Luppo Kuillman

Chapter 2 46 Strengths and limitations One of the major strengths of this research lies in its robust study design (employing CFA), including the assessment of the convergent and divergent validity of the scales. Another important strength is that the results are based on a representative sample that reflects the characteristics of the PA and NP workforces in the Netherlands with regard to gender and age (Laurant, van de Camp, Boerboom, & Wijers, 2014). For this reason, the results can be generalized to a certain extent to both the NP and PA workforces at large. We also expect that the MSQ-DELIB and MSQ-PATER are applicable to other healthcare professionals who share a comparable framework regarding knowledge, skills, and legal boundaries (e.g., MDs). One weakness of the study, however, is that the stability of the instrument (ie, its test-retest reliability) was not assessed. The study design did not allow for testing the two scales for longitudinal validity. By definition, cross-sectional studies cannot examine the stability of the attitudes or traits of subjects over time. A follow-up study will investigate longitudinal psychometric research questions focusing on the test- retest stability of the instruments. Another limitation of the current study is that no a priori calculations of sample size were performed. Given the lack of studies assessing moral sensitivity among PAs and NPs, however, the field was open to exploration. Given the actual sample size addressed in the study (155 records), it may not be necessary to assume that the results of our CFA were compromised by the sample size. Although we are aware of the various rules and opinions used to determine the sample size needed for CFA, this study was based on a convenience sample with an N (=155) to P (number of items = 11) ratio of 14.1. We therefore felt confident that the assumption underlying CFA was not violated. (Gagne & Hancock, 2006) Finally, even though our analyses revealed statistically significant correlations for both the MSQ-DELIB and the MSQ-PATER scales based on convergent and divergent instruments, the explained variances were relatively low. CONCLUSION The results of this study provide evidence of two new latent dimensions derived from the items of the original MSQ. Because the scales MSQ-DELIB and MSQ-PATER have been validated only for NPs and PAs, further exploration and validation may be needed before the three items with loadings less than 0.40 from Factor 1 (MSQ-