ArticleInternational journal of nursing studies advances2026
Entrepreneurial and innovative skills in healthcare: Development and preliminary validation of an assessment instrument for Portuguese nurses.
Article in International journal of nursing studies advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Innovative and entrepreneurial competences, defined as the ability to identify opportunities, mobilize resources, and implement creative solutions responsibly, are essential for tackling complex challenges. In the health sector, particularly in nursing, these skills enhance innovation, quality of care, and sustainability of health services. Currently, there is no validated instrument with good psychometric properties designed for nurses that assesses these competencies. Objective: To develop a content-valid instrument to assess innovative and entrepreneurial competences in nurses. Methods: A three-phase instrument-development study was conducted from November 2024 to August 2025. Phase I comprised a narrative literature review and five focus groups to generate and refine items tailored to nursing practice. Phase II used a two-round Modified Delphi process with seven experts to evaluate the relevance and clarity of the instrument's title, instructions, response scale, and items; consensus was quantified using the item-level and scale-level Content Validity Index. Phase III involved a pre-test with 15 nurses from the target population to assess comprehensibility and perceived adequacy of each item. Results: Through the narrative literature review, seven instruments were identified that served as the basis for the experts' discussion in the five focus groups and subsequently for the assessment conducted in two rounds of the Delphi method. The resulting questionnaire includes 69 items mapped to the 15 EntreComp competences across three areas (Ideas and Opportunities, Resources, and Into Action) and uses a 7-point Likert response scale (1 - completely disagree to 7 - completely agree), with higher scores indicating higher perceived competence. In the second Delphi round, item-level Content Validity Index ranged from 0.86 to 1.000 and the overall scale Content Validity Index/Average was 0.96. In the pre-test, item comprehensibility/adequacy ranged from 87% to 100%, and minor semantic refinements were made to seven items. Conclusions: This study produced a content-valid instrument to assess innovative and entrepreneurial competences in nurses, grounded in the EntreComp framework and demonstrating strong expert consensus (scale Content Validity Index/Average = 0.96) and high comprehensibility among the target population. The final 69-item, 7-point Likert scale questionnaire fills an important gap in the field and shows promise for use in academic, clinical, and organizational contexts to foster innovation and entrepreneurship in nursing, pending further psychometric validation.
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