New 17-Item Questionnaire Measures Patient Experience in Nurse-Led Hospital Care

When a loved one is hospitalized, families in many countries face an exhausting dilemma: who will stay at the bedside, feed the patient, help with bathing, and relay information between exhausted staff and the person in the bed? In South Korea, the answer to that question has been changing. A national model known as the Integrated Nursing and Care Service (INCS) replaces family-dependent caregiving with nurse-led inpatient care, shifting the responsibility for daily bedside support from unpaid relatives and privately hired caregivers to trained nursing teams. Now, researchers report that they have built and validated a purpose-made questionnaire to find out what patients actually think of this new way of being cared for.

The study, published in BMC Nursing by Joo Yun Lee of Gachon University and colleagues, addresses a deceptively simple measurement problem. Patient experience is widely regarded as a key indicator of healthcare quality, and health systems around the world routinely survey patients about their stays. But the existing instruments were designed for conventional wards, where family members shoulder much of the daily care. In a nurse-led model, the entire texture of the hospital experience changes: who helps you to the bathroom, who explains your medication, who notices when you have not eaten. A generic questionnaire, the researchers argued, may simply not capture the features that matter most in this new arrangement.

To close that gap, the team carried out a methodological study that followed the classic sequence of instrument development. First, they mined the published literature for the dimensions of patient experience relevant to inpatient care. Then they conducted focus group interviews with nurses who work directly within the INCS model, an approach that grounds the questionnaire in the lived reality of the wards rather than in abstract theory. Items drafted from these sources were then subjected to expert content validation, in which specialists judged whether each item was clear, relevant, and representative of the construct it was meant to measure. Only after this multi-stage vetting did the candidate items advance to formal psychometric testing.

That testing drew on survey data from 237 recently discharged patients recruited across 126 hospitals, a notably broad sampling frame that spans a large share of the institutions delivering the INCS model. Because the respondents had all experienced nurse-led inpatient care firsthand, their ratings could be used to interrogate the internal structure of the draft scale. The researchers assessed construct validity, which asks whether the statistical pattern of patient responses matches the theoretical domains the questionnaire was designed around, as well as concurrent validity, which checks that scores on the new instrument behave as expected when compared against established measures of the same underlying concept.

The results were strikingly clean for an instrument at this stage of development. The final INCS Patient Experience Scale, abbreviated INCS-PES, settled at just 12 items organized into four domains: personalized care, information and communication, support for activities of daily living, and facilities and environment. Each domain maps onto a distinct question about the nurse-led ward. Personalized care probes whether treatment felt tailored to the individual. Information and communication examines whether patients understood what was happening to them and could converse effectively with staff. Support for activities of daily living captures the hands-on help with eating, hygiene, and mobility that families would traditionally have provided. Facilities and environment rounds out the picture with the physical conditions of the stay.

The statistical evidence for this four-factor structure was strong. Confirmatory analysis yielded a comparative fit index of 0.966 and a Tucker-Lewis index of 0.953, both comfortably above the conventional 0.95 threshold that psychometricians treat as indicating good model fit. The root mean square error of approximation, a measure of how far the model deviates from perfect fit, came in at 0.069, within the acceptable range. Internal consistency, which reflects how coherently the items within the scale hang together, was measured by Cronbach’s alpha at 0.90, a value generally interpreted as excellent for a multi-domain experience scale. Concurrent validity was also supported, meaning the new scale tracks with established measures of patient experience rather than diverging from them.

The 12-item scale does not stand alone. The researchers packaged it with three contextual items, which gather background about the patient’s hospitalization, and two global evaluation items, which ask for overall judgments of the care received. Together these components form the 17-item INCS Patient Experience Questionnaire, or INCS-PEQ. This architecture reflects a practical design philosophy: the core scale measures specific, actionable dimensions of the nurse-led care experience, while the contextual and global items allow administrators to interpret those scores and to benchmark overall satisfaction. A hospital can administer the full questionnaire in minutes, yet obtain a granular map of where its inpatient experience excels and where it falls short.

Why does this matter beyond South Korea? The INCS model emerged from a genuine systemic crisis. With one of the world’s lowest birth rates and a rapidly aging population, South Korea cannot rely indefinitely on family members, often adult children balancing jobs of their own, to provide unpaid bedside care. The nurse-led model professionalizes that work, and its expansion has been supported by the National Health Insurance Service of Korea, which supported the present research. But any large-scale service transformation needs feedback loops. Without a validated way to ask patients whether the new model is actually working for them, policymakers are steering by instruments that were built for a different ship. The INCS-PEQ supplies that instrument, and its development path, from nurse focus groups through expert review to a 237-patient validation sample, offers a template other countries could follow as they experiment with similar shifts away from family-dependent caregiving.

The study also carries a broader lesson for the science of measurement in healthcare. Instruments are not neutral rulers; they encode assumptions about what care looks like. When the structure of care changes fundamentally, as it does when informal caregivers are removed from the equation, the old rulers can silently mislead, undercounting the dimensions that matter and overweighting those that no longer apply. The four domains identified here, particularly the explicit attention to support for activities of daily living, would likely have been framed differently in a questionnaire intended for wards where families handle those tasks. In that sense, the INCS-PEQ is less a minor technical refinement than a recalibration of the yardstick to match a new reality of hospital care.

Limitations, as always, temper the enthusiasm. The validation rests on a single cross-sectional survey of 237 patients, and further work will be needed to confirm the instrument’s performance over time, across different hospital types, and in translated versions for international use. The authors themselves frame the questionnaire as a tool to support quality improvement and patient-centered care rather than a finished verdict on the INCS model. Still, the publication arrives at a moment when health systems worldwide are searching for ways to deliver more with fewer informal caregivers, and a rigorously validated, context-specific measure of patient experience is a small but consequential piece of that puzzle. Funded by a National Research Foundation of Korea grant from the Ministry of Science and ICT and approved by the Institutional Review Board of Sungshin Women’s University, the study was conducted with participants giving informed consent through a mobile-based survey system, in line with the Declaration of Helsinki. As nurse-led care models spread, the quiet work of asking patients what they experienced, and measuring the answers properly, may prove as important as the clinical reforms themselves.

Subject of Research: Development and validation of a patient experience questionnaire for nurse-led inpatient care in South Korea's Integrated Nursing and Care Service model

Article Title: Patient experiences in nurse-led inpatient care: development and validation of a questionnaire to support the shift toward patient-centered services

Article References: Lee, J. Y., Kim, S.-A., Park, J., Kwon, H., Kim, K., & Lee, E. (2026). Patient experiences in nurse-led inpatient care: development and validation of a questionnaire to support the shift toward patient-centered services. BMC Nursing. https://doi.org/10.1186/s12912-026-05458-2

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05458-2

Keywords: patient experience, nurse-led care, Integrated Nursing and Care Service, questionnaire validation, psychometrics, patient-centered care, inpatient care, South Korea, nursing research, instrument development, healthcare quality, BMC Nursing