The development and psychometric validation of an instrument to evaluate nurses' attitudes towards communication with the patient (ACO).

Background: Patient communication is a key skill for nurses involved in clinical care. Its measurement is a complex phenomenon that can be addressed through attitude evaluation.

Objectives: To develop and psychometrically test a measure of nurses' attitudes towards communication with patients (ACO), to study the relationship between these dimensions, and to analyse nursing attitudes.

Design: To develop and psychometrically test the ACO questionnaire.

Settings: All hospitals in the province of Valencia were invited by e-mail to distribute the ACO instrument. Ten hospitals took part in the study.

Participants: The study population was composed of a convenience sample of 400 hospital nurses on general or special services. The inclusion criteria were nurses at the selected centres who had previously provided an informed consent to participate.

Methods: A literature review and expert consultation (N = 10) was used to develop the content of the questionnaire. The 62-item version of the instrument was applied to a convenience sample of 400 nurses between May 2015 and March 2016. Factor structure was evaluated with exploratory and confirmatory factor analysis (EFA, CFA), and reliability was evaluated with Cronbach's alpha, composite reliability (CR), and average variance extracted (AVE).

Results: The final instrument (ACO), composed of 25 items grouped into three attitude dimensions (cognitive, affective and behavioural), had good psychometric properties. In the study sample, nurses had a favourable attitude towards communication. The cognitive and affective dimensions of the ACO should be able to predict the behaviour dimension.

Conclusion: The ACO is useful for evaluating current clinical practices, identifying educational needs and assessing the effectiveness of communication training or other interventions intended to improve communication.