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Development and Validation of the Just Culture Assessment Tool for Nursing Education

Walker, Danielle PhD, RN, CNE; Altmiller, Gerry EdD, APRN, ACNS-BC, FAAN; Barkell, Nina MSN, RN, ACNS-BC; Hromadik, Lora PhD, RN; Toothaker, Rebecca PhD, RN

doi: 10.1097/NNE.0000000000000705
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Background Patient safety efforts in practice have focused on creating a just culture where errors can be identified and reported, and system remedies created to prevent reoccurrence. The same is not true of nursing education where student experiences with error and the sequelae that follow focus on individual performance.

Purpose The purpose of this study was to adapt the Just Culture Assessment Tool (JCAT) used in practice settings into a valid and reliable instrument to evaluate just culture in academic settings.

Methods A 27-item instrument was adapted for academia. Content validity was established. Reliability was determined in a pilot study with 133 prelicensure nursing students.

Results The scale content validity index (CVI) was calculated at 1. The reliability of the instrument is strong (α = .75).

Conclusions The CVI and pilot study findings support the use of the JCAT for Nursing Education as a valid and reliable instrument to evaluate student perception of just culture in academia.

Author Affiliations: Assistant Professor (Dr Walker), Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth; Professor (Dr Altmiller); School of Nursing, Health, and Exercise Science, The College of New Jersey, Ewing; Faculty (Ms Barkell), Nursing, Oakland Community College, Waterford, Michigan; Associate Professor (Dr Hromadik), Department of Nursing and Allied Health Professions, Indiana University of Pennsylvania; Assistant Professor (Dr Toothaker), Department of Nursing, Bloomsburg University, Pennsylvania.

The authors declare no conflicts of interest.

Correspondence: Dr Walker, TCU Box 298620, Fort Worth, TX 76129 (

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Accepted for publication: May 1, 2019

Published ahead of print: May 30, 2019

Online date: June 7, 2019

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