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Doctor of Philosophy (Ph.D.) Nursing




Statement of the Problem Many studies have explored the concept of family-centered care (FCC) as the framework in which the nurse recognizes and incorporates the family into the care of the patient. Implementation of FCC in the Neonatal Intensive Care Unit (NICU) has not been clearly or consistently described in the literature and is often included with Pediatric Intensive Care Units (PICU). The Family Nurse Caring Belief Scale (FNCBS) was developed to measure nurses’ beliefs regarding provision of family-sensitive care to families in crisis that incorporate concepts important to care for a family unit. Initial psychometric evaluation of the FNCBS was tested on a sample of NICU and PICU nurses. Considering the differences between NICU and PICU, the beliefs of the neonatal nurse towards the family as a unit in the unique NICU setting may differ from those of nurses working in the PICU setting. Method Registered nurses who work in NICU and are members of the professional organization, the Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN) were recruited for this study. Neonatal nurses with less than one year experience were excluded. Neonatal nurses (1,580) were contacted via e-mail address by AWHONN. The invitation included the purpose of the study, importance of their participation and assurance of anonymity. Consent included an explanation of the study, risks, and benefits. An e-mail/web address link was provided to enable participants to respond to the survey electronically, therefore implying consent. Prior to conducting ii confirmatory factor analysis (CFA), a factor analysis was conducted on the new sample data, replicating the original principal components analysis. CFA of the 25-item FNCBS, using the factor structure based on the original exploratory principal components analysis, was used to test that the constructs are reliably measured and to determine whether the individual constructs are in fact different from each other. Goodness-of-fit statistics were used to evaluate model fit. The chi-square test of model fit, comparative fit index (CFI) and Tucker-Lewis index (TLI) evaluated the fit of the model by examining the baseline comparisons and is dependent on the average size of the correlations. Root mean square of error approximation (RMSEA) and the standardized root mean square residual (SRMR) analyzed the discrepancy between the hypothesized model and the population covariance matrix. The “Working with Families” questionnaire was used to measure convergent and discriminant validity with the FNCBS. Results Confirmatory factor analysis (CFA) examined the factor structure of the FNCBS using the NICU nurse sample recruited for this study. Goodness-of-fit statistics assessed how well the model fit the data. The chi-square test determined overall model fit, however, is sensitive to sample size. Comparative fit index (CFI) and Tucker-Lewis index (TLI) were both <.9 therefore, neither of these indices indicated good fit. The root mean square of error approximation (RMSEA) of the sample data is >.06 and the standardized root mean square residual (SRMR) of the sample data is >.08 and, therefore, the data did not demonstrate good fit. In addition, the factor correlations between the four latent variables were weak. This suggests there is no parsimony and the sample data with neonatal nurses did not fit the model. iii Conclusion The Family Nurse Caring Belief Scale (FNCBS) was not psychometrically validated with the population of neonatal nurses and this study was unable to strengthen the construct validity of the FNCBS.

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