Development and Validation of the Perceived Compassion Scale: A Reliable Tool for Assessing Patient-Centered Nursing Care

Development and Validation of the Perceived Compassion Scale: A Reliable Tool for Assessing Patient-Centered Nursing Care | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and Validation of the Perceived Compassion Scale: A Reliable Tool for Assessing Patient-Centered Nursing Care Yasemin Erden, Ayşe Metin, Nurgül Karakurt, Ulviye Aydan Nacak This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5551309/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jun, 2025 Read the published version in BMC Nursing → Version 1 posted 4 You are reading this latest preprint version Abstract Aim: To develop and validate the perceived compassion scale in nursing care to measure compassion from the patient’s perspective. Background: Compassion in nursing care is a Professional value that affects nurses' decision-making and actions. It contributes to excellence in nursing practice and facilitates nursing care. Methods : This study, designed as a methodological type, was conducted with 398 patients between October and March 2023. The study utilized the Personal Information Form, and a draft version of the Perceived compassion in nursing care as data collection instruments. The collected data were analyzed to assess validity and reliability. Validity analyses included content validity, Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA). Reliability was evaluated through Cronbach’s Alpha and the split-half method. Statistical analyses were conducted using SPSS 22 and AMOS. EFA was performed with the Kaiser-Meyer-Olkin (KMO) test and Bartlett’s test (KMO=1284.5, P =.000), applying Varimax rotation, while CFA verified the factor structure. Pearson correlation analysis was used to determine criterion validity. Results: The content validity index for the scale reviewed by the expert panel was 0.80. In the component analysis, all item factor loadings exceeded 0.30, and the explained variance was 51.71%. The x²/SD ratio ranged from 2.37. Fit indices such as GFI, AGFI, CFI, NFI, TLI, IFI, PGFI, and PNFI ranged between 0.68 and 0.94. The RMSEA and SRMR values were both 0.068 in the confirmatory factor analysis. The Cronbach’s α coefficient for the scale, which includes two sub-dimensions and 19 items, was 0.922, with sub-dimension Cronbach’s α values ranging from 0.921 to 0.931. Conclusions: The Scale of Perceived Compassion in Nursing Care is a valid and reliable tool for assessing the impact of perceived compassion in nursing care from the patient’s perspective. Implications for nursing policy: The Perceived Compassion Scale provides a foundation for policies emphasizing patient-centered care and integrating compassion metrics into healthcare quality assessments. Care Compassion Holistic Care Nurse Scale Figures Figure 1 Why is this research or review needed? Compassion is a key component of holistic care. It ensures that patient care addresses emotional, spiritual, and physical needs, improving overall care quality. This scale evaluates patients' perception of compassion in nursing care, filling a gap in assessing care from the patient's holistic perspective. What are the key findings? During the design and initial validation stages, a tool was created and validated to assess patients' perceptions of compassion in nursing care. The psychometric assessment of the tool demonstrated strong psychometric properties. How should the findings influence policy/practice/research/education? This instrument, grounded in holistic care, measures perceived compassion by considering the patient's emotional, spiritual, and physical well-being. The tool enables healthcare providers to assess and improve practices that enhance compassionate, patient-centered care from a holistic perspective. INTRODUCTION Compassion in healthcare has recently gained prominence, especially in patient-centered nursing. Compassionate care involves recognizing and alleviating patient suffering, enhancing their experience and quality of life. [ 1 ] This notion is particularly relevant in nursing, where the caregiver's ability to connect with patients on an emotional level can significantly influence the healing process. Nurses are often the frontline providers of care, and their interactions with patients can foster a sense of trust and safety, which are critical for effective treatment. [ 2 ] Nursing requires technical skills, emotional intelligence, and empathy. This connection is vital, as compassionate nursing care has been shown to improve patient outcomes, satisfaction, and even adherence to treatment plans. [ 3 ] Despite its importance, nursing education lacks structured training on integrating compassionate care. While technical proficiency and evidence-based decision-making are central to nursing curricula, emotional intelligence and patient-centered communication are frequently underrepresented in formal education. [ 4 , 5 ] Although nursing students recognize compassionate care, they struggle to apply it due to insufficient training. Structured frameworks are needed for effective integration. [ 6 ] Recent studies have emphasized the importance of compassionate care in various healthcare settings. For instance, Tadele's research highlights the quality of compassionate care among children with chronic heart failure, demonstrating that a reliable assessment tool can significantly impact care delivery. [ 7 ] This aligns with Sinclair et al.'s empirical model of compassion, which provides a framework for understanding how compassionate care can be operationalized in clinical practice. [ 8 ] The model underscores the necessity of measuring compassion from the patient's perspective, informing healthcare practices prioritizing patient needs. Moreover, the Schwartz Center Compassionate Care Scale (SCCCS) has been recognized as a valid instrument for assessing patient perceptions of compassionate care delivered by healthcare professionals. [ 9 ] This tool, along with others like the compassionate care assessment tool (CCAT), has been instrumental in evaluating the effectiveness of nursing care in acute settings. [ 8 ] The validation of these scales is essential for establishing a standardized approach to measuring compassion in nursing, which can ultimately lead to improved patient outcomes. The significance of compassionate care extends beyond individual patient interactions; it also influences the broader healthcare environment. Research indicates that compassionate care positively affects patient-reported outcomes, including satisfaction and quality of life, while reducing the likelihood of complaints and malpractice suits. [ 8 ] This highlights the need for healthcare organizations to foster a culture of compassion, which can be achieved through targeted training and leadership initiatives. [ 10 ] Furthermore, integrating compassionate care principles into nursing education is vital for preparing future healthcare providers. Studies have shown that nursing students' understanding of compassion is shaped by their clinical experiences, underscoring the importance of exposure to diverse patient interactions during training. [ 11 ] However, it remains challenging to develop evidence-based educational interventions without validated measurement tools to assess nursing students' competency in compassionate care. The Perceived Compassion in Nursing Care Scale (PCNC) aims to address this gap by providing a reliable instrument for evaluating how patients perceive compassion in nursing care, ultimately supporting the enhancement of education and practice By utilizing validated tools to assess perceived compassion, healthcare organizations can identify areas for improvement and implement targeted training programs that enhance the compassionate competencies of nursing staff. [ 12 ] Such initiatives benefit patients and contribute to a more supportive and fulfilling work environment for nurses, ultimately fostering a culture of compassion within healthcare systems. [ 13 ] In conclusion, developing and validating the Perceived Compassion Scale is critical to assessing and enhancing patient-centered nursing care. By addressing the existing deficiencies in nursing education regarding compassionate care, [ 14 ] this study contributes to the ongoing effort to integrate compassion as a measurable and essential component of healthcare practice. By utilizing established frameworks and tools, healthcare providers can better understand and address the compassionate needs of their patients, leading to improved care experiences and outcomes. The ongoing research in this area will continue to inform best practices and contribute to the evolution of compassionate care in nursing. Methods Study Design and Population The study population consisted of adult patients receiving inpatient treatment in a hospital in eastern Turkey between March and May 2023. The number of items in the draft “Perceived Compassion in Nursing Care Scale” was considered in determining the sample size. As suggested in the literature, it was aimed to reach 5–10 times the number of 27 items in the draft scale. [ 15 , 16 ] According to this information, the study population comprised 398 individuals over 18 who consented to participate, did not have communication issues, had been hospitalized for a minimum of one week, and agreed to participate in the study. As a result, the sample size was 14.74 times the number of items. The literature outlines two different approaches for preparing a dataset for factor analysis. The first approach involves collecting two separate datasets: exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The second approach consists in collecting sufficient samples in one batch to conduct both EFA and CFA; in this case, a portion of the samples (e.g., 50%) can be randomly selected for EFA, while the remaining samples are used for CFA. [ 17 ] Doğan et al. stated that it would not be a problem if the groups resulting from the division of the sample had a sufficient sample size. [ 18 ] For this reason, in this study, the sample group was randomly divided into 2 groups (n1 = 208; n2 = 190) for EFA (n1) and CFA (n2). The randomization process was conducted using SPSS’s random number generator to ensure an unbiased distribution of participants. Additionally, demographic characteristics such as age and gender were examined to confirm that the groups were balanced. No statistically significant differences were found between the two groups (p > 0.05), ensuring the validity of the factor analyses. Data Collection Tools The study's data were collected through the “Personal Information Form and Draft Scale of Perceived Compassion in Nursing Care”. Personal information form This form, prepared by the researchers, consists of 7 questions including the descriptive characteristics of individuals such as age, gender, marital status, educational status, presence of chronic disease, previous hospitalization and the clinic where they were hospitalized. Draft Form of the Scale of Perceived Compassion in Nursing Care (PCNC) The researchers searched the keywords compassion, care, nurse, patient, compassion scale, and care perception in Turkish and English in databases. The literature review led to the development of a conceptual framework on the subject, and a pool of 36 items was generated. The item pool created according to the Davis technique was sent to two experts in the Turkish language, a scale development specialist, and seven field experts. Experts evaluated each item in the draft form of the PCNC prepared according to the Davis Technique as "the item is very suitable," "the item is suitable but minor changes are required," "the item needs to be brought into appropriate form" and "not suitableIn the Davis method, the number of experts selecting "the item is very appropriate" or "the item is appropriate but requires minor revisions" is divided by the total number of experts, resulting in the content validity index (CVI) for that item. In the CVI, a value of .80 is considered the standard. [ 19 ] As a result, 9 items from the draft version of the PCNC with a CVI score below 0.80 were eliminated from the scale. Following this, the pilot testing phase began with the remaining 27 items. Pilot Implementation Phase For the pilot phase, Seçer (2018) suggests a sample size of around 50 participants for scales with 20 or fewer items, and for scales with more than 20 items, 2 to 3 times the number of items. [ 20 ] Following this, the pilot study included 40 patients. The data revealed item-total correlations above 0.30 for all items, with an overall Cronbach's α of 0.83 for the 27 items. Thus, the primary study proceeded with these 27 items. Main Implementation Phase This phase, which is the main application phase of the scale, was completed with 27 items and 398 patients. The data of the study were obtained from patients hospitalized in gynecology, surgery, internal medicine, urology, neurology, ophthalmology and cardiology services of a training and research hospital in eastern Turkey. The researchers collected the study data face-to-face after obtaining the patient’s consent. The researchers asked the patients the questions on the scale one by one, and their answers were marked. Data Collection The research data was collected through face-to-face interviews after patients were informed about the study's purpose, benefits, and interview duration. Verbal consent was obtained, and data collection, including the Introductory Information Form and the "Perceived Compassion in Nursing Care Scale," took 5–8 minutes. Statistical Analysis The data were analyzed using SPSS for Windows 22 and AMOS software. Descriptive statistics such as frequencies, percentages, minimum and maximum values, means, and standard deviations were calculated. Moreover, the validity and reliability assessments included the Davis method, sample adequacy, KMO and Bartlett’s tests, exploratory factor analysis, confirmatory factor analysis, Cronbach's α, and item-total correlations. A p-value of less than 0.05 was considered statistically significant. Due to inconsistencies in responses, 15 participants were excluded from the analysis. RESULTS Sociodemographic Characteristics Of the 398 individuals who participated in the main implementation phase of the study, the mean age of the patients was 41.27 ± 12.43, %63.3 were female, %85.5 were married %41.4 were primary school graduates. 53.5% had a chronic disease, 52.5% had been hospitalized before, 30.3% were hospitalized in the obstetrics clinic, and 94.9% had good communication with the nurse. Validity To assess the suitability of the items, exploratory factor analysis and reliability analysis were conducted. Initially, the scale had an overall Cronbach's α of 0.88. However, one item had an item-total correlation below 0.30, which was removed before the exploratory factor analysis. Subsequent analysis was conducted to verify construct validity and ensure no redundant items were present on the scale. Items with an eigenvalue of 1 and a factor loading of at least 0.30 were retained. The Cronbach's Alpha for the 26 items that remained was 0.887. Before performing exploratory and confirmatory factor analyses, the adequacy of the sample size and dataset was assessed using the KMO and Bartlett's test of sphericity. Additionally, the anti-image test was conducted to evaluate sampling adequacy further. The KMO value was 0.921, Bartlett's test of sphericity was significant (χ2 = 2464.853, P = .000), and all anti-image test results were above 0.50. During the analysis, seven items were sequentially removed from the scale due to overlap with other items. After each removal, the Cronbach’s α, KMO test value, Bartlett’s test of sphericity, and anti-image value were reassessed. In the exploratory factor analysis (EFA) conducted with the remaining 19 items, the KMO test value was 0.901, and Bartlett's test of sphericity was significant (χ2 = 1284.5, P = .000). The lowest anti-image value recorded was 0.764. Since the scale factors were considered to have a direct relationship, the direct oblimin rotation method was applied. [ 21 ] The oblimin analysis revealed that the scale items clustered into two factors (Table 1 ). Consequently, CFA was conducted on the 19-item scale with two factors. Table 1 PCNC Two-Factor Structure, Items, Explained Variance and Factor Loadings Factors and Items Explained variance Factor loading 1. Factor Kindness and Compassion %40.31 i4 She/He approaches me with love. .797 İ5 Answers my questions sincerely. .750 İ6 She/He speaks to me within earshot. .737 İ9 She/He listens carefully to understand me. .721 İ10 She/He treats me with respect. .713 İ12 She/He explains her practices to me in a way that I can understand. .709 İ14 I feel safe when I am around her/him. .708 İ17 She/He is compassionate. .702 İ18 She/He acts fairly. .663 İ20 She/He notices my suffering and makes an effort to alleviate it .661 i21 She/He approaches me sincerely and genuinely .654 İ22 She/He treats me with honesty. .636 İ25 She/He gives me enough time. .536 İ27 She/He is accessible. .528 2.Factor: Consciousness and Awareness %11.40 i3 She/He addresses me by my name. .834 i8 She/He doesn't reflect negative situations onto me .800 i11 She/He makes eye contact while speaking. .766 i15 She/He is there for me when I need it. .649 İ16 She/He makes me feel valued. .465 Total Variance Explained % 51.71 Factor loadings ≥ 0.30 are acceptable. Total variance explained: 51.71%. Table 2 PCNC Item and Item-Total Score Statistics İtems Mean SD Corrected Item-Total Correlation Cronbach's Alpha if Item Deleted i3 She/He addresses me by my name. 3.81 1.373 .347 .903 i4 She/He approaches me with love. 4.20 .595 .598 .889 i5 Answers my questions sincerely. 4.31 .644 .562 .889 i6 She/He speaks to me within earshot. 4.26 .622 .574 .889 i8 She/He doesn't reflect negative situations onto me 3.97 1.199 .454 .895 i9 She/He listens carefully to understand me. 4.16 .662 .552 .889 i10 She/He treats me with respect. 4.16 .676 .628 .887 i11 She/He makes eye contact while speaking. 4.12 1.040 .580 .888 i12 She/He explains her practices to me in a way that I can understand. 4.10 .620 .504 .891 i14 I feel safe when I am around her/him. 4.16 .705 .577 .888 i15 She/He is there for me when I need it. 4.16 1.049 .517 .891 i16 She/He makes me feel valued. 4.17 .992 .591 .888 i17 She/He is compassionate. 4.13 .709 .571 .889 i18 She/He acts fairly. 4.18 .644 .668 .887 i20 She/He notices my suffering and makes an effort to alleviate it 4.15 .619 .549 .890 i21 She/He approaches me sincerely and genuinely 4.19 .705 .698 .885 i22 She/He treats me with honesty. 4.17 .651 .642 .887 i25 She/He gives me enough time. 4.11 .700 .585 .888 i27 She/He is accessible. 4.07 .622 .453 .892 Cronbach’s α 0.922 N = 398 SD = Standard Deviation; N = 398; Cronbach’s α = 0.922 (high reliability) Table 2 presents the item averages for the PCNC scale, the item-total correlations, and the Cronbach’s α coefficients if an item were deleted. The overall Cronbach’s α coefficient for the PCNC Scale was 0.922. All item-total correlations were positive, and removing any item did not significantly increase the Cronbach's α coefficient. Consequently, no items were removed from the scale at that stage (Table 2 ). This indicates the scale's ability to differentiate effectively. Participants had a mean score of 77.39 (SD = 10.70) on the PCNC scale, with scores ranging from 38 to 95. The analysis revealed that factor 1, “kindness and compassion," comprised 14 items (items 4, 5, 6, 9, 10, 12, 14, 17, 18, 20, 21, 22, 25, and 27) and accounted for 40.313% of the total variance. Factor 2, "consciousness and awareness," included five items (items 3, 8, 11, 15, and 16) and explained 11.401% of the total variance. The 19-item scale's analysis revealed a two-factor structure, with factor loadings ranging from 0.465 to 0.834. These two factors explained 51.713% of the variance (Table 1 ). Confirmatory Factor Analysis Confirmatory factor analysis (CFA) was conducted using the structure identified in the EFA. Based on CFA modification recommendations, adjustments were made between items 17 and 18 and 3 and 8. These modifications resulted in improvements in the χ2 value (Table 3 ). The items were deemed significant for their respective factors, and an analysis of the path diagram confirmed that the item-factor alignment was appropriate. (Fig. 1 ). Table 3 Goodness-of-fit indices from the confirmatory factor analysis and their standard values Index Normal value Allowable value Measurement Result χ2 “p” Value p > 0.05 - 0.000 Excellent compatibility χ2/sd (CMIN/DF) < 2 0.95 > 0.90 0.866 Acceptable compatibility AGFI > 0.95 > 0.85 0.853 Acceptable compatibility CFI > 0.95 > 0.90 0.941 Excellent compatibility RMSEA < 0.05 < 0.08 0.068 Acceptable compatibility SRMR < 0.05 0.95 > 0.80 0.902 Acceptable compatibility TLI 0.95 < TLI < 1 0.90 < TLI 0.90 - 0.941 Excellent compatibility PGFI > 0.89 > 0.50 0.694 Acceptable compatibility PNFI > 0.89 > 0.50 0.786 Acceptable compatibility Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) 0.90 suggest acceptable model fit. Adjusted Goodness-of-Fit Index (AGFI), Tucker-Lewis Index (TLI), and Parsimony Fit Indices (PGFI, PNFI) assess model simplicity. χ²/sd < 2 represents excellent fit, while values < 5 indicate acceptable fit. Higher values of CFI, TLI, and NFI reflect better model performance. Reliability Internal Consistency (Cronbach’s Alpha) Coefficients. The Cronbach’s Alpha coefficient was calculated to assess the reliability of the final scale's 19 items. The "kindness and compassion" factor had a Cronbach’s Alpha of 0.921, and the " consciousness and awareness" factor had a Cronbach’s Alpha of 0.931. Overall, the scale attained a Cronbach’s Alpha of 0.922. Discussion The findings of this study confirm that patients' expectations of compassionate care align with previous research, which highlights the role of nurses in delivering patient-centered, emotionally supportive care. Considering the scales developed for compassion in the literature, the Compassion-Compassion and Compassion Scale were developed as measurement tools that are not specific to nursing. Although several scales exist to measure general compassion, such as the Compassion Scale and Compassionate Love Scale, none of these tools specifically assess how patients perceive compassion in nursing care. Unlike these general tools, the PCNC scale was developed to evaluate patient-perceived compassion in nursing practice, addressing a crucial gap in the literature. Our results align with previous studies emphasizing that perceived compassion in patient care enhances patient satisfaction, adherence to treatment, and overall healthcare outcomes. This finding reinforces the importance of integrating compassionate care assessment into nursing education and practice. [22, 23] On the other hand, some measurement tools, such as the Self-Compassion Scale, are specific to nursing. [24], 'Compassion Fatigue Scale' [25, 26] 'Compassion Fear Scale' [27], 'Compassionate Interest and Action Scale' [28], 'Compassionate Communication Scale' [29] is among these measurement tools. When we look at the scales developed previously, no measurement tool was found that evaluates compassion in nursing care with patient perception. As a result, the PCNC scale was created in this study to evaluate perceived compassion in nursing care, and its validity and reliability were assessed. The results confirm that the PCNC scale provides a robust and valid measurement framework, as evidenced by the strong factor loadings, internal consistency reliability, and high explained variance. To be considered a scale, a measurement tool must demonstrate both validity and reliability [17, 29]. Various methods, including construct validity, content validity, and criterion validity, are employed to assess the validity of a scale. In this study, Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to evaluate the construct validity of the scale [17]. The results of the EFA indicated that the PCNC was composed of two factors and 19 items, with a 2-factor structure and an eigenvalue greater than 1, accounting for 51.71% of the total variance. Higher variance percentages indicate a more robust factor structure for the scale. It is generally considered sufficient if the percentage of explained variance from factor loadings is 40% or higher [17, 20]. With an explained variance of 51.71%, the PCNC significantly surpasses the commonly accepted threshold of 40%, highlighting its strong factor structure and demonstrating its capability to assess the various dimensions of compassion effectively. The PCNC scale consists of 19 items categorized under two sub-dimensions: “Kindness and Compassion” (14 items) and “Consciousness and Awareness” (5 items). These sub-dimensions measure the compassionate behaviors perceived from nurses and patients' awareness of the compassion they receive, respectively. The findings indicate that the Perceived Compassion in Nursing Care Scale (PCNC) effectively captures the two-factor structure of compassion in nursing, with strong validity and reliability metrics. The consciousness and awareness sub-dimension consists of 5 items. This sub-dimension includes questions that assess patients' awareness of the compassionate behaviors of nurses, such as expressing love, showing respect, maintaining eye contact, and avoiding negative emotional reflections during care. Confirmatory factor analysis (CFA) is a method used to assess construct validity by evaluating whether the collected data align with the theoretical framework. The fit indices derived from the analysis indicate how well the model corresponds to the theory. The analysis revealed that the CFA fit indices, such as X²/df, RMSEA, CFI, NFI, GFI, AGFI, and TLI, met the standards for a good fit. Specifically, X²/df was less than 2, RMSEA was below 0.80 (p > 0.05), and GFI, AGFI, NFI, and CFI were all greater than 0.90, indicating a good fit. [20, 30] Therefore, all goodness-of-fit indices for the scale fell within acceptable ranges. The CFA validated the structure of the PCNC scale identified by the EFA (Table 3). In the CFA, all standardized factor loadings for the scale items exceeded 0.40, and the fit indices validated the structure identified in the EFA. [31, 32] Internal consistency reliability measures how uniformly the items of a scale are related. For a scale to be considered internally consistent, Cronbach's α should be at least 0.70, and item-total score correlations should be greater than 0.30. [21, 33] The reliability analysis of the PCNC scale revealed that Cronbach's α exceeded 0.90, with all sub-dimensions having coefficients above 0.80. Additionally, item-total score correlations were all found to be greater than 0.40. [34] As healthcare practices vary across cultural contexts, further research must assess the scale's adaptability and effectiveness in different regions. Future research should explore how the PCNC scale performs in various healthcare settings and among diverse patient populations to establish its generalizability further. Additionally, longitudinal studies should be conducted to assess the scale’s sensitivity to changes in perceived compassion over time and its potential impact on patient outcomes. While this study confirms the validity and reliability of the PCNC scale in the current sample, additional cross-cultural validation studies are needed to determine its applicability across different healthcare systems. Strengths and Limitations This study's strengths lie in the rigorous development and validation of the Perceived Compassion Scale, which offers a reliable tool for measuring compassion in nursing care from the patient's perspective. Explanatory and confirmatory factor analysis ensures the scale's robust structure, while high Cronbach’s Alpha values demonstrate reliability. Additionally, the scale’s focus on compassion aligns with holistic care principles, making it a valuable instrument for improving patient-centered practices in diverse healthcare settings. Although the study results show that this scale is a valid and reliable measurement tool, it has some limitations. First, the fact that the scale has only been tested in a specific population may limit its general validity. Additionally, the scale was developed in a context where cultural differences were not considered, which does not provide precise information about how it will perform regarding validity and reliability across different cultures. Future studies should focus on adapting the scale to diverse populations and evaluating its psychometric properties in various cultural settings. Moreover, potential biases in the study should be considered. Since the data were collected through self-reported measures, there is a possibility of social desirability bias, meaning that participants may have responded in a way they perceived as favorable rather than providing entirely objective answers. Additionally, selection bias may be present, as the sample may not fully represent the broader patient population, limiting the applicability of the findings to other healthcare settings. Another limitation is generalizability. The study was conducted in a specific healthcare setting, and the findings may not directly apply to different clinical environments or patient groups. Future research should involve more diverse healthcare institutions and patient demographics to enhance the external validity of the scale. Additionally, longitudinal studies can provide more insight into the scale's stability and effectiveness over time. Implications for Nursing and Health Policy The PCNC scale has broad applicability across various clinical and educational settings, making it a valuable tool for improving patient-centered care. In acute care units, it can assess and enhance nurse-patient interactions, ultimately improving patient satisfaction and adherence to treatment. In palliative care, the scale can guide interventions prioritizing emotional support and dignity for end-of-life patients. Additionally, the PCNC scale can be integrated into curriculum assessments to measure students’ competencies in delivering compassionate care in nursing education programs. From a health policy perspective, the scale supports evidence-based interventions to enhance compassionate care, which is linked to improved patient outcomes and well-being. Furthermore, healthcare institutions can implement the scale in quality improvement initiatives, ensuring that compassion remains a fundamental aspect of patient-centered care. Applying this tool across different healthcare environments, the PCNC scale fosters a more empathetic and patient-focused nursing practice while providing a structured framework for assessing and enhancing compassionate interactions in clinical settings. Conclusion and Recommendation In conclusion, the PCNC scale, developed by Erden et al., is a valid and reliable measurement tool consisting of 19 items and two sub-dimensions for assessing patients' perceived compassion in nursing care. By providing a standardized framework, the scale contributes to evaluating compassionate care objectively from the patient’s perspective. Future studies should focus on cross-cultural adaptation and validation in different clinical settings to enhance its generalizability. Additionally, further research could explore its predictive value about patient outcomes and satisfaction. Declarations Declarations Abbreviations Not applicable Ethics approval and consent to participate This study received ethical approval from the Erzurum Technical University Scientific Research and Publication Board on 17.11.2022, with decision number 08. Additionally, permission for the study was obtained from the relevant institution with the official letter numbered E-42190979-000-2300085279. All procedures followed in this study were by the ethical standards set by the institutional research committee, the Helsinki Declaration, and its subsequent amendments. Participants were provided verbal and written information regarding the study’s purpose and objectives, with assurances of strict confidentiality of their data. To ensure confidentiality, all collected data were anonymized and stored in password-protected electronic files, accessible only to the research team. Hard copies of study-related documents were securely locked in a designated cabinet to prevent unauthorized access. No personally identifiable information was recorded at any stage of the research. Before data collection, participants were verbally briefed about the study, and their consent was obtained through recorded verbal agreement, ensuring that they fully understood their rights, including voluntary participation and withdrawal without consequences. Written consent was not obtained; verbal consent was acquired from all participants to respect their preferences while maintaining ethical research standards. Consent for publication Not applicable. Availability of data and materials Availability of data and materials. Data is provided within the manuscript or supplementary information files. Competing Interests The authors declare no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions 1. Study design: Y.E, A.M., N.K., U.A.N. 2. Data collection: U.A.N., N.K. 3. Data analysis: Y.E, A.M. 4. Study supervision: Y.E, A.M., 5. Manuscript writing: Y.E, A.M. 6. Critical revisions for important intellectual content: N.K. Acknowledgments We thank all patients in this study for their participation and contribution. Conflict of Interest Statement The authors declare no conflicts of interest. Clinical trial number Not applicable Human Ethics and Consent to Participate Declarations Not applicable References Sinclair S, Kondejewski J, Jaggi P, Dennett L, des Ordons ALR, Hack TF: What is the state of compassion education? A systematic review of compassion training in health care . Academic Medicine 2021, 96 (7):1057-1070. https://doi.org/10.1097/acm.0000000000004114 Coffey A, Saab MM, Landers M, Cornally N, Hegarty J, Drennan J, Lunn C, Savage E: The impact of compassionate care education on nurses: A mixed‐method systematic review . Journal of advanced nursing 2019, 75 (11):2340-2351. https://doi.org/10.1111/jan.14088 Faghihi F, Zarshenas L, Tehranineshat B: Compassionate care of nurses for the elderly admitted to the COVID-19 wards in teaching hospitals of southern Iran . BMC nursing 2024, 23 (1):14. https://doi.org/10.1186/s12912-023-01670-6 Çiftçi B, Aras GN: Adaptation of the compassion competence scale to Turkish . Perspectives in Psychiatric Care 2022, 58 (2). https://doi.org/10.1111/ppc.12846 McKenna L, Boyle M, Brown T, Williams B, Molloy A, Lewis B, Molloy L: Levels of empathy in undergraduate nursing students . International Journal of Nursing Practice 2012, 18 (3):246-251. https://doi.org/10.1111/j.1440-172x.2012.02035.x Sinclair S, McClement S, Raffin-Bouchal S, Hack TF, Hagen NA, McConnell S, Chochinov HM: Compassion in health care: an empirical model . Journal of pain and symptom management 2016, 51 (2):193-203. https://doi.org/10.1186/s12904-016-0080-0 Tadele H, Moges T: Quality of compassionate care among children with chronic heart failure at Tikur Anbessa Specialized Hospital: a cross-sectional analysis . Ethiopian Journal of Pediatrics and Child Health 2023, 18 (2). https://doi.org/10.4314/ejpch.v18i2.2 Sinclair S, Norris JM, McConnell SJ, Chochinov HM, Hack TF, Hagen NA, McClement S, Bouchal SR: Compassion: a scoping review of the healthcare literature . BMC palliative care 2016, 15 :1-16. https://doi.org/10.1186/s12904-016-0080-0 Zeray M, Mariam DH, Sahile Z, Hailu A: Validity and reliability of the Amharic version of the Schwartz Center Compassionate Care Scale . PloS one 2021, 16 (3):e0248848. https://doi.org/10.1371/journal.pone.0248848 D'Agostino SR, Douglas SN, Meadan H: Compassionate Care Within Early Intervention Caregiver Coaching:“They Won't Care What You Know Until They Know That You Care” . Infants & Young Children 2023, 36 (2):147-163. https://doi.org/10.1097/iyc.0000000000000238 Hunter D, McCallum J, Howes D: Compassion in emergency departments. Part 1: nursing students’ perspectives . Emergency Nurse 2018, 26 (2). https://doi.org/10.7748/en.2018.e1774 Kouta C, Apostolara P, Rousou E, Maria M, Papadopoulos I: Nursing and Midwifery Managers’ Views on Compassion in Daily Practice: A Survey in Greece and Cyprus . Journal of Health Management 2022, 24 (4):572-582. https://doi.org/10.1177/09720634221128087 Natsui S, Aaronson EL, Joseph TA, Goldsmith AJ, Sonis JD, Raja AS, White BA, Luciani-Mcgillivray I, Mort E: Calling on the patient’s perspective in emergency medicine: analysis of 1 year of a patient callback program . Journal of patient experience 2019, 6 (4):318-324. https://doi.org/10.1177/2374373518805542 Dincer A, Çiftçi B: The relationship between nursing students’ compassion competencies and perceptions of spirituality and spiritual care . Palliative & Supportive Care 2024, 22 (2):325-330. https://doi.org/10.1017/s1478951523000433 Bujang MA: A step-by-step process on sample size determination for medical research . The Malaysian journal of medical sciences: MJMS 2021, 28 (2):15. https://doi.org/10.21315/mjms2021.28.2.2 White M: Sample size in quantitative instrument validation studies: A systematic review of articles published in Scopus, 2021 . Heliyon 2022, 8 (12). https://doi.org/10.1016/j.heliyon.2022.e12223 Orçan F: Exploratory and confirmatory factor analysis: which one to use first? Journal of Measurement and Evaluation in Education and Psychology 2018, 9 (4):414-421. https://doi.org/10.21031/epod.394323 Doğan N, Soysal S, Karaman H: Aynı örnekleme açımlayıcı ve doğrulayıcı faktör analizi uygulanabilir mi? Pegem Atıf İndeksi 2017:373-400. https://doi.org/10.14527/9786053188407.25 Davis LL: Instrument review: Getting the most from a panel of experts . Applied nursing research 1992, 5 (4):194-197. https://doi.org/10.1016/s0897-1897(05)80008-4 Seçer İ: Psikolojik test geliştirme ve uyarlama süreci: SPSS ve LISREL uygulamaları : Anı yayıncılık; 2018. ISBN: 9786051700144 Büyüköztürk Ş: Sosyal bilimler için veri analizi el kitabı . Pegem Atıf İndeksi 2018:001-214. ISBN: 9789756802748 Cho H, Noh S, Park S, Ryu S, Misan V, Lee J-S: The development and validation of the lovingkindness-compassion scale . Personality and Individual Differences 2018, 124 :141-144. https://doi.org/10.1016/j.paid.2017.12.019 Pommier E, Neff KD, Tóth-Király I: The development and validation of the compassion scale . Assessment 2020, 27 (1):21-39. https://doi.org/10.1177/1073191119874108 Neff KD: The development and validation of a scale to measure self-compassion . Self and identity 2003, 2 (3):223-250. https://doi.org/10.1080/15298860309027 Portnoy D: Overextended and Undernourished: A Self-Care Guide for People in Helping Roles : Johnson Institute; 1996. https://doi.org/10.1177/104990919601300402 Uçar Özdemir S, Koca Kutlu A: Şefkat Yorgunluğu Ölçeği'nin Hemşireler Üzerinde Türkçe Geçerlilik ve Güvenilirliği Çalışması: Metodolojik Araştırma . Turkiye Klinikleri Journal of Nursing Sciences 2022, 14 (2). https://doi.org/10.5336/nurses.2020-78721 Gilbert P, McEwan K, Matos M, Rivis A: Fears of compassion: Development of three self‐report measures . Psychology and Psychotherapy: Theory, research and practice 2011, 84 (3):239-255. https://doi.org/10.1348/147608310x526511 Gilbert P, Catarino F, Duarte C, Matos M, Kolts R, Stubbs J, Ceresatto L, Duarte J, Pinto-Gouveia J, Basran J: The development of compassionate engagement and action scales for self and others . Journal of Compassionate Health Care 2017, 4 :1-24. https://doi.org/10.1186/s40639-017-0033-3 Salazar LR: Communicating with compassion: The exploratory factor analysis and primary validation process of the compassionate communication scale : Arizona State University; 2013. https://doi.org/10.26226/morressier.5c76c8bbe2ea5a7237612619 Tavşanel E: Measurement of the Attitudes and data analysis with SPSS . Ankara: Atlas Publishing House, 2002, 2nd Ed pp 17 2019, 61 . ISBN. 978-605-133-740-1 DeVellis RF, Thorpe CT: Scale development: Theory and applications : Sage publications; 2021. ISBN, 1544379323, 9781544379326 Jackson DL, Gillaspy Jr JA, Purc-Stephenson R: Reporting practices in confirmatory factor analysis: an overview and some recommendations . Psychological methods 2009, 14 (1):6. https://doi.org/10.1037/a0014694 Field A: Discovering statistics using IBM SPSS statistics . In . : sage London; 2013. https://doi.org/10.1024/1012-5302/a000397 Karakoç F, Dönmez L: Basic principles of scale development . Tıp Eğitimi Dünyası 2014, 40 :39-49. https://doi.org/10.25282/ted.228738 Additional Declarations No competing interests reported. Supplementary Files Scaleitems.docx Cite Share Download PDF Status: Published Journal Publication published 03 Jun, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 06 May, 2025 Editor assigned by journal 06 May, 2025 Submission checks completed at journal 02 May, 2025 First submitted to journal 25 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5551309","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":450794367,"identity":"5f2a1493-2977-41bc-925f-e52ad07dafc6","order_by":0,"name":"Yasemin Erden","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYNACAxhZgRBjbCBOyxkULcxE2MXYRoQWg+PHHz66UXCHgV/68MbHhfNs8uVn5D6TusFgI7vhAP+xD9i0nMkxNs4xeMYg2ZdWbDxzW5pl44x0M+kchjTjDQeYmWdg03Igh006x+AwUC+PmTTvtsMGzBJpQBGGw4kgLVgddv75898gLfZneMx/8875b8AG0fIft5YbCWbMYFt4eMyYeRsOGPBAtBzAqUXyxhtjkMN4JM6wFUvzHEs2kOB5xmydY5BsPPMwszE2LXzn0x9+zvlzWI6/h3njZ54aOwP59jTG2zkVdrJ9xxsfY9OicABC86A7GIhxxKR8A3bxUTAKRsEoGAUIAADSFlqoyfOzSgAAAABJRU5ErkJggg==","orcid":"","institution":"Erzurum Technical University","correspondingAuthor":true,"prefix":"","firstName":"Yasemin","middleName":"","lastName":"Erden","suffix":""},{"id":450794369,"identity":"e6995359-61af-44d0-94c7-612bf0dd18dc","order_by":1,"name":"Ayşe Metin","email":"","orcid":"","institution":"Erzurum Technical University","correspondingAuthor":false,"prefix":"","firstName":"Ayşe","middleName":"","lastName":"Metin","suffix":""},{"id":450794370,"identity":"b11c4930-7907-4563-bbb8-eeff5ea33ff7","order_by":2,"name":"Nurgül Karakurt","email":"","orcid":"","institution":"Erzurum Technical University","correspondingAuthor":false,"prefix":"","firstName":"Nurgül","middleName":"","lastName":"Karakurt","suffix":""},{"id":450794371,"identity":"b2c0127a-b72d-44ac-bc6c-b5c2c4899529","order_by":3,"name":"Ulviye Aydan Nacak","email":"","orcid":"","institution":"Erzurum Technical University","correspondingAuthor":false,"prefix":"","firstName":"Ulviye","middleName":"Aydan","lastName":"Nacak","suffix":""}],"badges":[],"createdAt":"2024-11-29 20:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5551309/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5551309/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-03290-8","type":"published","date":"2025-06-03T15:56:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82042331,"identity":"100a33f9-67c2-4de0-ae9a-ef2ae48a30b3","added_by":"auto","created_at":"2025-05-06 09:20:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":259730,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe Scale of Perceived Compassion in Nursing Care Confirmatory Factor Analysis Diagram\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ei: item, e: error terms\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5551309/v1/b31f0ed6d1a568ad1ca8bb42.png"},{"id":84242346,"identity":"a4a4dd98-6c10-4ffb-a43c-b650bb40cbef","added_by":"auto","created_at":"2025-06-09 16:03:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2533515,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5551309/v1/2ca829f4-46bd-4c67-aec8-ce343d4303bc.pdf"},{"id":82042330,"identity":"5319633e-5d6a-4a81-9377-0e422a2de3ae","added_by":"auto","created_at":"2025-05-06 09:20:36","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14653,"visible":true,"origin":"","legend":"","description":"","filename":"Scaleitems.docx","url":"https://assets-eu.researchsquare.com/files/rs-5551309/v1/5a8e5cc6c621055dc0375c3e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development and Validation of the Perceived Compassion Scale: A Reliable Tool for Assessing Patient-Centered Nursing Care","fulltext":[{"header":"Why is this research or review needed?","content":"\u003cul\u003e\n \u003cli\u003eCompassion is a key component of holistic care. It ensures that patient care addresses emotional, spiritual, and physical needs, improving overall care quality.\u003c/li\u003e\n \u003cli\u003eThis scale evaluates patients' perception of compassion in nursing care, filling a gap in assessing care from the patient's holistic perspective.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat are the key findings?\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eDuring the design and initial validation stages, a tool was created and validated to assess patients' perceptions of compassion in nursing care.\u003c/li\u003e\n \u003cli\u003eThe psychometric assessment of the tool demonstrated strong psychometric properties.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eHow should the findings influence policy/practice/research/education?\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eThis instrument, grounded in holistic care, measures perceived compassion by considering the patient's emotional, spiritual, and physical well-being.\u003c/li\u003e\n \u003cli\u003eThe tool enables healthcare providers to assess and improve practices that enhance compassionate, patient-centered care from a holistic perspective.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eCompassion in healthcare has recently gained prominence, especially in patient-centered nursing. Compassionate care involves recognizing and alleviating patient suffering, enhancing their experience and quality of life. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] This notion is particularly relevant in nursing, where the caregiver's ability to connect with patients on an emotional level can significantly influence the healing process. Nurses are often the frontline providers of care, and their interactions with patients can foster a sense of trust and safety, which are critical for effective treatment. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Nursing requires technical skills, emotional intelligence, and empathy. This connection is vital, as compassionate nursing care has been shown to improve patient outcomes, satisfaction, and even adherence to treatment plans. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDespite its importance, nursing education lacks structured training on integrating compassionate care. While technical proficiency and evidence-based decision-making are central to nursing curricula, emotional intelligence and patient-centered communication are frequently underrepresented in formal education. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Although nursing students recognize compassionate care, they struggle to apply it due to insufficient training. Structured frameworks are needed for effective integration. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eRecent studies have emphasized the importance of compassionate care in various healthcare settings. For instance, Tadele's research highlights the quality of compassionate care among children with chronic heart failure, demonstrating that a reliable assessment tool can significantly impact care delivery. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] This aligns with Sinclair et al.'s empirical model of compassion, which provides a framework for understanding how compassionate care can be operationalized in clinical practice. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] The model underscores the necessity of measuring compassion from the patient's perspective, informing healthcare practices prioritizing patient needs. Moreover, the Schwartz Center Compassionate Care Scale (SCCCS) has been recognized as a valid instrument for assessing patient perceptions of compassionate care delivered by healthcare professionals. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] This tool, along with others like the compassionate care assessment tool (CCAT), has been instrumental in evaluating the effectiveness of nursing care in acute settings. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] The validation of these scales is essential for establishing a standardized approach to measuring compassion in nursing, which can ultimately lead to improved patient outcomes. The significance of compassionate care extends beyond individual patient interactions; it also influences the broader healthcare environment. Research indicates that compassionate care positively affects patient-reported outcomes, including satisfaction and quality of life, while reducing the likelihood of complaints and malpractice suits. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] This highlights the need for healthcare organizations to foster a culture of compassion, which can be achieved through targeted training and leadership initiatives. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Furthermore, integrating compassionate care principles into nursing education is vital for preparing future healthcare providers. Studies have shown that nursing students' understanding of compassion is shaped by their clinical experiences, underscoring the importance of exposure to diverse patient interactions during training. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] However, it remains challenging to develop evidence-based educational interventions without validated measurement tools to assess nursing students' competency in compassionate care. The Perceived Compassion in Nursing Care Scale (PCNC) aims to address this gap by providing a reliable instrument for evaluating how patients perceive compassion in nursing care, ultimately supporting the enhancement of education and practice\u003c/p\u003e \u003cp\u003eBy utilizing validated tools to assess perceived compassion, healthcare organizations can identify areas for improvement and implement targeted training programs that enhance the compassionate competencies of nursing staff. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Such initiatives benefit patients and contribute to a more supportive and fulfilling work environment for nurses, ultimately fostering a culture of compassion within healthcare systems. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn conclusion, developing and validating the Perceived Compassion Scale is critical to assessing and enhancing patient-centered nursing care. By addressing the existing deficiencies in nursing education regarding compassionate care, [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] this study contributes to the ongoing effort to integrate compassion as a measurable and essential component of healthcare practice. By utilizing established frameworks and tools, healthcare providers can better understand and address the compassionate needs of their patients, leading to improved care experiences and outcomes. The ongoing research in this area will continue to inform best practices and contribute to the evolution of compassionate care in nursing.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Population\u003c/h2\u003e \u003cp\u003eThe study population consisted of adult patients receiving inpatient treatment in a hospital in eastern Turkey between March and May 2023. The number of items in the draft \u0026ldquo;Perceived Compassion in Nursing Care Scale\u0026rdquo; was considered in determining the sample size. As suggested in the literature, it was aimed to reach 5\u0026ndash;10 times the number of 27 items in the draft scale. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] According to this information, the study population comprised 398 individuals over 18 who consented to participate, did not have communication issues, had been hospitalized for a minimum of one week, and agreed to participate in the study. As a result, the sample size was 14.74 times the number of items. The literature outlines two different approaches for preparing a dataset for factor analysis. The first approach involves collecting two separate datasets: exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The second approach consists in collecting sufficient samples in one batch to conduct both EFA and CFA; in this case, a portion of the samples (e.g., 50%) can be randomly selected for EFA, while the remaining samples are used for CFA. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Doğan et al. stated that it would not be a problem if the groups resulting from the division of the sample had a sufficient sample size. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] For this reason, in this study, the sample group was randomly divided into 2 groups (n1\u0026thinsp;=\u0026thinsp;208; n2\u0026thinsp;=\u0026thinsp;190) for EFA (n1) and CFA (n2). The randomization process was conducted using SPSS\u0026rsquo;s random number generator to ensure an unbiased distribution of participants. Additionally, demographic characteristics such as age and gender were examined to confirm that the groups were balanced. No statistically significant differences were found between the two groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), ensuring the validity of the factor analyses.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection Tools\u003c/h3\u003e\n\u003cp\u003eThe study's data were collected through the \u0026ldquo;Personal Information Form and Draft Scale of Perceived Compassion in Nursing Care\u0026rdquo;.\u003c/p\u003e\n\u003ch3\u003ePersonal information form\u003c/h3\u003e\n\u003cp\u003eThis form, prepared by the researchers, consists of 7 questions including the descriptive characteristics of individuals such as age, gender, marital status, educational status, presence of chronic disease, previous hospitalization and the clinic where they were hospitalized.\u003c/p\u003e\n\u003ch3\u003eDraft Form of the Scale of Perceived Compassion in Nursing Care (PCNC)\u003c/h3\u003e\n\u003cp\u003eThe researchers searched the keywords compassion, care, nurse, patient, compassion scale, and care perception in Turkish and English in databases. The literature review led to the development of a conceptual framework on the subject, and a pool of 36 items was generated. The item pool created according to the Davis technique was sent to two experts in the Turkish language, a scale development specialist, and seven field experts. Experts evaluated each item in the draft form of the PCNC prepared according to the Davis Technique as \"the item is very suitable,\" \"the item is suitable but minor changes are required,\" \"the item needs to be brought into appropriate form\" and \"not suitableIn the Davis method, the number of experts selecting \"the item is very appropriate\" or \"the item is appropriate but requires minor revisions\" is divided by the total number of experts, resulting in the content validity index (CVI) for that item. In the CVI, a value of .80 is considered the standard. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] As a result, 9 items from the draft version of the PCNC with a CVI score below 0.80 were eliminated from the scale. Following this, the pilot testing phase began with the remaining 27 items.\u003c/p\u003e\n\u003ch3\u003ePilot Implementation Phase\u003c/h3\u003e\n\u003cp\u003eFor the pilot phase, Se\u0026ccedil;er (2018) suggests a sample size of around 50 participants for scales with 20 or fewer items, and for scales with more than 20 items, 2 to 3 times the number of items. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Following this, the pilot study included 40 patients. The data revealed item-total correlations above 0.30 for all items, with an overall Cronbach's α of 0.83 for the 27 items. Thus, the primary study proceeded with these 27 items.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMain Implementation Phase\u003c/h2\u003e \u003cp\u003eThis phase, which is the main application phase of the scale, was completed with 27 items and 398 patients. The data of the study were obtained from patients hospitalized in gynecology, surgery, internal medicine, urology, neurology, ophthalmology and cardiology services of a training and research hospital in eastern Turkey. The researchers collected the study data face-to-face after obtaining the patient\u0026rsquo;s consent. The researchers asked the patients the questions on the scale one by one, and their answers were marked.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eThe research data was collected through face-to-face interviews after patients were informed about the study's purpose, benefits, and interview duration. Verbal consent was obtained, and data collection, including the Introductory Information Form and the \"Perceived Compassion in Nursing Care Scale,\" took 5\u0026ndash;8 minutes.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed using SPSS for Windows 22 and AMOS software. Descriptive statistics such as frequencies, percentages, minimum and maximum values, means, and standard deviations were calculated. Moreover, the validity and reliability assessments included the Davis method, sample adequacy, KMO and Bartlett\u0026rsquo;s tests, exploratory factor analysis, confirmatory factor analysis, Cronbach's α, and item-total correlations. A p-value of less than 0.05 was considered statistically significant. Due to inconsistencies in responses, 15 participants were excluded from the analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eSociodemographic Characteristics\u003c/h2\u003e\n \u003cp\u003eOf the 398 individuals who participated in the main implementation phase of the study, the mean age of the patients was 41.27\u0026thinsp;\u0026plusmn;\u0026thinsp;12.43, %63.3 were female, %85.5 were married %41.4 were primary school graduates. 53.5% had a chronic disease, 52.5% had been hospitalized before, 30.3% were hospitalized in the obstetrics clinic, and 94.9% had good communication with the nurse.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eValidity\u003c/h2\u003e\n \u003cp\u003eTo assess the suitability of the items, exploratory factor analysis and reliability analysis were conducted. Initially, the scale had an overall Cronbach\u0026apos;s \u0026alpha; of 0.88. However, one item had an item-total correlation below 0.30, which was removed before the exploratory factor analysis. Subsequent analysis was conducted to verify construct validity and ensure no redundant items were present on the scale. Items with an eigenvalue of 1 and a factor loading of at least 0.30 were retained. The Cronbach\u0026apos;s Alpha for the 26 items that remained was 0.887. Before performing exploratory and confirmatory factor analyses, the adequacy of the sample size and dataset was assessed using the KMO and Bartlett\u0026apos;s test of sphericity. Additionally, the anti-image test was conducted to evaluate sampling adequacy further. The KMO value was 0.921, Bartlett\u0026apos;s test of sphericity was significant (\u0026chi;2\u0026thinsp;=\u0026thinsp;2464.853, P\u0026thinsp;=\u0026thinsp;.000), and all anti-image test results were above 0.50.\u003c/p\u003e\n \u003cp\u003eDuring the analysis, seven items were sequentially removed from the scale due to overlap with other items. After each removal, the Cronbach\u0026rsquo;s \u0026alpha;, KMO test value, Bartlett\u0026rsquo;s test of sphericity, and anti-image value were reassessed. In the exploratory factor analysis (EFA) conducted with the remaining 19 items, the KMO test value was 0.901, and Bartlett\u0026apos;s test of sphericity was significant (\u0026chi;2\u0026thinsp;=\u0026thinsp;1284.5, P\u0026thinsp;=\u0026thinsp;.000). The lowest anti-image value recorded was 0.764.\u003c/p\u003e\n \u003cp\u003eSince the scale factors were considered to have a direct relationship, the direct oblimin rotation method was applied. [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e] The oblimin analysis revealed that the scale items clustered into two factors (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Consequently, CFA was conducted on the 19-item scale with two factors.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePCNC Two-Factor Structure, Items, Explained Variance and Factor Loadings\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactors and Items\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExplained variance\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactor loading\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1. Factor Kindness and Compassion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e%40.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He approaches me with love.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.797\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnswers my questions sincerely.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.750\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He speaks to me within earshot.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He listens carefully to understand me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.721\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He treats me with respect.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He explains her practices to me in a way that I can understand.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.709\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI feel safe when I am around her/him.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.708\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He is compassionate.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He acts fairly.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.663\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He notices my suffering and makes an effort to alleviate it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.661\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He approaches me sincerely and genuinely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.654\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He treats me with honesty.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.636\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He gives me enough time.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He is accessible.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.Factor: Consciousness and Awareness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e%11.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He addresses me by my name.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.834\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He doesn\u0026apos;t reflect negative situations onto me\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.800\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He makes eye contact while speaking.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.766\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He is there for me when I need it.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.649\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eİ16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He makes me feel valued.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.465\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Variance Explained\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e51.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003eFactor loadings\u0026thinsp;\u0026ge;\u0026thinsp;0.30 are acceptable. Total variance explained: 51.71%.\u003c/em\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePCNC Item and Item-Total Score Statistics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eİtems\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCorrected Item-Total Correlation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCronbach\u0026apos;s Alpha if Item Deleted\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He addresses me by my name.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.903\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He approaches me with love.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnswers my questions sincerely.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He speaks to me within earshot.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He doesn\u0026apos;t reflect negative situations onto me\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.895\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He listens carefully to understand me.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He treats me with respect.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He makes eye contact while speaking.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.888\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He explains her practices to me in a way that I can understand.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.620\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.891\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI feel safe when I am around her/him.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.705\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.888\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He is there for me when I need it.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.517\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.891\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He makes me feel valued.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.888\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He is compassionate.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He acts fairly.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.668\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He notices my suffering and makes an effort to alleviate it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.890\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He approaches me sincerely and genuinely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.705\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.885\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He treats me with honesty.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.651\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He gives me enough time.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.888\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ei27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eShe/He is accessible.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e.892\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCronbach\u0026rsquo;s \u0026alpha;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;398\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eSD\u0026thinsp;=\u0026thinsp;Standard Deviation; N\u0026thinsp;=\u0026thinsp;398; Cronbach\u0026rsquo;s \u0026alpha;\u0026thinsp;=\u0026thinsp;0.922 (high reliability)\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the item averages for the PCNC scale, the item-total correlations, and the Cronbach\u0026rsquo;s \u0026alpha; coefficients if an item were deleted. The overall Cronbach\u0026rsquo;s \u0026alpha; coefficient for the PCNC Scale was 0.922. All item-total correlations were positive, and removing any item did not significantly increase the Cronbach\u0026apos;s \u0026alpha; coefficient. Consequently, no items were removed from the scale at that stage (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). This indicates the scale\u0026apos;s ability to differentiate effectively. Participants had a mean score of 77.39 (SD\u0026thinsp;=\u0026thinsp;10.70) on the PCNC scale, with scores ranging from 38 to 95.\u003c/p\u003e\n \u003cp\u003eThe analysis revealed that factor 1, \u0026ldquo;kindness and compassion,\u0026quot; comprised 14 items (items 4, 5, 6, 9, 10, 12, 14, 17, 18, 20, 21, 22, 25, and 27) and accounted for 40.313% of the total variance. Factor 2, \u0026quot;consciousness and awareness,\u0026quot; included five items (items 3, 8, 11, 15, and 16) and explained 11.401% of the total variance.\u003c/p\u003e\n \u003cp\u003eThe 19-item scale\u0026apos;s analysis revealed a two-factor structure, with factor loadings ranging from 0.465 to 0.834. These two factors explained 51.713% of the variance (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eConfirmatory Factor Analysis\u003c/h2\u003e\n \u003cp\u003eConfirmatory factor analysis (CFA) was conducted using the structure identified in the EFA. Based on CFA modification recommendations, adjustments were made between items 17 and 18 and 3 and 8. These modifications resulted in improvements in the \u0026chi;2 value (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The items were deemed significant for their respective factors, and an analysis of the path diagram confirmed that the item-factor alignment was appropriate. (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGoodness-of-fit indices from the confirmatory factor analysis and their standard values\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNormal value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAllowable value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMeasurement\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eResult\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;2 \u0026ldquo;p\u0026rdquo; Value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExcellent compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026chi;2/sd\u003c/p\u003e\n \u003cp\u003e(CMIN/DF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExcellent compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExcellent compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTLI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95\u0026thinsp;\u0026lt;\u0026thinsp;TLI\u0026thinsp;\u0026lt;\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90\u0026thinsp;\u0026lt;\u0026thinsp;TLI\u0026thinsp;\u0026lt;\u0026thinsp;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.941\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExcellent compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePNFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcceptable compatibility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003eRoot Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR)\u0026thinsp;\u0026lt;\u0026thinsp;0.08 indicate good model fit. Normed Fit Index (NFI), Comparative Fit Index (CFI), Goodness of Fit Index (GFI), and Incremental Fit Index (IFI)\u0026thinsp;\u0026gt;\u0026thinsp;0.90 suggest acceptable model fit. Adjusted Goodness-of-Fit Index (AGFI), Tucker-Lewis Index (TLI), and Parsimony Fit Indices (PGFI, PNFI) assess model simplicity. \u0026chi;\u0026sup2;/sd\u0026thinsp;\u0026lt;\u0026thinsp;2 represents excellent fit, while values\u0026thinsp;\u0026lt;\u0026thinsp;5 indicate acceptable fit. Higher values of CFI, TLI, and NFI reflect better model performance.\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eReliability\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eInternal Consistency (Cronbach\u0026rsquo;s Alpha) Coefficients.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe Cronbach\u0026rsquo;s Alpha coefficient was calculated to assess the reliability of the final scale\u0026apos;s 19 items. The \u003cem\u003e\u0026quot;kindness and compassion\u0026quot;\u003c/em\u003e factor had a Cronbach\u0026rsquo;s Alpha of 0.921, and the \u0026quot;\u003cem\u003econsciousness and awareness\u0026quot;\u003c/em\u003e factor had a Cronbach\u0026rsquo;s Alpha of 0.931. Overall, the scale attained a Cronbach\u0026rsquo;s Alpha of 0.922.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study confirm that patients\u0026apos; expectations of compassionate care align with previous research, which highlights the role of nurses in delivering patient-centered, emotionally supportive care. Considering the scales developed for compassion in the literature, the Compassion-Compassion and Compassion Scale were developed as measurement tools that are not specific to nursing. Although several scales exist to measure general compassion, such as the Compassion Scale and Compassionate Love Scale, none of these tools specifically assess how patients perceive compassion in nursing care. Unlike these general tools, the PCNC scale was developed to evaluate patient-perceived compassion in nursing practice, addressing a crucial gap in the literature. Our results align with previous studies emphasizing that perceived compassion in patient care enhances patient satisfaction, adherence to treatment, and overall healthcare outcomes. This finding reinforces the importance of integrating compassionate care assessment into nursing education and practice. \u0026nbsp; [22, 23]\u0026nbsp; On the other hand, some measurement tools, such as the Self-Compassion Scale, are specific to nursing. [24], \u0026apos;Compassion Fatigue Scale\u0026apos; [25, 26] \u0026apos;Compassion Fear Scale\u0026apos; [27], \u0026apos;Compassionate Interest and Action Scale\u0026apos; [28], \u0026apos;Compassionate Communication Scale\u0026apos; [29] is among these measurement tools.\u0026nbsp;When we look at the scales developed previously, no measurement tool was found that evaluates compassion in nursing care with patient perception.\u0026nbsp;As a result, the PCNC scale was created in this study to evaluate perceived compassion in nursing care, and its validity and reliability were assessed.\u0026nbsp;The results confirm that the PCNC scale provides a robust and valid measurement framework, as evidenced by the strong factor loadings, internal consistency reliability, and high explained variance.\u003c/p\u003e\n\u003cp\u003eTo be considered a scale, a measurement tool must demonstrate both validity and reliability [17, 29]. Various methods, including construct validity, content validity, and criterion validity, are employed to assess the validity of a scale. In this study, Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to evaluate the construct validity of the scale [17]. The results of the EFA indicated that the PCNC was composed of two factors and 19 items, with a 2-factor structure and an eigenvalue greater than 1, accounting for 51.71% of the total variance. Higher variance percentages indicate a more robust factor structure for the scale.\u0026nbsp;It is generally considered sufficient if the percentage of explained variance from factor loadings is 40% or higher [17, 20]. With an explained variance of 51.71%, the PCNC significantly surpasses the commonly accepted threshold of 40%, highlighting its strong factor structure and demonstrating its capability to assess the various dimensions of compassion effectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe PCNC scale consists of 19 items categorized under two sub-dimensions: \u003cem\u003e\u0026ldquo;Kindness and Compassion\u0026rdquo;\u003c/em\u003e (14 items) and \u003cem\u003e\u0026ldquo;Consciousness and Awareness\u0026rdquo;\u003c/em\u003e (5 items). These sub-dimensions measure the compassionate behaviors perceived from nurses and patients\u0026apos; awareness of the compassion they receive, respectively. The findings indicate that the Perceived Compassion in Nursing Care Scale (PCNC) effectively captures the two-factor structure of compassion in nursing, with strong validity and reliability metrics. The consciousness and awareness sub-dimension consists of 5 items. This sub-dimension includes questions that assess patients\u0026apos; awareness of the compassionate behaviors of nurses, such as expressing love, showing respect, maintaining eye contact, and avoiding negative emotional reflections during care.\u003c/p\u003e\n\u003cp\u003eConfirmatory factor analysis (CFA) is a method used to assess construct validity by evaluating whether the collected data align with the theoretical framework. The fit indices derived from the analysis indicate how well the model corresponds to the theory.\u0026nbsp;The analysis revealed that the CFA fit indices, such as X\u0026sup2;/df, RMSEA, CFI, NFI, GFI, AGFI, and TLI, met the standards for a good fit. Specifically, X\u0026sup2;/df was less than 2, RMSEA was below 0.80 (p \u0026gt; 0.05), and GFI, AGFI, NFI, and CFI were all greater than 0.90, indicating a good fit. [20, 30] Therefore, all goodness-of-fit indices for the scale fell within acceptable ranges. The CFA validated the structure of the PCNC scale identified by the EFA (Table 3). In the CFA, all standardized factor loadings for the scale items exceeded 0.40, and the fit indices validated the structure identified in the EFA. [31, 32]\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInternal consistency reliability measures how uniformly the items of a scale are related. For a scale to be considered internally consistent, Cronbach\u0026apos;s \u0026alpha; should be at least 0.70, and item-total score correlations should be greater than 0.30. [21, 33] The reliability analysis of the PCNC scale revealed that Cronbach\u0026apos;s \u0026alpha; exceeded 0.90, with all sub-dimensions having coefficients above 0.80. Additionally, item-total score correlations were all found to be greater than 0.40. [34] As healthcare practices vary across cultural contexts, further research must assess the scale\u0026apos;s adaptability and effectiveness in different regions. Future research should explore how the PCNC scale performs in various healthcare settings and among diverse patient populations to establish its generalizability further.\u0026nbsp;Additionally, longitudinal studies should be conducted to assess the scale\u0026rsquo;s sensitivity to changes in perceived compassion over time and its potential impact on patient outcomes. While this study confirms the validity and reliability of the PCNC scale in the current sample, additional cross-cultural validation studies are needed to determine its applicability across different healthcare systems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study\u0026apos;s strengths lie in the rigorous development and validation of the Perceived Compassion Scale, which offers a reliable tool for measuring compassion in nursing care from the patient\u0026apos;s perspective. Explanatory and confirmatory factor analysis ensures the scale\u0026apos;s robust structure, while high Cronbach\u0026rsquo;s Alpha values demonstrate reliability. Additionally, the scale\u0026rsquo;s focus on compassion aligns with holistic care principles, making it a valuable instrument for improving patient-centered practices in diverse healthcare settings.\u003c/p\u003e\n\u003cp\u003eAlthough the study results show that this scale is a valid and reliable measurement tool, it has some limitations. First, the fact that the scale has only been tested in a specific population may limit its general validity. Additionally, the scale was developed in a context where cultural differences were not considered, which does not provide precise information about how it will perform regarding validity and reliability across different cultures. Future studies should focus on adapting the scale to diverse populations and evaluating its psychometric properties in various cultural settings. Moreover, potential biases in the study should be considered. Since the data were collected through self-reported measures, there is a possibility of social desirability bias, meaning that participants may have responded in a way they perceived as favorable rather than providing entirely objective answers. Additionally, selection bias may be present, as the sample may not fully represent the broader patient population, limiting the applicability of the findings to other healthcare settings. Another limitation is generalizability. The study was conducted in a specific healthcare setting, and the findings may not directly apply to different clinical environments or patient groups. Future research should involve more diverse healthcare institutions and patient demographics to enhance the external validity of the scale. Additionally, longitudinal studies can provide more insight into the scale\u0026apos;s stability and effectiveness over time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Nursing and Health Policy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe PCNC scale has broad applicability across various clinical and educational settings, making it a valuable tool for improving patient-centered care. In acute care units, it can assess and enhance nurse-patient interactions, ultimately improving patient satisfaction and adherence to treatment. In palliative care, the scale can guide interventions prioritizing emotional support and dignity for end-of-life patients. Additionally, the PCNC scale can be integrated into curriculum assessments to measure students\u0026rsquo; competencies in delivering compassionate care in nursing education programs. From a health policy perspective, the scale supports evidence-based interventions to enhance compassionate care, which is linked to improved patient outcomes and well-being. Furthermore, healthcare institutions can implement the scale in quality improvement initiatives, ensuring that compassion remains a fundamental aspect of patient-centered care. Applying this tool across different healthcare environments, the PCNC scale fosters a more empathetic and patient-focused nursing practice while providing a structured framework for assessing and enhancing compassionate interactions in clinical settings.\u003c/p\u003e"},{"header":"Conclusion and Recommendation","content":"\u003cp\u003eIn conclusion, the PCNC scale, developed by Erden et al., is a valid and reliable measurement tool consisting of 19 items and two sub-dimensions for assessing patients\u0026apos; perceived compassion in nursing care. By providing a standardized framework, the scale contributes to evaluating compassionate care objectively from the patient\u0026rsquo;s perspective. Future studies should focus on cross-cultural adaptation and validation in different clinical settings to enhance its generalizability. Additionally, further research could explore its predictive value about patient outcomes and satisfaction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclarations\u0026nbsp;Abbreviations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the Erzurum Technical University Scientific Research and Publication Board on 17.11.2022, with decision number 08. Additionally, permission for the study was obtained from the relevant institution with the official letter numbered E-42190979-000-2300085279. All procedures followed in this study were by the ethical standards set by the institutional research committee, the Helsinki Declaration, and its subsequent amendments.\u003c/p\u003e\n\u003cp\u003eParticipants were provided verbal and written information regarding the study\u0026rsquo;s purpose and objectives, with assurances of strict confidentiality of their data. To ensure confidentiality, all collected data were anonymized and stored in password-protected electronic files, accessible only to the research team. Hard copies of study-related documents were securely locked in a designated cabinet to prevent unauthorized access. No personally identifiable information was recorded at any stage of the research. Before data collection, participants were verbally briefed about the study, and their consent was obtained through recorded verbal agreement, ensuring that they fully understood their rights, including voluntary participation and withdrawal without consequences. Written consent was not obtained; verbal consent was acquired from all participants to respect their preferences while maintaining ethical research standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials. Data is provided within the manuscript or supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Study design: Y.E, A.M., N.K., U.A.N. \u0026nbsp;2. Data collection: U.A.N., N.K. \u0026nbsp;3. Data analysis: Y.E, A.M. 4. Study supervision: Y.E, A.M., 5. Manuscript writing: Y.E, A.M. 6. Critical revisions for important intellectual content: N.K.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all patients in this study for their participation and contribution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate Declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSinclair S, Kondejewski J, Jaggi P, Dennett L, des Ordons ALR, Hack TF: \u003cstrong\u003eWhat is the state of compassion education? A systematic review of compassion training in health care\u003c/strong\u003e. \u003cem\u003eAcademic Medicine \u003c/em\u003e2021, \u003cstrong\u003e96\u003c/strong\u003e(7):1057-1070. https://doi.org/10.1097/acm.0000000000004114\u003c/li\u003e\n\u003cli\u003eCoffey A, Saab MM, Landers M, Cornally N, Hegarty J, Drennan J, Lunn C, Savage E: \u003cstrong\u003eThe impact of compassionate care education on nurses: A mixed‐method systematic review\u003c/strong\u003e. \u003cem\u003eJournal of advanced nursing \u003c/em\u003e2019, \u003cstrong\u003e75\u003c/strong\u003e(11):2340-2351. https://doi.org/10.1111/jan.14088\u003c/li\u003e\n\u003cli\u003eFaghihi F, Zarshenas L, Tehranineshat B: \u003cstrong\u003eCompassionate care of nurses for the elderly admitted to the COVID-19 wards in teaching hospitals of southern Iran\u003c/strong\u003e. \u003cem\u003eBMC nursing \u003c/em\u003e2024, \u003cstrong\u003e23\u003c/strong\u003e(1):14. https://doi.org/10.1186/s12912-023-01670-6\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;ift\u0026ccedil;i B, Aras GN: \u003cstrong\u003eAdaptation of the compassion competence scale to Turkish\u003c/strong\u003e. \u003cem\u003ePerspectives in Psychiatric Care \u003c/em\u003e2022, \u003cstrong\u003e58\u003c/strong\u003e(2). https://doi.org/10.1111/ppc.12846\u003c/li\u003e\n\u003cli\u003eMcKenna L, Boyle M, Brown T, Williams B, Molloy A, Lewis B, Molloy L: \u003cstrong\u003eLevels of empathy in undergraduate nursing students\u003c/strong\u003e. \u003cem\u003eInternational Journal of Nursing Practice \u003c/em\u003e2012, \u003cstrong\u003e18\u003c/strong\u003e(3):246-251. https://doi.org/10.1111/j.1440-172x.2012.02035.x \u003c/li\u003e\n\u003cli\u003eSinclair S, McClement S, Raffin-Bouchal S, Hack TF, Hagen NA, McConnell S, Chochinov HM: \u003cstrong\u003eCompassion in health care: an empirical model\u003c/strong\u003e. \u003cem\u003eJournal of pain and symptom management \u003c/em\u003e2016, \u003cstrong\u003e51\u003c/strong\u003e(2):193-203. https://doi.org/10.1186/s12904-016-0080-0\u003c/li\u003e\n\u003cli\u003eTadele H, Moges T: \u003cstrong\u003eQuality of compassionate care among children with chronic heart failure at Tikur Anbessa Specialized Hospital: a cross-sectional analysis\u003c/strong\u003e. \u003cem\u003eEthiopian Journal of Pediatrics and Child Health \u003c/em\u003e2023, \u003cstrong\u003e18\u003c/strong\u003e(2). https://doi.org/10.4314/ejpch.v18i2.2\u003c/li\u003e\n\u003cli\u003eSinclair S, Norris JM, McConnell SJ, Chochinov HM, Hack TF, Hagen NA, McClement S, Bouchal SR: \u003cstrong\u003eCompassion: a scoping review of the healthcare literature\u003c/strong\u003e. \u003cem\u003eBMC palliative care \u003c/em\u003e2016, \u003cstrong\u003e15\u003c/strong\u003e:1-16. https://doi.org/10.1186/s12904-016-0080-0\u003c/li\u003e\n\u003cli\u003eZeray M, Mariam DH, Sahile Z, Hailu A: \u003cstrong\u003eValidity and reliability of the Amharic version of the Schwartz Center Compassionate Care Scale\u003c/strong\u003e. \u003cem\u003ePloS one \u003c/em\u003e2021, \u003cstrong\u003e16\u003c/strong\u003e(3):e0248848. https://doi.org/10.1371/journal.pone.0248848\u003c/li\u003e\n\u003cli\u003eD\u0026apos;Agostino SR, Douglas SN, Meadan H: \u003cstrong\u003eCompassionate Care Within Early Intervention Caregiver Coaching:\u0026ldquo;They Won\u0026apos;t Care What You Know Until They Know That You Care\u0026rdquo;\u003c/strong\u003e. \u003cem\u003eInfants \u0026amp; Young Children \u003c/em\u003e2023, \u003cstrong\u003e36\u003c/strong\u003e(2):147-163. https://doi.org/10.1097/iyc.0000000000000238\u003c/li\u003e\n\u003cli\u003eHunter D, McCallum J, Howes D: \u003cstrong\u003eCompassion in emergency departments. Part 1: nursing students\u0026rsquo; perspectives\u003c/strong\u003e. \u003cem\u003eEmergency Nurse \u003c/em\u003e2018, \u003cstrong\u003e26\u003c/strong\u003e(2). https://doi.org/10.7748/en.2018.e1774\u003c/li\u003e\n\u003cli\u003eKouta C, Apostolara P, Rousou E, Maria M, Papadopoulos I: \u003cstrong\u003eNursing and Midwifery Managers\u0026rsquo; Views on Compassion in Daily Practice: A Survey in Greece and Cyprus\u003c/strong\u003e. \u003cem\u003eJournal of Health Management \u003c/em\u003e2022, \u003cstrong\u003e24\u003c/strong\u003e(4):572-582. https://doi.org/10.1177/09720634221128087\u003c/li\u003e\n\u003cli\u003eNatsui S, Aaronson EL, Joseph TA, Goldsmith AJ, Sonis JD, Raja AS, White BA, Luciani-Mcgillivray I, Mort E: \u003cstrong\u003eCalling on the patient\u0026rsquo;s perspective in emergency medicine: analysis of 1 year of a patient callback program\u003c/strong\u003e. \u003cem\u003eJournal of patient experience \u003c/em\u003e2019, \u003cstrong\u003e6\u003c/strong\u003e(4):318-324. https://doi.org/10.1177/2374373518805542\u003c/li\u003e\n\u003cli\u003eDincer A, \u0026Ccedil;ift\u0026ccedil;i B: \u003cstrong\u003eThe relationship between nursing students\u0026rsquo; compassion competencies and perceptions of spirituality and spiritual care\u003c/strong\u003e. \u003cem\u003ePalliative \u0026amp; Supportive Care \u003c/em\u003e2024, \u003cstrong\u003e22\u003c/strong\u003e(2):325-330. https://doi.org/10.1017/s1478951523000433\u003c/li\u003e\n\u003cli\u003eBujang MA: \u003cstrong\u003eA step-by-step process on sample size determination for medical research\u003c/strong\u003e. \u003cem\u003eThe Malaysian journal of medical sciences: MJMS \u003c/em\u003e2021, \u003cstrong\u003e28\u003c/strong\u003e(2):15. https://doi.org/10.21315/mjms2021.28.2.2\u003c/li\u003e\n\u003cli\u003eWhite M: \u003cstrong\u003eSample size in quantitative instrument validation studies: A systematic review of articles published in Scopus, 2021\u003c/strong\u003e. \u003cem\u003eHeliyon \u003c/em\u003e2022, \u003cstrong\u003e8\u003c/strong\u003e(12). https://doi.org/10.1016/j.heliyon.2022.e12223\u003c/li\u003e\n\u003cli\u003eOr\u0026ccedil;an F: \u003cstrong\u003eExploratory and confirmatory factor analysis: which one to use first?\u003c/strong\u003e \u003cem\u003eJournal of Measurement and Evaluation in Education and Psychology \u003c/em\u003e2018, \u003cstrong\u003e9\u003c/strong\u003e(4):414-421. https://doi.org/10.21031/epod.394323\u003c/li\u003e\n\u003cli\u003eDoğan N, Soysal S, Karaman H: \u003cstrong\u003eAynı \u0026ouml;rnekleme a\u0026ccedil;ımlayıcı ve doğrulayıcı fakt\u0026ouml;r analizi uygulanabilir mi?\u003c/strong\u003e \u003cem\u003ePegem Atıf İndeksi \u003c/em\u003e2017:373-400. https://doi.org/10.14527/9786053188407.25\u003c/li\u003e\n\u003cli\u003eDavis LL: \u003cstrong\u003eInstrument review: Getting the most from a panel of experts\u003c/strong\u003e. \u003cem\u003eApplied nursing research \u003c/em\u003e1992, \u003cstrong\u003e5\u003c/strong\u003e(4):194-197. https://doi.org/10.1016/s0897-1897(05)80008-4\u003c/li\u003e\n\u003cli\u003eSe\u0026ccedil;er İ: \u003cstrong\u003ePsikolojik test geliştirme ve uyarlama s\u0026uuml;reci: SPSS ve LISREL uygulamaları\u003c/strong\u003e: Anı yayıncılık; 2018. ISBN: 9786051700144\u003c/li\u003e\n\u003cli\u003eB\u0026uuml;y\u0026uuml;k\u0026ouml;zt\u0026uuml;rk Ş: \u003cstrong\u003eSosyal bilimler i\u0026ccedil;in veri analizi el kitabı\u003c/strong\u003e. \u003cem\u003ePegem Atıf İndeksi \u003c/em\u003e2018:001-214. ISBN: 9789756802748\u003c/li\u003e\n\u003cli\u003eCho H, Noh S, Park S, Ryu S, Misan V, Lee J-S: \u003cstrong\u003eThe development and validation of the lovingkindness-compassion scale\u003c/strong\u003e. \u003cem\u003ePersonality and Individual Differences \u003c/em\u003e2018, \u003cstrong\u003e124\u003c/strong\u003e:141-144. https://doi.org/10.1016/j.paid.2017.12.019\u003c/li\u003e\n\u003cli\u003ePommier E, Neff KD, T\u0026oacute;th-Kir\u0026aacute;ly I: \u003cstrong\u003eThe development and validation of the compassion scale\u003c/strong\u003e. \u003cem\u003eAssessment \u003c/em\u003e2020, \u003cstrong\u003e27\u003c/strong\u003e(1):21-39. https://doi.org/10.1177/1073191119874108\u003c/li\u003e\n\u003cli\u003eNeff KD: \u003cstrong\u003eThe development and validation of a scale to measure self-compassion\u003c/strong\u003e. \u003cem\u003eSelf and identity \u003c/em\u003e2003, \u003cstrong\u003e2\u003c/strong\u003e(3):223-250. https://doi.org/10.1080/15298860309027\u003c/li\u003e\n\u003cli\u003ePortnoy D: \u003cstrong\u003eOverextended and Undernourished: A Self-Care Guide for People in Helping Roles\u003c/strong\u003e: Johnson Institute; 1996. https://doi.org/10.1177/104990919601300402\u003c/li\u003e\n\u003cli\u003eU\u0026ccedil;ar \u0026Ouml;zdemir S, Koca Kutlu A: \u003cstrong\u003eŞefkat Yorgunluğu \u0026Ouml;l\u0026ccedil;eği\u0026apos;nin Hemşireler \u0026Uuml;zerinde T\u0026uuml;rk\u0026ccedil;e Ge\u0026ccedil;erlilik ve G\u0026uuml;venilirliği \u0026Ccedil;alışması: Metodolojik Araştırma\u003c/strong\u003e. \u003cem\u003eTurkiye Klinikleri Journal of Nursing Sciences \u003c/em\u003e2022, \u003cstrong\u003e14\u003c/strong\u003e(2). https://doi.org/10.5336/nurses.2020-78721\u003c/li\u003e\n\u003cli\u003eGilbert P, McEwan K, Matos M, Rivis A: \u003cstrong\u003eFears of compassion: Development of three self‐report measures\u003c/strong\u003e. \u003cem\u003ePsychology and Psychotherapy: Theory, research and practice \u003c/em\u003e2011, \u003cstrong\u003e84\u003c/strong\u003e(3):239-255. https://doi.org/10.1348/147608310x526511\u003c/li\u003e\n\u003cli\u003eGilbert P, Catarino F, Duarte C, Matos M, Kolts R, Stubbs J, Ceresatto L, Duarte J, Pinto-Gouveia J, Basran J: \u003cstrong\u003eThe development of compassionate engagement and action scales for self and others\u003c/strong\u003e. \u003cem\u003eJournal of Compassionate Health Care \u003c/em\u003e2017, \u003cstrong\u003e4\u003c/strong\u003e:1-24. https://doi.org/10.1186/s40639-017-0033-3\u003c/li\u003e\n\u003cli\u003eSalazar LR: \u003cstrong\u003eCommunicating with compassion: The exploratory factor analysis and primary validation process of the compassionate communication scale\u003c/strong\u003e: Arizona State University; 2013. https://doi.org/10.26226/morressier.5c76c8bbe2ea5a7237612619\u003c/li\u003e\n\u003cli\u003eTavşanel E: \u003cstrong\u003eMeasurement of the Attitudes and data analysis with SPSS\u003c/strong\u003e. \u003cem\u003eAnkara: Atlas Publishing House, 2002, 2nd Ed pp 17 \u003c/em\u003e2019, \u003cstrong\u003e61\u003c/strong\u003e. ISBN. 978-605-133-740-1\u003c/li\u003e\n\u003cli\u003eDeVellis RF, Thorpe CT: \u003cstrong\u003eScale development: Theory and applications\u003c/strong\u003e: Sage publications; 2021. ISBN, 1544379323, 9781544379326\u003c/li\u003e\n\u003cli\u003eJackson DL, Gillaspy Jr JA, Purc-Stephenson R: \u003cstrong\u003eReporting practices in confirmatory factor analysis: an overview and some recommendations\u003c/strong\u003e. \u003cem\u003ePsychological methods \u003c/em\u003e2009, \u003cstrong\u003e14\u003c/strong\u003e(1):6. https://doi.org/10.1037/a0014694\u003c/li\u003e\n\u003cli\u003eField A: \u003cstrong\u003eDiscovering statistics using IBM SPSS statistics\u003c/strong\u003e. In\u003cem\u003e.\u003c/em\u003e: sage London; 2013. https://doi.org/10.1024/1012-5302/a000397\u003c/li\u003e\n\u003cli\u003eKarako\u0026ccedil; F, D\u0026ouml;nmez L: \u003cstrong\u003eBasic principles of scale development\u003c/strong\u003e. \u003cem\u003eTıp Eğitimi D\u0026uuml;nyası \u003c/em\u003e2014, \u003cstrong\u003e40\u003c/strong\u003e:39-49. https://doi.org/10.25282/ted.228738\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Care, Compassion, Holistic Care, Nurse, Scale","lastPublishedDoi":"10.21203/rs.3.rs-5551309/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5551309/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eTo develop and validate the perceived compassion scale in nursing care to measure compassion from the patient’s perspective.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eCompassion in nursing care is a Professional value that affects nurses' decision-making and actions. It contributes to excellence in nursing practice and facilitates nursing care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This study, designed as a methodological type, was conducted with 398 patients between October and March 2023. The study utilized the Personal Information Form, \u0026nbsp;and a draft version of the Perceived compassion in nursing care as data collection instruments. The collected data were analyzed to assess validity and reliability. Validity analyses included content validity, Exploratory Factor Analysis (EFA), and Confirmatory Factor Analysis (CFA). Reliability was evaluated through Cronbach’s Alpha and the split-half method. Statistical analyses were conducted using SPSS 22 and AMOS. EFA was performed with the Kaiser-Meyer-Olkin (KMO) test and Bartlett’s test (KMO=1284.5, P =.000), applying Varimax rotation, while CFA verified the factor structure. Pearson correlation analysis was used to determine criterion validity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe content validity index for the scale reviewed by the expert panel was 0.80. In the component analysis, all item factor loadings exceeded 0.30, and the explained variance was 51.71%. The x²/SD ratio ranged from 2.37. Fit indices such as GFI, AGFI, CFI, NFI, TLI, IFI, PGFI, and PNFI ranged between 0.68 and 0.94. The RMSEA and SRMR values were both 0.068 in the confirmatory factor analysis. The Cronbach’s α coefficient for the scale, which includes two sub-dimensions and 19 items, was 0.922, with sub-dimension Cronbach’s α values ranging from 0.921 to 0.931.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe Scale of Perceived Compassion in Nursing Care is a valid and reliable tool for assessing the impact of perceived compassion in nursing care from the patient’s perspective.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for nursing policy:\u003c/strong\u003e The Perceived Compassion Scale provides a foundation for policies emphasizing patient-centered care and integrating compassion metrics into healthcare quality assessments.\u003c/p\u003e","manuscriptTitle":"Development and Validation of the Perceived Compassion Scale: A Reliable Tool for Assessing Patient-Centered Nursing Care","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 09:20:32","doi":"10.21203/rs.3.rs-5551309/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-06T06:12:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-06T06:08:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-03T02:17:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-04-25T13:17:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a64f2f34-9fca-45a0-b05f-709da28cf042","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-09T15:58:21+00:00","versionOfRecord":{"articleIdentity":"rs-5551309","link":"https://doi.org/10.1186/s12912-025-03290-8","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-06-03 15:56:50","publishedOnDateReadable":"June 3rd, 2025"},"versionCreatedAt":"2025-05-06 09:20:32","video":"","vorDoi":"10.1186/s12912-025-03290-8","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03290-8","workflowStages":[]},"version":"v1","identity":"rs-5551309","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5551309","identity":"rs-5551309","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}