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Validation of the Presence of Nursing Scale Using Data Triangulation

Hansbrough, Wendy B.; Georges, Jane M.

doi: 10.1097/NNR.0000000000000381

Background Nursing presence has been developed as a distinct concept with identifiable behaviors but remains only partially defined as a quantifiable construct.

Objectives This study asked if the Presence of Nursing Scale (PONS) is a reliable and valid instrument to measure nursing presence from the patient’s perspective.

Methods A convenience sample of 75 adult acute care inpatients were verbally administered the 25-item PONS considering the registered nurse taking care of them on the day of data collection. Open-ended questions elicited the patients’ explanations of their ratings. They also rated their overall satisfaction with the nursing care provided by the subject nurse using a 5-point scale.

Results The mean PONS score was 104.5 (SD = 17.26) on the 25–125 scale. Instrument reliability reported as a Cronbach’s alpha coefficient of .95 was .94 in this study. Instrument validity was tested correlating PONS scores to the satisfaction rating. The Spearman’s rho correlation was large and statistically significant, r (73) = .708. The higher the PONS score, the more satisfied the patient was with care from that nurse. Nineteen narratives selected from the lower quartile PONS scores (PONS < 99) and 11 from the upper quartile (PONS > 116) were thematically analyzed. Lower PONS scores corresponded with themes of patients being objectified as the work of the nurse without a respectful and caring nurse–patient relationship. Higher PONS scores coincided with patients’ perceptions of enhanced nurse–patient rapport, feelings of better coping, and decreased anxiety.

Discussion These results demonstrate reliability and validity of the PONS and add to the body of evidence about nurse behaviors exhibited in the nurse–patient relationship, which influence patients’ feelings of being cared for and satisfied with nursing care. These findings may be useful in the development of educational materials aimed at the advancement of nursing presence competency.

Wendy B. Hansbrough, PhD, RN, CNE, is Assistant Professor and Associate Director, California State University San Marcos School of Nursing.

Jane M. Georges, PhD, RN, is Professor and Dean, University of San Diego Hahn School of Nursing and Health Science, California.

Accepted for publication March 26, 2019.

The authors have no conflicts of interest to report.

Ethical Conduct of Research: This study was approved by the institutional review board of the University of California Human Research Protections Program and conducted according to human subjects research ethical conduct guidelines.

Clinical Trial Registration: NA

Corresponding author: Wendy B. Hansbrough, PhD, RN, CNE, School of Nursing, College of Education, Health and Human Services, California State University San Marcos, 333 S. Twin Oaks Valley Road, San Marcos, CA 92096-0001 (e-mail:

Online date: August 2, 2019

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