Measuring Reasons for Unfinished Nursing Care as Perceived by Community Care Nurses: A Binational Development and Validation Study

Objective: To develop and validate the Unfinished Community Nursing Care Reasons Survey (UCNC_RS) transnationally and compare Unfinished Nursing Care (UNC) reasons across countries. Design: This development and validation study was conducted in Israel and Italy, following the COnsensus-based Standards for the selection of health Measurement Instruments guidelines. Sample and measurement: Tool identification, adaptation, and development were followed by content and language validation; structural validation was then performed with 309 community nurses (156 in Israel and 153 in Italy) who agreed to participate. Exploratory Factor Analysis (EFA), Mokken analysis, and descriptive statistics were conducted. Results: The UCNC_RS consists of 23 items. Israeli EFA identified three factors, while the Italian EFA identified two, with items loading on more than one factor in both countries. Mokken analysis indicated a good model fit. Reasons for UNC differed between countries, both in their order of importance and in their averages, indicating different patterns of perceived elements affecting UNC occurrence. Conclusion: Overall, the UCNC_RS may be used in daily practice to survey and proactively address factors that may increase the occurrence of UNC. Reasons for UNC are organized hierarchically, suggesting that actions should target different system levels to reduce its occurrence. In Israel, priority policies are needed at the macro-, exo-, and nurse-system levels, while in Italy, policies are needed at the macro-, meso-, and micro-levels. Moreover, the reasons for UNC differ across countries, both in their order of importance and in their scores, with only some common elements, indicating different patterns of perceived reasons.