bland altman analysis. Biochemia Medica, 25, 141–151.

11.

Harman

H. H.

(1960). Modern factor analysis. Journal of the American Statistical Association, 56, 219–219.

12.

Hutchinson

A. M.

Johnston

(2006). Beyond the BARRIERS Scale—Commonly reported barriers to research use. Journal of Nursing Administration, 36, 189–199.

13.

Kueny

Shever

L. L.

Mackin

M. L.

Titler

M. G.

(2015). Facilitating the implementation of evidence-based practice through contextual support and nursing leadership. Journal of Healthcare Leadership, 7, 29–39.

14.

Mancini

Salarian

Carlson-Kuhta

Zampieri

King

Chiari

Horak

F. B.

(2012). Isway: A sensitive, valid and reliable measure of postural control. Journal of NeuroEngineering and Rehabilitation, 9, 59.

15.

Melnyk

B. M.

Fineout-Overholt

Stetler

Allan

(2005). Outcomes and implementation strategies from the first U.S. evidence-based practice leadership summit. Worldviews on Evidence-Based Nursing, 2, 113–121.

16.

Moser

L. L.

Deluca

N. L.

Bond

G. R.

Rollins

A. L.

(2004). Implementing evidence-based psychosocial practices: Lessons learned from statewide implementation of two practices. CNS Spectrums, 9, 926–936.

17.

Murphy

P. A.

(2011). Evidence-based practice: What evidence counts? Journal of Midwifery & Women’s Health, 56, 323–324.

18.

Osburn

H. G.

(2000). Coefficient alpha and related internal consistency reliability coefficients. Psychological Methods, 5, 343–355.

19.

Polit

D. F.

Beck

C. T.

Owen

S. V.

(2007). Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health, 30, 459.

20.

Pryse

McDaniel

Schafer

(2014). Psychometric analysis of two new scales: The evidence-based practice nursing leadership and work environment scales. Worldviews on Evidence-Based Nursing, 11, 240–247.

21.

Reynolds

Perkins

Brutten

(1994). A comparative item analysis study of a language testing instrument. Language Testing, 11, 1–13.

22.

Sandstrom

Borglin

Nilsson

Willman

(2011). Promoting the implementation of evidence-based practice: A literature review focusing on the role of nursing leadership. Worldviews on Evidence-Based Nursing, 8, 212–223.

23.

Sapountzi-Krepia

Zyga

Prezerakos

Malliarou

Efstathiou

Christodoulou

Charalambous

(2017). Kuopio University Hospital Job Satisfaction Scale (KUHJSS): Its validation in the Greek language. Journal of Nursing Management, 25, 13–21.

24.

Shuman

C. J.

Ploutz-Snyder

R. J.

Titler

M. G.

(2018). Development and testing of the nurse manager EBP competency scale. Western Journal of Nursing Research, 40, 175–190.

25.

Sousa

V. D.

Rojjanasrirat

(2011). Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline. Journal of Evaluation in Clinical Practice, 17, 268–274.

26.

Tucker

Olson

M. E.

Frusti

D. K.

(2009). Validity and reliability of the evidence-based practice self-efficacy scale. Western Journal of Nursing Research, 31, 1090–1091.

27.

Upton

Scurlock-Evans

(2014). The reach, transferability, and impact of the Evidence-Based Practice Questionnaire: A methodological and narrative literature review. Worldviews on Evidence-Based Nursing, 11, 46–54.

28.

Wallen

G. R.

Mitchell

S. A.

Melnyk

Fineout-Overholt

Miller-Davis

Yates

Hastings

(2010). Implementing evidence-based practice: Effectiveness of a structured multifaceted mentorship programme. Journal of Advanced Nursing, 66, 2761–2771.

29.

Wamper

K. E.

Sierevelt

I. N.

Poolman

R. W.

Bhandari

Haverkamp

(2010). The Harris hip score: Do ceiling effects limit its usefulness in orthopedics?. Acta Orthopaedica, 81, 703–707.

30.

Williams

Perillo

Brown

(2015). What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurse Education Today, 35, e34–e41.