Development and validation of a questionnaire assessing nurses’ negative emotional responses to single-checking medications: a cross-sectional survey in Japanese university hospitals
- 1Department of Patient Safety, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 2Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- 3Japanese Red Cross Osaka Hospital, Osaka, Japan
Abstract
Objectives Medication errors are a major patient safety concern, and double-checking is a commonly used method to mitigate risks during administration. Despite its questionable efficacy, Japanese hospitals are reluctant to transition to single-checking, particularly due to nurses’ resistance. This study developed and psychometrically evaluated a questionnaire assessing nurses’ negative emotional responses to single-checking medications to enable targeted interventions aimed at easing their resistance.Design Cross-sectional survey, with multisource questionnaire development and psychometric validation.Setting Three Japanese university hospitals. Surveys were distributed in September–October 2023.Participants Full-time registered nurses working in inpatient wards, not in management positions, with more than 1 year of experience. Of 1861 questionnaires distributed, 1224 (66%) were analysed.Outcome measures Psychometric evaluation included exploratory factor analysis (EFA), internal consistency reliability (Cronbach’s α), convergent validity against the Japanese version of the State–Trait Anxiety Inventory (STAI) and known-groups validity across levels of nursing experience and duration of single-checking practice.Results EFA (maximum-likelihood extraction, Promax rotation) supported a final four-factor, 18-item solution (Kaiser-Meyer-Olkin=0.947, 64.6% variance explained). Factors were as follows: lack of self-confidence (α=0.92), fear of error due to situational factors (α=0.84), fear of being held responsible (α=0.91) and fear of being perceived as inadequate (α=0.80). Items were scored 1–5, with higher scores indicating stronger negative emotional responses; factor means ranged from 2.23 to 3.23. Correlations with the STAI were low-to-moderate (r=0.23–0.45), supporting convergent validity while indicating the questionnaire is not simply a proxy for state and trait anxiety. Known-groups validity was supported: early-career nurses scored 11.1 points higher than experienced nurses (d=0.85, p<0.001), with similar patterns for recent versus veteran single-checkers (d=0.67, p<0.001)—all exceeding the prespecified minimal important difference.Conclusions The questionnaire demonstrates promising preliminary reliability and validity for assessing nurses’ negative emotional responses towards single-checking medications. Its factor structure could allow targeted interventions to address resistance during the transition to single-checking.
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BibTeX
@article{ganbileg2026development,
title = {{Development and validation of a questionnaire assessing nurses’ negative emotional responses to single-checking medications: a cross-sectional survey in Japanese university hospitals}},
author = {Altanshagai Ganbileg and Megumi Iida and Yu Hidaka and Takashi Yamamoto and Mariko Morishita and Sawako Hiroi and Yumi Matsumura},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-120532},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120532},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Development and validation of a questionnaire assessing nurses’ negative emotional responses to single-checking medications: a cross-sectional survey in Japanese university hospitals
AU - Altanshagai Ganbileg
AU - Megumi Iida
AU - Yu Hidaka
AU - Takashi Yamamoto
AU - Mariko Morishita
AU - Sawako Hiroi
AU - Yumi Matsumura
PY - 2026
DA - 2026/10/23
JO - BMJ Open
DO - 10.1136/bmjopen-2026-120532
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120532
AB - Objectives Medication errors are a major patient safety concern, and double-checking is a commonly used method to mitigate risks during administration. Despite its questionable efficacy, Japanese hospitals are reluctant to transition to single-checking, particularly due to nurses’ resistance. This study developed and psychometrically evaluated a questionnaire assessing nurses’ negative emotional responses to single-checking medications to enable targeted interventions aimed at easing their resistance.Design Cross-sectional survey, with multisource questionnaire development and psychometric validation.Setting Three Japanese university hospitals. Surveys were distributed in September–October 2023.Participants Full-time registered nurses working in inpatient wards, not in management positions, with more than 1 year of experience. Of 1861 questionnaires distributed, 1224 (66%) were analysed.Outcome measures Psychometric evaluation included exploratory factor analysis (EFA), internal consistency reliability (Cronbach’s α), convergent validity against the Japanese version of the State–Trait Anxiety Inventory (STAI) and known-groups validity across levels of nursing experience and duration of single-checking practice.Results EFA (maximum-likelihood extraction, Promax rotation) supported a final four-factor, 18-item solution (Kaiser-Meyer-Olkin=0.947, 64.6% variance explained). Factors were as follows: lack of self-confidence (α=0.92), fear of error due to situational factors (α=0.84), fear of being held responsible (α=0.91) and fear of being perceived as inadequate (α=0.80). Items were scored 1–5, with higher scores indicating stronger negative emotional responses; factor means ranged from 2.23 to 3.23. Correlations with the STAI were low-to-moderate (r=0.23–0.45), supporting convergent validity while indicating the questionnaire is not simply a proxy for state and trait anxiety. Known-groups validity was supported: early-career nurses scored 11.1 points higher than experienced nurses (d=0.85, p<0.001), with similar patterns for recent versus veteran single-checkers (d=0.67, p<0.001)—all exceeding the prespecified minimal important difference.Conclusions The questionnaire demonstrates promising preliminary reliability and validity for assessing nurses’ negative emotional responses towards single-checking medications. Its factor structure could allow targeted interventions to address resistance during the transition to single-checking.
SN - 2044-6055
SN - 2044-6055
ER -