Background: The promotion of family nursing by public health nurses (PHN) presupposes an accurate assessment of the family nursing support they already provide. However, as there is no assessment tool for this purpose, this study aimed to develop a scale to assess family nursing currently provided by PHN. Methods: We developed the Family Nursing Practice Scale (FNPS) for PHN based on the results of a previous study. The content validity of the FNPS was established through discussion with three other researchers. A pilot study was conducted to confirm face validity. To confirm reliability and validity, an anonymous, self-reported questionnaire was sent to PHN working in municipal offices. The statistical analyses included the Kaiser-Meyer-Olkin (KMO), Barlett’s Test of Sphericity, exploratory factor analysis (EFA), Cronbach’s alpha, correlation coefficient and t-test. Results: Seven hundred fifty-four PHN participated in this study. Cronbach’s alpha of FNPS was 0.94. The KMO measure was 0.948, and Bartlett’s Test of Sphericity was p < 0.01. Two factors together accounted for 63.2% of the variance in EFA. No items were excluded because of low loadings. Construct validity was confirmed through comparison with categories from a previous study. The correlation coefficient of FNPS and selected items of the Practice of Breastfeeding Support Scale was r = 0.56 (p < 0.01). The result of the t-test showed that the FNPS score of PNH who had received training in family nursing was significantly higher than that of PHN who had not (t = -2.0; p < 0.05). Conclusion: The reliability and validity of the FNPS were confirmed. The FNPS comprised 15 items and two factors. The score for “Active support for the family” was lower than “Support given with awareness of the family’s situation.” The findings of this study strongly suggested that the FNPS would be effective in clarifying the current state of family nursing provided by PHN and factors related to this activity and thus greatly assist the efforts of PHN to promote family nursing.
The family structure and community relations are changing in today’s Japan. For instance, the number of single-parent households is swelling due to a rising divorce rate [
Family nursing is recognized as an important practice for its potential to mitigate some of these conditions and has therefore been actively promoted throughout Japan [
Public health nurses (PHN) have been at work in the community for more than 70 years throughout Japan to promote health and disease-prevention and to provide other public health services. An outstanding instance of such services is the family nursing approach used by PHN to promote community health activities [
Previous studies have developed scales or indicators to assess caring belief as well as the skills of nurses engaged in family nursing. Meiers [
In 2004 Shibagaki [
The role of the PHN is closer to that of the visiting nurse than that of the hospital nurse. However, there are clearly differences as well. Therefore, this study aimed to develop a family nursing practice scale (FNPS) for PHN and to assess the current state of PHNs’ family nursing practices to supply an empirical basis for improving their activities.
We developed the Family Nursing Practice Scale (FNPS) questionnaire for PHN based on the results of a previous study [
To confirm reliability and validity, an anonymous self-reported questionnaire, a letter explaining the study, the instructions, and a return envelope were sent to the directors of maternal and child health (MCH) divisions in all the municipalities throughout Japan, who were requested to select one PHN as a respondent. The PHNs then returned the completed questionnaires to the researchers.
PHN working at municipal offices participated in this study. To control for potential confounders, only PHN working for MCH services without midwife qualifications and those with five to 15 years of work experience were included. If no PHN in a given municipality met these conditions, any PHN with the closest number of years of work experience to the requirements of the study was recruited.
SPSS version 23 for Windows was used and p < 0.05 was considered statistically significant. The Kaiser-Meyer-Olkin (KMO) measure was used for sampling adequacy (using a cut-off of 0.5), and Barlett’s Test of Sphericity (using a cut-off p < 0.01) was used to ensure the appropriateness of the data set for exploratory factor analysis. To find the factor structure, factor analysis (principal factor method, promax rotation) was conducted. Cronbach’s alpha was calculated to examine the reliability of the scale. To confirm criterion-related validity, items from the Practice of Breastfeeding Support Scale (PBSS) [
Ethical approval was obtained from the ethical review board of the Faculty of Medicine of The University of Tokyo (Clearance No. 3035).
Of the 1750 questionnaires sent, 831 were returned (response rate: 47.5%). Seventy-seven were excluded from analysis due to missing data. Therefore, the valid response rate was 43.1% (754).
Category | n (%) | Average ± SD | (Range) | |
---|---|---|---|---|
Sex | Male | 2 (0.3) | ||
Femal | 752 (99.7) | |||
Work experience | 10.7 ± 5.5 | (0 - 33) | ||
Final education | Vocational school | 389 (52.0) | ||
Junior college | 131 (17.4) | |||
University | 229 (30..4) | |||
Graduate School | 8 (1.1) | |||
No answer | 1 (0.1) | |||
Experience of childbirth (respondent or their partner) | Yes No No answer | 496 (65.8) 257 (34.1) 1 (0.1) | ||
Learned family nursing | Yes No No answer | 544 (72.1) 193 (25.6) 17 (2.3) |
The KMO measure was 0.948, indicating sampling adequacy. Sufficient variability in the data, confirmed by Barlett’s Test of Sphericity (p < 0.01), demonstrated the validity of the data for exploratory factor analysis.
Two factors together accounted for 63.2% of the variance. No items were excluded because of low loadings (below 0.3). Analysis produced two factors including 15 items (
Latent variables were labeled as follows: Factor 1) Active support for the family (10 items); and Factor 2) Support given with awareness of the family’s situation (5 items). The factor contribution was 8.29 for Factor 1, 1.19 for Factor 2.
Cronbach’s alpha was calculated to verify the reliability of FNPS. The reliability of FNPS was 0.93 for Factor 1, 0.86 for Factor 2, and 0.94 overall.
The participants in the pilot study were 22 PHNs. The results of the pilot study showed that there were no data missing from the questionnaire and no complaints about difficulties in answering the questions.
The two factors resulting from factor analysis were compared with five categories from a previous study on PHN family nursing practice: Category 1) Accepting family’s feelings; Category 2) Showing consideration for the family’s anxiety; Category 3) Health and daily life of family; Category 4) Words of appreciation;
1 | 2 | |
---|---|---|
Factor 1: Active support for the family (α = 0.93) | ||
⑥ I support each family. | 0.70 | 0.09 |
⑦ I tell the family that I am their supporter. | 0.63 | 0.15 |
⑧ I am a worker who understands how the family truly feels. | 0.80 | 0.06 |
⑨ I communicate purposefully with the family. | 0.80 | 0.07 |
⑩ I take the initiative to approach the family. | 0.75 | 0.09 |
⑪ I try to create opportunities to converse with the family. | 0.81 | 0.01 |
⑫ I try to see things from the family’s perspective when I talk to them. | 0.50 | 0.32 |
⑬ I support the family when they express their feelings. | 0.64 | 0.13 |
⑭ I encourage the self-expression of the family. | 0.83 | 0.01 |
⑮ I intervene in the family’s problems. | 0.89 | −0.27 |
Factor 2: Support given with awareness of the family’s situation. (α = 0.86) | ||
① I want to be aware of what the family considers to be important in my interactions with them? | −0.04 | 0.81 |
② I always keep the family in mind from the first. | −0.19 | 0.98 |
③ I express my appreciation to the family. | 0.14 | 0.73 |
④ I provide support while being aware of my influence on the family. | 0.05 | 0.79 |
⑤ I understand the health status of the family. | 0.17 | 0.60 |
Factor contribution | 8.29 | 1.19 |
Cumulative contribution ratio (%) | 55.3% | 7.9% |
Principal factor method, promax rotation.
and Category 5) Partnership with family [
Criterion-related validity was assessed by calculating Spearman’s correlation coefficient between the FNPS total score and 12 items selected from the PBSS total score (r = 0.56, p < 0.01). A significant positive correlation was observed between the FNPS and PBSS.
The result of the t-test showed that the FNPS score of PNH who had received training in family nursing was significantly higher than that of PHN who had not (t = −2.0; p < 0.05).
The mean of the total FNPS was 3.7 (SD ± 0.6; see
Mean | ±SD | (Range) | |
---|---|---|---|
Factor 1: Active support for the family | 3.5 | ±0.7 | (1 - 5) |
⑥ I support each family. | 3.2 | ±1.0 | (1 - 5) |
⑦ I tell the family that I am their supporter. | 3.5 | ±1.0 | (1 - 5) |
⑧ I am a worker who understands how the family truly feels. | 3.4 | ±0.9 | (1 - 5) |
⑨ I communicate purposefully with the family. | 3.6 | ±0.9 | (1 - 5) |
⑩ I take the initiative to approach the family. | 3.8 | ±0.9 | (1 - 5) |
⑪ I try to create opportunities to converse with the family. | 3.5 | ±0.9 | (1 - 5) |
⑫ I try to see things from the family’s perspective when I talk to them. | 3.9 | ±0.9 | (1 - 5) |
⑬ I support the family when they express their feelings. | 3.7 | ±0.9 | (1 - 5) |
⑭ I encourage the self-expression of the family. | 3.5 | ±0.9 | (1 - 5) |
⑮ I intervene in the family’s problems. | 3.0 | ±0.9 | (1 - 5) |
Factor 2: Support given with awareness of the family’s situation | 4.1 | ±0.6 | (2 - 5) |
① I want to be aware of what the family considers to be important in my interactions with them? | 4.0 | ±0.7 | (2 - 5) |
② I always keep the family in mind from the first. | 4.3 | ±0.7 | (2 - 5) |
③ I express my appreciation to the family. | 4.1 | ±0.8 | (1 - 5) |
④ I provide support while being aware of my influence on the family. | 4.0 | ±0.8 | (1 - 5) |
⑤ I understand the health status of the family. | 4.1 | ±0.8 | (1 - 5) |
Average | 3.7 | ±0.6 | (2 - 5) |
mind from the first” had the highest mean among all the items (M 4.3, SD ± 0.7), and “I intervene in the family’s problems” had the lowest mean (M 3.0, SD ± 0.9).
Cronbach’s alpha indicated that all factors exceeded the reference value, thereby ensuring the reliability of the scale.
The validity of the FNPS was assessed in terms of content validity, face validity, construct validity, and known-groups validity.
The FNPS was based on a previous study of family nursing practice by home visiting nurses in Japan [
The construct validity was assessed through a comparison with the categories used in the aforementioned study and the results of exploratory factor analysis [
A significant positive correlation was observed between the FNPS total score and the selected PBSS total score demonstrating criterion-related validity for the FNPS.
The FNPS score of PNH who had received training in family nursing was significantly higher than that of PHN who had not, thus demonstrating known- groups validity for the FNPS.
The results of the FNPS showed that the score for “Active support for the family” was lower than “Support given with awareness of the family’s situation.” In particular, the score for “I intervene in the family’s problems” was extremely low, indicating that the PHN did not provide satisfactory support. Previous studies which assessed family nursing provided by visiting nurses also showed that items related to “I intervene in the family’s problems” had lower average scores than other items [
Test-retest reliability was not confirmed in this study. Therefore, further studies are needed to improve the family nursing practice assessment scale for PHN.
The reliability and validity of the FNPS were confirmed by the results of our analyses. The FNPS comprised 15 items and two factors including “Active support for the family” and “Support given with awareness of the family’s situation.” The score for “Active support for the family” was lower than “Support given with awareness of the family’s situation.”
The findings of this study strongly suggested that the FNPS would be effective in clarifying the current status of, and the factors related to, family nursing services provided by PHN and thus contribute to promoting family nursing by PHN.
We are grateful to the PHNs who took the time to answer the questionnaire. We would like to express our gratitude to the faculty and members of the Department of Family Nursing, Graduate School of Medicine, School of Health Science & Nursing in the University of Tokyo.
We declare no conflict of interest.
This study was funded by Grants-in-Aid for scientific research expenses of the Ministry of Education, Culture, Sports, Science and Technology (grant number 2139 0589).
Noriko Toyama: study design, data collection, data input, data analysis, discussion, and finalization of the manuscript.
Mineko Muranaka: study design, data collection, discussion, and reviewing of the paper.
Kayoko Kurihara: study design, data analysis, discussion, and reviewing of the paper.
Kokoro Shirai: data analysis, discussion, and reviewing of the paper.
Kiyoko Kamibeppu: supervised all the processes involved in this study.
All authors read and approved the final manuscript.
Toyama, N., Kurihara, K., Muranaka, M., Shirai, K. and Kamibeppu, K. (2017) Designing a Scale to Assess Family Nursing Practice among Public Health Nurses in Japan. Health, 9, 1019-1028. https://doi.org/10.4236/health.2017.97074