Psychometric Validation of the Perceived Perioperative Competence Scale–Revised Short Form (PPCS-R-SF)

1. Introduction

The perioperative environment is a high-risk and complex clinical setting that necessitates the management of intricate processes. Consequently, it is imperative for patients to receive evidence-based and high-quality care throughout the surgical continuum1. Providing adequate and appropriate nursing care is essential to ensure that patients receive safe, patient-centered care in the operating theatre2. Furthermore, the opportunity for self-assessment of competence allows nurses to gain significant insights into their strengths, weaknesses, and overall clinical practice3. Competence is inherently job-related, defining the actions, behaviors, or outcomes that must be demonstrated in one's performance. Simultaneously, it is person-oriented, describing the fundamental characteristics and qualities that enable an individual to perform effectively and exceptionally within a workplace4. It is defined as a combination of skills, knowledge, attitudes, values, and abilities that contribute to effective performance5. Within the field of nursing, competence encompasses the cognitive, social, and psychomotor skills required for nurses to perform their duties safely2.

As nursing competence is foundational to clinical practice6. The assessment of clinical competence is vital for identifying specific areas where professional development and further education are required1. Various measurement methods have been utilized to evaluate nursing competence1,5,7,8,9,19. Competence scales are generally employed to assess broad nursing attributes, such as diagnostic reasoning, interventions, evaluations, decision-making, patient care, and professionalism1. Perioperative competence specifically integrates both technical (practical) and non-technical skills, including cognitive and social abilities such as teamwork, communication, leadership, and coordination11,12. The emergence of this concept led to the development of the Perceived Perioperative Competence Scale–Revised (PPCS-R), a robust and psychometrically tested instrument1. This scale consists of 40 items across six dimensions and was adapted into Turkish by Sönmez and Ayoğlu (2019)13. However, systemic factors in Turkey, such as high-intensity workloads in operating rooms and staffing shortages, limit the time available for nurses to complete long-form scales, which may subsequently compromise data quality and participant engagement.

Short-form scales derived from psychometrically validated instruments are widely utilized to evaluate both clinical and non-clinical constructs, including performance, cognition (decision-making and/or perception), attitudes, and physical or psychological functioning14,15. The primary motivation for developing short forms of existing measures is to reduce the time and cost associated with assessments. Short versions enable studies to be conducted more cost-effectively, allow for larger sample sizes, and mitigate participant fatigue, which can otherwise compromise data quality16. In accordance with these rationales, the Perceived Perioperative Competence Scale–Revised Short Form (PPCS-R-SF) was developed by Gillespie et al. (2023). Compared to the original 40-item version, this 15-item short form has been shown to reduce the completion time for nurses by approximately 60% while preserving structural validity17. Given the high operational pace and stress levels inherent in perioperative settings, long-form scales can lead to clinical data loss or diminished response quality. While the 40-item full version adapted into Turkish by Sönmez and Ayoğlu (2019) offers a theoretically comprehensive framework, its feasibility is limited within demanding shift schedules13.

In this regard, a psychometrically robust and time-efficient measurement tool fills a critical gap, enabling nurse managers to monitor team competence without disrupting clinical workflow. Reflecting the advantages offered by shortened instruments, this study aims to adapt and validate the Perceived Perioperative Competence Scale–Revised Short Form (PPCS-R-SF) within the Turkish context while providing a methodological roadmap for non-English speaking settings. The specific objectives include ensuring linguistic and conceptual equivalence, evaluating the scale’s psychometric properties including internal consistency and construct validity and determining the baseline perioperative competence profiles of operating room nurses.

2. Materials and Methods

3. Results

4. Discussion

This study was conducted to establish the validity and reliability of the “Perceived Perioperative Competence Scale-Revised-Short Form” (PPCS-R-SF) for Turkish culture, aiming to rapidly and effectively assess the competence perceptions of perioperative nurses. The total Cronbach’s alpha coefficient of. 852 found in the reliability analysis indicates that the instrument has a high level of internal consistency20. This result is similar to the reliability values obtained in the original short-form development study17. Furthermore, the high reliability levels identified in the Turkish adaptation of the 40-item long form of the scale support that the short form also preserves its structural integrity13. In the literature, it is highlighted that short forms offer the advantage of collecting higher-quality data by reducing participant fatigue, especially in high-paced operating room environments16. The findings obtained regarding the construct validity of the scale in this study indicate that the six-factor structure defined in the original scale was also preserved in the Turkish nurse sample¹. The fit indices obtained from the confirmatory factor analysis (CMIN/DF = 1.489, RMSEA = 0.074) fall within acceptable limits, demonstrating that the model has a good fit to the data². In particular, a CMIN/DF value below 2 and an RMSEA value below 0.08 support that the model possesses strong structural validity. These findings suggest that the theoretical structure of the scale remains valid in a different cultural context and that the construct being measured is represented consistently. The results are consistent with those of the original study in which the short form of the scale was developed, supporting the cross-cultural stability of the factor structure. In this respect, the study provides important evidence that the scale is a valid measurement tool for use among Turkish perioperative nurses.

One of the notable findings of this study is that female nurses scored significantly higher than male nurses in the “Collaboration” and “Empathy” subdimensions1. This finding can be interpreted within the context of the historical association of the nursing profession with women in Türkiye and the attribution of caregiving roles to women within prevailing gender norms. Indeed, recent literature indicates that nursing care is often characterized as a “female-associated” attribute, with qualities such as compassion, altruism, and emotional labor being closely linked to feminine identity21. Studies conducted in the Turkish context similarly demonstrate that nursing is perceived as a female-dominated profession and that gender stereotypes shape role expectations in both educational and clinical settings22. This sociocultural framework may contribute to female nurses reporting higher levels of perceived self-efficacy in non-technical skills such as empathy and collaboration. Furthermore, it has been reported that female students and nurses tend to demonstrate higher levels of expressive caring behaviors compared to their male counterparts23. In line with this, female nurses reporting higher scores on items related to interpersonal skills, such as comforting the patient (Item 12) and active listening (Item 14), underscores the importance of the psychosocial dimension of surgical care. Moreover, in high-technology operating room environments (Item 3), the integration of technical skills with non-technical competencies such as empathy and the ability to provide reassurance (Item 13) emerges as a critical requirement for ensuring patient safety. In this regard, the findings suggest that nursing education and clinical training should not focus solely on technical competencies but also prioritize the systematic development of empathy, communication, and collaboration skills among all nurses, in a manner that helps balance gender-based differences.

A noteworthy finding of the study is that female nurses scored significantly higher than their male counterparts in the “Partnership” and “Empathy” subdimensions1. Similarly, the literature indicates that female nurses may exhibit greater sensitivity in patient-centered care and intra-team communication processes24. The fact that female nurses reported higher perceptions in items focusing on interpersonal skills, such as making the patient feel comfortable (Item 12) and active listening (Item 14), highlights the importance of the psychosocial dimension of care in the surgical process. In the high-technology environment of the operating room (Item 3), the ability of female staff to integrate these technical competencies with non-technical skills such as “empathy” and “providing appropriate reassurance” (Item 13) offers a holistic advantage in terms of patient safety. This finding demonstrates that clinical education planning should focus not only on instrumental familiarity but also on standardizing these emotionally demanding competencies among all team members.

The lack of a significant difference in perceived competence based on educational level can be explained by the highly specialized nature of perioperative nursing2. In Turkey, operating room nursing is carried out in a clinical environment characterized by advanced technology, the need for rapid decision-making, and intensive multidisciplinary teamwork. In this context, it is known that the competencies of operating room nurses are shaped not only by academic education but also by clinical experience and practice-based learning processes25. It is thought that clinical experience gained in the operating room environment and in-service training bring nurses' perceptions of competence to similar levels, regardless of their academic education level. This situation reveals that professional competence has a dynamic and practice-based structure.