Measurement of professional nursing communication competence: Psychometric properties of the Nursing Communication Competence Measurement Instrument.

Background: Effective communication plays a crucial role in improving nursing practices and health outcomes, leading to higher patient satisfaction and enhanced safety. The Nursing Communication Competence Measurement Instrument was developed to address gaps in evaluating communication competence. This tool is applicable for both simulation-based education and real-world clinical practice, providing a valuable framework for assessment. Objective: To assess the psychometric properties of the Nursing Communication Competence Measurement Instrument, focusing on its components of knowledge, skills, and attitudes. The study aims to standardize and normalize its administration while also conducting a cross-cultural adaptation. Design: Methodological study. Settings: The study was conducted at the Simulation Laboratories of the Federal University of Piauí (northeastern Brazil), the Federal University of Paraná, and the Pequeno Príncipe College (both in southern Brazil). Participants: A total of 249 senior undergraduate nursing students participated in the study. Method: The study was conducted in three phases: (a) planning educational interventions, which included delivering classes and applying simulation-based education focused on the targeted competency; (b) conducting psychometric analyses to assess dimensionality, item difficulty, discrimination, and internal consistency reliability; and (c) establishing the standardization and normalization of the instrument. Data were collected at three points: before the communication competence class, immediately after the clinical simulation scenario, and after the simulation debriefing. Results: Participants (n = 249) had a mean age of 24.4 years (SD = 4.6), with 87.6 % identifying as women. Most were in the final year of undergraduate nursing education, and over half (53.8 %) had recent experience with advanced clinical simulation. Confirmatory Factor Analysis confirmed the three-dimensional structure of the instrument- knowledge (ω = 0.928), skills (ω = 0.927), and attitudes (ω = 0.939) - with excellent model fit (CFI = 1.00, TLI = 1.00, GFI = 0.98, RMSEA = 0.000, SRMR = 0.059) and high overall internal consistency (ω = 0.972). Item Response Theory analysis revealed strong psychometric performance, with discrimination values ranging from moderate (1.21) to very high (3.13); 69.6 % of the items demonstrated very high discrimination, and items covered a wide range of difficulty levels across the latent trait continuum. The normalization process transformed raw scores into a percentage-based effectiveness index, facilitating participant classification into five levels of communication competence: non-effective, slightly effective, moderately effective, very effective, and extremely effective. These findings support the validity, reliability, and interpretability of the instrument for assessing professional nursing communication competence. Conclusion: The instrument demonstrated validity, reliability, and accuracy as an educational tool for assessing communication competence in nursing. It effectively differentiated student proficiency levels, identified challenges in advancing the Likert scale, and established cutoff points to rank the components of competence. The instrument's reliability and accuracy in pinpointing gaps in knowledge, skills, and attitudes make it well-suitable for simulation-based education, clinical practice, and classroom settings. It can be used for formative, summative, and high-stakes assessments, benefiting educators and learners.