Validated Scale Measures Chinese Nurses’ Protection Motivation After Needlestick Injuries

Needlestick injuries remain one of the most persistent occupational hazards in modern healthcare, and a new study published in Discover Psychology offers a fresh psychological lens on why so many nurses fail to seek timely screening after being stuck by a contaminated needle. In a single-author investigation conducted by ZhengDa Long of the Department of Nursing at Wuming Hospital of Guangxi Medical University in Nanning, China, researchers developed and validated a purpose-built questionnaire—the Nurses’ Motivation for Screening Protection after Needlestick Injuries Scale, or NMSP-NSI—designed to measure the psychological forces that drive, or fail to drive, nurses toward post-exposure screening. The work, published as an open-access article on 13 August 2026, is grounded in protection motivation theory, a well-established framework in health psychology that explains how people weigh threats against their perceived ability to respond.

Protection motivation theory, first articulated by Ronald Rogers in the 1970s and refined in the decades since, proposes that protective behavior is the product of two parallel appraisal processes. The first is threat appraisal, in which an individual judges how susceptible they are to a hazard, how severe its consequences would be, and how much fear the hazard arouses. The second is coping appraisal, in which the individual evaluates whether a recommended response would actually work (response efficacy), what that response would cost them in time, money, or discomfort (response costs), and whether they are personally capable of carrying it out (self-efficacy). When the perceived threat outweighs the perceived barriers, protective motivation rises; when barriers loom larger, motivation collapses. In the context of a needlestick injury, this translates into a stark set of questions: How likely is the source patient to carry hepatitis B, hepatitis C, or HIV? How severe would infection be? Would screening and follow-up actually reduce harm, and can the nurse realistically navigate the hospital’s reporting bureaucracy to complete it?

The scale’s construction followed a rigorous multi-stage pipeline. The initial item pool was generated through a systematic literature review and semi-structured interviews with clinical nurses, ensuring that the questionnaire reflected the lived experience of frontline staff rather than armchair theorizing. The pool was then refined through two rounds of Delphi expert consultation, a structured method in which a panel of subject-matter experts independently rates and comments on draft items across successive rounds until consensus emerges. This approach is particularly valued in instrument development because it filters out ambiguous, redundant, or theoretically misaligned items before expensive data collection begins. The result was a candidate questionnaire ready for empirical testing in the field.

For the psychometric evaluation, Long recruited 431 clinical nurses using purposive sampling, a technique that deliberately selects participants with direct relevance to the research question—in this case, nurses with clinical exposure to needlestick injury risk. The full sample was used for classical item analysis, examining metrics such as item discrimination and floor and ceiling effects. The sample was then randomly split into two halves: subsample A, comprising 215 nurses, for exploratory factor analysis, and subsample B, comprising 216 nurses, for confirmatory factor analysis. This split-sample strategy is considered best practice in scale validation because it prevents the same data from being used both to discover a factor structure and to confirm it, which would inflate apparent fit. Separately, 77 nurses completed the scale a second time after two weeks, allowing the researchers to compute test–retest reliability. Content validity was assessed using content validity indices, in which expert raters judge the relevance of each item to the underlying construct.

The exploratory factor analysis on subsample A identified six common factors corresponding exactly to the theory-driven dimensions: perceived susceptibility, perceived severity, fear arousal, response efficacy, response costs, and self-efficacy. Together these factors explained 75.176 percent of the total variance, an unusually high figure that suggests the six dimensions capture the bulk of the meaningful variation in nurses’ protection motivation. Confirmatory factor analysis on subsample B produced mixed but broadly supportive fit indices: the comparative fit index and incremental fit index both reached 0.903, hovering at the conventional threshold of 0.90 for acceptable fit, while the root mean square residual of 0.038 and standardized root mean square residual of 0.063 fell comfortably within accepted limits. The root mean square error of approximation, however, registered 0.105, above the commonly cited 0.08 threshold, indicating that while the six-factor model is a reasonable approximation of the data, some local misfit remains—likely reflecting overlapping variance between conceptually adjacent dimensions.

Reliability figures were strong across the board. Cronbach’s alpha for the overall 24-item scale reached 0.955, indicating exceptional internal consistency, and composite reliability for the individual dimensions ranged from 0.851 to 0.959, all well above the 0.70 benchmark. The average variance extracted, a measure of how much of a construct’s variance is explained by its own indicators relative to measurement error, ranged from 0.590 to 0.855, exceeding the conventional 0.50 threshold for all six dimensions. Split-half reliability, computed using both the Spearman–Brown coefficient (0.771) and Guttman’s coefficient (0.736), was moderate to good, and the two-week test–retest coefficient of 0.936 demonstrated that the scale yields highly stable scores over time—an essential property for an instrument intended to track motivation before and after interventions. Content validity was equally impressive, with item-level content validity indices ranging from 0.93 to 1.00 and a scale-level index of 0.97 based on the averaging method.

Discriminant validity, the degree to which the six dimensions are empirically distinguishable from one another, was tested using the Fornell–Larcker criterion, which requires that the square root of each construct’s average variance extracted exceed the correlations between that construct and all others. The criterion was satisfied for most construct pairs, with one notable exception: response efficacy and response costs sat at the boundary of the criterion, meaning the data could not cleanly separate the perceived benefits of screening from the perceived burdens of undergoing it. This finding is theoretically interesting rather than merely statistical. It suggests that for many nurses, the calculus of whether screening “works” and whether screening is “worth it” are psychologically intertwined—perhaps because the efficacy of screening is judged largely in terms of whether its inconvenience and expense justify the protection it affords. The author explicitly recommends that the stability of the factor structure and the distinction between these two constructs be re-examined in independent samples.

The practical implications of the NMSP-NSI extend well beyond the psychometrics laboratory. Needlestick injuries expose nurses to bloodborne pathogens including hepatitis B virus, hepatitis C virus, and HIV, and post-exposure protocols—immediate washing, reporting, source-patient testing, and serial screening of the injured worker—are only effective if nurses actually complete them. Underreporting and incomplete follow-up are chronic problems in hospitals worldwide, driven by factors the new scale is designed to capture: underestimation of susceptibility, minimization of severity, fear of stigma or job repercussions, uncertainty about whether screening helps, and perceived logistical burdens. By pinpointing which of the six motivational dimensions is weakest in a given nurse or department, hospital administrators and occupational health teams can tailor education and process redesign precisely where they are needed, rather than delivering generic safety lectures that may miss the actual psychological bottleneck. A nurse who already understands the severity of HIV but doubts her self-efficacy in navigating the reporting system needs a very different intervention from one who simply does not perceive the injury as a threat.

The study was conducted entirely online, with participants receiving key information about the purpose, content, and confidentiality of the research before indicating consent—an approach approved by the Research Ethics Committee of Wuming Hospital of Guangxi Medical University under decision number WM-2025(11) and conducted in accordance with the Declaration of Helsinki. The work was funded by the 2023 Guangxi University Young and Middle-aged Teachers’ Scientific Research Basic Ability Enhancement Project (no. 2023KY0077) and the 2025 Self-funded Scientific Research Project of the Health Commission of the Guangxi Zhuang Autonomous Region (no. Z-A20250654). The author acknowledges the contributions of the participating nurses, the Delphi expert panel, and staff at the eight hospitals that assisted with data collection.

As an open-access publication released under a Creative Commons Attribution-NonCommercial-NoDerivatives license, the article makes its instruments and findings freely available to occupational health researchers globally, and the author notes that the version shared is a citable, DOI-bearing early-release that will be superseded by the final Version of Record. Whether the NMSP-NSI will prove equally valid in healthcare systems outside China, among other at-risk professions such as physicians, laboratory technicians, and sanitation workers, and whether motivational scores actually predict real-world screening behavior over time, are questions for future research. But the study marks a meaningful step toward treating post-exposure screening not merely as a protocol to be enforced, but as a psychological decision to be understood—and, with the right tools, nudged in the direction of safety.