Development and Validation of a Conservation of Resources Theory-Based Scale for Patient Incivility, Emotional Labor, Ethical Norm Practice, and Patient Safety Behavior

Author : Chia-Yu Chang, Yan-Jyun Tsai, Yi-Wen Tsai, Tzu-Hsi Liu, Yii-Ching Lee

Abstract : This study aimed to develop and validate a measurement scale, based on the Conservation of Resources (COR) Theory, to assess patient incivility, emotional labor, ethical norm practice, and patient safety behavior, thereby establishing a reliable and valid measurement instrument. This study was approved by the Institutional Review Board (IRB). A purposive sample of healthcare professionals, including physicians, nurses, and allied health personnel, who had been employed for at least three months at a regional teaching hospital in central Taiwan, was recruited. The questionnaire was evaluated by four experts using the Content Validity Index (CVI), and inappropriate items were removed through a pilot test and item analysis. A total of 320 valid questionnaires (response rate = 98.4%) were collected. Confirmatory Factor Analysis (CFA) with Maximum Likelihood Estimation (MLE) was conducted to examine multivariate normality, convergent validity, discriminant validity, and model fit. CVI scores ranged from 0.94 to 1.00. After item analysis, 37 items were retained. CFA confirmed multivariate normality, and the standardized factor loadings, composite reliability (CR), and average variance extracted (AVE) all met the recommended criteria. After removing 10 items based on the modification indices (MI), the final model demonstrated good overall fit. The developed scale demonstrated satisfactory reliability and validity and can serve as an effective instrument for assessing patient incivility and its impact on healthcare professionals’ work behaviors and patient safety.

Keywords : Conservation of Resources Theory, Patient Incivility, Emotional Labor, Ethical Norm Practice, and Patient Safety Behavior.

Conference Name : International Conference on Nursing Workforce and Healthcare Development (ICNWHD-26)

Conference Place : Toronto, Canada

Conference Date : 3rd Aug 2026