Development of a self-assessment scale of difficulties in nursing practice for individuals with major depressive disorder

Objective: This study developed a self-assessment scale to measure psychiatric nurses' perceived difficulties in caring for individuals with major depressive disorder.
Methods: Scale development followed a multi-stage process involving a scoping review, interviews with experienced psychiatric nurses (n = 7), item generation using the KJ method, and expert validation. An online survey of psychiatric nurses (n = 208) in the Tokyo metropolitan area was then conducted to examine the scale’s psychometric properties. Item analysis, exploratory factor analysis, confirmatory factor analysis, verification of reliability and known- groups validity testing were conducted.
Results and Discussion: During the validity assessment of the 28-item draft scale, expert review resulted in a revised 30-item draft scale rated on a four-point Likert scale (for a total of 120 points). Of the 845 nurses invited, 218 responded, and 208 surveys were usable after excluding cases with missing data. Following the item analysis, 20 items were retained for exploratory factor analysis, which yielded a 17-item, three-factor structure (total 68 points): Factor 1, "Difficulty in Providing Support for Symptom Management" (8 items, Cronbach’s α: 0.85); Factor 2, "Difficulty in Providing Psychosocial Support Aimed at Recovery" (6 items, Cronbach’s α: 0.88); and Factor 3, "Difficulty in Daily Living Support" (3 items, Cronbach’s α: 0.82). The reliability of the scale was confirmed for items within each factor. Confirmatory factor analysis indicated acceptable model fit (CFI = 0.924; RMSEA = 0.070). Additionally, known- groups validity was supported. Nurses with fewer than five years of psychiatric nursing experience scored significantly higher on the scale than those with five or more years. These findings align with interview data suggesting that experienced nurses continue to provide care with belief despite ongoing challenges.
Conclusion: A validated 17-item version of the Self-Assessment Scale for Difficulties in Depression Nursing for Psychiatric Nurses was developed. This scale demonstrated a stable three-factor structure, acceptable reliability, and known-groups validity, indicating its suitability for assessing challenges in depression nursing practice. It offers a practical tool for guiding educational support and strengthening psychiatric nurses' clinical competencies.

Mrs. Kimura studied nursing at Kitasato University, Japan, and graduated with an MS degree in 2005. She is a faculty member of the Department of Nursing at Juntendo University, Japan. She was expected to graduate the course of Ph.D. program at Juntendo University this year. Her major was mental health nursing and research topic was challenges in the nursing practice of individuals with MDD. She believed this would help build educational support that would also help provide effective mental health support for nurses.