Instrument validation: hospital nurse perceptions of their Behavioral Health Care Competency


  • Dana N. Rutledge,

    1. Dana N. Rutledge PhD RN Nursing Research Facilitator St. Joseph Hospital, Orange, California, USA, and Professor California State University Fullerton, Fullerton, California, USA
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  • Mary Wickman,

    1. Mary Wickman PhD RN Research Coordinator St. Jude Hospital, Fullerton, California, USA, and Nursing Program Director Vanguard University, Costa Mesa, California, USA
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  • Diane Drake,

    1. Diane Drake PhD RN Nurse Research Scientist Mission Hospital, Mission Viejo, California, USA and Assistant Clinical Professor University of California, Irvine, California, USA
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  • Elizabeth Winokur,

    1. Elizabeth Winokur RN PhD Candidate University of Arizona, Tucson, Arizona, USA and Clinical Educator Emergency Services & Behavioral Health, St. Joseph Hospital, California, USA
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  • Jeannine Loucks

    1. Jeannine Loucks MSN RN-BC Clinical Coordinator Behavioral Health, St Joseph Hospital, California, USA
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D.N. Rutledge: e-mail:


Aim.  To report the development and psychometric testing of the Behavioral Health Care Competency survey, designed to measure hospital nurse perceptions of behavioral healthcare competency.

Background.  Hospital nurses working in general or other non-psychiatric units may lack behavioral healthcare competency to manage disruptive behaviours associated with mental illnesses.

Design.  Instrument development.

Method.  A nurse study team including clinical experts and nurse researchers from three community hospitals in southern California (USA) reviewed content validity of each item and the 31-item instrument and created a behavioral health care competency conceptual model based on the nursing process. Separate institutional review board permissions were obtained from each hospital. The study team collaborated in the timing of survey administration (November 2010), analysis of the results and survey validation.

Results.  A total of 844 nurses completed the survey, representing approximately 23–41% of eligible nurses from each hospital. Using principal component analysis with varimax rotation, 23 items led to a factor structure with four components. Four subscales with adequate alpha coefficients were formed: Resource Adequacy, Patient Assessment, Practice/Intervention Competency, and Psychotropic Recommendation.

Conclusion.  The 23-item hospital nurse Behavioral Health Care Competency survey is an adequate and valid newly developed instrument. Further testing with diverse samples is needed to strengthen generalizability and address unique and specialized nursing care needs.