The research, led by Gürkan Özden, Öznur İpek Aslan, Ahmet Ceviz, and Sevim Dolu, was a methodological study, meaning its goal was not to test a treatment or measure a health outcome but to build and verify an instrument. The team recruited 240 nursing students in their second, third, or fourth years at a state university in eastern Türkiye. Data collection took place entirely online between November and December 2024, using a descriptive information form alongside the scale itself. Before any student could access the questionnaire, an electronic consent process required them to read an information tab describing the study’s purpose and voluntary nature and to actively select an option agreeing to participate.

Why does rights awareness matter so much in nursing education specifically? Clinical training environments differ radically from lecture halls. Students rotate through operating theatres, emergency departments, and internal medicine wards, each with its own hierarchies, pace, and hazards. In these settings, a student may be asked to perform procedures beyond their competence, work shifts that conflict with regulations, or simply endure treatment that a licensed professional would recognize as inappropriate. Without awareness of their rights, students cannot assert them; and without a valid measurement tool, educators and researchers cannot even quantify how widespread the gaps in awareness are. That measurement gap is precisely what the Turkish adaptation is designed to close.

The validation process followed the internationally recognized standards of psychometric scale adaptation. Translation and cultural adaptation come first, ensuring that each item means the same thing in Turkish as it did in the original language, and that concepts such as the right to supervision or the right to a safe working environment make sense in the Turkish clinical context. Crucially, the team obtained permission from Mi-Young Choi, the original author of the scale, before beginning the work, a step that reflects proper scientific practice in cross-cultural instrument adaptation.

Validity was assessed through two complementary approaches. First, content validity analysis asked expert reviewers to judge whether each item adequately captures the construct it targets. The results were exceptionally strong: the scale-level Content Validity Index came out at 0.95, far above the commonly recommended threshold of around 0.80, indicating near-consensus among experts that the translated items faithfully represent the domain of nursing students’ rights in clinical practice. Second, confirmatory factor analysis, a structural equation modeling technique, tested whether the data collected from the 240 students fit the theoretical structure of the original instrument. The analysis confirmed the original three-factor structure, meaning that the items cluster into the same three dimensions of rights awareness that the original scale proposed, and the three factors together explained 67.5 percent of the total variance in responses, a proportion generally regarded as very satisfactory for a multidimensional health sciences scale.

Reliability, the second pillar of the study, concerns whether the instrument produces consistent measurements. The Turkish version demonstrated excellent internal consistency, with a Cronbach’s alpha of 0.97. Alpha values range from 0 to 1, and values above 0.90 are typically considered excellent; a value of 0.97 means that the items within the scale respond in a highly coordinated fashion, so students who score high on some items tend to score high on the others as well. The researchers also evaluated temporal stability, the degree to which the instrument yields similar results when administered at different points in time under unchanged conditions, and found good stability. In addition, every item-total correlation exceeded the recommended minimum threshold, confirming that no single item behaves erratically relative to the scale as a whole, and factor loadings were satisfactory across all three dimensions.

The technical rigor of these analyses deserves some unpacking for readers unfamiliar with psychometrics. Confirmatory factor analysis works by specifying a model in advance, here the hypothesized three-factor structure, and then using maximum likelihood estimation to determine how well the observed pattern of answers could have been produced by that model. Fit statistics such as the Comparative Fit Index, the Tucker-Lewis Index, the Root Mean Square Error of Approximation, and the Standardized Root Mean Square Residual quantify the closeness of the fit, allowing researchers to state with quantitative confidence whether the translated instrument truly measures the same construct as the original. The confirmation of the three-factor structure in a different language and culture is more than a formality; it is evidence that the concept of clinical rights awareness is a coherent, cross-culturally stable construct rather than an artifact of one country’s educational system.

The practical implications reach well beyond psychometric theory. With a validated Turkish-language instrument in hand, nursing faculties across Türkiye can now systematically assess how aware their students are of their rights before, during, and after clinical placements. Nursing schools could incorporate the scale into orientation programs to identify incoming students who need targeted education on professional rights, ethics, and self-advocacy. Researchers can use it to compare awareness levels across universities, regions, and years of study, and to evaluate whether specific interventions, such as rights-focused workshops or revised clinical supervision policies, actually raise awareness over time. Over the longer term, aggregated data from such measurements could inform national accreditation standards and curricular reform in nursing education.

The study also contributes to a broader conversation in health professions education about the ethics of clinical training. Nursing, like medicine, relies heavily on apprenticeship-style learning in real care environments, and the tension between service delivery and education is inherent to that model. Students in every country report experiences ranging from being used as extra pairs of hands to facing outright mistreatment. Measurement instruments like this one are a precondition for evidence-based policy: institutions cannot fix what they cannot measure. The authors note that awareness of rights is essential precisely because nursing students train in such varied clinical settings, and the new Turkish scale gives Turkish-speaking educators the tools to quantify that essential quality.

The findings, published open access so that any educator or researcher can read and use them, mark a concrete step forward for nursing education research in Türkiye and provide a template for future adaptations in other languages. The study received no external funding, was approved by the Ethics Committee for Scientific Research and Publications of Inonu College of Health Sciences, and obtained institutional approval from the Dean’s Office of the Faculty of Nursing. For the 240 students who took part, and for the many thousands who will benefit from the instrument they helped validate, the message is clear: the rights of nursing students in clinical practice are now something that can be measured, tracked, and defended with scientific evidence rather than anecdote.

Subject of Research: Cross-cultural validation of a scale measuring nursing students' awareness of their rights in clinical practice

Article Title: Validity and reliability of the Turkish version of the nursing students’ rights awareness scale in clinical practice

Article References: Özden, G., İpek Aslan, Ö., Ceviz, A., & Dolu, S. (2026). Validity and reliability of the Turkish version of the nursing students’ rights awareness scale in clinical practice. BMC Nursing. https://doi.org/10.1186/s12912-026-05425-x

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05425-x

Keywords: nursing students, clinical practice, rights awareness, scale validation, psychometrics, confirmatory factor analysis, Cronbach's alpha, nursing education, Türkiye, reliability, content validity, BMC Nursing