Psychometric Properties of the Nursing Start-up Attitude Scale in Iranian nursing students

Psychometric Properties of the Nursing Start-up Attitude Scale in Iranian nursing students | 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 Psychometric Properties of the Nursing Start-up Attitude Scale in Iranian nursing students Iman Jafari, Mehdi Jafari-Oori, Abbas Ebadi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5304614/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Jan, 2025 Read the published version in BMC Nursing → Version 1 posted 4 You are reading this latest preprint version Abstract Background Entrepreneurial attitudes among nursing students are crucial for fostering innovation and addressing the evolving challenges in healthcare. However, measuring these attitudes accurately requires robust and validated instruments. The Nursing Start-up Attitude Scale is a valid and reliable instrument specifically designed to measure nursing students' attitudes towards start-ups. However, its psychometric properties in the context of the Iranian nursing field have not been thoroughly examined. Methods This methodological study was conducted online between 2022 and 2023, involving nursing students from various universities across Iran. The study employed the following procedures: forward-backward translation, assessment of face and content validities, concurrent validity analysis (n = 80 nursing students), exploratory factor analysis (n = 120), confirmatory factor analysis (n = 220), and reliability analysis, which included the assessment of Cronbach's alpha coefficient, interclass correlation coefficient, interpretability, and ceiling and floor effects. Results A total of 370 nursing students participated in the study. After ensuring the face and content validities, the concurrent validity was confirmed (r = 0.89). The five factors extracted in the exploratory factor analysis, which accounted for 80.74% of the explained variance, were subsequently confirmed in the confirmatory factor analysis. The Cronbach's alpha coefficient was found to be 0.85. Additionally, the interclass correlation coefficient for the total scale was 0.812, and there were no ceiling or floor effects observed (0%). Conclusion The present study confirms the validity and reliability of the Nursing Start-up Attitude Scale in the Iranian context. This scale can serve as a valuable tool for identifying both the strengths and areas for improvement in nursing entrepreneurial education programs. By utilizing the Nursing Start-up Attitude Scale, these programs can effectively enhance the development of entrepreneurial skills among future nursing professionals. Nursing students Psychometric properties Start-up Figures Figure 1 Figure 2 Background Nursing professionals have the ability to play a significant role in tackling worldwide healthcare obstacles such as chronic diseases, the emergence of new illnesses like COVID-19, the growing elderly population, advancements in technology, and inequalities in healthcare access(1). Through the expansion of their skill set and the exploration of entrepreneurship opportunities, nurses have the potential to emerge as leaders in population health management, effectively facilitating access to healthcare services for diverse populations (2). Consequently, nurses are uniquely positioned to make a substantial impact on the healthcare system by assuming the role of nurse entrepreneurs (3). According to the International Council of Nurses, nurse entrepreneurs are individuals who are owners of businesses that encompass a wide range of nursing services, including the provision of direct patient care, educational initiatives, research endeavors, administrative functions, and consultation services (4). These nurse entrepreneurs are independent practitioners and business owners who deliver care to their patients (5). The American Nurses Association Enterprise Innovation (2023) reports that over 300 nurse entrepreneurs are currently driving innovation in the nursing field as change agents. They are involved in various aspects of nursing entrepreneurship such as medical equipment and devices, care delivery models, business creation, research, and educational interventions(6). Additionally, Sanders and Kingma (2012) outline the characteristics of entrepreneurial nursing, which include nurse-led units, clinics, emergency services, telephone consultation services, and nurse-owned nursing homes (4). These contributions signify the rise of new healthcare roles, innovative care models, advancements in healthcare legislation, and progress in health equity (7). However, data from the National Nurses Association suggests that only a small percentage, ranging from 0.5–1%, of nurses worldwide currently pursue entrepreneurial roles (8). In New Zealand, the percentage is less than 1%(9), while in the United States, it is 0.18%(10). It is worth noting that no specific statistics are available for the Iranian context. Entrepreneurial attitude pertains to an individual's acquired inclination, either positive or negative, towards a specific object that is connected to personal views regarding entrepreneurship (11). A positive attitude is linked to optimistic beliefs about the results of particular actions and favorable outcomes in terms of behavior (12). Prior to embarking on entrepreneurial endeavors, attitudes towards entrepreneurship play a crucial role in various activities such as formulating a business plan, securing investments, establishing a company, and engaging in entrepreneurial pursuits (13). Essentially, a positive entrepreneurial attitude can act as a motivating factor for commencing and prospering in entrepreneurship. Research on entrepreneurial attitudes in nursing remains limited. While qualitative research utilizing the Q-method has explored nursing students' attitudes towards entrepreneurship (14), there is a scarcity of quantitative studies that objectively measure these attitudes within the Iranian context (15, 16). One possible reason for this gap could be the absence of valid instruments for assessing entrepreneurial attitudes. The most of existing measurement tools for entrepreneurial attitudes have primarily been developed and studied in the field of business management. These tools often contain items that are specific to certain specialized areas, such as "development of business products and services" or "entrepreneurial expert networks"(17). Using such tools to measure entrepreneurial attitudes in the nursing field has limitations. Several instruments, including the Nursing Start-up Attitude Scale (NSAS)(11), Personal Attitude in Liñán and Chen entrepreneurial intention instrument (18), and Son’s start-up attitude scale (15) have been used to measure nurse attitude. Among these instruments, the 12- item NSAS was originally developed to measure six key factors: opportunity for self-realization, network formation, enhance start-up capabilities, achievements of start-ups, start-up preparation, and risk taking. These factors are derived from a robust theoretical framework grounded in entrepreneurship theory(19), which underscores the importance of these dimensions in predicting entrepreneurial success (11). The developer of this scale recommended that, due to the dynamic nature of entrepreneurship and its susceptibility to societal and temporal shifts, it is essential to consistently evaluate the validity and reliability of the scale. Additionally, it is important to make appropriate adjustments and enhancements to align with the changing landscape. Continuous assessment and refinement of the tool are strongly advised to maintain its relevance and effectiveness in measuring nursing students' entrepreneurial attitudes in the future (11). Considering the lack of a Persian version of this scale in Iran and the increasing recognition and importance of entrepreneurship in nursing, it is crucial to have reliable and valid measurement tools that accurately assess the attitudes of nursing students towards start-up ventures. Therefore, the objective of this study was to evaluate the psychometric properties of the NSAS among Iranian nursing students. By establishing a validated and reliable scale, researchers, educators, and policymakers will be equipped with an effective tool to measure and comprehend the entrepreneurial mindset and inclination among Iranian nursing students. Methods Study Design In this methodological study, the NSAS translated into Persian and assessed its psychometric properties between 2022 and 2023. Study Population/Sampling The study population consisted of nursing students enrolled in nursing faculties in Iran. A blended approach involving online and in-person methods was used for data collection. The online component included concurrent validity assessment, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). ace and content validity, as well as reliability analysis, were conducted in person, as these methods require smaller, readily available samples. The convenience sampling method was employed in data collection. A total of 80 nursing students participated in the concurrent validity assessment, while EFA involved 120 participants, and CFA included 220 participants. Hobart et al. suggested a minimum sample size of 79 participants for concurrent validation (20). For EFA, it is recommended to have 3–10 participants per item (19), for CFA, Munro (2005) advised having 20–30 items per factor (19). In terms of face validity, 10 students were recruited to provide feedback on the scale. Additionally, four experts were invited to evaluate the qualitative content validity of the Iranian version of the NSAS. The inclusion criteria for the study were as follows: being a nursing student currently enrolled in a program in Iran, having fluency in Farsi or Persian language, and not having any cognitive or psychiatric issues. Non-cooperation or incomplete scale responses were considered as exclusion criteria. Study Instruments Demographic Information The online questionnaire included demographic items such as age, gender, education level, and previous experience in entrepreneurship or starting a business. The NSAS The NSAS is specifically designed to assess nursing students' attitudes towards entrepreneurship and starting a nursing-related business. It consists of 12 items that are divided into six factors: self-actualization opportunities (3 items), network building (2 items), enhancing start-up competencies (2 items), start-up outcomes (2 items), preparation for start-ups (2 items), and risk-taking, (1 item). Each item is rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The total score of the scale ranges from 12 to 60, with higher scores indicating more positive attitudes towards entrepreneurship in nursing field (11). Entrepreneurial attitude Entrepreneurial attitude was assessed using a modified version of Son's (2018) instrument, which comprises eight items rated on a five-point Likert scale (Cronbach's α. = 0.88). Higher scores on the scale indicate greater levels of entrepreneurial attitude (15). Translation Procedure Upon obtaining permission from the NSAS developer, the translation process was initiated. Initially, the scale was translated from English (source language) to Persian (target language) by two translators, one of whom was a health specialist and the other a general translator. The translated version was then back-translated to English by two additional translators, resulting in a final version of the Persian scale. The translations were analyzed, and a final version of the Persian scale was obtained. The quality of the translation was evaluated using the International Quality of Life Assessment (IQOLA) translation process, which is a widely recognized translation methodology (21). The translated scale was then provided to the developer for further assessment. Face and Content Validity To evaluate the qualitative face validity of the NSAS, cognitive interviews were conducted with 10 nursing students. During the cognitive interviews, the participants' cognitive processes were observed while completing the questionnaire, and any sources of errors in the tool were identified (22). The interviews were conducted face-to-face, and the Persian version of the scale was modified based on the feedback received from the participants. The participants were also asked to evaluate the readability, clarity, item structure, ease of understanding, item complexity, ambiguous terms, question categorization, ease of replying, language forms, and wording of the questionnaire. To assess the content validity, the questionnaire was sent to four experts for feedback on language forms, diction, and the placement of words and phrases. Criteria validity To evaluate the criterion validity, the adapted version of Son's (2018) tool, consisting of eight items with a five-point Likert scale, was considered as reference tool (15). The correlation between the two scales was assessed using the Pearson correlation test. Construct Validity To assess the underlying relationships between the items, an EFA using Maximum likelihood and Promax rotation was conducted. The principal component analysis (PCA) method was used to extract the factors, and the Promax rotation was used to interpret the factors (23). The Kaiser–Meyer–Olkin (KMO) coefficient was used to evaluate sampling adequacy. KMO values ranging from 0.7 to 0.8 and from 0.8 to 0.9 are considered good and excellent, respectively. High KMO values (above 0.7) suggest that factor analysis is appropriate for the data (24). The significance of the correlation matrix between the items was examined using the Bartlett’s test of sphericity. A factor loading cut-off point of 0.30 was considered. CFA was conducted to determine whether the data confirms to the theoretical model, based on the results of the EFA, using the maximum likelihood estimation method and covariance indices. Goodness-of-fit was assessed using several indices, including the goodness-of-fit index (GFI), relative chi-square (χ2/df), normed fit index (NFI), comparative fit index (CFI), standardized root mean square residual (SRMR), and root mean square error of approximation (RMSEA). Acceptable values for these indices were considered to be χ2/df ≤ 2, GFI, CFI, and NFI > 0.95, and RMSEA < 0.08. Reliability Internal consistency was measured using Cronbach's ⍺. In order to assess the reliability of the NSAS, both relative and absolute reliability measures were utilized. The relative reliability was evaluated by employing the interclass correlation coefficient (ICC) with the inter-rater method. A sample of 30 nursing students completed the start-up attitude scale on two separate occasions, with a two-week gap between assessments. To determine the absolute reliability of the start-up attitude scale, calculations were performed to obtain the Standard Error of Measurement (SEM) and Minimal Detectable Changes (MDC). The SEM represents the measurement error associated with the tool, while the MDC indicates the minimum amount of change in scores that can be considered beyond the measurement error (25). The formulas used to calculate the SEM and MDC were as follows: SEM = SD Pooled √1– ICC (26), and MDC = SEM X 1.96 X √2. Additionally, the MDC% was computed as (MDC / mean) * 100, where the mean represents the average of all observations from test sessions 1 and 2. An acceptable MDC percentage is considered to be 30%, while values below 10% are regarded as excellent (27). Interpretability Additionally, in order to evaluate interpretability, the study examined the percentage of unanswered items as well as the presence of ceiling and floor effects. The sample size for the EFA assessment was used to evaluate the interpretability. Optimal values for the percentage of unanswered items are typically considered to be between 10% and 20%(28), while ceiling and floor effects are ideally kept below 15%(29). Furthermore, to further assess interpretability, the minimal important change (MIC) was determined using the formula: MIC = 0.5 * SD of Δ score. Data collection From August 20232 to November 2023, data collection was conducted using online surveys. The target participants for this study were nursing students who were part of an online community. Those who agreed to take part in the survey received the questionnaire links either through mobile phone or email. To ensure confidentiality, the collected data were encoded and securely downloaded, preventing the identification of personal information. The data analysis was carried out on the author's computer, adhering to the password-protected measures in accordance with the guidelines set by the Institutional Review Board Data Analysis For the EFA and CFA, we used SPSS software, version 22.0 and AMOUS software, version 26, respectively. The significance level for all analyses was set at P < 0.05. Ethical Consideration This study was approved in the ethics committee of Baqiyatallah University of Medical Sciences (BMSU), with the ethics code IR.BMSU.REC.1400.096. The researcher ensured that all participants provided informed consent before their participation. The study approach was clearly explained to the participants, and appropriate authorization and coordination with relevant authorities were obtained. Participants were assured that their data would be treated confidentially, and they were informed of their right to withdraw from the study at any point. Results Demographic characteristics In the EFA phase, out of the total samples, 102 (85%) were male, and 18 (15%) were female. The participants had a mean age of 25.73 ± 8.81. In the CFA phase, the mean age of the samples was 24.99 years. Among them, 95 (79.16%) were male, and 25 (20.84%) were female. Additional details about the study participants can be found in Table 1 Table 1 The demographic information of samples in the EFA and CFA Characteristics Category Criterion validity (N = 80) n (%) EFA (N = 120) n (%) CFA (N = 220) n (%) Gender Male 69 (86.3) 102 (85) 187 (85) Female 11 (13.8) 18 (15) 33 (15) Age-group (year) - 26.63 ± 9.26 25.73 ± 8.81 26.85 ± 9.26 Education level Bachelor's degree 58 (72.5) 98 (81.7) 159 (72.3) Master's degree 16 (20) 16 (13.4) 42 (19.1) Doctoral degree 6 (7.5) 6 (5) 15 (6.8) Year of study Year 1 28 (35) 44 (36.6) 77 (35) Year 2 17 ( 33) 40 (33.3) 77 (35) Year 3 13 (16) 19 (15.8) 33 (15) Year 4 and above 12 (0.15) 17 (14.2) 33 (15) University University 1 80 (100) 100 (83.3) 186 (84) Other universities (n = 9) - 20 (16.7) 34 ((16) City Tehran 49 (61) 66 (55) 133 (60) Other cites (n = 30) 31 (39) 54 (45) 87 (39) Previous participation in start-up workshops Yes 18 (22.5) 28 (23.3) 53 (24.1) No 62 (77.5) 92 (76.7) 167 (75.9) Former start-up work experience Yes 12 (15) 16 (13.3) 31 (14.1) No 68 (85) 104 (86.7) 189 (85.9) Face and Content Validity Face validity was established through the participation of 10 students who provided confirmation. Additionally, content validity was determined by consulting a group of 4 expert specialists. It is noteworthy that the items demonstrated consistent simplicity and clarity throughout the face and content validity evaluations, without requiring any modifications. Criteria validity A statistically significant positive correlation was found between the scores of the son's attitude scale and the NSAS (r = 0.89, p < 0.001). Construct Validity EFA The KMO test at 0.75 and Bartlett’s test were significant (P < 0.001). According to the results, five factors of opportunity for self-realization (items 1,2 and 3), network formation (items 4and 5), enhance start-up (items 6 and 7), achievements of start-ups (items 8 and 9), and start-up preparation (items 10,11 and 12) were extracted, accounting for 80.74% of the variance of nursing start-up attitude (Table 2 ). The screen plot in Fig. 1 illustrate the number of factors with Eigenvalues more than one. Table 2 EFA of the Persian version of the nursing start-up attitude Factor Items Factor loading variances Eigenvalues Opportunity for self-realization 1-A startup in nursing presents a prospect to apply specialized nursing knowledge and skills to serve society. 0.87 20.60 3.35 2-Starting a nursing business can offer a chance for personal fulfillment and growth. 0.88 3-A nursing startup can be a valuable asset in the context of the Fourth Industrial Revolution 0.90 Network formation 4-The involvement of relevant organizations such as Nursing Associations, Small and Medium Business Administration, Small Business Associations, etc. is crucial in supporting the establishment of nursing startups0.88 0.84 18.53 2.08 5-Establishing a network to maintain a collaborative relationship with relevant institutions such as hospitals, community health centers, etc. is essential for the success of a nursing startup. 0.86 Enhance start-up capabilities 6- To prepare for a nursing startup, it is necessary to complete a business theory course in fields such as business administration, administration, social welfare, etc. 0.93 15.47 1.65 7-To prepare for a nursing startup, it is necessary to undergo business training courses such as business establishment training, field trips, etc. 0.93 Achievements of start-ups 8-Starting a nursing business provides an opportunity to work even after retirement 0.88 13.40 1.40 9- Establishing a nursing startup can leave a legacy that endures after death 0.86 Start-up preparation 10- When starting a nursing business, it is important to be aware of and adaptable to changes in the healthcare environment 0.90 12.73 1.20 11- To establish a successful nursing startup, thorough planning in advance is crucial, including aspects such as market research, staffing, and more. 0.88 12- To initiate a nursing startup, one must overcome the fear of failure 0.77 Cumulative % - - 80.74 - CFA Figure 2 shows the factor loadings for each items. The results of analysis confirmed the fitness of model (x2 = 75.17 and P = 0.002, RMSEA: 0.057; NFI: 0.93; CFI: 0.97; IFI: 0.97; RFI: 0.90; AGFI: 0.90; PGFI: 0.53; standardized RMR: 0.025) Reliability As Table 3 demonstrates, the Cronbach's ⍺ was ranged from 0.75 to 0.88. Further, excellent relative and absolute reliabilities across all factors were estimated. Further, the ICC ranged from 0.82 to 0.98. Additionally, the SEM and MDC values were consistently low, further supporting the excellent reliability of NSAS. Interpretability The NSAS demonstrated minimal instances of participants reaching the highest or lowest possible scores, with only 3% of participants achieving the maximum score and none achieving the minimum score for the entire assessment. The individual subscales of the NSAS also exhibited low occurrences of ceiling and floor effects, ranging from 0.04 to 0.6. The absence of any missing items further indicates the comprehensive nature of the data. Moreover, the MIC scores, which ranged from 0.16 to 1.22, provide additional evidence supporting the ease of interpretation of the NSAS. Table 3 Relative and absolute reliabilities of the NSAS Components Score range Cronbach's ⍺ ICC CI 95% P-value SEM MDC MDC% MIC Interpretation F1 3–15 0.78 0.97 0.96–0.98 P < 0.001 1 2.77 5.63 0.27 Excellent F2 2–10 0.75 0.97 0.96–0.98 P < 0.001 1 2.77 5.63 0.19 Excellent F3 2–10 0.82 0.98 0.98–0.99 P < 0.001 0.83 2.29 4.67 0.16 Excellent F4 2–10 0.79 0.95 0.93–0.97 P < 0.001 1.31 3.62 7.38 0.31 Excellent F5 3–5 0.85 0.82 0.74–0.88 P < 0.001 2.04 5.65 12.08 0.43 Excellent Total score 12–60 0.88 0.95 0.94–0.96 P < 0.001 1.31 3.62 7.38 1.22 Excellent Discussion The present study focused on evaluating the psychometric characteristics of a 12-item Persian version of the NSAS in Iran. The orginal scale was developed through a review of relevant literature on nursing entrepreneurship and an analysis of in-depth interviews with actual nurse entrepreneurs and then validated through various methods such as EFA (11). According to the nursing students' perspectives, the scale adequately covered the fundamental elements associated with each stage of the start-up process, ranging from self-awareness to accomplishments. Comparing to the orginal version with six factors, the final Iranian version of NSAS was found to have five factors, in which the factor 5 and 6 was merged during EFA. Since the risk-taking factor in the original scale consists of only one item, and given that start-up preparation inherently involves risk, we decided to transfer the risk-taking item to the start-up preparation factor. This decision was further supported by our EFA analysis, which indicated that the factor loadings of the items for risk-taking and start-up preparation loaded onto a single factor. Factor 1 was identified as "Opportunities for Self-realization" (3 items), Factor 2 as "Network Formation" (2 items), Factor 3 as "Enhancement of Entrepreneurial Competence" (2 items), Factor 4 as "Entrepreneurial Performance" (2 items), and Factor 5 as "Preparation of Entrepreneurial Foundation" (3 items). Through gathering feedback from 10 nursing students, the face validity of the scale were assessed, revealing that the items were easily understandable and unambiguous. Further, during content validity, the experts confirmed that the scale has acceptable given to language forms, diction, and the placement of words and phrases. Further, the criterion validity demonstrated that the iranian-version of nursing start-ups attitude scale has strong correlation with the Son's entrepreneurial attitude scale (15). According to the results of EFA, The first factor with three items accounted for 20.6% of the explained variance. The included items suggested that nursing entrepreneurship has a higher chance of success when there is a blend of specialized nursing knowledge and skills, as well as experiences in community service (11). Entrepreneurs typically possess a greater inclination towards seeking new challenges and experiences. Additionally, Hurst and Pugsley's study (30) revealed that nursing students perceive entrepreneurship as a path towards self-fulfillment, with non-monetary motivations carrying more weight than financial ones. Nursing students generally exhibit a strong sense of belief and pride in their field, considering entrepreneurship as a valuable opportunity to apply their expertise (31). The second factor accounted for 18.53% of the explained variance. Nursing students recognize that nursing entrepreneurship requires collaboration with external entities, and they believe that networking and partnerships with relevant organizations and institutions are crucial for achieving success (11). Furthermore, networking should extend beyond mere connections and encompass active collaboration and interdisciplinary work with experts in fields such as medical engineering, IT, and others(32). The third factor, accounting for 15.47% of the explained variance, included two items, which emphasized the importance of nursing students acquiring knowledge in entrepreneurial theory courses and completing practical training courses in entrepreneurship (like practical training in entrepreneurial facilities, field visits) for nursing entrepreneurship preparation(33). Currently, nursing bachelor's degree programs like other programs lack entrepreneurship-related courses or educational programs in Iran(34). However, in light of the evolving healthcare policy direction towards primary healthcare and health promotion in an aging society, nursing students need to develop competencies in various nursing entrepreneurship models suitable for integrated home care services within the local community. This calls for the expansion of entrepreneurship education and support programs. Additionally, different studies (35–37) reported that the nursing requires the profession to be responsive to changes in the fields of population, new diseases, and others. Future programs should prioritize the development of nursing students' entrepreneurial capabilities, including fostering creativity, openness, and other essential practical skills, in addition to specific disciplines like management and administration. The fourth factor, accounting for 13.40% of the explained variance, consisted of two items. Based on research findings, nearly half (44.2%) of young entrepreneurs in South Korea expressed the desire to work well into their later years as a driving force behind their decision to embark on entrepreneurial ventures. Similarly, nursing students perceive nursing entrepreneurship as a pathway to extend their professional careers beyond retirement and create a significant and lasting impact in their field. The fifth factor, accounting for 12.73% of the explained variance, consisted of three items. Despite consisting of a relatively small number of 12 items, the iranian version of scale proves to have a high explanatory power of 80.74%. As a result, it can be deemed a reliable and valid instrument for assessing nursing students' attitudes towards entrepreneurship. The total predicted varince to the orginal version was 74.4%. CFA of the Persian version of the NSAS indicated satisfactory goodness-of-fit indices, confirming the adequacy of the model. These results were consistent with the five factors identified during the EFA phase. These findings provide support for the validity and reliability of the Persian version of the scale. The relative and absolute reliability of our modified scale demonstrated significant improvement, underscoring the methodological soundness of our approach.Furthermore, the analysis of floor and ceiling effects revealed minimal bias, indicating that the instrument has a good distribution of responses and is capable of distinguishing between different levels of entrepreneurial attitudes among nursing students. This is a crucial methodological advantage, as it enhances the scale's sensitivity and specificity. The literature currently has limited standardized, valid, and reliable tools specifically designed for assessing start-up attitudes. This limitation hinders researchers from comparing the psychometric properties of the Persian version of the NSAS with other studies. However, the Persian version of the scale can still be utilized in future research endeavors. Parsha Jyoti Bharadwaj in his study, developed an attitude scale to find out the attitude of students toward business. Although the scale was developded using literature reviewe and then by interviewing with the respondents, the 42 –items attitude scale was lack of any reporting of vaidity and reliabilty (38). Similarly, in som other studies, the attitude toward starts-up was measured using self developed scale without and validity and reliabilty measurments (16, 39–41) Conclusion The findings of this study indicated that the Persian adaptation of the NSAS exhibited favorable face, content, and structural validity, as demonstrated through various assessments such as EFA and CFA. Additionally, the reliability of the tool was reported to be satisfactory. The developed measurement tool for nursing students' entrepreneurial attitudes has multiple applications, including research studies on nursing entrepreneurship, evaluating the effectiveness of entrepreneurship education programs, and developing and evaluating nursing entrepreneurship curricula. Moreover, utilizing this tool, along with exploring nursing entrepreneurship and entrepreneurial spirit, is expected to improve support mechanisms and competencies for nursing students engaged in nursing entrepreneurship. Limitation The contribution of one university was greater than the others, which might introduce a potential bias in the study results. Additionally, the sample was primarily limited to participants from Tehran, which may restrict the generalizability of the findings to a broader population. Furthermore, the use of convenience sampling in this study may introduce sampling bias and limit the extent to which the sample represents the larger population of interest. It is important for future research to address these limitations in order to enhance the understanding and application of the NSAS scale. Abbreviations Nursing Start-up Attitude Scale (NSAS) exploratory factor analysis (EFA) confirmatory factor analysis (CFA) interclass correlation coefficient (ICC) Standard Error of Measurement (SEM) Minimal Detectable Changes (MDC) Declarations Acknowledgments: The authors would like to express their gratitude for the guidance and advice provided by the Clinical Research Development Unit of Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Tehran, Iran. FUNDING INFORMATION : No funding source AUTHOR CONTRIBUTIONS Study concept, design and supervision: Mehdi Jafari-Oori, Abbas Ebadi; acquisition of data: Mehdi Jafari-Oori, Iman Jafari; analysis and interpretation of data: Mehdi Jafari-Oori, Abbas Ebadi; drafting of the manuscript; Iman Jafari and Mehdi Jafari-Oori; critical revision of the manuscript for important intellectual content, statistical analysis and administrative, technical and material support: Mehdi Jafari-Oori, Abbas Ebadi Conflicts of interest: The authors declare no conflict of interest Clinical trial number: not applicable. References Wakefield M, Williams DR, Le Menestrel S. The future of nursing 2020-2030: Charting a path to achieve health equity: National Academy of Sciences; 2021. Vannucci MJ, Weinstein SM. The nurse entrepreneur: empowerment needs, challenges, and self-care practices. Nursing: Research and Reviews. 2017:57-66. Thepna A, Cochrane BB, Salmon ME. 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Willis GB. Cognitive interviewing: A tool for improving questionnaire design: sage publications; 2004. Samitsch C. Data Quality and Its Impacts on Decision-Making: How Managers Can Benefit From Good Data. Innsbruck: Springer. 2014. Kievit AJ, Kuijer PPF, de Haan LJ, Koenraadt KL, Kerkhoffs GM, Schafroth MU, et al. Patients return to work sooner after unicompartmental knee arthroplasty than after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28:2905-16. Harvill LM. Standard error of measurement: an NCME instructional module on. Educational Measurement: issues and practice. 1991;10(2):33-41. Polit DF. Assessing measurement in health: Beyond reliability and validity. International journal of nursing studies. 2015;52(11):1746-53. Luque-Siles C, Gallego-Izquierdo T, Jímenez-Rejano JJ, de-la-Orden SG, Plaza-Manzano G, López-Illescas-Ruiz A, et al. Reliability and minimal detectable change of three functional tests: forward-lunge, step-up-over and sit-to-stand. Journal of Physical Therapy Science. 2016;28(12):3384-9. Burns N, Grove SK. Understanding nursing research-eBook: Building an evidence-based practice: Elsevier Health Sciences; 2010. Munro BH. Statistical methods for health care research: lippincott williams & wilkins; 2005. Hurst E, Pugsley BW. What do small businesses do? : National Bureau of Economic Research; 2011. Sherrod MM, Sherrod MS. Developing nurse entrepreneurs: Improving healthcare delivery and outcomes in the 21st century. 2017. Moirano R, Sánchez MA, Štěpánek L. Creative interdisciplinary collaboration: A systematic literature review. Thinking Skills and Creativity. 2020;35:100626. Wong HY, Chan CK. A systematic review on the learning outcomes in entrepreneurship education within higher education settings. Assessment & Evaluation in Higher Education. 2022;47(8):1213-30. Karimi S, Chizari M, Biemans HJ, Mulder M. Entrepreneurship education in Iranian higher education: The current state and challenges. European Journal of Scientific Research. 2010;48(1):35-50. Altman SH, Butler AS, Shern L. Assessing progress on the Institute of Medicine report The Future of Nursing: National Academies Press Washington, DC; 2016. Theresa M. Nursing education trends: Future implications and predictions. Nursing Clinics. 2012;47(4):423-34. Shin S, Yang EB, Hwang E, Kim K, Kim Y, Jung D. Current status and future direction of nursing education for clinical practice. Korean Medical Education Review. 2017;19(2):76-82. Bharadwaj PJ. Attitude of youth of Jorhat district of Assam towards start-ups. 2023. Palos Sánchez PR, Saura JR, Grilo A, Robina Ramírez R. How attitudes, vision and ability to capture opportunities affect startups’ business creativity. 2020. Sankelo M, ÅKERBLAD L. Nurse entrepreneurs’ attitudes to management, their adoption of the manager’s role and managerial assertiveness. Journal of Nursing Management. 2008;16(7):829-36. Farsi JY, Arabiun A, Moradi M. The impact of opportunity recognition skills training on entrepreneurial intention of female nursing students. Journal of Knowledge Management, Economics and Information Technology. 2012;2(4):411-23. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Jan, 2025 Read the published version in BMC Nursing → Version 1 posted Editorial decision: Revision requested 01 Nov, 2024 Editor assigned by journal 01 Nov, 2024 Submission checks completed at journal 01 Nov, 2024 First submitted to journal 21 Oct, 2024 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. 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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-5304614","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":372909430,"identity":"d6dd5538-28a9-4da9-a647-19bf080c7d8e","order_by":0,"name":"Iman Jafari","email":"","orcid":"","institution":"Baqiyatallah University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Iman","middleName":"","lastName":"Jafari","suffix":""},{"id":372909431,"identity":"f78028ff-237b-47ca-bce4-b5fdab822610","order_by":1,"name":"Mehdi Jafari-Oori","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYHCCBIYKBgYeEOvAByDBxk6MljNQLQdngLQwE2PPGSjNDNZISItuA8PDDwdq7snws/c+PGzza5s8HzMD44ePObi1mB1gSJY4cKyYR7LnuMHh3L7bhm3MDMySM7fh1ZIg/YEtgcfgRhrD4dye24xALWzMvPi1JP848A+qxbLntj0xWtIkDrZBtTD8uJ1IWMthhjSLg30JQL8cYzjY23A7uY2ZsRm/X473JN848C3Bnp+9jfnDjz+3bee3Nx/88BGPFmBcJCA4jG1gsgGPehBgP4DE+UNA8SgYBaNgFIxIAAD5l1Jr4/ICVgAAAABJRU5ErkJggg==","orcid":"","institution":"Baqiyatallah University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mehdi","middleName":"","lastName":"Jafari-Oori","suffix":""},{"id":372909432,"identity":"b3829d5f-57d5-418f-b15c-9c27d6dd5991","order_by":2,"name":"Abbas Ebadi","email":"","orcid":"","institution":"Baqiyatallah University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abbas","middleName":"","lastName":"Ebadi","suffix":""}],"badges":[],"createdAt":"2024-10-21 12:53:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5304614/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5304614/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-024-02631-3","type":"published","date":"2025-01-21T15:57:03+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":68910894,"identity":"2a8e630d-5b72-4a19-a5fe-7311e5a72fe2","added_by":"auto","created_at":"2024-11-13 11:51:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22292,"visible":true,"origin":"","legend":"\u003cp\u003eThe screen plot of extracted factors\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5304614/v1/8174e08f7623492637bbc845.png"},{"id":68910896,"identity":"b6049b07-9d2a-48a7-809d-440fa0adde11","added_by":"auto","created_at":"2024-11-13 11:51:14","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":166716,"visible":true,"origin":"","legend":"\u003cp\u003eThe final structure of the model\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5304614/v1/31591d60d68bed0785436ac6.png"},{"id":74858462,"identity":"b828a30e-806b-4c5c-9fbe-e6554096b812","added_by":"auto","created_at":"2025-01-27 16:09:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1075102,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5304614/v1/39151801-9b0f-4944-8837-d52023d0cdde.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometric Properties of the Nursing Start-up Attitude Scale in Iranian nursing students","fulltext":[{"header":"Background","content":"\u003cp\u003eNursing professionals have the ability to play a significant role in tackling worldwide healthcare obstacles such as chronic diseases, the emergence of new illnesses like COVID-19, the growing elderly population, advancements in technology, and inequalities in healthcare access(1). Through the expansion of their skill set and the exploration of entrepreneurship opportunities, nurses have the potential to emerge as leaders in population health management, effectively facilitating access to healthcare services for diverse populations (2). Consequently, nurses are uniquely positioned to make a substantial impact on the healthcare system by assuming the role of nurse entrepreneurs (3).\u003c/p\u003e \u003cp\u003eAccording to the International Council of Nurses, nurse entrepreneurs are individuals who are owners of businesses that encompass a wide range of nursing services, including the provision of direct patient care, educational initiatives, research endeavors, administrative functions, and consultation services (4). These nurse entrepreneurs are independent practitioners and business owners who deliver care to their patients (5). The American Nurses Association Enterprise Innovation (2023) reports that over 300 nurse entrepreneurs are currently driving innovation in the nursing field as change agents. They are involved in various aspects of nursing entrepreneurship such as medical equipment and devices, care delivery models, business creation, research, and educational interventions(6). Additionally, Sanders and Kingma (2012) outline the characteristics of entrepreneurial nursing, which include nurse-led units, clinics, emergency services, telephone consultation services, and nurse-owned nursing homes (4). These contributions signify the rise of new healthcare roles, innovative care models, advancements in healthcare legislation, and progress in health equity (7). However, data from the National Nurses Association suggests that only a small percentage, ranging from 0.5\u0026ndash;1%, of nurses worldwide currently pursue entrepreneurial roles (8). In New Zealand, the percentage is less than 1%(9), while in the United States, it is 0.18%(10). It is worth noting that no specific statistics are available for the Iranian context.\u003c/p\u003e \u003cp\u003eEntrepreneurial attitude pertains to an individual's acquired inclination, either positive or negative, towards a specific object that is connected to personal views regarding entrepreneurship (11). A positive attitude is linked to optimistic beliefs about the results of particular actions and favorable outcomes in terms of behavior (12). Prior to embarking on entrepreneurial endeavors, attitudes towards entrepreneurship play a crucial role in various activities such as formulating a business plan, securing investments, establishing a company, and engaging in entrepreneurial pursuits (13). Essentially, a positive entrepreneurial attitude can act as a motivating factor for commencing and prospering in entrepreneurship. Research on entrepreneurial attitudes in nursing remains limited. While qualitative research utilizing the Q-method has explored nursing students' attitudes towards entrepreneurship (14), there is a scarcity of quantitative studies that objectively measure these attitudes within the Iranian context (15, 16). One possible reason for this gap could be the absence of valid instruments for assessing entrepreneurial attitudes.\u003c/p\u003e \u003cp\u003eThe most of existing measurement tools for entrepreneurial attitudes have primarily been developed and studied in the field of business management. These tools often contain items that are specific to certain specialized areas, such as \"development of business products and services\" or \"entrepreneurial expert networks\"(17). Using such tools to measure entrepreneurial attitudes in the nursing field has limitations.\u003c/p\u003e \u003cp\u003eSeveral instruments, including the Nursing Start-up Attitude Scale (NSAS)(11), Personal Attitude in Li\u0026ntilde;\u0026aacute;n and Chen entrepreneurial intention instrument (18), and Son\u0026rsquo;s start-up attitude scale (15) have been used to measure nurse attitude. Among these instruments, the 12- item NSAS was originally developed to measure six key factors: opportunity for self-realization, network formation, enhance start-up capabilities, achievements of start-ups, start-up preparation, and risk taking. These factors are derived from a robust theoretical framework grounded in entrepreneurship theory(19), which underscores the importance of these dimensions in predicting entrepreneurial success (11). The developer of this scale recommended that, due to the dynamic nature of entrepreneurship and its susceptibility to societal and temporal shifts, it is essential to consistently evaluate the validity and reliability of the scale. Additionally, it is important to make appropriate adjustments and enhancements to align with the changing landscape. Continuous assessment and refinement of the tool are strongly advised to maintain its relevance and effectiveness in measuring nursing students' entrepreneurial attitudes in the future (11).\u003c/p\u003e \u003cp\u003eConsidering the lack of a Persian version of this scale in Iran and the increasing recognition and importance of entrepreneurship in nursing, it is crucial to have reliable and valid measurement tools that accurately assess the attitudes of nursing students towards start-up ventures. Therefore, the objective of this study was to evaluate the psychometric properties of the NSAS among Iranian nursing students. By establishing a validated and reliable scale, researchers, educators, and policymakers will be equipped with an effective tool to measure and comprehend the entrepreneurial mindset and inclination among Iranian nursing students.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eIn this methodological study, the NSAS translated into Persian and assessed its psychometric properties between 2022 and 2023.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population/Sampling\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of nursing students enrolled in nursing faculties in Iran. A blended approach involving online and in-person methods was used for data collection. The online component included concurrent validity assessment, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). ace and content validity, as well as reliability analysis, were conducted in person, as these methods require smaller, readily available samples. The convenience sampling method was employed in data collection.\u003c/p\u003e \u003cp\u003eA total of 80 nursing students participated in the concurrent validity assessment, while EFA involved 120 participants, and CFA included 220 participants. Hobart et al. suggested a minimum sample size of 79 participants for concurrent validation (20). For EFA, it is recommended to have 3\u0026ndash;10 participants per item (19), for CFA, Munro (2005) advised having 20\u0026ndash;30 items per factor (19). In terms of face validity, 10 students were recruited to provide feedback on the scale. Additionally, four experts were invited to evaluate the qualitative content validity of the Iranian version of the NSAS.\u003c/p\u003e \u003cp\u003eThe inclusion criteria for the study were as follows: being a nursing student currently enrolled in a program in Iran, having fluency in Farsi or Persian language, and not having any cognitive or psychiatric issues. Non-cooperation or incomplete scale responses were considered as exclusion criteria.\u003c/p\u003e\n\u003ch3\u003eStudy Instruments\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDemographic Information\u003c/h2\u003e \u003cp\u003eThe online questionnaire included demographic items such as age, gender, education level, and previous experience in entrepreneurship or starting a business.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eThe NSAS\u003c/h3\u003e\n\u003cp\u003eThe NSAS is specifically designed to assess nursing students' attitudes towards entrepreneurship and starting a nursing-related business. It consists of 12 items that are divided into six factors: self-actualization opportunities (3 items), network building (2 items), enhancing start-up competencies (2 items), start-up outcomes (2 items), preparation for start-ups (2 items), and risk-taking, (1 item). Each item is rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). The total score of the scale ranges from 12 to 60, with higher scores indicating more positive attitudes towards entrepreneurship in nursing field (11).\u003c/p\u003e \u003cp\u003eEntrepreneurial attitude\u003c/p\u003e \u003cp\u003eEntrepreneurial attitude was assessed using a modified version of Son's (2018) instrument, which comprises eight items rated on a five-point Likert scale (Cronbach's α. = 0.88). Higher scores on the scale indicate greater levels of entrepreneurial attitude (15).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTranslation Procedure\u003c/h2\u003e \u003cp\u003eUpon obtaining permission from the NSAS developer, the translation process was initiated. Initially, the scale was translated from English (source language) to Persian (target language) by two translators, one of whom was a health specialist and the other a general translator. The translated version was then back-translated to English by two additional translators, resulting in a final version of the Persian scale. The translations were analyzed, and a final version of the Persian scale was obtained. The quality of the translation was evaluated using the International Quality of Life Assessment (IQOLA) translation process, which is a widely recognized translation methodology (21). The translated scale was then provided to the developer for further assessment.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFace and Content Validity\u003c/h3\u003e\n\u003cp\u003eTo evaluate the qualitative face validity of the NSAS, cognitive interviews were conducted with 10 nursing students. During the cognitive interviews, the participants' cognitive processes were observed while completing the questionnaire, and any sources of errors in the tool were identified (22). The interviews were conducted face-to-face, and the Persian version of the scale was modified based on the feedback received from the participants. The participants were also asked to evaluate the readability, clarity, item structure, ease of understanding, item complexity, ambiguous terms, question categorization, ease of replying, language forms, and wording of the questionnaire.\u003c/p\u003e \u003cp\u003eTo assess the content validity, the questionnaire was sent to four experts for feedback on language forms, diction, and the placement of words and phrases.\u003c/p\u003e\n\u003ch3\u003eCriteria validity\u003c/h3\u003e\n\u003cp\u003eTo evaluate the criterion validity, the adapted version of Son's (2018) tool, consisting of eight items with a five-point Likert scale, was considered as reference tool (15). The correlation between the two scales was assessed using the Pearson correlation test.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eConstruct Validity\u003c/h2\u003e \u003cp\u003eTo assess the underlying relationships between the items, an EFA using Maximum likelihood and Promax rotation was conducted. The principal component analysis (PCA) method was used to extract the factors, and the Promax rotation was used to interpret the factors (23).\u003c/p\u003e \u003cp\u003eThe Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) coefficient was used to evaluate sampling adequacy. KMO values ranging from 0.7 to 0.8 and from 0.8 to 0.9 are considered good and excellent, respectively. High KMO values (above 0.7) suggest that factor analysis is appropriate for the data (24). The significance of the correlation matrix between the items was examined using the Bartlett\u0026rsquo;s test of sphericity. A factor loading cut-off point of 0.30 was considered.\u003c/p\u003e \u003cp\u003eCFA was conducted to determine whether the data confirms to the theoretical model, based on the results of the EFA, using the maximum likelihood estimation method and covariance indices. Goodness-of-fit was assessed using several indices, including the goodness-of-fit index (GFI), relative chi-square (χ2/df), normed fit index (NFI), comparative fit index (CFI), standardized root mean square residual (SRMR), and root mean square error of approximation (RMSEA). Acceptable values for these indices were considered to be χ2/df\u0026thinsp;\u0026le;\u0026thinsp;2, GFI, CFI, and NFI\u0026thinsp;\u0026gt;\u0026thinsp;0.95, and RMSEA\u0026thinsp;\u0026lt;\u0026thinsp;0.08.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eInternal consistency was measured using Cronbach's ⍺. In order to assess the reliability of the NSAS, both relative and absolute reliability measures were utilized. The relative reliability was evaluated by employing the interclass correlation coefficient (ICC) with the inter-rater method. A sample of 30 nursing students completed the start-up attitude scale on two separate occasions, with a two-week gap between assessments. To determine the absolute reliability of the start-up attitude scale, calculations were performed to obtain the Standard Error of Measurement (SEM) and Minimal Detectable Changes (MDC). The SEM represents the measurement error associated with the tool, while the MDC indicates the minimum amount of change in scores that can be considered beyond the measurement error (25). The formulas used to calculate the SEM and MDC were as follows: SEM\u0026thinsp;=\u0026thinsp;SD Pooled \u0026radic;1\u0026ndash; ICC (26), and MDC\u0026thinsp;=\u0026thinsp;SEM X 1.96 X \u0026radic;2. Additionally, the MDC% was computed as (MDC / mean) * 100, where the mean represents the average of all observations from test sessions 1 and 2. An acceptable MDC percentage is considered to be 30%, while values below 10% are regarded as excellent (27).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eInterpretability\u003c/h2\u003e \u003cp\u003eAdditionally, in order to evaluate interpretability, the study examined the percentage of unanswered items as well as the presence of ceiling and floor effects. The sample size for the EFA assessment was used to evaluate the interpretability. Optimal values for the percentage of unanswered items are typically considered to be between 10% and 20%(28), while ceiling and floor effects are ideally kept below 15%(29). Furthermore, to further assess interpretability, the minimal important change (MIC) was determined using the formula: MIC\u0026thinsp;=\u0026thinsp;0.5 * SD of Δ score.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eFrom August 20232 to November 2023, data collection was conducted using online surveys. The target participants for this study were nursing students who were part of an online community. Those who agreed to take part in the survey received the questionnaire links either through mobile phone or email. To ensure confidentiality, the collected data were encoded and securely downloaded, preventing the identification of personal information. The data analysis was carried out on the author's computer, adhering to the password-protected measures in accordance with the guidelines set by the Institutional Review Board\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eFor the EFA and CFA, we used SPSS software, version 22.0 and AMOUS software, version 26, respectively. The significance level for all analyses was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEthical Consideration\u003c/h2\u003e \u003cp\u003e This study was approved in the ethics committee of Baqiyatallah University of Medical Sciences (BMSU), with the ethics code IR.BMSU.REC.1400.096. The researcher ensured that all participants provided informed consent before their participation. The study approach was clearly explained to the participants, and appropriate authorization and coordination with relevant authorities were obtained. Participants were assured that their data would be treated confidentially, and they were informed of their right to withdraw from the study at any point.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics\u003c/h2\u003e \u003cp\u003eIn the EFA phase, out of the total samples, 102 (85%) were male, and 18 (15%) were female. The participants had a mean age of 25.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.81. In the CFA phase, the mean age of the samples was 24.99 years. Among them, 95 (79.16%) were male, and 25 (20.84%) were female. Additional details about the study participants can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe demographic information of samples in the EFA and CFA\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCriterion validity (N\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEFA (N\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCFA (N\u0026thinsp;=\u0026thinsp;220)\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (86.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e187 (85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge-group (year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.85\u0026thinsp;\u0026plusmn;\u0026thinsp;9.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (72.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98 (81.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e159 (72.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster's degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (19.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctoral degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (6.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eYear of study\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77 (35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 ( 33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77 (35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYear 4 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eUniversity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e186 (84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther universities (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 ((16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTehran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e133 (60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther cites (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87 (39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePrevious participation in start-up workshops\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53 (24.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (77.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (76.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e167 (75.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFormer start-up work experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (14.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104 (86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e189 (85.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFace and Content Validity\u003c/h2\u003e \u003cp\u003eFace validity was established through the participation of 10 students who provided confirmation. Additionally, content validity was determined by consulting a group of 4 expert specialists. It is noteworthy that the items demonstrated consistent simplicity and clarity throughout the face and content validity evaluations, without requiring any modifications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eCriteria validity\u003c/h2\u003e \u003cp\u003eA statistically significant positive correlation was found between the scores of the son's attitude scale and the NSAS (r\u0026thinsp;=\u0026thinsp;0.89, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eConstruct Validity\u003c/h2\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003eEFA\u003c/h2\u003e \u003cp\u003eThe KMO test at 0.75 and Bartlett\u0026rsquo;s test were significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). According to the results, five factors of opportunity for self-realization (items 1,2 and 3), network formation (items 4and 5), enhance start-up (items 6 and 7), achievements of start-ups (items 8 and 9), and start-up preparation (items 10,11 and 12) were extracted, accounting for 80.74% of the variance of nursing start-up attitude (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The screen plot in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrate the number of factors with Eigenvalues more than one.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEFA of the Persian version of the nursing start-up attitude\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor loading\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003evariances\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEigenvalues\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eOpportunity for\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eself-realization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1-A startup in nursing presents a prospect to apply specialized nursing knowledge and skills to serve society.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e20.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2-Starting a nursing business can offer a chance for personal fulfillment and growth.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3-A nursing startup can be a valuable asset in the context of the Fourth Industrial Revolution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eNetwork formation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4-The involvement of relevant organizations such as Nursing Associations, Small and Medium Business Administration, Small Business Associations, etc. is crucial in supporting the establishment of nursing startups0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e18.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5-Establishing a network to maintain a collaborative relationship with relevant institutions such as hospitals, community health centers, etc. is essential for the success of a nursing startup.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEnhance start-up\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ecapabilities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6- To prepare for a nursing startup, it is necessary to complete a business theory course in fields such as business administration, administration, social welfare, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e15.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7-To prepare for a nursing startup, it is necessary to undergo business training courses such as business establishment training, field trips, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAchievements of start-ups\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8-Starting a nursing business provides an opportunity to work even after retirement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e13.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9- Establishing a nursing startup can leave a legacy that endures after death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eStart-up preparation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10- When starting a nursing business, it is important to be aware of and adaptable to changes in the healthcare environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e12.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11- To establish a successful nursing startup, thorough planning in advance is crucial, including aspects such as market research, staffing, and more.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12- To initiate a nursing startup, one must overcome the fear of failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCumulative %\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eCFA\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the factor loadings for each items. The results of analysis confirmed the fitness of model (x2\u0026thinsp;=\u0026thinsp;75.17 and P\u0026thinsp;=\u0026thinsp;0.002, RMSEA: 0.057; NFI: 0.93; CFI: 0.97; IFI: 0.97; RFI: 0.90; AGFI: 0.90; PGFI: 0.53; standardized RMR: 0.025)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eAs Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e demonstrates, the Cronbach's ⍺ was ranged from 0.75 to 0.88. Further, excellent relative and absolute reliabilities across all factors were estimated. Further, the ICC ranged from 0.82 to 0.98. Additionally, the SEM and MDC values were consistently low, further supporting the excellent reliability of NSAS.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eInterpretability\u003c/h2\u003e \u003cp\u003eThe NSAS demonstrated minimal instances of participants reaching the highest or lowest possible scores, with only 3% of participants achieving the maximum score and none achieving the minimum score for the entire assessment. The individual subscales of the NSAS also exhibited low occurrences of ceiling and floor effects, ranging from 0.04 to 0.6. The absence of any missing items further indicates the comprehensive nature of the data. Moreover, the MIC scores, which ranged from 0.16 to 1.22, provide additional evidence supporting the ease of interpretation of the NSAS.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelative and absolute reliabilities of the NSAS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComponents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScore range\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach's ⍺\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eICC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCI 95%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSEM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMDC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMDC%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMIC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eF1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96\u0026ndash;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eF2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96\u0026ndash;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eF3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.98\u0026ndash;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eF4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.93\u0026ndash;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eF5\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.74\u0026ndash;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e12.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.94\u0026ndash;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study focused on evaluating the psychometric characteristics of a 12-item Persian version of the NSAS in Iran. The orginal scale was developed through a review of relevant literature on nursing entrepreneurship and an analysis of in-depth interviews with actual nurse entrepreneurs and then validated through various methods such as EFA (11). According to the nursing students' perspectives, the scale adequately covered the fundamental elements associated with each stage of the start-up process, ranging from self-awareness to accomplishments. Comparing to the orginal version with six factors, the final Iranian version of NSAS was found to have five factors, in which the factor 5 and 6 was merged during EFA. Since the risk-taking factor in the original scale consists of only one item, and given that start-up preparation inherently involves risk, we decided to transfer the risk-taking item to the start-up preparation factor. This decision was further supported by our EFA analysis, which indicated that the factor loadings of the items for risk-taking and start-up preparation loaded onto a single factor. Factor 1 was identified as \"Opportunities for Self-realization\" (3 items), Factor 2 as \"Network Formation\" (2 items), Factor 3 as \"Enhancement of Entrepreneurial Competence\" (2 items), Factor 4 as \"Entrepreneurial Performance\" (2 items), and Factor 5 as \"Preparation of Entrepreneurial Foundation\" (3 items).\u003c/p\u003e \u003cp\u003eThrough gathering feedback from 10 nursing students, the face validity of the scale were assessed, revealing that the items were easily understandable and unambiguous. Further, during content validity, the experts confirmed that the scale has acceptable given to language forms, diction, and the placement of words and phrases. Further, the criterion validity demonstrated that the iranian-version of nursing start-ups attitude scale has strong correlation with the Son's entrepreneurial attitude scale (15).\u003c/p\u003e \u003cp\u003eAccording to the results of EFA, The first factor with three items accounted for 20.6% of the explained variance. The included items suggested that nursing entrepreneurship has a higher chance of success when there is a blend of specialized nursing knowledge and skills, as well as experiences in community service (11). Entrepreneurs typically possess a greater inclination towards seeking new challenges and experiences. Additionally, Hurst and Pugsley's study (30) revealed that nursing students perceive entrepreneurship as a path towards self-fulfillment, with non-monetary motivations carrying more weight than financial ones. Nursing students generally exhibit a strong sense of belief and pride in their field, considering entrepreneurship as a valuable opportunity to apply their expertise (31).\u003c/p\u003e \u003cp\u003eThe second factor accounted for 18.53% of the explained variance. Nursing students recognize that nursing entrepreneurship requires collaboration with external entities, and they believe that networking and partnerships with relevant organizations and institutions are crucial for achieving success (11). Furthermore, networking should extend beyond mere connections and encompass active collaboration and interdisciplinary work with experts in fields such as medical engineering, IT, and others(32).\u003c/p\u003e \u003cp\u003eThe third factor, accounting for 15.47% of the explained variance, included two items, which emphasized the importance of nursing students acquiring knowledge in entrepreneurial theory courses and completing practical training courses in entrepreneurship (like practical training in entrepreneurial facilities, field visits) for nursing entrepreneurship preparation(33). Currently, nursing bachelor's degree programs like other programs lack entrepreneurship-related courses or educational programs in Iran(34). However, in light of the evolving healthcare policy direction towards primary healthcare and health promotion in an aging society, nursing students need to develop competencies in various nursing entrepreneurship models suitable for integrated home care services within the local community. This calls for the expansion of entrepreneurship education and support programs. Additionally, different studies (35\u0026ndash;37) reported that the nursing requires the profession to be responsive to changes in the fields of population, new diseases, and others. Future programs should prioritize the development of nursing students' entrepreneurial capabilities, including fostering creativity, openness, and other essential practical skills, in addition to specific disciplines like management and administration.\u003c/p\u003e \u003cp\u003eThe fourth factor, accounting for 13.40% of the explained variance, consisted of two items. Based on research findings, nearly half (44.2%) of young entrepreneurs in South Korea expressed the desire to work well into their later years as a driving force behind their decision to embark on entrepreneurial ventures. Similarly, nursing students perceive nursing entrepreneurship as a pathway to extend their professional careers beyond retirement and create a significant and lasting impact in their field.\u003c/p\u003e \u003cp\u003eThe fifth factor, accounting for 12.73% of the explained variance, consisted of three items. Despite consisting of a relatively small number of 12 items, the iranian version of scale proves to have a high explanatory power of 80.74%. As a result, it can be deemed a reliable and valid instrument for assessing nursing students' attitudes towards entrepreneurship. The total predicted varince to the orginal version was 74.4%.\u003c/p\u003e \u003cp\u003eCFA of the Persian version of the NSAS indicated satisfactory goodness-of-fit indices, confirming the adequacy of the model. These results were consistent with the five factors identified during the EFA phase. These findings provide support for the validity and reliability of the Persian version of the scale.\u003c/p\u003e \u003cp\u003e The relative and absolute reliability of our modified scale demonstrated significant improvement, underscoring the methodological soundness of our approach.Furthermore, the analysis of floor and ceiling effects revealed minimal bias, indicating that the instrument has a good distribution of responses and is capable of distinguishing between different levels of entrepreneurial attitudes among nursing students. This is a crucial methodological advantage, as it enhances the scale's sensitivity and specificity.\u003c/p\u003e \u003cp\u003eThe literature currently has limited standardized, valid, and reliable tools specifically designed for assessing start-up attitudes. This limitation hinders researchers from comparing the psychometric properties of the Persian version of the NSAS with other studies. However, the Persian version of the scale can still be utilized in future research endeavors. Parsha Jyoti Bharadwaj in his study, developed an attitude scale to find out the attitude of students toward business. Although the scale was developded using literature reviewe and then by interviewing with the respondents, the 42 \u0026ndash;items attitude scale was lack of any reporting of vaidity and reliabilty (38). Similarly, in som other studies, the attitude toward starts-up was measured using self developed scale without and validity and reliabilty measurments (16, 39\u0026ndash;41)\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study indicated that the Persian adaptation of the NSAS exhibited favorable face, content, and structural validity, as demonstrated through various assessments such as EFA and CFA. Additionally, the reliability of the tool was reported to be satisfactory. The developed measurement tool for nursing students' entrepreneurial attitudes has multiple applications, including research studies on nursing entrepreneurship, evaluating the effectiveness of entrepreneurship education programs, and developing and evaluating nursing entrepreneurship curricula. Moreover, utilizing this tool, along with exploring nursing entrepreneurship and entrepreneurial spirit, is expected to improve support mechanisms and competencies for nursing students engaged in nursing entrepreneurship.\u003c/p\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThe contribution of one university was greater than the others, which might introduce a potential bias in the study results. Additionally, the sample was primarily limited to participants from Tehran, which may restrict the generalizability of the findings to a broader population. Furthermore, the use of convenience sampling in this study may introduce sampling bias and limit the extent to which the sample represents the larger population of interest. It is important for future research to address these limitations in order to enhance the understanding and application of the NSAS scale.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eNursing Start-up Attitude Scale (NSAS)\u003c/p\u003e\n\u003cp\u003eexploratory factor analysis (EFA)\u003c/p\u003e\n\u003cp\u003econfirmatory factor analysis (CFA)\u003c/p\u003e\n\u003cp\u003einterclass correlation coefficient (ICC)\u003c/p\u003e\n\u003cp\u003eStandard Error of Measurement (SEM)\u003c/p\u003e\n\u003cp\u003eMinimal Detectable Changes (MDC)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude for the guidance and advice provided by the Clinical Research Development Unit of Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Tehran, Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING INFORMATION\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding source\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy concept, design and supervision: Mehdi Jafari-Oori, Abbas Ebadi; acquisition of data: Mehdi Jafari-Oori, Iman Jafari; analysis and interpretation of data: Mehdi Jafari-Oori, Abbas Ebadi; drafting of the manuscript; Iman Jafari and Mehdi Jafari-Oori; critical revision of the manuscript for important intellectual content, statistical analysis and administrative, technical and material support: Mehdi Jafari-Oori, Abbas Ebadi\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWakefield M, Williams DR, Le Menestrel S. The future of nursing 2020-2030: Charting a path to achieve health equity: National Academy of Sciences; 2021.\u003c/li\u003e\n\u003cli\u003eVannucci MJ, Weinstein SM. The nurse entrepreneur: empowerment needs, challenges, and self-care practices. Nursing: Research and Reviews. 2017:57-66.\u003c/li\u003e\n\u003cli\u003eThepna A, Cochrane BB, Salmon ME. Self-efficacy in nurse entrepreneurs: A concept analysis. Nursing Outlook. 2023;71(6):102053.\u003c/li\u003e\n\u003cli\u003eSanders E, Kingma M. Handbook on Entrepreneurial Practice. International Council of Nurses, Geneva. 2003.\u003c/li\u003e\n\u003cli\u003eArnaert A, Mills J, Bruno FS, Ponzoni N. The educational gaps of nurses in entrepreneurial roles: An integrative review. Journal of Professional Nursing. 2018;34(6):494-501.\u003c/li\u003e\n\u003cli\u003eInnovation ANAE. . https://www.nursingworld. org/practice-policy/innovation/ 2023 [\u003c/li\u003e\n\u003cli\u003eLemberger O. Nurse Innovator Index. https://nurseinnovatorindex.com/about. 2023.\u003c/li\u003e\n\u003cli\u003eNurses. ICo. Guidelines on the nurse entre/ intrapreneur providing nursing service. Geneva, Switzerland: ICN; p. 1‑33 https://www.hrhresourcecenter.org/node/1150.html 2004. [\u003c/li\u003e\n\u003cli\u003eDrennan V, Davis K, Goodman C, Humphrey C, Locke R, Mark A, et al. Entrepreneurial nurses and midwives in the United Kingdom: an integrative review. Journal of Advanced Nursing. 2007;60(5):459-69.\u003c/li\u003e\n\u003cli\u003eCheater FM. Improving primary and community health services through nurse-led social enterprise. Quality in Primary Care. 2010;18(1):5-7.\u003c/li\u003e\n\u003cli\u003eLIM J-Y, KIM G-M, KIM E-J. Development of the Nursing Start-up Attitude Scale for Student Nurses. Journal of Korean Academy of Nursing Administration. 2020:388-99.\u003c/li\u003e\n\u003cli\u003eAjzen I. The theory of planned behavior. 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Journal of small business management. 2016;54(1):187-209.\u003c/li\u003e\n\u003cli\u003e임지영, 김근면, 김은주. 간호대학생의 간호창업태도 측정도구 개발. Journal of Korean Academy of Nursing Administration. 2020;26(4):388-99.\u003c/li\u003e\n\u003cli\u003eLi\u0026ntilde;\u0026aacute;n F, Chen YW. Development and cross\u0026ndash;cultural application of a specific instrument to measure entrepreneurial intentions. Entrepreneurship theory and practice. 2009;33(3):593-617.\u003c/li\u003e\n\u003cli\u003eKuratko DF. Entrepreneurship theory, process, and practice in the 21st century. International Journal of Entrepreneurship and Small Business. 2011;13(1):8-17.\u003c/li\u003e\n\u003cli\u003eGoldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychological medicine. 1979;9(1):139-45.\u003c/li\u003e\n\u003cli\u003eBullinger M, Alonso J, Apolone G, Lepl\u0026egrave;ge A, Sullivan M, Wood-Dauphinee S, et al. Translating health status questionnaires and evaluating their quality: the IQOLA project approach. Journal of clinical epidemiology. 1998;51(11):913-23.\u003c/li\u003e\n\u003cli\u003eWillis GB. Cognitive interviewing: A tool for improving questionnaire design: sage publications; 2004.\u003c/li\u003e\n\u003cli\u003eSamitsch C. Data Quality and Its Impacts on Decision-Making: How Managers Can Benefit From Good Data. Innsbruck: Springer. 2014.\u003c/li\u003e\n\u003cli\u003eKievit AJ, Kuijer PPF, de Haan LJ, Koenraadt KL, Kerkhoffs GM, Schafroth MU, et al. Patients return to work sooner after unicompartmental knee arthroplasty than after total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28:2905-16.\u003c/li\u003e\n\u003cli\u003eHarvill LM. Standard error of measurement: an NCME instructional module on. Educational Measurement: issues and practice. 1991;10(2):33-41.\u003c/li\u003e\n\u003cli\u003ePolit DF. Assessing measurement in health: Beyond reliability and validity. International journal of nursing studies. 2015;52(11):1746-53.\u003c/li\u003e\n\u003cli\u003eLuque-Siles C, Gallego-Izquierdo T, J\u0026iacute;menez-Rejano JJ, de-la-Orden SG, Plaza-Manzano G, L\u0026oacute;pez-Illescas-Ruiz A, et al. Reliability and minimal detectable change of three functional tests: forward-lunge, step-up-over and sit-to-stand. Journal of Physical Therapy Science. 2016;28(12):3384-9.\u003c/li\u003e\n\u003cli\u003eBurns N, Grove SK. Understanding nursing research-eBook: Building an evidence-based practice: Elsevier Health Sciences; 2010.\u003c/li\u003e\n\u003cli\u003eMunro BH. Statistical methods for health care research: lippincott williams \u0026amp; wilkins; 2005.\u003c/li\u003e\n\u003cli\u003eHurst E, Pugsley BW. What do small businesses do? : National Bureau of Economic Research; 2011.\u003c/li\u003e\n\u003cli\u003eSherrod MM, Sherrod MS. Developing nurse entrepreneurs: Improving healthcare delivery and outcomes in the 21st century. 2017.\u003c/li\u003e\n\u003cli\u003eMoirano R, S\u0026aacute;nchez MA, \u0026Scaron;těp\u0026aacute;nek L. Creative interdisciplinary collaboration: A systematic literature review. Thinking Skills and Creativity. 2020;35:100626.\u003c/li\u003e\n\u003cli\u003eWong HY, Chan CK. A systematic review on the learning outcomes in entrepreneurship education within higher education settings. Assessment \u0026amp; Evaluation in Higher Education. 2022;47(8):1213-30.\u003c/li\u003e\n\u003cli\u003eKarimi S, Chizari M, Biemans HJ, Mulder M. Entrepreneurship education in Iranian higher education: The current state and challenges. European Journal of Scientific Research. 2010;48(1):35-50.\u003c/li\u003e\n\u003cli\u003eAltman SH, Butler AS, Shern L. Assessing progress on the Institute of Medicine report The Future of Nursing: National Academies Press Washington, DC; 2016.\u003c/li\u003e\n\u003cli\u003eTheresa M. Nursing education trends: Future implications and predictions. Nursing Clinics. 2012;47(4):423-34.\u003c/li\u003e\n\u003cli\u003eShin S, Yang EB, Hwang E, Kim K, Kim Y, Jung D. Current status and future direction of nursing education for clinical practice. Korean Medical Education Review. 2017;19(2):76-82.\u003c/li\u003e\n\u003cli\u003eBharadwaj PJ. Attitude of youth of Jorhat district of Assam towards start-ups. 2023.\u003c/li\u003e\n\u003cli\u003ePalos S\u0026aacute;nchez PR, Saura JR, Grilo A, Robina Ram\u0026iacute;rez R. How attitudes, vision and ability to capture opportunities affect startups\u0026rsquo; business creativity. 2020.\u003c/li\u003e\n\u003cli\u003eSankelo M, \u0026Aring;KERBLAD L. Nurse entrepreneurs\u0026rsquo; attitudes to management, their adoption of the manager\u0026rsquo;s role and managerial assertiveness. Journal of Nursing Management. 2008;16(7):829-36.\u003c/li\u003e\n\u003cli\u003eFarsi JY, Arabiun A, Moradi M. The impact of opportunity recognition skills training on entrepreneurial intention of female nursing students. Journal of Knowledge Management, Economics and Information Technology. 2012;2(4):411-23.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"Nursing students, Psychometric properties, Start-up","lastPublishedDoi":"10.21203/rs.3.rs-5304614/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5304614/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEntrepreneurial attitudes among nursing students are crucial for fostering innovation and addressing the evolving challenges in healthcare. However, measuring these attitudes accurately requires robust and validated instruments. The Nursing Start-up Attitude Scale is a valid and reliable instrument specifically designed to measure nursing students' attitudes towards start-ups. However, its psychometric properties in the context of the Iranian nursing field have not been thoroughly examined.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis methodological study was conducted online between 2022 and 2023, involving nursing students from various universities across Iran. The study employed the following procedures: forward-backward translation, assessment of face and content validities, concurrent validity analysis (n\u0026thinsp;=\u0026thinsp;80 nursing students), exploratory factor analysis (n\u0026thinsp;=\u0026thinsp;120), confirmatory factor analysis (n\u0026thinsp;=\u0026thinsp;220), and reliability analysis, which included the assessment of Cronbach's alpha coefficient, interclass correlation coefficient, interpretability, and ceiling and floor effects.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 370 nursing students participated in the study. After ensuring the face and content validities, the concurrent validity was confirmed (r\u0026thinsp;=\u0026thinsp;0.89). The five factors extracted in the exploratory factor analysis, which accounted for 80.74% of the explained variance, were subsequently confirmed in the confirmatory factor analysis. The Cronbach's alpha coefficient was found to be 0.85. Additionally, the interclass correlation coefficient for the total scale was 0.812, and there were no ceiling or floor effects observed (0%).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe present study confirms the validity and reliability of the Nursing Start-up Attitude Scale in the Iranian context. This scale can serve as a valuable tool for identifying both the strengths and areas for improvement in nursing entrepreneurial education programs. By utilizing the Nursing Start-up Attitude Scale, these programs can effectively enhance the development of entrepreneurial skills among future nursing professionals.\u003c/p\u003e","manuscriptTitle":"Psychometric Properties of the Nursing Start-up Attitude Scale in Iranian nursing students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-13 11:51:09","doi":"10.21203/rs.3.rs-5304614/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-01T08:46:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-01T08:42:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-01T05:18:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2024-10-21T12:46:38+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":"edba0041-f15f-4c87-ac05-c6f2e748d06a","owner":[],"postedDate":"November 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-27T16:03:36+00:00","versionOfRecord":{"articleIdentity":"rs-5304614","link":"https://doi.org/10.1186/s12912-024-02631-3","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-01-21 15:57:03","publishedOnDateReadable":"January 21st, 2025"},"versionCreatedAt":"2024-11-13 11:51:09","video":"","vorDoi":"10.1186/s12912-024-02631-3","vorDoiUrl":"https://doi.org/10.1186/s12912-024-02631-3","workflowStages":[]},"version":"v1","identity":"rs-5304614","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5304614","identity":"rs-5304614","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}