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. 2025 Dec 15;12(12):e70344. doi: 10.1002/nop2.70344

Turkish Adaptation and Psychometric Characteristics of the Nurse Professional Competence Scale‐Short Version Among Nursing Students: Methodological Study

Seher Basaran‐Acil 1,✉, Emine Kuruca‐Ozdemir 1, Yıldız Erdat 1
PMCID: PMC12705335  PMID: 41398549

ABSTRACT

Aim

This study aimed to adapt the Nurse Professional Competence Scale‐Short Form (NPC‐SF) into Turkish and evaluate its validity and reliability study for nursing students.

Design

A methodological study was designed.

Methods

The study was conducted with 181 senior nursing students using a convenience sampling method from March 2021 to November 2021. Language adaptation was conducted using translation and back‐translation. Content validity was assessed using expert approval. Construct validity was assessed using confirmatory factor analysis. Convergent and discriminant validity were applied. Reliability was assessed using Cronbach's alpha, the test–retest reliability and Bland–Altman Method.

Results

The mean Content Validity Index of the items in the total scale was 0.98. Confirmatory factor analysis identified 21 items, which could be categorised under five factors (Nursing Care, Value‐based Nursing Care, Medical and Technical Care, Documentation and Administration of Nursing Care, Development, Leadership and Organization of Nursing Care). The scale preserved its original structure, but one sub‐dimension (Care Pedagogy) was removed from the scale. The fit indices of TR‐NPC‐SF are χ2/SD 1.928, GFI 0.928, NFI 0.964, NNFI 0.956, CFI 0.964, RMSEA 0.072 and SRMR 0.040. The five‐factor model achieved a good fit according to confirmatory factor analysis. The Cronbach's alpha reliability coefficient of the Turkish version of the NPC‐SF (TR‐NPC‐SF) was 0.974.

Conclusion

TR‐NPC‐SF is a valid and reliable tool with good psychometric properties. This scale can be used to evaluate nursing students' self‐assessed professional competence. Nurse managers and educators can also use TR‐NPC‐SF to improve nurses' competence and identify their competence gaps.

Patient or Public Contribution

No patient or public contribution.

Keywords: competence, nursing education, nursing students, psychometric, reliability, validity

1. Introduction

The education level of nurses has been considered an important factor in addressing the demands and needs of different health systems (Aiken et al. 2014; Nilsson, Johansson, et al. 2014; World Health Organization 2001). Therefore, developing and evaluating nurses' competence during their education has become an important issue. The World Health Organization (WHO) published two reports in 2001 and 2009 to establish the competence requirements and global standards in nursing education. These reports highlighted that nursing education should be based on competence and that competencies should be evaluated at regular intervals and developed in line with the changing needs of society (World Health Organization 2001, 2009).

In nursing literature, no standard definition of competence is adopted by authors and organisations (Church 2016; Scanlon 2017). The International Council of Nursing (ICN) defines competence as the ‘effective application of a combination of knowledge, skill and judgment demonstrated by an individual in daily practice or job performance’ (International Council of Nursing 2005). ICN separately defined the competence expected for enrolled, registered, specialist and advanced practice nurses (International Council of Nursing 2008).

Nursing programs are structured to ensure that students reach a certain level of competence until graduation (Zieber and Sedgewick 2018). Some nations have established a national competence framework to guarantee this principle and revised the curriculum according to this framework. Moreover, Italy holds a nationwide exam measuring students' competence level at graduation (Kajander‐Unkuri et al. 2021). These attempts enable faculties to improve the curriculum by assessing whether students can respond to global health concerns. For this reason, it is deemed notable to assess students' level of competence with valid and reliable measurement tools.

Although the significance of competence assessment has been emphasised, there is no global understanding of the competences required to be acquired during nursing education. With the start of the Bologna Process in 1999, it was aimed that common competence would be developed among European countries and these competences would be recognised among all countries (Ohlen et al. 2011). The European Parliament and the Council defined the minimum criteria for nursing education (duration of education, content, theoretical and clinical training) in 2005, but the competence areas were not set (European Union 2005). In order to close this gap, Satu et al. (2013) identified eight separate competence areas for students in the European Union. These are (1) professional and ethical values and practice, (2) nursing skills and interventions, (3) communication and interpersonal skills, (4) knowledge and cognitive ability, (5) assessment and improving quality in nursing, (6) professional development, (7) leadership, management and teamwork, (8) research utilisation.

2. Background

The American Association of Colleges of Nursing (2021) recommends the restructuring of nursing education programs on a competency‐based basis to close the gap between knowledge and action and nursing education programs prepare undergraduate nursing students by developing them in 10 competencies domains determined for community health and future healthcare environments. Therefore, nursing students should graduate from the nursing programs as skillful, qualified and competent healthcare workers and their pre‐graduate competencies should be evaluated and developed.

Evaluation of competence is as important as identifying the areas of competence and it is considered a part of quality assurance in nursing education. Some measurement tools are found in the literature that allow the competence of graduate nursing students to be measured by self‐assessment. These are the Six Dimension Scale of Nursing Performance (Six‐D Scale) (Schwirian 1978), Nurse Competence Scale (NCS) (Meretoja et al. 2004), Self‐Evaluated Core Competencies Scale (SECC) (Hsu and Hsieh 2009), Competency Inventory of Nursing Students (CINS) (Hsu and Hsieh 2013), Nursing Students Core Competencies Scale (NSCC) (Perng and Watson 2013) and Nurse Professional Competence Scale (NPC) (Nilsson, Johansson, et al. 2014). The Six Dimension Scale of Nursing Performance was developed based on a literature review and experts' opinions such as educators and deans (Schwirian 1978). The Nurse Competence Scale was derived from Benner's ‘From Novice to Expert’ competency framework (Meretoja et al. 2004). The Self‐Evaluated Core Competencies Scale (Hsu and Hsieh 2009) and Competency Inventory of Nursing Students (Hsu and Hsieh 2013) were developed based on the core competencies for nursing students established by the Taiwan Nursing Accreditation Council. The competences included in the Nursing Students Core Competencies Scale were defined based on a literature review (Perng and Watson 2013).

The ‘Nurse Professional Competence Scale (NPC)’ was developed in 2014, inspired by the guidelines (World Health Organization 2009) and is based on the competence requirements developed by the Swedish Board of Health and Welfare. Moreover, it complies with the competence areas defined by Satu et al. (2013) for nursing students within Europe (Nilsson, Johansson, et al. 2014). The scale was developed as a long version and includes 88 items and eight factors (Nilsson, Johansson, et al. 2014). It was reported that the scale has sufficient psychometric properties and can be used to assess the results of nursing education programs and nurses' professional competence regarding their needs in healthcare institutions and to prepare entry‐level programs for new nurses (Nilsson, Johansson, et al. 2014). The NPC Scale has also been used in the self‐assessment of professional competence of graduating nursing students (Gardulf et al. 2016), nursing students with or without international work experience (Nilsson, Carlsson, et al. 2014) and after curriculum changes in the three‐year university program (Theander et al. 2016). The short version of the scale was created in 2018. Even though the original NPC scale has been used in many studies, authors responded to a request by international researchers. They shortened the scale for advantages such as potentially enhancing the response rate and efficiently combining it with the other instruments. The short version of the scale was called NPC‐SF and included six factors and 35 items (Nilsson et al. 2018).

The NPC‐SF has been translated into many languages, such as English (van de Mortel et al. 2021), Chinese (Xu et al. 2021), Korean (Lee et al. 2023) and Arabic (Grande et al. 2023) used in many countries. Furthermore, Nilsson et al. (2018) reported that educators and managers can use the NPC‐SF as a self‐assessment measurement tool to assess the competence of both students and recent graduates. Considering that nursing education in Türkiye is structured in line with the criteria determined by the European Union for Nursing Education and the Bologna process and this scale is the most up‐to‐date compared to other scales, the NPC‐SF was deemed to be a suitable tool to measure the nursing students' competence in Türkiye.

3. Methods

3.1. Aim

This study aimed to adapt the Nurse Professional Competence Scale‐Short Form (NPC‐SF) (Nilsson et al. 2018) into Turkish and evaluate its psychometric characteristics.

3.2. Methodology

3.2.1. Study Design

Methodological research design was used in the study.

Research‐specific questions: There were two research questions as follows: (1) Does the Turkish version of NPC‐SF have an acceptable level of validity? and (2) Does the Turkish version of NPC‐SF have an acceptable level of reliability?

3.3. Participants

This study was conducted in higher education institutions providing undergraduate nursing education that consists of 4 years (eight semesters) in Türkiye. In calculating the sample size in validity‐reliability studies, it is recommended to include 5–10 individuals per number of items in the scale (Alpar 2022). Therefore, at least 175 participants were required for this study, with 35 items total in NPC‐SF. A convenience sample of 181 students at the point of graduation was recruited. The test–retest reliability was conducted with 30 volunteer fourth‐year students who participated in the construct validity during the same period.

3.4. Data Collection

The link was sent to students via online platforms (Facebook, WhatsApp, Twitter, Instagram and LinkedIn) between March 1, 2021 and November 30, 2021. Informed consent was provided to the students at the beginning of the online data collection form. Also, written consent was obtained for the test–retest in the online data collection form and the retest link was sent 1 week later to the students.

3.5. Instruments

3.5.1. Sociodemographic Form

A sociodemographic form was developed by researchers using literature to collect sociodemographic data from the students (Nilsson et al. 2018; Nilsson, Johansson, et al. 2014).

3.5.2. The Nurse Professional Competence Scale‐Short Form (NPC‐SF)

NPC‐SF was developed in 2018 to achieve a higher response rate and ensure the scale can be used with other measurement tools (Nilsson et al. 2018). The scale consists of 35 items that measure six different competence areas (factors): Nursing Care, Value‐based Nursing Care, Medical and Technical Care, Care Pedagogics, Documentation and Administration or Nursing Care and Development, Leadership and Organization of Nursing Care. Each item is coded from 1 (to a very low degree) to 7 (to a very high degree). To calculate the scale score, the items within each factor are summed, divided by the highest possible score for that factor and multiplied by 100. This converts the factor score into a range of 0 to 100, with higher scores indicating higher levels of nursing professional competence. Cronbach's alpha values of the scale factors ranged between 0.71 and 0.86. In the confirmatory factor analysis, the goodness of fit indices were 0.05 for the square root of the mean square mean and 0.89 for the comparative index of fit. It was reported that the scale can be used on nursing students and nurses.

This study followed a two‐step process: the translation process of the NPC‐SF (cross‐cultural validity) and the psychometric properties of the Turkish version of the NPC‐SF.

3.5.2.1. Translation Process

The NPC‐SF translation was done using the translation and back‐translation technique to establish language equality (Wild et al. 2005). The inclusion criteria for selecting the experts for translation and back‐translation were as follows: (a) holding a PhD degree in nursing, (b) being familiar with the English and Turkish languages and the cultures. Two faculty members from the Department of Nursing Management and one faculty member from the Department of Internal Medicine Nursing translated the scale from English to Turkish. After the review of the translations by the experts, the Turkish version of the scale was prepared by the researchers and presented to the opinion of an expert from the Department of Turkish Language and Literature. Back‐translation was made by three experts, including one lecturer from the Fundamentals of Nursing Department, one from the Psychiatric Nursing Department and one language expert, to determine whether the scale met the original version. In the translation and back‐translation process, the researchers reviewed and discussed the items to reach a consensus. The scale was sent to the developers by e‐mail to determine whether there was a change in meaning in the back‐translated expressions of the scale. The authors approved the English translation of the scale.

3.5.2.2. Content Validity

Consulting expert opinions is an efficient approach to determining content validity and it is recommended that the number of experts be above five (Alpar 2022). In this study, five experts were consulted to evaluate the content validity of the NPC‐SF. The experts were selected from different specialisations in nursing, including Nursing Management, Fundamentals of Nursing, Surgical Nursing, Obstetrics and Gynaecology and Psychiatric Nursing. Each expert holds a PhD and has extensive teaching experience in a baccalaureate nursing program. The selection criteria were based on their diverse expertise across various nursing specialisations to ensure a comprehensive evaluation of the scale and its dimensions. The experts selected for content validity assessment were independent of those involved in the language validity process. The Content Validity Index (CVI), developed by Waltz and Bausell (1981), was used. Davis technique was used to measure CVI. Davis (1992) technique rates expert opinions on a four‐point scale as (a) ‘Appropriate’, (b) ‘Item should be slightly revised’, (c) ‘Item should be seriously revised’ and (d) ‘Item is not appropriate’. In this technique, the number of experts who marked (a) and (b) options is divided by the total number of experts to obtain the ‘content validity index’ for the item and instead of comparing this value with a statistical criterion, the value of 0.80 is accepted as the criterion.

3.5.2.3. Construct Validity

Construct validity examines whether the set of variables considered to measure the relevant construct determines the predicted construct (Alpar 2022). In this study, the data collection forms were applied electronically to the participants to establish the construct validity. It is unnecessary to apply explanatory factor analysis to the scale when the scale structure is already known, which means that validity and reliability studies have been conducted before. The theoretical structure can be determined with the help of CFA (Şeker and Gençdoğan 2014; Alpar 2022). In this study, CFA was applied to 35 items on the scale to analyse construct validity. After the CFA analysis was applied, the scale's convergent and discriminant validity were evaluated using Average Variance Extracted (AVE) and Composite Reliability (CR). The χ2/df, Goodness of Fit Index (GFI), Normed Fit Index (NFI), Non‐Normed Fit Index (NNFI), Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA) and Standardised Root Mean Square Residual (SRMR) were used to evaluate the fitness.

3.5.2.4. Reliability Analysis

To determine the scales' reliability level, test–retest reliability and Cronbach's alpha Internal Consistency coefficient were used. The scale was applied to the students who volunteered to answer the retest part 1 week after the first test. Correlation analysis was performed between the students' first and second scores and the Pearson Correlation Coefficient was calculated accordingly (Alpar 2022). In addition, Cronbach's alpha Reliability Coefficient was calculated.

3.6. Ethical Consideration

Written permission was obtained from the Ethics Committee of *REDACTED* for the study. Prof. Margret Lepp, one of the developers, provided written permission to adapt the NPC‐SF to Turkish and conduct validity and reliability studies. Informed consent was obtained from the students at the beginning of the data collection form.

3.7. Statistical Analysis

For statistical analysis, the data were exported to IBM SPSS Statistics 26 and IBM SPSS Amos 23 version package software. Descriptive statistics such as frequency, mean and standard deviation were used. CFA was used to evaluate the construct validity. Primary‐level CFA was applied for the measurement model of the NPC‐SF. As a result of CFA, the measurement model was confirmed. The scale's reliability, whose construct validity was completed, was examined with test–retest reliability and internal consistency coefficient. The Bland–Altman method was used to show the situation between test–retest. The score should be 0.80 and above in order to argue that the scale has content validity (Waltz and Bausell 1981). It was reported that the values for acceptable model fit in GFI, NFI and RMSEA values and a good fit for χ2/df, NNFI, CFI and SRMR fit indices ranged from 0 to 1, with 1 indicating the best fit (Kline 2015). While zero indicates the best fit for RMSEA, a value of 0.06 or less indicates an acceptable model fit (Kline 2015). Cronbach's alpha reliability coefficient and Pearson correlation coefficient were calculated for reliability. It is expected that the correlation coefficient will be above 0.80 or not below 0.70 (Alpar 2022). A correlation coefficient between 0.00 and 0.29 means a low‐level relationship, 0.30 and 0.69 means a medium level and 0.70 and 1.00 means a high‐level relationship (Gürbüz and Sahin 2018). In convergent validity, CR and AVE values were calculated for each dimension. CR values of 0.70 and above and AVE values of 0.50 and above are desired for convergent validity (Hair et al. 2010; Malhotra 2010). For discriminant validity, correlations between variables should be calculated and the square roots of AVE values should be higher than these correlation values (Fornell and Larcker 1981).

4. Results

4.1. Characteristics of the Participants

Of the participants, 92.3% (n = 167) are female, 73.4% (n = 133) are studying at a state university, 86.2% (n = 156) are national students, 96.1% (n = 174) have not had higher education in any field before undergraduate education in nursing, 93.9% (n = 170) have not worked as a healthcare professional, 92.3% (n = 167) do not currently work in any healthcare institution and 78.5% (n = 142) were involved in activities that contributed to the development of their professional nursing competence during university life (Table 1).

TABLE 1.

Sociodemographic characteristics of the participants (n = 181).

Demographic characteristics n %
Graduation year
2021 177 97.8
Other 4 2.2
Gender
Woman 167 92.3
Man 14 7.7
Type of university
State 133 73.5
Foundation 12 6.6
Private 36 19.9
Student status
National 156 86.2
International 25 13.8
Getting higher education in any field before undergraduate nursing education
Yes 7 3.9
No 174 96.1
Working as a healthcare professional before undergraduate nursing education
Yes 11 6.1
No 170 93.9
Currently working in any health institution
Yes 14 7.7
No 167 92.3
Participating in activities that contribute to professional competence development throughout the university life
Yes 142 78.5
No 39 21.5
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4.2. Descriptive Statistics of the TR‐NPC‐SF for Nursing Students

The Kolmogorov Smirnov Test (n > 30) was used to determine whether the TR‐NPC‐SF sub‐dimension scores provided a normal distribution. As a result of the test, all scores did not meet the assumption of normal distribution (p < 0.001). Skewness and kurtosis values are not in the desired range (Alpar 2022). Finally, when the histogram graphs are examined, the scores do not conform to the normal distribution.

The mean scores of the nursing students were found to be 82.38 ± 12.005 for Nursing Care, 92.38 ± 6.680 for Value‐based Nursing Care, 79.33 ± 15.187 for Medical and Technical Care, 84.76 ± 11.087 for Documentation and Administration of Nursing Care, 82.98 ± 14.275 for Development, Leadership and Organization of Nursing Care and 84.36 ± 10.268 for the total scale.

4.3. Content Validity

In this study, no item had a CVI below 0.80, item CVI was between 0.8 and 1.00, and the mean CVI of the items in the total scale was found to be 0.98. The Turkish version of the scale was revised according to the experts' suggestions and the mean score (Davis 1992).

4.4. Construct Validity

Before applying the CFA, item analysis was performed to examine the contribution of the items to the scale. Corrected item‐total correlation coefficients were used for item analysis. It was found that the item‐total correlation coefficients were higher than +0.25 and no items were removed from the scale (Büyüköztürk 2007).

As a result of primary‐level CFA, it was found that the model did not fit enough and model improvement analysis was carried out. First, the factor loading values of the items were examined and the items that did not contribute to the model were not determined. In the second stage, the table of modification indices was examined and the reduced chi‐square values (‘M.I.’ values) were examined for possible changes to be made in the model. It should be controlled if the M.I. values are above 4 (Meydan and Şeşen 2015). The model was carried out by linking the modification indicated by the highest ‘M.I.’ value in cases where it was conceptually appropriate (e4↔e7, e94↔e10, e164↔e17, e194↔e20, e214↔e22). However, this result showed that the model did not fit sufficiently and ‘M.I.’ values are stated again. Different sizes and high ‘M.I.’ values were extracted at regular intervals by examining the products produced (item 4, item 5, item 13, item 14, item 17, item 18, item 19, item 20, item 21, item 22, item 23, item 29, item 31, item 32). The fit index values of the model were also examined and it was found that the measurement model was confirmed with 21 items and five sub‐dimensions (Table 2). When the fit index values obtained for the measurement model are examined, the acceptable fit of GFI, NFI and RMSEA values; χ2/df, NNFI, CFI and SRMR values are in good fit (Kline 2015). As a result, the validated measurement model (Figure 1) and factor loads (Table 3) are presented below.

TABLE 2.

Fit indices for the TR‐NPC‐SF.

Fit index values of the model Good fit Acceptable fit
χ2/df 1.878 ≤ 3 3–5
GFI 0.859 ≥ 0.90 > 0.85
NFI 0.930 ≥ 0.95 > 0.90
NNFI (TLI) 0.959 ≥ 0.95 > 0.90
CFI 0.966 ≥ 0.95 > 0.90
RMSEA 0.070 ≤ 0.05 < 0.08
SRMR 0.036 ≤ 0.05 < 0.08
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Abbreviations: CFI, Comparative Fit Index; df, degree of freedom; GFI, Goodness of Fit Index; NFI, Normed Fit Index; NNFI, Non‐Normed Fit Index; RMSEA, Root Mean Square of Error Approximation; SRMR, Standardise Root Mean Square Residual.

FIGURE 1.

FIGURE 1

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Path diagram for the TR‐NPC‐SF. DANC, documentation and administration of nursing care; DLONC, development, leadership and organization of nursing care; MTC, medical and technical care; NC, nursing care; VNC, value‐based nursing care.

TABLE 3.

Factor loads and Cronbach Alpha internal consistency results of TR‐NPC‐SF.

Original order of items TR‐NPC‐SF order of items Factor loads Standard error t p Cronbach alpha (α)
Nursing Care 0.936
NPC1 1 0.854
NPC2 2 0.967 0.062 19.247 ***
NPC3 3 0.925 0.072 17.727 ***
Value‐Based Nursing Care 0.924
NPC6 4 0.959
NPC7 5 0.926 0.040 23.567 ***
NPC8 6 0.762 0.064 14.283 ***
NPC9 7 0.880 0.050 17.187 ***
Medical and Technical Care 0.931
NPC11 8 0.809
NPC12 9 0.806 0.075 12.625 ***
NPC13 10 0.823 0.077 13.017 ***
NPC15 11 0.907 0.064 15.103 ***
NPC16 2 0.926 0.067 15.629 ***
Documentation and Administration of Nursing Care 0.958
NPC24 13 0.909
NPC25 14 0.936 0.047 22.025 ***
NPC26 15 0.931 0.044 21.569 ***
NPC27 16 0.893 0.049 19.131 ***
NPC28 17 0.843 0.056 16.696 ***
Development, Leadership and Organisation of Nursing Care 0.926
NPC30 18 0.863
NPC33 29 0.949 0.069 14.059 ***
NPC34 20 0.817 0.077 13.217 ***
NPC35 21 0.835 0.074 13.664 ***
Total 0.974
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***

p < 0.001.

4.5. Convergent‐Discriminant Validity

Correlations between factor scores, CR and AVE values are given in Table 4. All CR values are above 0.70 and AVE values are above 0.50. In addition, since CR>AVE values for all dimensions, convergent validity of dimensions is provided. Conversely, the square roots of AVE values are above 0.50 and higher than the correlation values between factors and discriminant validity is also provided (Table 4).

TABLE 4.

Analysis of correlations between AVE, CR and factors.

Factors AVE CR 1 2 3 4 5
1. Nursing Care 0.820 0.932 (0.905)
2. Value‐based Nursing Care 0.760 0.927 0.672 (0.871)
3. Medical and Technical Care 0.718 0.927 0.772 0.678 (0.847)
4. Documentation and Administration of Nursing Care 0.798 0.952 0.754 0.698 0.877 (0.893)
5. Development, Leadership and Organization of Nursing Care 0.747 0.922 0.693 0.565 0.767 0.764 (0.864)
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Note: The values in parentheses on the diagonal are the square roots of the AVE values.

4.6. Reliability Analysis

4.6.1. Test–Retest Reliability

The scale, which was applied to 181 nursing students, was reapplied to 30 students selected from among these students 1 week later. In the study, the assumptions of normal distribution of the scale scores were examined and it was observed that the scores were normally distributed (applied to 30 participants). Therefore, the Pearson Correlation Coefficient was used to examine the relationship between the scores. In the test and retest, there was a positive and highly significant linear relationship between the scale and subscale scores (r = 0.770–0.894; p < 0.001) (Table 5). The high correlations between the test–retest scores indicate that the scale is reliable (Alpar 2022).

TABLE 5.

Relationships between the test–retest scores of the TR‐NPC‐SF.

Test Re‐test r p Bland–Altman analysis
Mean ± SD Mean ± SD Mean difference SD Limits of agreement (MD ± 1.96 × SD)
Nursing Care 82.38 ± 12.005 80.95 ± 12.996 0.807 *** 1.43 7.825 −13.9 16.8
Value‐based Nursing Care 92.38 ± 6.680 91.19 ± 7.546 0.770 *** 1.19 6.453 −11.5 13.8
Medical and Technical Care 79.33 ± 15.187 77.90 ± 13.209 0.843 *** 1.43 8.176 −14.6 17.5
Documentation and Administration of Nursing Care 84.76 ± 11.087 84.10 ± 11.019 0.803 *** 0.67 7.491 −14.0 15.4
Development, Leadership and Organization of Nursing Care 82.98 ± 14.275 80.12 ± 19.577 0.894 *** 2.86 9.350 −15.5 21.2
Total 84.36 ± 10.268 82.85 ± 10.575 0.892 *** 1.51 4.849 −8.0 11.0
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***

p < 0.001, r = Pearson Correlation Coefficient, p = Significance level, SD, Standard deviation.

4.6.2. Bland–Altman Method

It is a graphing method used to measure the agreement between two results. While the test–retest differences were found to comply with the normal distribution assumption (p > 0.05), there was no statistically significant difference between the test–retest means and differences (p > 0.05). Since both assumptions required by the Bland–Altman method were met, the agreement of test–retest scores was examined with this method (Table 5). When the graphs are examined, the averages of the differences in the measurement results obtained according to test–retest are not distributed systematically but show a random distribution. Since the average of the differences should spread around zero according to the Bland–Altman method (Figure 2), it would be correct to examine the harmony of these two methods with the Bland–Altman method and according to the results of the analysis, there is harmony between the two measurements (Figure S1–S5).

FIGURE 2.

FIGURE 2

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Bland–Altman plot for comparison of TR‐NPC‐SF test–retest scores.

4.6.3. Internal Consistency Reliability

The reliability analysis found that the Turkish version scale (TR‐NPC‐SF), consisting of 21 items, was highly reliable (α = 0.974). The Nursing Care (α = 0.936), Value‐based Nursing Care (α = 0.924), Medical and Technical Care (α = 0.931), Documentation and Administration of Nursing Care (α = 0.958) and Development, Leadership and Organization of Nursing Care (α = 0.926) subscales were also found to be highly reliable (Table 3).

The item‐total correlation values in the scale vary between 0.665 and 0.889. According to this method, the correlation values between the items in the scale and the total scores of the items are expected to be +0.25 and above (Büyüköztürk 2007). The item‐total correlation values of all items in the scale are above 0.25. Accordingly, these results show that all items in the scale serve the purpose of the scale (Table 6). In addition, when the Hotelling T2 test result is examined, the scale has no response bias (p < 0.001).

TABLE 6.

Item‐total correlations of scale items and Cronbach's alpha values when an item is deleted.

Items Average of scale if the item is deleted Variance of the scale if the item is deleted Corrected item‐total correlation Cronbach alpha value if the item is deleted
NPC1 114.82 428.735 0.770 0.973
NPC2 114.85 423.220 0.845 0.973
NPC3 115.01 420.611 0.802 0.973
NPC6 114.37 428.357 0.796 0.973
NPC7 114.24 432.596 0.724 0.974
NPC8 114.70 429.222 0.665 0.974
NPC9 114.15 434.828 0.692 0.974
NPC11 115.49 419.874 0.762 0.973
NPC12 115.34 420.458 0.789 0.973
NPC13 114.97 418.488 0.801 0.973
NPC15 114.60 421.674 0.858 0.972
NPC16 114.85 418.454 0.869 0.972
NPC24 114.75 420.068 0.848 0.973
NPC25 114.70 418.322 0.879 0.972
NPC26 114.60 421.386 0.889 0.972
NPC27 114.73 421.687 0.855 0.972
NPC28 114.78 421.314 0.810 0.973
NPC30 115.18 419.202 0.727 0.974
NPC33 114.77 417.279 0.869 0.972
NPC34 115.12 414.981 0.740 0.974
NPC35 115.04 414.465 0.767 0.974
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5. Discussion

This study was conducted to adapt the NPC‐SF into Turkish, evaluate psychometric properties among Turkish nursing students and evaluate nursing students' professional competencies. A total of 181 nursing students at the point of graduation from the four‐year nursing program in Türkiye were included in the study. According to the findings of this study, TR‐NPC‐SF showed an excellent psychometric property with 21 items and a 5‐factor construct in assessing professional nursing competence (Supporting Information).

Charette et al. (2020) stated that NPC‐SF was deemed very good in construct validity. Validity‐reliability studies of NPC‐SF were conducted in various countries, including China (Xu et al. 2021), Slovenia (Prosen et al. 2021), Australia (van de Mortel et al. 2021), Saudi Arabia (Halabi et al. 2021; Grande et al. 2023), Korea (Lee et al. 2023) and Croatia (Ivanišević et al. 2022). These studies showed that the NPC‐SF is a valid and reliable tool to measure self‐assessed nursing professional competence in different countries and languages.

The 21‐item and 5‐factor construct of TR‐NPC‐SF (Nursing Care, three items; Value‐based Nursing Care, four items; Medical and Technical Care, five items; Documentation and Administration of Nursing Care, five items; Development, Leadership and Organization of Nursing Care, four items) differed from the original version (Nilsson et al. 2018) (Table S1). Other studies showed that the factor structure and number of items differed from the original NPC‐SF in line with our study. In a study in the Slovenian context by Prosen et al. (2021), the scale had a structure of 35 items and four factors and the factors are ‘Development, leadership and organization of nursing care (13 items); Factor 2: Value‐based nursing care (7 items); Factor 3: Documentation and administration of nursing care (9 items); and Factor 4: Nursing care (6 items)’. Another study conducted in Korea concluded that NPC‐SF‐K had a construct of 34 items and five factors; the factor ‘Nursing Care’ was not included and the titles of the other factors remained the same (Lee et al. 2023). In addition to these findings, in a current study conducted in Saudi Arabia, NPC‐SF had 21 items and three factors (Professional Care Pedagogics—9 items, Holistic Value‐Based Care—6 items and Direct Nursing Care—6 items) (Grande et al. 2023). Such differences in the factor structure of NPC‐SF can be related to the differences in expected nurse competence, variability in the nursing curriculum adopted in the nursing programs and the scope of the nursing practices provided in these countries. Conversely, China (Xu et al. 2021), Saudi Arabia (Halabi et al. 2021), Australia (van de Mortel et al. 2021) and Croatia (Ivanišević et al. 2022) versions of NPC‐SF were similar to the original NPC‐SF in terms of the factors.

The five factors of TR‐NPC‐SF align with the competencies included in the National Nurse Education Core Program (HUÇEP 2022), the National Guideline of Core Competency in Nursing (Turkish Ministry of Health 2021), the Criteria of the European Union for Nursing Education (European Union 2005) and the Turkish National Qualifications Framework for Higher Education (Higher Education Institution 2010). All these national and international frameworks include similar themes to educate qualified nurses who will address the health‐related needs of the country. Each nursing education institution in Türkiye bases its curriculum on these national and international frameworks. Especially, HUÇEP (2022) has assigned responsibility to institutions to review their curriculum in accordance with HUÇEP components and ensure that a minimum of 70% of the curriculum covers these components. Therefore, TR‐NPC‐SF is expected to be shaped around these five factors.

According to the CFA result, the ‘Care Pedagogics’ factor was removed from the TR‐NPC‐SF. Similar to our result, the care pedagogics factor was removed from the scale in the Slovenian version of NPC‐SF (Prosen et al. 2021). This factor covers the nursing competence regarding patient education activities in the original NPC‐SF. Patient education is one of nurses' most important autonomous roles and it is a highlighted role in the nursing regulations in Türkiye (Turkish Ministry of Health 2011). In our country, patient education is offered as part of a compulsory course. However, due to the limited number of nursing faculty specialising in the education field, the course is primarily taught by faculty members specialising in other nursing areas. In addition, many nursing courses emphasise patient education content as an effective patient care intervention. Therefore, nursing students tend to think patient education is a part of nursing care, not a separate intervention; this may be an explanation for removing the care pedagogic factor from the TR‐NPC‐SF.

In this study, the total Cronbach's alpha coefficient of TR‐NPC‐SF was found to be 0.974 and the Cronbach's alpha coefficient of the factors ranged from 0.926 to 0.958. A reliability coefficient close to 1 means high reliability and internal consistency among the items (Alpar 2022). These data suggested that the TR‐NPC‐SF is reliable for measuring nursing students' self‐assessed professional competence. In the original NPC‐SF, Cronbach's alpha coefficient was 0.86 in total and 0.71–0.84 for the factors (Nilsson et al. 2018). In other studies, the Cronbach's alpha coefficient of the scale was reported to be 0.97 in Korea (factors: 0.84–0.97) (Lee et al. 2023), 0.97 in China (factors: 0.784–0.945) (Xu et al. 2021), 0.96 in Australia (0.83–0.89) (van de Mortel et al. 2021), 0.97 in Slovenia (factors: 0.892–0.972) (Prosen et al. 2021), 0.981 in Saudi Arabia (factors: 0.956–0.971) (Grande et al. 2023). The study results were similar to the reliability analysis of TR‐NPC‐SF.

According to fit indices, GFI, NFI, NNFI and CFI values close to 1 and an RMSEA value of 0.070 show that all items of TR‐NPC‐SF were distributed properly in five subscales and contributed significantly to the total score of the scale. These results also provided evidence for the construct validity of TR‐NPC‐SF.

According to the results of this study, the TR‐NPC‐SF overall score of the students was 84.36 ± 10.268; Value‐based Nursing Care had the highest mean score with 92.38 ± 6.680; and Medical and Technical Care had the lowest factor mean score with 79.33 ± 15.187. Nurses must have high professional competence to ensure patient safety and better patient outcomes in healthcare institutions (Tyndall et al. 2018). The findings of this study, which was conducted using NPC‐SF, showed that nursing students assessed their professional competencies as high. Previous studies showed similar results in terms of mean factor scores for NPC‐SF. The highest mean scores for the NPC were ‘Value‐based nursing care’ in China (Xu et al. 2021), Australia (van de Mortel et al. 2021), Korea (Lee et al. 2023), Slovenia (Prosen et al. 2021) and Saudi Arabia (Grande et al. 2023) similar to our study results. The lowest mean factors of this study were the Medical and Technical Care subscale. This finding is different from the previous study conducted in Korean (Lee et al. 2023), Sweden (Lachmann and Nilsson 2021), Australian (van de Mortel et al. 2021), Saudi Arabian (Halabi et al. 2021) contexts with the scores of the factor ‘Development, leadership and organisation of nursing care’. These results showed that nursing students feel more competent in value‐based nursing care but need more support in medical and technical care. The nursing curriculum should highlight these aspects of nursing education to develop future nurses.

5.1. Implications for Practice

Professional nurses should be competent to improve patient, nurse and organisational outcomes. Evaluation of competence is as important as identifying the areas of competence and it is considered a part of quality assurance in nursing education. Nursing faculty members can use this scale to assess and support nursing students' competence before graduation. Nursing education policymakers can benefit from this study's findings to develop future nursing education programs and competent nurses for the national or international healthcare sector. Nurse managers can use this scale before hiring nurses and planning an orientation education program. The TR‐NPC‐SF has excellent psychometric properties to assess nursing students' professional nursing competence for Turkish nursing students.

6. Limitations

This study has some limitations. Firstly, the convenience sampling method was used in the study and the generalizability of the sample to the Turkish context is low. Secondly, since data were collected via a self‐reported questionnaire, students might have been influenced by social desirability. Another limitation of this study is that the comprehensive evaluation of the TR‐NPC‐SF and its ability to represent the multidimensional nature of nursing professional competence might have been impacted by reducing the scale to 14 items.

7. Conclusions

The study results show that the TR‐NPC‐SF instrument is a valid and reliable tool for assessing nursing students' professional nursing competence for Turkish nursing students and nurses. The professional competence level of the students participating in the study was found to be high. It is recommended that the study be repeated in a larger sample, which includes nurses and nursing students. Also, considering that the data were collected when distance education was ongoing due to the pandemic, it is recommended to repeat the study and compare the results with the face‐to‐face educational settings.

Author Contributions

S.B.‐A., E.K.‐O. and Y.E. were responsible for the conceptualization. S.B.‐A. and E.K.‐O. were responsible for the methodology. S.B.‐A., E.K.‐O. and Y.E. performed the data collection. S.B.‐A. performed the data analysis. All writers were responsible for the drafting of the manuscript. S.B.‐A. supervised the study. All authors made the writing – review and editing of the article. All authors agreed on the final manuscript.

Disclosure

Statistics: The statistics were checked prior to submission by an expert statistician whose name is Damla Kirendibi, damlakirendibi@gmail.com.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Appendix S1: nop270344‐sup‐0001‐AppendixS1.docx.

NOP2-12-e70344-s001.docx (112.4KB, docx)

Acknowledgements

We thank the experts who commented on the data collection tool and the students for their participation in the study. Supporting Information includes comparing original NPC‐SF and TR‐NPC‐SF items (Table S1), Bland–Altman plot for comparison of the sub scales of the TR‐NPC‐SF test–retest scores (Figures S1–S5), TR‐NPC‐SF in English and TR‐NPC‐SF in Turkish for future researcher/users.

Basaran‐Acil, S. , Kuruca‐Ozdemir E., and Erdat Y.. 2025. “Turkish Adaptation and Psychometric Characteristics of the Nurse Professional Competence Scale‐Short Version Among Nursing Students: Methodological Study.” Nursing Open 12, no. 12: e70344. 10.1002/nop2.70344.

Funding: The authors have nothing to report.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Appendix S1: nop270344‐sup‐0001‐AppendixS1.docx.

NOP2-12-e70344-s001.docx (112.4KB, docx)

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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