Date of Award


Degree Name

Doctor of Nursing Science


empirical instruments, health education, nursing, psychometric evaluation


The purpose of this research was to conceptualize, construct and establish psychometric properties of an instrument to examine unmeasured dimensions of autonomy in practice through a process of retroduction and triangulation. In the context of ongoing rapid change and increasing competition in the health care delivery arena there is valid reason for nursing and other health professions to be concerned with their autonomous practice status. However, research and instrumentation activities have been hindered by the abstract nature of autonomy with only limited theoretical dimensions empirically measured. There is need to develop new, original, useful, and generalizable tools with a wide range of variables that have relevance for understanding, prediction, and control related to autonomy in practice in the present and future health care arena. Theoretical literature and empirical studies of autonomy were critically reviewed for conceptual analysis and identification of dimensions. This deductive pursuit was supplemented by an inductive study with in-depth interviews of 28 key informants. The resultant conceptual schema presented four theoretical unmeasured dimensions of readiness, empowerment, actualization, and valuation of autonomy in practice. Item formulation emerged through content analysis of authentic verbalizations from the qualitative study and the theoretical and empirical literature. The instrument was developed with a Likert-type format and a five point scaling and summated scoring basis related to the extent of autonomous behaviors in practice. The Content Validity Index of the Dempster Practice Behaviors Scale (DPBS) was 1.00. Based on a sample of 569 practicing registered nurses, psychometric evaluation including exploratory and confirmatory factor analysis reduced the DPBS to 30 items. Cronbach's alpha for the instrument was.95 with an inter-item correlation mean of.39. Moderate to high subscale correlations evidenced empirical unidimensionality. Using a multitrait-multimethod matrix, construct validity was established through application of convergent and discriminant procedures. Therefore, the theoretically multidimensional DPBS was determined to have strong initial psychometric properties. It is felt the Dempster Practice Behaviors Scale has potential to expand measurement parameters of autonomy in practice to the benefit of nursing and other professions.

Document Type

Dissertation: Open Access



Included in

Nursing Commons