Psychometric evaluation of the ethical caring competency scale among Iranian Nurses: A methodological study

BACKGROUND: Nurses face complex ethical challenges across diverse healthcare settings, making ethical caring competency essential to professional practice. Given that Iranian nurses encounter ethically sensitive situations shaped by sociocultural and religious values and that no validated tool exists to assess this construct the aim of this study was to culturally adapt and psychometrically validate the Ethical Caring Competency Scale (ECCS) for use among Iranian nurses. METHODS: This methodological, cross‑sectional study included 697 registered nurses who were recruited through convenience sampling from seven teaching hospitals affiliated with Mazandaran University of Medical Sciences, Iran. Data were collected in person by the researcher through visits to hospital wards, during which nurses completed the instruments at the end of their work shifts. The Ethical Caring Competency Scale (ECCS; 22 items across four dimensions) was culturally adapted for the Iranian context following World Health Organization (WHO) translation protocols, including forward-back translation, expert panel review, and pilot testing with 20 nurses. Construct validity was evaluated using Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), Exploratory Graph Analysis (EGA), and the Random Forest Model (RFM). In addition, internal consistency reliability and measurement invariance across gender were examined. RESULTS: All 697 nurses fully completed the data collection instruments. Participants had a mean age of 35.17 ± 8.41 years and 10.55 ± 7.24 years of work experience; most were female (80.6%) and held a bachelor's degree (89.4%). EFA identified a four‑factor structure that explained 52.80% of the total variance. CFA results confirmed an adequate model fit, with all fit indices (PCFI = 0.737, PNFI = 0.713, CMIN/DF = 2.76, RMSEA = 0.071, IFI = 0.934, CFI = 0.933, and GFI = 0.918) meeting acceptable criteria. EGA results also reproduced the four-factor structure in 99.4% of bootstrap samples. Convergent validity (AVE > 0.5) and divergent validity (√AVE > inter-construct correlations) were confirmed. All reliability coefficients were above 0.7. The RFM demonstrated that the component 'Acting while thinking about how to provide better care' was the most significant factor (contributing 37.56%) in predicting the total ethical caring competency score. The measurement invariance test indicated that the factor structure was stable across genders. CONCLUSIONS: The Persian version of the ECCS demonstrated acceptable psychometric properties, a stable conceptual structure, cultural sensitivity, and good discriminant validity for the components of ethical caring competency. Therefore, it can be considered a valid and reliable instrument for assessing the ethical caring competency of nurses in Iran.