Development of the Hospital Nurses' Silence Behavior Scale

Purpose: This study aimed to develop a scale to measure hospital nurses' silence behavior and examine its validity and reliability. Methods: A total of 52 preliminary items on hospital nurses' silence behavior were selected using a content validity test by seven experts on 53 candidate items derived from a literature review and in-depth interviews with 14 nurses. A total of 405 hospital nurses participated in a psychometric testing. Data analysis comprised item analysis, exploratory and confirmatory factor analyses, and convergent and discriminant validity tests. Pearson's correlation coefficient was used for assessing concurrent validity, and Cronbach's alpha was used for the reliability test. Results: The final scale consisted of nine factors with 31 items, exhibiting acceptable model fit indices, convergent validity, and discriminant validity. The score of the entire scale was positively correlated with the 'Organizational Silence Scale (OSS)-the issues on which nurses remain silent' (r =.60, p <.001) and 'OSS-the reasons why nurses remain silent' (r =.68, p <.001). Cronbach's alpha of the scale was.92, and alpha of each subscale ranged from.71 to.90. Conclusion: The Hospital Nurses' Silence Behavior Scale is a useful tool for assessing multifaceted silence behavior among nurses. It can provide basic data for developing better communication strategies among nurses and other hospital staff.