New 28-Item Scale Measures How Deeply Nurses Feel Ownership of Patient Care

Psychology has long recognized that people treat the things they feel they own differently from the things they merely use. A gardener tends an allotment with an intensity no hired laborer can match, and a founder defends a startup with a ferocity no salaried manager usually replicates. Researchers call this phenomenon psychological ownership: the felt sense that a target, whether material or abstract, is mine. A team of Iranian nursing scientists has now brought this concept into the clinical workplace with a rigorously validated measuring instrument, the Nursing Care Psychological Ownership Scale, or NCPOS, designed to quantify how strongly nurses feel that the care they deliver belongs to them. The work, published in BMC Nursing, describes both the construction of the instrument and the extensive statistical testing that supports its use.

The research team, led by Mansoureh Ashghali Farahani and Elham Akhlaghi of Iran University of Medical Sciences together with Hamid Sharif-Nia of Mazandaran University of Medical Sciences and Mansoureh Z. Tafreshi of Shahid Beheshti University of Medical Sciences, began from a simple but consequential premise. Psychological ownership, they argue, is not a vague motivational buzzword but a measurable psychological state with real behavioral consequences. When a nurse feels genuine ownership of patient care, that feeling is expected to translate into more attentive, more responsible, and more holistic caring behavior. Until now, however, the field lacked a validated instrument capable of capturing this construct specifically in the context of nursing care, rather than in organizational settings more broadly.

The study followed a sequential-exploratory mixed-method design, a strategy deliberately chosen when existing theory is too thin to generate items from the literature alone. In the first, qualitative phase, the researchers interviewed 13 nurses in depth, asking them to describe their lived experience of feeling, or failing to feel, that patient care was theirs. From these narratives, and from a subsequent item-analysis stage, the team drafted an initial pool of candidate statements. Each item was then screened for content validity, including computation of the Content Validity Ratio, a classical index that quantifies how many experts judge an item to be essential. Items that survived this filtering were assembled into a 28-item scale, meaning the qualitative material was distilled into a compact questionnaire suitable for large-scale administration.

The second, quantitative phase recruited 400 nurses for a cross-sectional survey, providing a sample large enough for the factor-analytic machinery of modern psychometrics. The first analytical step was exploratory factor analysis, a technique that examines the pattern of correlations among items and asks whether a smaller number of latent dimensions can explain those correlations. The analysis was encouraging from the outset: the Kaiser-Meyer-Olkin measure of sampling adequacy reached 0.935, a value far above the conventional 0.60 threshold and an indication that the items shared strong common variance, while Bartlett’s test of sphericity was significant at p below 0.001, confirming the data were factorable.

Exploratory factor analysis extracted five distinct factors that together accounted for 42.26 percent of the total variance in responses. The researchers labeled these dimensions Holistic Support, with seven items; Professional Identity, with five items; Responsibility, with six items; Interactive Interaction, with six items; and Competence, with four items. The labels themselves offer a psychological map of what ownership of care means to working nurses. It encompasses the breadth of support a nurse provides around the patient, the degree to which professional identity is fused with the caregiving role, the felt obligation to answer for outcomes, the quality of interaction with patients and colleagues, and the confidence in one’s own clinical skill.

Because exploratory factor analysis can, in principle, find structure in noise, the team then subjected the five-factor solution to confirmatory factor analysis, a stricter procedure in which a predefined model is tested against the data rather than derived from it. The five-factor model showed acceptable fit: the ratio of chi-square to degrees of freedom was 2.27, comfortably within the commonly accepted range below 3, and the root mean square error of approximation was 0.056, below the 0.08 threshold generally treated as indicating reasonable fit. In plain terms, the structure discovered in one half of the analysis held up when tested as a hypothesis in the other.

The investigators then turned to the questions that determine whether a scale is scientifically useful rather than merely statistically elegant. Convergent validity was established through composite reliability and average variance extracted, indices showing that items intended to measure the same construct do in fact correlate strongly with one another. Discriminant validity was assessed with the heterotrait-monotrait ratio, or HTMT, which verifies that the five factors, although related, are genuinely distinct from one another rather than redundant reflections of a single general positivity. Internal consistency was confirmed twice over, with both Cronbach’s alpha and McDonald’s omega exceeding 0.7 for the scales, the standard benchmark for acceptable reliability.

Stability over time, a property often neglected in scale development, was also examined. The intraclass correlation coefficient reached 0.951, an exceptionally high figure indicating that nurses’ scores remained nearly identical across repeated administrations, so the instrument measures a stable disposition rather than a fleeting mood. Equally important, the analyses found no floor or ceiling effects, meaning the scale neither bunches respondents at the bottom nor at the top of its range. A scale with such effects loses sensitivity at the extremes and cannot detect meaningful change; the NCPOS avoids this pitfall and therefore retains full measurement resolution across the spectrum of ownership levels.

Why does this matter beyond the psychometric laboratory? The concept of patient care ownership has been linked in the broader literature to accountability, professional autonomy, and the quality and safety of care. A validated measure gives hospital administrators and nursing researchers a tool for the first time to quantify this construct, to test whether it predicts outcomes such as patient satisfaction, adverse events, or nurse retention, and to evaluate whether interventions aimed at strengthening ownership actually work. The five-factor structure also gives managers a diagnostic vocabulary: a unit may score well on competence yet poorly on interactive interaction, suggesting a specific target for improvement rather than a diffuse call for engagement.

The authors are careful to scope their claims appropriately. The instrument was developed and validated among Iranian nurses, and its conclusion is correspondingly modest: the 28-item NCPOS is a valid and reliable measure of psychological ownership of care within the Iranian nursing community. Cross-cultural validation in other health systems remains a task for future research, as does longitudinal work testing whether ownership scores prospectively predict caring behavior. The study was approved by the ethics committee of Iran University of Medical Sciences under code IR.IOMS.REC.1399.1105, conducted in accordance with the Declaration of Helsinki, and carried out without external funding. Even with those caveats, the work represents a concrete step in a growing movement to bring the psychology of ownership out of the laboratory and into the ward, where the difference between caring for a patient and owning that care may be the difference between a task completed and a life genuinely attended to.

Subject of Research: Development and psychometric validation of a scale measuring nurses' psychological ownership of patient care

Article Title: Development and psychometric evaluation of nursing care psychological ownership scale: a sequential-exploratory mixed-method study

Article References: Ashghali Farahani, M., Sharif-Nia, H., Z. Tafreshi, M., & Akhlaghi, E. (2026). Development and psychometric evaluation of nursing care psychological ownership scale: a sequential-exploratory mixed-method study. BMC Nursing. https://doi.org/10.1186/s12912-026-05019-7

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05019-7

Keywords: psychological ownership, nursing care, psychometrics, scale development, factor analysis, validity, reliability, nursing research, mixed methods, patient care ownership, Iran, BMC Nursing