Adaptation of Hess Professional Nursing Governance Index to Turkish and determining the factors associated with nurses'perceptions of governance

Introduction: The decision-making structure, as a core component of a professional practice environment, serves as a significant indicator of excellence. Shared governance is regarded as an effective framework that empowers nurses to actively participate in decisions concerning their professional practice. Purpose: This study is structured in two phases. The aim of the first stage was to adapt the Index of Professional Nursing Governance into Turkish, conduct validity and reliability analyses, and evaluate nurses' perceptions of professional nursing governance. The second phase aims to examine the relationship between professional nursing governance, psychological capital, nursing care quality and nurse satisfaction in line with the hypothesized model. Method: The first phase of the study involved the methodological design. The study population consisted of nurses working in Istanbul, and the sample comprised 657 nurses, determined based on the number of index items. To assess the validity of the index, exploratory and confirmatory factor analyses were conducted, along with evaluations of reliability through the Cronbach's alpha coefficient, test-retest reliability, and parallel (equivalent) form reliability analyses. The second phase of the study employed a cross-sectional, descriptive, and correlational design. The target population comprised nurses working in Istanbul, and the sample included 514 nurses who were recruited using a non-probability sampling method. The hypothesized model developed for the second phase was tested using structural equation modeling. Results: The index, whose validity and reliability were evaluated in the first phase, retained its original structure, consisting of 30 items and six sub-dimensions, albeit with certain modifications. The confirmatory factor analysis (CFA) produced statistically significant results (p<0,01), and the goodness-of-fit indices indicated acceptable to good model fit. In the reliability analysis, the overall Cronbach's alpha coefficient for the index was 0,924, indicating high internal consistency. In the second phase, professional nursing governance was found to be significantly and positively correlated with unit-level nursing care quality (r=0,464), hospital-level nursing care quality (r=0,492), and nurse job satisfaction (r=0,512). A significant positive correlation was also observed between professional nursing governance and psychological capital (r=0,459). Based on the findings, the proposed model demonstrated an acceptable to good fit. Conclusion: Based on the analysis results, the first phase confirmed that the index is a valid and reliable measurement instrument. In the second phase, model fit indices supported the structural model, indicating a significant and positive effect of professional nursing governance on psychological capital, nursing care quality, and nurse job satisfaction. Analysis of both direct and indirect effects revealed that psychological capital partially mediated the relationship between professional nursing governance and both nursing care quality and nurse job satisfaction. This study introduced a newly adapted index, the validity and reliability of which were established, into the national literature. It is expected to make significant contributions to both nursing management practice and the academic literature by emphasizing nurses' involvement in decision-making processes through shared governance and by addressing key concepts related to governance in nursing.