Integral leadership in nursing: Development and psychometric validation of a Korean version of the Integral Nursing Leadership Scale.

BACKGROUND: With the importance of nursing leadership roles, there is a need for a more integrated approach to nursing leadership that can adapt quickly to many challenges in today's healthcare environments. In recent years, integral leadership that can apply a more holistic and inclusive approach to leadership has gained growing attention in other disciplines. However, research on integral leadership in nursing is sparse since no instrument specifically measuring integral leadership in nursing contexts is available. OBJECTIVE: The study aimed to develop an integral nursing leadership scale and evaluate its psychometric properties. METHODS: The scale was developed in two phases. In the first phase, items were generated to reflect the attributes of integral leadership in the nursing context. These attributes were identified through a conceptualization process using a literature review and semi-structured interviews. The process was based on the four dimensions of the integral leadership framework, adopting Wilber's four quadrants of integral theory. Then, the psychometric properties of the scale, including content validity, structural validity, and internal consistency reliability, were evaluated. Data were collected from a convenience sample of 806 Korean nurses and were analyzed using both exploratory factor analysis and second-order confirmatory factor analysis, using two separate random halves of the sample. RESULTS: The newly developed scale consisted of 30 items across four dimensions: individual leadership qualities, individual performance, influencing organizational culture, and organizational excellence. Content validity for the 30 items was calculated to be 0.84 for item-level content validity and 0.96 for the scale's content validity averaging method, indicating adequate content validity. The four-factor structure of integral nursing leadership was cross-validated by exploratory factor analysis and second-order confirmatory factor analysis. The internal consistency reliability was also found to be acceptable, as indicated by a Cronbach's alpha of 0.97 and a McDonald's ω estimate of 0.98. CONCLUSION: Findings demonstrate that the Integral Nursing Leadership Scale has acceptable content validity, structural validity, and reliability in measuring integral leadership, specifically in the context of nursing. More research is needed to further refine and establish strong validity of the scale.

Patient Safety Culture Associated With Patient Safety Competencies Among Registered Nurses.

PURPOSE: To investigate the relationships between registered nurses' (RNs') perceptions of the culture of patient safety in their workplace and their patient safety competency-attitudes, skills, and knowledge. DESIGN: A cross-sectional study design was used. Data were collected by using a self-reported survey from 343 RNs working in a university hospital in Seoul, South Korea. METHODS: Patient safety culture was measured using the Korean version of the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture (Hospital SOPSTM). Patient safety competency was measured using the Patient Safety Competency Self-Evaluation tool. Multiple regression analysis was performed using Stata version 14 to examine the relationships between patient safety culture and RNs' patient safety competency, while adjusting for the RNs nested in their units. FINDINGS: Of the 10 specific aspects of patient safety culture, only teamwork within units was significantly related to overall safety competency. In relation to each of the three patient safety competencies, teamwork within and across units and supervisor or manager expectations were significantly related to attitudes, while teamwork within units and learning were significantly related to skills. Only organizational learning was significantly related to knowledge. CONCLUSIONS: Although teamwork, leadership, and continuous learning in the nursing unit were major factors influencing RNs' safety competency, the relationships of these factors to patient safety attitudes, skills, and knowledge among RNs were varied. CLINICAL RELEVANCE: Creating a unit-specific patient safety culture that is tailored to the competencies of the unit's RNs in patient safety practice would be essential to enhance and maintain high levels of patient safety attitudes, skills, and knowledge among the unit's RNs, which would ultimately affect patient safety.