The concept of unintended consequences is widely discussed in the realms of politics or economics, but not as frequently as related to health care. Nursing professionals act with the intent to improve health outcomes for patients; however, with every action, there are risks and consequences that may or may not be anticipated. This article utilizes a modified version of Walker and Avant’s framework for concept analysis (2011) to identify the characteristics, defining attributes, and antecedents of the concept of unintended consequences, present a model case and empirical referents, and provide a practical and theoretical application to nursing. Opportunities for future research related to the concept of unintended consequences include a closer study of nurses’ choices that may affect their well-being or productivity, as well as educational opportunities to better inform nurses of the impact unintended consequences may have on them and the care they provide.

The purpose of this study was to evaluate the psychometric properties of two scales—one to measure the self-efficacy of parents to discuss sexual health issues with their adolescents and the other to measure parents’ outcome expectancy associated with such discussions. Understanding how parents feel about their confidence in talking with their children about important sexual health issues and the outcomes they expect as a result of such discussions can be useful in guiding both the development and refinement of educational programs to promote parent-child discussions. The responses of 491 mothers who participated in an HIV prevention intervention with their adolescents were used for the present analysis. Mothers ranged in age from 25 to 68 years with a mean of 37.9 years (SD = 6.9). Of mother participants, 33% were married, 96.7% were African American, and 89.2% had completed high school. Their adolescents ranged in age from 11 to 14 years, and 61.5% were male. Assessment of reliability for both scales showed that internal consistency reliability was acceptable for the total scales as well as three of the five subscales. With the exception of one item on the outcome expectancy scale, the inter-item correlations, the mean inter-item correlations, and the item-to-total correlations meet the standard criteria for scale development for both scales. Factor analysis was used to identify the underlying structure of the scales, and hypothesis testing was used to assess construct validity. The results of these analyses provide support for the construct validity of the scales.

Background and Purpose: The ethical challenges of the COVID-19 pandemic have contributed to an increase in moral distress (MD) in nurses—a long-standing, ubiquitous issue in nursing—highlighting its detrimental impact on nurses, patients, and healthcare organizations. MD is the negative outcome of a moral situation or dilemma in which a nurse is prevented from taking action on ethical decisions usually related to organizational constraints. On the opposite end of the spectrum, moral comfort (MC), an emerging concept in nursing, is an individual’s feelings of ease with decisions and actions related to a moral dilemma or the positive outcome of a moral situation or dilemma. However, nursing literature on MC is sparse. While several instruments to measure MD exist, an instrument to measure MC was not found. The MC Questionnaire (MCQ) was theoretically developed. The purpose of this study was to conduct a psychometric evaluation of the new 35-item MCQ. Methods: Psychometric evaluation design was used. Reliability testing consisted of the examination of internal consistency (Cronbach’s alpha values) and stability (test–retest reliability: Spearman’s correlation coefficient, weighted Kappa, and Bland–Altman [B&A] analysis). Validity was examined using content validity (content expert evaluation) and discriminant validity (r < .30). Model fit of a proposed five-factor model was tested using confirmatory factor analysis (CFA). Results: Hospital-based direct-care (HB-DC) RNs (n = 466) participated from February 2019 to September 2019 in this Institutional Review Board–approved study. Participants completed demographic information, the MCQ, and the Moral Distress Scale—Revised (MDSR). The psychometric evaluation included a priori content validation and multiple statistical analyses: Cronbach’s alpha, Spearman’s correlation coefficient, weighted Kappa, B&A, discriminant validity, and CFA. Cronbach’s alpha was .951, suggesting internal consistency. Spearman’s correlation coefficient was 0.605 (p < .001), suggesting a strong correlation between Time 1 and Time 2. Weighted Kappa values for each item (range = .139–.559) suggested slight to moderate agreement between responses over time. The B&A plot suggested agreement of responses over time. Discriminant validity results suggested no correlation between the MCQ and MDSR (r = −.219), which was expected. CFA results suggest a poor model fit of the proposed five-factor model. A post hoc hierarchical cluster analysis showed the presence of two clusters. A subsequent two-factor exploratory factor analysis showed items loading onto one of the two factors (internal and external). Conclusions: MC in nurses is essential to promoting positive outcomes for nurses. An instrument to measure MC in nurses is needed to gain a further understanding of the concept. The MCQ was theoretically developed and psychometrically evaluated. Results suggest the validity and reliability of the MCQ with further testing of a two-factor model. Knowledge acquired from studies using the MCQ could potentially be used to develop strategies to promote MC in nurses, thereby promoting positive outcomes for nurses, patients, and healthcare organizations.

Background and Purpose: Cultural competence is significant in addressing the health needs of vulnerable populations. This study conducted psychometric testing of a cultural competency instrument in the Philippines. Methods: Brislin’s translation and a cross-sectional online design were used. Exploratory factor analysis (EFA) with varimax rotation examined construct validity of the 23-item scale among 157 adult LGBTQ+ residents. The scale revealed overall reliability (α = .85) including two subscales (α = .87, α = .81, and α = .61). The EFA yielded three theoretical factorial solutions. Conclusion: The Filipino version of the instrument demonstrated reliability and validity. Measuring clients’ perceptions of provider and organizational cultural competency can improve the utilization of healthcare in Filipino LGBTQ+ communities. Future research will examine the dimensional structures of the instrument among expanded LGBTQ+ communities.

Background and Purpose: The prevention of aggressive behavior in child and adolescent inpatient settings is essential. However, it can be difficult to prompt a quick appropriate intervention without an early warning scale for the prevention and management of behavioral emergencies in a psychiatric inpatient adolescent unit. Behavioral emergencies often result in restraint/seclusion and/or administration of psychotropic medications. The objectives are to develop and evaluate the Pediatric Behavioral Early Warning Scale (Pedi-BEWS) as a screening tool to prompt quick appropriate interventions and to decrease incidents of restraint/seclusion and/or administration of psychotropic medications. Methods: A two-phase methodological design was applied. A total of 447 inpatients and 21 nurses were used to test internal consistency reliability and validity. Results: Receiver operating characteristic curve areas for the developed instrument were calculated to be 0.890 (Cognition), 0.959 (affect), and 0.951 (behavior). The overall Pedi-BEWS indicated high reliability (Cronbach’s alpha = .98). Conclusions: The Pedi-BEWS shows high internal consistency and validity. The use of the newly developed tool may reduce or eliminate episodes of seclusion and restraint for pediatric patients with a behavioral problem. In addition, the tool has the potential to enhance psychiatric nurses’ assessment skills and competencies. The use of the newly-developed Pedi-BEWS can promote an appropriate and timely nursing assessment and intervention before the deterioration in psychiatric nursing practice.

Background and Purpose: The study aims to examine the validity and reliability of the impact of 16-item Short-Form Child Perception Questionnaire (CPQ_11–14-ISF:16) in Persian-speaking elementary schoolers. Methods: From two main cities in Iran, 708 mother–child dyads were enrolled in 2018. Decayed, missing, and filled teeth (DMFT/dmft) indexes were examined for divergent validity. Two built-in indexes of overall oral health and overall impacted well-being were used for concurrent validity. Exploratory factor analysis (EFA) with Geomin rotation, Cronbach’s α, and Spearman’s correlation were executed. Results: The total Cronbach’s α was 0.71. EFA indicated CPQ_11–14-ISF:11 (α = 0.66) to compose three eligible factors (α = 0.66), including oral problems (α = 0.54), emotional problems (α = 0.66), and social problems (α = 0.41). The concurrent/divergent validity of CPQ_11–14-ISF:11 and the subscales was partially confirmed. Conclusions: The use of CPQ_11–14-ISF:11 to multidimensionally address dental care for children requires further investigations.

Background and Purpose: This study is aimed at translating the third version of the Atlanta Heart Failure Knowledge Test (AHFKTv3) into the Persian language and evaluating its psychometric properties. Methods: In this methodological study, the AHFKTv3 was translated into Persian and its face, content, construct validity, and reliability were assessed. Results: The content validity of AHFKTv3 items was >0.78 and the validity of the instrument was 0.96. The standardized factor loading value of all items, except for item 16, was >0.3. The scores of the AHFKTv3 and European Heart Failure Self-Care Behavior Scale had a significant correlation with each other (p < .001). The AHFKTv3 score had a significant relationship with the educational level. The Kuder-Richardson Formula 20 coefficient was 0.908. Conclusion: The Persian AHFKTv3 is a valid and reliable instrument for assessing HF-related knowledge; therefore, it can be used in nursing practice to identify and address the deficits aiming for better patient care and in research to evaluate treatment and healthcare programs.

Background and Purpose: A healthy lifestyle is an important condition for the protection and improvement of the health of individuals. The aim of the study is to adapt the psychometric properties of the Turkish version of the Healthy Lifestyle Screening Tool (HLST) in adults and to analyze their healthy lifestyle levels. Methods: It is a methodological type of research. The factor structure of the scale was evaluated by exploratory and confirmatory factor analysis, and the sample of 377 adult individuals was evaluated with Cronbach’s alpha value for reliability. Results: The Cronbach alpha value of the scale is 0.825 and it is above the accepted limit. In the seven-factor structure, 48.95% of the total variance was explained. The scale has 34 items and the factor loads of each item vary between 0.24–0.58. Confirmatory factor analysis was compatible with the data obtained with theoretical data. Conclusion: The Turkish version of the HLST scale is a valid and reliable scale that can be used to evaluate healthy lifestyle behaviors in adults.