Development and validation of a questionnaire assessing nurses’ negative emotional responses to single-checking medications: a cross-sectional survey in Japanese university hospitals

Abstract

Abstract Objectives Medication errors are a major patient safety concern, and double-checking is a commonly used method to mitigate risks during administration. Despite its questionable efficacy, Japanese hospitals are reluctant to transition to single-checking, particularly due to nurses’ resistance. This study developed and psychometrically evaluated a questionnaire assessing nurses’ negative emotional responses to single-checking medications to enable targeted interventions aimed at easing their resistance. Design Cross-sectional survey, with multisource questionnaire development and psychometric validation. Setting Three Japanese university hospitals. Surveys were distributed in September–October 2023. Participants Full-time registered nurses working in inpatient wards, not in management positions, with more than 1 year of experience. Of 1861 questionnaires distributed, 1224 (66%) were analysed. Outcome measures Psychometric evaluation included exploratory factor analysis (EFA), internal consistency reliability (Cronbach’s α), convergent validity against the Japanese version of the State–Trait Anxiety Inventory (STAI) and known-groups validity across levels of nursing experience and duration of single-checking practice. Results EFA (maximum-likelihood extraction, Promax rotation) supported a final four-factor, 18-item solution (Kaiser-Meyer-Olkin=0.947, 64.6% variance explained). Factors were as follows: lack of self-confidence (α=0.92), fear of error due to situational factors (α=0.84), fear of being held responsible (α=0.91) and fear of being perceived as inadequate (α=0.80). Items were scored 1–5, with higher scores indicating stronger negative emotional responses; factor means ranged from 2.23 to 3.23. Correlations with the STAI were low-to-moderate (r=0.23–0.45), supporting convergent validity while indicating the questionnaire is not simply a proxy for state and trait anxiety. Known-groups validity was supported: early-career nurses scored 11.1 points higher than experienced nurses (d=0.85, p<0.001), with similar patterns for recent versus veteran single-checkers (d=0.67, p<0.001)—all exceeding the prespecified minimal important difference. Conclusions The questionnaire demonstrates promising preliminary reliability and validity for assessing nurses’ negative emotional responses towards single-checking medications. Its factor structure could allow targeted interventions to address resistance during the transition to single-checking.