PROFESSOR MARIUSZ PANCZYK (Orcid ID : 0000-0003-1830-2114)

Accepted Article
Article type : Research Methodology: Instrument Development

Title: Psychometric properties of Authentic Leadership Self-Assessment

Questionnaire in a population-based sample of Polish nurses

Running title: Authentic Leadership Self-Assessment Questionnaire

Mariusz PANCZYK, Pharm.D, Assoc. Prof.

Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical
University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
Mariusz JAWORSKI, PhD
Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical
University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
Lucyna IWANOW, MSc, RN
Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical
University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
Ilona CIEŚLAK, MSc
Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical
University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
Joanna GOTLIB, PhD, Assoc. Prof.
Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical
University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland

* Corresponding author
Mariusz Panczyk, PhD, Assoc. Prof.
Division of Teaching and Outcomes of Education,
Faculty of Health Science, Medical University of Warsaw
Żwirki i Wigury 61,

This article has been accepted for publication and undergone full peer review but has not
been through the copyediting, typesetting, pagination and proofreading process, which may
lead to differences between this version and the Version of Record. Please cite this article as
doi: 10.1111/jan.13922
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 02-091 Warsaw, Poland
Telephone: +48-225-720490, Fax: +48-225-720491
e-mail: mariusz.panczyk@wum.edu.pl
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Acknowledgements
We would like to thank Halina Żmuda-Trzebiatowska for her assistance and involvement in
the organisation of surveys in the Centre for Postgraduate Education for Nurses and
Midwives in Warsaw; Elżbieta Drapiewska for her assistance in digitalisation of the survey
data; Walumbwa and associates for granting permit to use ALSAQ. We would like to thank
all nurses and students who took part in the study.
Conflict of Interest statement
No conflict of interest has been declared by the author(s).

Funding Statement
This research received no specific grant from any funding agency in the public, commercial,
or not-for-profit sectors.

Author Contributions
All authors have agreed on the final version and meet at least one of the following criteria
(recommended by the ICMJE: http://www.icmje.org/recommendations/):
1) substantial contributions to conception and design, acquisition of data, or analysis
and interpretation of data;
2) drafting the article or revising it critically for important intellectual content.

Criteria Author Initials

Made substantial contributions to conception and design, MP, MJ, JG
or acquisition of data, or analysis and interpretation of
data;
Involved in drafting the manuscript or revising it critically MP,JG
for important intellectual content;
Given final approval of the version to be published. Each MP, MJ, LI, IC, JG
author should have participated sufficiently in the work to
take public responsibility for appropriate portions of the
content;
Agreed to be accountable for all aspects of the work in MP, MJ, LI, IC, JG
ensuring that questions related to the accuracy or
integrity of any part of the work are appropriately
investigated and resolved.

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 ABSTRACT

Aim: The purpose of the study was to adapt and evaluate the psychometric characteristics of
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the Polish language version of the Authentic Leadership Self-Assessment Questionnaire

(ALSAQ) intended for use among registered nurses.

Design: A cross-sectional study where the ALSAQ was administered to a representative

group of 3,299 Polish registered nurses was carried out between September and November

2017.

Methods: Linguistic–cultural adaptation of the ALSAQ was carried out according to the

WHO guidelines. The following psychometric properties of the ALSAQ were evaluated:

content validity (content validity index), theoretical relevance (exploratory and confirmative

factor analysis), unidimensionality of subscales (principal component analysis), internal

consistency (Cronbach’s alpha), test−retest reliability and criterion validity.

Findings: The content validity analysis revealed a need to reduce the original ALSAQ

version from 16 to 13 items. The factor structure of ALSAQ differed from the original

version. A three-factor model was better fitted to the data than a four-factor model. The three

distinguished subscales (moral processing, self-awareness and relational transparency) were

characterised by unidimensionality. ALSAQ has a good internal consistency (Cronbach’s

alpha 0.84) and test−retest analysis confirmed stability of the measurement for subscales and

particular items. Moreover, the ALSAQ-P criterion validity with external variables, being of

key importance for shaping the leadership skills (self-efficacy and universal moral

foundations) was confirmed.

Conclusions: Authentic leadership skills in nursing practice are characterised by their

individual specificity, which was indicated in the ALSAQ validation. The ALSAQ can be

considered a reliable and valid tool for self-assessment of leadership skills in a group of

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 nursing practitioners. The identified standards help measuring strengths and weaknesses of

authentic leadership.
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KEYWORDS: instrument development; nursing leadership; authentic leadership;

reproducibility of results; linguistic–cultural adaptation

SUMMARY STATEMENT

Why is this research needed?

 Development and strengthening of different leadership theories in nursing

is of particular importance in countries where health-care system transformation

is jeopardised due to insufficient financial resources and a progressive crisis in nursing (e.g.

in Central and Eastern European countries such as Slovakia, the Czech Republic, Poland,

Latvia, Lithuania and Estonia).

 This is the first evaluation of Authentic Leadership Self-Assessment Questionnaire

in Central and Eastern European countries and it could be very useful to empower the nursing

workforce and to create a workforce development policy in this part of Europe.

What are the key findings?

 Authentic leadership skills in nursing practice are characterised by individual

specificity of nurses.

 The Authentic Leadership Self-Assessment Questionnaire can be considered a reliable

and valid tool for self-assessment of leadership skills in a group of nursing practitioners.

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 How should the findings be used to influence policy/practice/research/education?

 In the context of shortage of nurses worldwide, the potential of leadership skills in

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nurses should be analysed and used as a way to resolve the most important issues of rationing

nursing care.

 Leadership skills should be reinforced as soon as nursing education begins and

programmes of education should be based on leadership competences

INTRODUCTION

Authentic leadership is closely connected with the current and future role that the leaders in

nursing should fulfil both in the sphere of practice and research priorities conducted in favour

of introducing indispensable changes in the nurses’ working environment (Read &

Laschinger, 2015; Wong & Laschinger, 2013). It is connected to the fact that authentic

leadership is focused on relational aspects of leadership that are the basic moral/ethical

element, constituting a potential link between the positive mental capital and engagement in

work, which forms the attribute of a true leader (Wong & Cummings, 2009). Development

and strengthening of this leadership type in nursing is important in countries where

transformation of health-care system is jeopardised due to insufficient financial resources and

a progressive crisis in nursing (e.g. in Central and Eastern European countries such as

Slovakia, the Czech Republic, Poland, Latvia, Lithuania and Estonia).

In this context, developing a tool that would facilitate the self-assessment of nurses’

leadership skills can be of key importance. The level of authentic leadership can be evaluated

with one of two available instruments: the Authentic Leadership Questionnaire (ALQ) and

Authentic Leadership Self-Assessment Questionnaire (ALSAQ). Both questionnaires were

developed by Walumbwa et al. (2008) but the ALQ was initially designed to confirm

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 theoretical assumptions of the authentic leadership concept. ALSAQ is recommended by

Northouse (2016) for practical use to perform self-assessment. Self-assessment is determined

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as a dynamic process, whereby an individual monitors, evaluates and identifies the current

state on their own and it is the key ability that increases the motivation and is conducive to

the achievement of goals, of a given person (Harris & McCann, 1994; Miller, 2008). Self-

assessment fulfils a very important role in developing the skills of self-perception, which

increases the motivation of an individual to further action. This sense of confidence and

perceived self-mastery resulting from self-assessment could contribute to self-efficacy.

Moreover, the use of various kinds of self-assessment techniques along with appropriate

instructional feedback can improve self-efficacy (Ammentorp et al., 2013; Blanch-Hartigan,

2011), which is important for the development of leadership skills (Murphy & Johnson,

2016).

Since the ALSAQ recommended by Northouse (2016) was not a tool designed with a

view to be used among professionally active nurses, it has not so far been validated in this

professional group. The same applies to the ALQ, the other of the available tools for the

evaluation of the level of authentic leadership. It was designed for general population by

Walumbwa et al. (2008) (multiple samples obtained from China, Kenya and the United

States) and the questionnaire was not evaluated in terms of psychometric properties in a

professional group of nurses. The ALQ has so far been used in a few studies (Gardner,

Cogliser, Davis, & Dickens, 2011) two of which pertained new graduate nurses (Giallonardo,

Wong, & Iwasiw, 2010) and registered nurses working in acute care hospitals (Wong, Spence

Laschinger, & Cummings, 2010). There is lack of research into the application of either ALQ

or ALSAQ for the Polish population.

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 Background

In 2011, the Institute of Medicine issued a landmark report “The Future of Nursing: Leading
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Change, Advancing Health”, which highlighted that nurses play a crucial role in promoting

patient safety and quality of care (Institute of Medicine & Committee on the Robert Wood

Johnson Foundation Initiative on the Future of Nursing, 2011). However, despite the fact that

the nurses’ role in the global health system was considered crucial for ensuring the quality of

care and guaranteeing the safety of patients and medical personnel in the health system, the

past few decades have observed a deepening crisis in nursing in most countries (Buchan,

O'May, & Dussault, 2013; Buchan, Twigg, Dussault, Duffield, & Stone, 2015). Many

strategies have been suggested to resolve the problem of workforce shortages in nursing,

including increasing the number of places of education for future nurses, changing the scope

of their competences and autonomy in decision-making pertaining to patient care and

transferring part of their current responsibilities to unlicensed workers (World Health

Organization, 2016).

Recently, it has been stressed in the literature that effective leadership in nursing is

among crucial elements contributing to the proper functioning of health-care systems

guaranteeing patients' safety (McCay, Lyles, & Larkey, 2017; Smith & Johnson, 2018).

Effective leadership can directly contribute to a positive change in the nurses’ behaviour in

everyday clinical work: increasing the effectiveness of interdisciplinary teams, reducing the

number of medical errors, increasing the safety of patients and medical staff and −

consequently − improve medical services (Agnew, Flin, & Reid, 2012; Dirik & Seren

Intepeler, 2017; Stewart & Usher, 2010).

There are many leadership models in nursing (e.g. transformative or authentic).

According to a meta-analysis developed by Cummings et al. (2010), a transformative style

was most often analysed in the literature. However, researchers have reported that this style is

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 not effective enough (Fischer, 2016; Hutchinson & Jackson, 2013), because of changes in

health-care systems, the working conditions of nurses and the changed ethos of a nurse’s job
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in new generations (Fischer, 2016). That is why more attention is paid to the role of authentic

leadership in nursing practice (Alexander & Lopez, 2018; Dirik & Seren Intepeler, 2017;

Heath & Swartz, 2017; Perry, 2017). In differentiating an authentic leader from a

transformational leader, an authentic leader is required to exhibit a deep sense of self in his or

her expression of a position; whereas a transformational leader is focused more on having a

clear sense of purpose, on valuing and empowering, on achieving balance and connectedness

and on joining with others (Waite, McKinney, Smith-Glasgow, & Meloy, 2014).

The study

Aim

The purpose of the study was to adapt and evaluate the psychometric characteristics of the

Polish language version of the Authentic Leadership Self-Assessment Questionnaire

(ALSAQ-P) intended for use among registered nurses.

METHODOLOGY

The authors of the study obtained an approval from the author of the original ALSAQ version

to use the instrument in the studies carried out by the Medical University of Warsaw. To

carry out the linguistic–cultural adaptations and the validation process, guidance provided by

WHO “Process of translation and adaptation of instruments” (World Health Organization,

2017) and Sousa and Rojjanasrirat (2011) were used. The translation and validation

procedure consisted of four phases (see details Appendix 1).

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 Participants

A cross-sectional study where the ALSAQ was administered to a representative group of

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3,299 Polish registered nurses was carried out between September - November 2017. All

professionally active nurses, who participated in a specialization training program in 2017,

were invited to take part in the study. Potential participants in the study were identified and

recruited from the Centre for Postgraduate Education for Nurses and Midwives in Warsaw,

Poland.

The cohort consisted of 6,407 registered nurses, but the return rate was 51.5%. Thus,

3,299 participants took part in the study. The cohort was representative of the broader Polish

nurse population. The cohort was representative in terms of the mean age (t = 0.407, P =

0.684) and the selected specialization (χ2 = 10.112, P = 0.606). With this cohort size and the

number of registered nurses working in Poland (N = 280,000 (Central Registry of Nurses and

Midwives, 2016)), the error margin was 1.7% (95% confidence level and proportion 0.50).

A group of registered nurses, recruited from among 200 M.A. studies, studying at the

Medical University of Warsaw, Poland, participated in the component of the study where

absolute stability (test-retest analysis) was evaluated. Retesting was performed four weeks

after the original test. A full set of data was collected from 91 students.

Data collection

Participation in the study was voluntary and anonymous. Results were collected using an

auditorium method (self-report questionnaire), whereby respondents filled in the

questionnaires individually in one room. By virtue of large number of participants of the

study, the random survey was conducted in 25 turns. Every time the place and procedure of

the study was identical. A trained interviewer did not conduct the interview personally with

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 every participant, nor did he read the questions. He only limited himself to providing the aim

of the research conducted and presenting the instruction of filling out the questionnaire.
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Instruments

The evaluation of the level of authentic leadership can be performed by means of one of two

existing tools: Authentic Leadership Questionnaire (ALQ) or Authentic Leadership Self-

Assessment Questionnaire (ALSAQ), both created by Walumbwa et al. (2008). Both tools are

made up of 16 items, forming four subscales. ALQ, however, was originally designed to

confirm the theoretical assumptions of authentic leadership, while ALSAQ is recommended

by Northouse (2016) for practical applications to do self-assessment. The most important

differentiating feature between the two questionnaires is the means of formulating statements

that create the scale. In the ALQ tool, each item begins with the phrase "As a leader I…".

Such a statement makes the respondent place himself/herself in a leader’s position and

provide an answer as if they were “the leader”. This can create specific conditions of the

study that do not necessarily reflect the reality and the respondent’s behaviour. That is why

the obtained data can be misleading as it reflects an idealized image of self as a leader. In the

case of the studied group of nurses it was very important to identify their actual perception of

their leadership skills and not their idealised perception of the skills. That is why an

alternative version of the ALQ, i.e. ALSAQ, was chosen for the study. The questionnaire

does not contain the statement "As a leader I…" or a statement that would directly indicate

the analysed leadership skills. With regard to the above, the main variable measured by

means of the questionnaire can be masked. The study participants refer each item they rank to

themselves and their actual functioning. This is of great practical importance and reduces the

risk or responding to the questions according to social approval, i.e. giving answers according

to the researcher’s expectations rather than the actual opinions of the respondent.

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 The ALSAQ consists of 16 items forming the following four subscales: self-

awareness; internalised moral perspective; balanced processing; and relational transparency.

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The study participants rank the questionnaire statements on a five-point Likert scale (1 =

strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly disagree) (Northouse,

2016; Walumbwa et al., 2008). The measurement helps to evaluate the strongest and the

weakest components of authentic leadership (Northouse, 2016).

For the evaluation of the criterion validity of ALSAQ-P, two additional tools were

used (both in Polish adaptations): the Moral Foundations Questionnaire (MFQ) (Graham,

Haidt, & Nosek, 2018; Jarmakowski-Kostrzanowski & Jarmakowska-Kostrzanowska, 2016)

and the General Self-Efficacy Scale (GSES) (Juczyński, 2012; Schwarzer & Jerusalem,

1995).

The MFQ measures five universal moral foundations of harm/care,

fairness/reciprocity, ingroup/loyalty, authority/respect and purity/sanctity. The codes provide

the basis for evaluation of one’s behaviour for morality. It is expected that leaders should

have a deep sense of ethics and be driven by such ideals as fairness. They should observe

moral principles and support and motivate others towards development by presenting a good

example to follow. In relation to the above it was assumed that the results obtained from

measurements with ALSAQ-P should be positively correlated with the scores for each MFQ

subscale.

The prerequisites for selecting GSES in the evaluation of ALSAQ-P criterion validity

included the results of studies by Murphy and Johnson (2016) and Seibert et al. (2017). Self-

efficacy is key in enhancing leader development efforts. Two dimensions of self-efficacy are

of particular importance. The first is leader self-efficacy, which is focused on the conviction

of one’s own abilities in achieving success as a leader. The second, however, is leader

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 developmental efficacy, which is linked with the conviction that as a leader I possess the

ability to change and develop my own leadership skills (Murphy & Johnson, 2016).
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Ethical considerations

The aim of the study and its anonymity in the course of the research process, as well as the

voluntary character of participation, were all explained to the participants before entering the

interview and their informed consent was obtained. The participants were also informed that

the data obtained would be used for research purposes only. Permission to conduct the

presented study (AKBE\169\16) was granted to the authors from the Bioethics Committee of

Medical University of Warsaw.

Data analysis

To evaluate the psychometric properties of the ALSAQ-P, we assessed: content validity

(content validity index); theoretical relevance (exploratory and confirmative factor analysis);

unidimensionality of subscales (principal component analysis); internal consistency

(Cronbach’s alpha); test−retest reliability; and criterion validity.

The item-level content validity index (I-CVI) and scale-level content validity index

(S-CVI) (Polit, Beek, & Owen, 2007) were identified to determine the content validity. Seven

experts were asked to express their opinions according to a four-point Likert scale (1=not

relevant, 2=somewhat relevant, 3=quite relevant, 4=highly relevant) on each of the items in

the context of their importance for creating the leadership approach in nursing. The team of

experts included representatives of the Ministry of Health, the Polish Nursing Association,

the Students’ Self-Government, the Director for Nursing of the Clinical Hospital, public

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 health experts, HR experts and a psychologist. A CVI of more than 0.80 was interpreted as

indicating content validity (Polit et al., 2007).

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An exploratory factor analysis (EFA) with direct oblimin rotation was used to

evaluate construct validity. An evaluation was made as to whether the ALSAQ-P structure

was a four-element structure, which should correspond to the structure of the original

ALSAQ version. The number of factors was distinguished based on two criteria: Kaiser

(1958) (specific value) and Cattell (1966) (scree plot). To determine which items would be

included in their respective factors, we decided a priori to include items that loaded at more

than 0.40 on one factor. The minimum recommended cohort size is 10 subjects per item.

A confirmatory factor analysis (CFA) was used to evaluate the goodness of fit of the

obtained results for the imposed structure resulting from theoretical assumptions or another

structure resulting from the EFA. The results of the CFA for different factor models were

compared based on the following model fitness indicators: goodness-of-fit index (GFI

Jöreskog), adjusted goodness-of-fit index (AGFI), root mean square error of approximation

(RMSEA Steigera-Linda), Akaike Information Criterion (AIC). The values of the GFI and

AGFI should be at least 0.95, while RMSEA should be 0.05 or less. The value of AIC helps

to compare two different models, whereby a model with a lower AIC value is preferred

(Schermelleh-Engel, Moosbrugger & Müller, 2003).

An analysis of unidimensionality of each ALSAQ-P subscale was performed by

means of an analysis of the main components. It was assumed that a subscale can be

considered unidimensional when it meets the Kaiser criterion (eigenvalue exceeds the value 1

only once) and the degree of recreating the variability of the indicator variables by the first

principal component should exceed 40% (Kaiser, 1958).

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 The analysis of internal consistency of the distinguished subscales of ALSAQ-P was

performed based on a formula proposed by Cronbach (Tavakol & Dennick, 2011). The
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assumed satisfactory internal consistency threshold for Cronbach’s alpha amounted to over

0.7 (Nunnally & Bernstein, 1967).

Absolute stability test−retest reliability) was measured calculating the weighted kappa

coefficient and intraclass correlation coefficient (ICC), which identified the level of

consistency of the answers provided in the first and second measurement (Sullivan, 2011).

Criterion validity was estimated by identifying the Pearson correlation coefficients

between the total ALSAQ-P score and its subscales and the score calculated for the two

questionnaires: MFQ (Graham et al., 2018; Jarmakowski-Kostrzanowski & Jarmakowska-

Kostrzanowska, 2016) and GSES (Juczyński, 2012; Schwarzer & Jerusalem, 1995).

Identification of norms was the last element of the validation. The obtained total score

and results in individual subscales were transformed into sten scores. Sten scores is a

normalized scale, where raw results are transformed in such a way that the average takes the

value of 5.5 and standard deviation 2.0. The scale includes 10 slots (from 1 to 10) called

stens. Standards for the following score ranges were identified: low level (stens 1−3),

medium level (stens 4−7) and high level (stens 8−10). The calculations were performed with

the use of the statistics program IBM SPSS v23.0. A 5% level of significance was set.

RESULTS

Demographic characteristics

Table 1 reports the demographic characteristics of the 3,299 participants who completed this

study. The mean age of the study participants was 44.0 years (min. 26, max. 71, SD 7.35,

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 coefficient of variation = 16.7%) and professional experience was 21.0 years (min. 3, max.

50, SD 8.67, CV = 41.3%).

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Content validity

The I-CVI evaluation form was distributed to seven experts who were asked to rate content

validity on the 16-item questionnaires regarding the agreement or disagreement with

statements. The result of the I-CVI for three items was below the assumed threshold of 0.80.

After excluding these items, the mean result for the other I-CVI amounted to 0.95. The value

of S-CVI obtained this way was on a satisfactory level.

The panel of experts suggested that three statements were removed from the original

version of ALSAQ: (Item_3) I seek others’ opinions before making up my own mind;

(Item_10) Other people know where I stand on controversial issues; (Item_12) I rarely

present a “false” front to others. According to the experts’ opinion, the statements do not

characterise an approach of authentic leadership in nursing at all or they characterise it only

slightly (CVI-S < 0.80). Two statements (Item_3 and Item_10) are of key importance for the

work of clinical nurses, because they are related to a continuous need for occupational

improvement in evidence-based nursing practice. In clinical practice one shall follow the

developed strategies (algorithms) that are intended to ensure patients' safety. The job of a

nurse requires a moral and empathic approach towards the patient (item_12). Therefore, it

can be assumed that the three items mentioned above are not characterised by a sufficiently

diagnostic power. Inclusion of the items in the ALSAQ-P could cause a reduction in the

validity of measurement. For the Polish version of the questionnaire to fulfil the criterion of

content validity, a decision was made to limit the ALSAQ-P to 13 items (Appendix 2).

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 Factor structure

The initial evaluation of data revealed that the assumptions for EFA were met. The value of
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the matrix determinant was close to zero and the matrix of correlation coefficients was not an

identity matrix (Bartlett’s test of sphericity, χ2 = 10196.2, df = 78, P < 0.001). The

Kaiser−Mayer−Olkin index (adequacy of the sample selection adequacy) was 0.900, which

meets the assumptions for the parameter (> 0.5).

In the first EFA sample, 13 items were divided into three factors according to the

Kaiser criterion, which explained 51.4% of the total variance. However, such an arrangement

of factors was not in compliance with the concept of the ALSAQ division into four subscales.

The scree plot (Cattell criterion) indicated a two-factor solution (the total variance explained

amounted to 43.2%). Therefore, a three-factor solution was imposed, which corresponded to

a higher percentage of the explained variance.

Based on comparing the content of the statements that create ALSAQ-P subscale and

the original ALSAQ version, non-compliance of items in particular subscales were noted. In

this regard, the names of the ALSAQ-P subscales were developed based on the content

evaluation and recommendation of three judges competent in the fields of nursing,

psychology and psychometrics. On the basis of the content of three items forming the three

separated subscales, the following names were proposed: moral processing, self-awareness

and relational transparency. The obtained solution and factor loads are presented in Table 2.

A comparison of the degree of fitness of a three-factor and four-factor model for the

selected data was performed with a CFA. The results for the original subscales were less

satisfactory (Table 3). Therefore, we consider our three-factor model of EFA as confirmed.

Consequently, we used the ALSAQ-P subscales as described in our EFA for further

calculations.

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 Unidimensionality

Using a principal component analysis, specific values and share of variance explained by the
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first factor were checked (Table 4). The obtained results confirm unidimensionality of the

three ALSAQ-P subscales.

Internal consistency

For the three subscales forming the ALSAQ-P (moral processing, self-awareness and

relational transparency) the obtained value of the Cronbach’s alpha coefficient was 0.78, 0.66

and 0.60, respectively, while for the whole ALSAQ-P the Cronbach’s alpha was 0.84.

Moreover, the values of the correlation item-total coefficients for all items were > 0.40 (Table

5).

Test−retest reliability

The test−retest reliability evaluation revealed a good stability of ALSAQ-P and its subscales.

The assumptions concerning stability of the retest measurements were fulfilled, while the

value ranges of weighted kappas were satisfactory (Table 6). Test−retest analysis for the first

subscale, as measured by the ICC, was 0.895 [95%CI 0.888−0.902] (F = 9.929, P < 0.001),

for the second subscale the ICC was 0.789 [95%CI 0.771−0.805] (F = 5.055, P < 0.001) and

for the third subscale the ICC was 0.970 [95%CI 0.960−0.980] (F = 10.641, P < 0.001).

Criterion validity

The identified Pearson’s r coefficients show that for each of the three ALSAQ-P subscales

and for the total result for the whole scale there are statistically significant positive

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 correlations with the scores reached by the study participants in the GSES and individual

MFQ subscales (Table 7). The results confirm the ALSAQ-P criterion validity.
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Setting norms

The results obtained for individual items of the ALSAQ-P reveal a high degree of their

affinity in the studied group (the mean value from 3.5-4.0). A small degree of diversification

of the results for subsequent items was also observed, which means high uniformity (SD

range from 0.81 to 1.03). The observation leads to the conclusion that there was no floor and

ceiling effect with the ALSAQ-P validation. Furthermore, the obtained score was

characterised by a slight negative skewness of the distribution.

After transforming the total score obtained in the measurement with the ALSAQ-P

into a sten scale, norms were identified (Table 8). Since variables such as age, job seniority,

education and place of residence did not diversify the ALSAQ-P score, the characteristics

were not taken into consideration when identifying the norms.

DISCUSSION

The study findings show that the performed validation reveals good psychometric properties

of the ALSAQ-P, especially in relation to unidimensionality of subscales, internal

consistency, test−retest reliability and criterion validity.

An important difference between the ALSAQ-P and the original ALSAQ was a

discrepancy in the arrangement of the subscales. The Kaiser (1958) criterion indicated a

three-element structure of the scale, while Walumbwa et al. (2008) and Northouse (2016)

state that the ALSAQ consists of four subscales. Since the results of the EFA obtained by the

authors suggested a three-factor solution, such a structure was imposed further in the

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 validation. A decision was made to distinguish three subscales, which was achieved by means

of a comparative evaluation of the goodness of fit of the two models. The CFA confirmed
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that the three-element ALSAQ-P (moral processing, self-awareness and relational

transparency) was a better solution than the four-element one (the three above plus

internalised moral perspective).

The difference in structure between the original ALSAQ and the ALSAQ-P is a

testimony to a limited construct validity of the scale. It can be attributed, for instance, to a

reduced number of items as a result of the above-mentioned evaluation procedure of the

content validity. Moreover, the observed difference in the scale structure can be partly

assigned to cultural differences and specificity of the nursing profession. Lack of coherence

of the subscales between ALSAQ-P (scale for the nurses) and ALSAQ (scale for the general

population) indicates the uniqueness of authentic leadership of nurses. At the same time, it

stresses that the devised Polish adaptation evaluates authentic leadership in nursing more

accurately than does it the general scale for the evaluation of the skills. Since the original

version of the ALSAQ was not designed especially for nurses, the instrument validation in

this occupational group can bring slightly different results. The obtained results indicate a

need to develop a model of authentic leadership specific to nursing.

Leadership skills competences are among social competences that are closely related

to communication proficiency and are important in the job of a nurse. That is why the

curriculum of nursing education puts emphasis on relevant communication skills in the

relationship with patients and members of a therapeutic team. The ability of active listening

and empathy (understanding the patient’s emotions) are of special importance in this context.

The reference skills are intermingled in nursing and it is very hard to make a clear distinction

between balanced processing and relational transparency. Additionally, specificity of the

nursing occupation and the related mobbing, bullying (Ovayolu, Ovayolu, & Karadag, 2014)

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 and harassment (Wiwanitkit, 2016) can be of key importance as they can affect the

development of a proper interpersonal relationship in the workplace. Balanced processing is

Accepted Article
related to taking into account opinions and viewpoints of other people before making a

decision. This is not fully possible when there is a lack of staff, which entails poorer

execution of rationing nursing care (Fast & Rankin, 2017) and the need to prioritise tasks and

medical care and causes much organisational negligence.

For instance, item_9 I seek feedback as a way of understanding who I really am as a

person in its original version belongs to the self-awareness subscale. In the ALSAQ-P version

the statement was included in the relational transparency subscale. This shows that the

interpersonal and intrapersonal aspects in the nursing profession are of great importance for

self-awareness. Additionally, being a nurse requires a high moral and ethical attitude in an

interpersonal relationship (Makaroff, Storch, Pauly, & Newton, 2014). This is highlighted by

the partial mixing of statements included in the original subscales of self-awareness, balanced

processing and moral perspective. For instance, the statement I admit my mistakes to others

(item_16), which was originally a part of the relational transparency, was qualified into the

moral processing subscale. The above-mentioned observations support the thesis about the

need to develop a model of authentic leadership dedicated to nursing, which would consider

rationing nursing care (Fast & Rankin, 2017) and patient safety (Agnew et al., 2012; Dirik &

Seren Intepeler, 2017; Perry, 2017; Stewart & Usher, 2010). Such a model can be important

for in improving the curricula of pre- and post-graduate courses.

Internal consistency of the whole scale measured with the Cronbach’s alpha

coefficient turned out to be good and clearly exceeded the recommended value of 0.7

(Nunnally & Bernstein, 1967). A high value of discriminating indices was observed for all

items, which is an evidence of a good diversification of study participants evaluated with the

ALSAQ-P. Internal consistency of individual subscales was far worse than for the whole

This article is protected by copyright. All rights reserved.

 scale. For two out of three subscales, the Cronbach’s alpha value was below the assumed

threshold. The results are testimony to a limited reliability of measurement in the ALSAQ-P
Accepted Article
subscale, especially in relational transparency (alpha = 0.60). Such a low result for

Cronbach’s alpha can be attributed to a low number of statements making the subscale (only

three items).

In the ALSAQ-P stability evaluation there were no cases of weighted kappa lower

than 0.40. With regard to a lack of detailed data from the test−retest analysis carried out

during the validation of the original ALSAQ version, it is hard to evaluate which items

rendered poorer (moderate) results in both validation studies and which ones produced better

results (substantial and excellent). Besides good results for individual items, good stability of

results for the repeated measurement was also observed for the three subscales. This means

that the results of measurements in the subscales reveal high resistance to incidental

variability (good absolute stability parameters) (Weir, 2005). The only limitation of the

presented test−retest analysis results is the long-time interval between the repeated

measurements (four-week interval), while Streiner, Norman and Cairney (2015) recommends

that the interval should be at least two weeks.

The setting standards for the ALSAQ-P and their three subscales can be used by

nurses to identify their leadership skills in relation to the whole population. High ALSAQ-P

results were observed in a group of about 5% of the studied nurses. There have been no

previous large studies that would help identify people with high level of leadership skills in a

population. The presented results mark the first attempt to make such an evaluation among

nursing practitioners.

The criterion relevance evaluation revealed that the results on the ALSAQ-P scale are

characterised by a positive correlation with an increase of self-efficacy, which is a personality

trait of key importance for the development of leadership skills (Murphy & Johnson, 2016).

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 Self-efficacy is described as the conviction of one’s own abilities to achieve a given level of

effectiveness (Bandura, 1982). There are numerous studies about leader self-efficacy
Accepted Article
(Chemers, Watson, & May, 2000; Hannah, Avolio, Luthans, & Harms, 2008; Hoyt, Murphy,

Halverson, & Watson, 2003; Murphy & Johnson, 2016; Watson, Chemers, & Preiser, 2001).

Leader self-efficacy has a vital influence on leadership, motivation and effectiveness (Hannah

et al., 2008; Watson et al., 2001), as well as on the effectiveness of the group, with whom the

leader works (Chemers et al., 2000; Hoyt et al., 2003). Furthermore, Hannah et al. (2008)

indicate that the feeling of one’s own effectiveness as a leader may be one of the most

important factors influencing effective leadership and team effectiveness. It should be noted

that leader developmental efficacy (LDE) is a very important predicator of leader

development. This is connected with the fact that in the future people with high

developmental efficacy will (1) be more eager to engage in self-development as leaders, (2)

undertake pro-developmental activities more often, (3) be more prone to continue activities

despite encountered difficulties and (4) become more effective leaders with time (Murphy &

Johnson, 2016).

The evaluation of criterion relevance investigated the relationship between the results

on the ALSAQ-P scale and the intensity of the five universal moral foundations of harm/care,

fairness/reciprocity, in-group/loyalty, authority/respect and purity/sanctity. It was

demonstrated that authentic leadership skills show a positive relationship with all analysed

moral dimensions. This supports the key importance of moral behaviour in the context of

authentic leadership in nursing. Zahedi et al. (2013) emphasise that codes of ethics are

fundamental guidance for nursing, which is one the most-trusted professions. An appropriate

moral attitude plays a central role in nurses’ behaviour towards patients, which greatly

contributes to patients’ health improvement. Besides, the respect for people’s values, rights

and dignity are indispensable parts of the nurse’s work. From the clinical point of view,

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 nurses should adhere to three basic principles in their work: ethics, proper clinical evaluation

and care (Weaver, 2007). One should note that the literature contains publications dealing
Accepted Article
with ethics in the context of leadership skills in nurses (Barkhordari-Sharifabad, Ashktorab,

& Atashzadeh-Shoorideh, 2017; Edmonson, 2010; Esmaelzadeh, Abbaszadeh, Borhani, &

Peyrovi, 2017). Redman and Fry (2003) published a paper that described ethical conflicts

among nurse leaders. In this study, they showed that nearly 39% of the nurse leaders reported

experiencing ethics and human rights issues one to four times a week or more. This study

showed implications for ethics education and resource support for nurses in leadership roles.

Summing up, it should be emphasised that authentic leadership skills in nursing are

characterised by their individualised specificity, which was demonstrated in the ALSAQ

scale validation. Further studies in the area should take into account the role of self-efficacy

and moral attitude in developing authentic leadership skills in this occupational group.

LIMITATIONS

The study was performed with a group of people who actively wish to improve their

professional qualifications, which may be not representative of all nurses. Another limitation

was related to a low number of males, which made it impossible to compare the results

obtained with the ALSAQ-P depending on the sex and potential identification of separate

standards for the groups. A weakness of the validated tool is an insufficient level of internal

coherence of two out of the three subscales. An important limitation of the study is also the

fact that ALSAQ-P evaluates the improvement of social skills, which may be important in

interpersonal relations. Therefore, respondents with high level of social approval could have

responded in line with the researcher’s expectations. The use of random survey, which may

not provide full anonymity of the respondents gathered in one room, is an additional

This article is protected by copyright. All rights reserved.

 limitation of the study. Although the questionnaires themselves are anonymous, the presence

of third parties may influence the answers provided by the respondents.

Accepted Article
CONCLUSION

Validation of the ALSAQ-P revealed that it is a reliable and valid tool for the self-assessment

of leadership skills for nursing practitioners. The questionnaire meets the criteria intended for

psychometric scales. ALSAQ-P can be successfully used by nurses for the self-assessment of

skills related to authentic leadership. Moreover, the standards developed for the subscales

help to identify the strengths and weaknesses of leadership. ALSAQ-P is characterised by

good external relevance with variables of key importance for the development of leadership

skills (e.g. self-efficacy). That is why the ALSAQ-P can also be used in training programmes

aimed at improving soft skills in nurses. Nurses’ knowledge of their own leadership skills

could improve patient safety and care outcomes on the one hand and promote self-

development on the other

Author Contributions:
All authors have agreed on the final version and meet at least one of the following criteria
(recommended by the ICMJE*):
1) substantial contributions to conception and design, acquisition of data, or analysis and
interpretation of data;
2) drafting the article or revising it critically for important intellectual content.
* http://www.icmje.org/recommendations/

This article is protected by copyright. All rights reserved.

 REFERENCES
Agnew, C., Flin, R., & Reid, J. (2012). Nurse leadership and patient safety. British Medical
Accepted Article
Journal, 345, e4589. https://doi.org/10.1136/bmj.e4589

Alexander, C., & Lopez, R. P. (2018). A Thematic Analysis of Self-described Authentic

Leadership Behaviors Among Experienced Nurse Executives. Journal of Nursing

Administration, 48(1), 38-43. https://doi.org/10.1097/nna.0000000000000568

Ammentorp, J., Thomsen, J. L., Jarbol, D. E., Holst, R., Ovrehus, A. L., & Kofoed, P. E.

(2013). Comparison of the medical students' perceived self-efficacy and the

evaluation of the observers and patients. BMC Medical Education, 13, 49.

https://doi.org/10.1186/1472-6920-13-49

Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist,

37(2), 122-147. https://doi.org/10.1037/0003-066X.37.2.122

Barkhordari-Sharifabad, M., Ashktorab, T., & Atashzadeh-Shoorideh, F. (2017). Ethical

leadership outcomes in nursing: A qualitative study. Nursing Ethics, (on-line first).

https://doi.org/10.1177%2F0969733016687157

Blanch-Hartigan, D. (2011). Medical students' self-assessment of performance: results from

three meta-analyses. Patient Education and Counseling, 84(1), 3-9.

https://doi.org/10.1016/j.pec.2010.06.037

Buchan, J., O'May, F., & Dussault, G. (2013). Nursing workforce policy and the economic

crisis: a global overview. Journal of Nursing Scholarship, 45(3), 298-307.

https://doi.org/10.1111/jnu.12028

Buchan, J., Twigg, D., Dussault, G., Duffield, C., & Stone, P. W. (2015). Policies to sustain

the nursing workforce: an international perspective. International Nursing Review,

62(2), 162-170. https://doi.org/10.1111/inr.12169

This article is protected by copyright. All rights reserved.

 Cattell, R. B. (1966). The Scree Test For The Number Of Factors. Multivariate Behavioral

Research, 1(2), 245-276. https://doi.org/10.1207/s15327906mbr0102_10

Accepted Article
Central Registry of Nurses and Midwives. (2016). [Number of registered and employed

nurses and midwives]. Retrieved from

http://arch.nipip.pl/index.php/samorzad/stat/404-liczba-zarejestrowanych-

pielegniarek-i-poloznych

Chemers, M. M., Watson, C. B., & May, S. T. (2000). Dispositional affect and leadership

effectiveness: A comparison of self-esteem, optimism and efficacy. Personality and

Social Psychology Bulletin, 26(3), 267-277.

https://doi.org/10.1177%2F0146167200265001

Cummings, G. G., MacGregor, T., Davey, M., Lee, H., Wong, C. A., Lo, E., . . . Stafford, E.

(2010). Leadership styles and outcome patterns for the nursing workforce and work

environment: a systematic review. International Journal of Nursing Studies, 47(3),

363-385. https://doi.org/10.1016/j.ijnurstu.2009.08.006

Dirik, H. F., & Seren Intepeler, S. (2017). The influence of authentic leadership on safety

climate in nursing. Journal of Nursing Management, 25(5), 392-401.

https://doi.org/10.1111/jonm.12480

Edmonson, C. (2010). Moral courage and the nurse leader. Online Journal of Issues in

Nursing, 15(3), Manuscript 5. https://doi.org/10.3912/OJIN.Vol15No03Man05

Esmaelzadeh, F., Abbaszadeh, A., Borhani, F., & Peyrovi, H. (2017). Ethical sensitivity in

nursing ethical leadership: a content analysis of Iranian nurses experiences. Open

Nursing Journal, 11, 1-13. https://doi.org/10.2174%2F1874434601711010001

Fast, O., & Rankin, J. (2017). Rationing nurses: Realities, practicalities and nursing

leadership theories. Nursing Inquiry, 25(2), e12227. https://doi.org/10.1111/nin.12227

This article is protected by copyright. All rights reserved.

 Fischer, S. A. (2016). Transformational leadership in nursing: a concept analysis. Journal of

Advanced Nursing, 72(11), 2644-2653. https://doi.org/10.1111/jan.13049

Accepted Article
Gardner, W. L., Cogliser, C. C., Davis, K. M., & Dickens, M. P. (2011). Authentic

leadership: A review of the literature and research agenda. Leadership Quarterly,

22(6), 1120-1145. https://doi.org/10.1016/j.leaqua.2011.09.007

Giallonardo, L. M., Wong, C. A., & Iwasiw, C. L. (2010). Authentic leadership of preceptors:

predictor of new graduate nurses' work engagement and job satisfaction. Journal of

Nursing Management, 18(8), 993-1003. https://doi.org/10.1111/j.1365-

2834.2010.01126.x

Graham, J., Haidt, J., & Nosek, B. (2018). Moral Foundations Questionnaire. Retrieved from

http://www.moralfoundations.org/questionnaires

Hannah, S. T., Avolio, B. J., Luthans, F., & Harms, P. D. (2008). Leadership efficacy:

Review and future directions. Leadership Quarterly, 19(6), 669-692.

https://doi.org/10.1016/j.leaqua.2008.09.007

Harris, M., & McCann, P. (1994). Assessment (Vol. 435). London: Macmillan Heinemann

English Language Teaching.

Heath, J., & Swartz, C. (2017). Building a Culture of Authentic Partnership: One Academic

Health Center Model for Nursing Leadership. Journal of Nursing Administration,

47(9), 458-464. https://doi.org/10.1097/nna.0000000000000514

Hoyt, C. L., Murphy, S. E., Halverson, S. K., & Watson, C. B. (2003). Group leadership:

Efficacy and effectiveness. Group Dynamics: Theory, Research and Practice, 7(4),

259-274. https://doi.org/10.1037/1089-2699.7.4.259

This article is protected by copyright. All rights reserved.

 Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a

more critical interpretation. Nursing Inquiry, 20(1), 11-22.

Accepted Article
https://doi.org/10.1111/nin.12006

Institute of Medicine, & Committee on the Robert Wood Johnson Foundation Initiative on

the Future of Nursing. (2011). The Future of Nursing: Leading Change, Advancing

Health. Washington (DC): National Academies Press.

Jarmakowski-Kostrzanowski, T., & Jarmakowska-Kostrzanowska, L. (2016). Polska

Adaptacja Kwestionariusza Moral Foundations Questionnaire (MFQ-PL).

Psychologia społeczna, 4(39), 489-508.

Juczyński, Z. (2012). Narzędzia pomiaru w promocji i psychologii zdrowia. Warszawa:

Pracownia Testów Psychologicznych.

Kaiser, H. F. (1958). The varimax criterion for analytic rotation in factor analysis.

Psychometrika, 23(3), 187-200. https://doi.org/10.1007/BF02289233

Makaroff, K. S., Storch, J., Pauly, B., & Newton, L. (2014). Searching for ethical leadership

in nursing. Nursing Ethics, 21(6), 642-658.

https://doi.org/10.1177/0969733013513213

McCay, R., Lyles, A. A., & Larkey, L. (2018). Nurse Leadership Style, Nurse Satisfaction

and Patient Satisfaction: A Systematic Review. Journal of Nursing Care Quality,

33(4), 361-367. https://doi.org/10.1097/ncq.0000000000000317

Miller, P. A. (2008). Self-Assessment: The Disconnect between Research and Rhetoric.

Physiotherapy Canada, 60(2), 117-124. https://doi.org/10.3138/physio.60.2.117

Murphy, S. E., & Johnson, S. K. (2016). Leadership and Leader Developmental

Self‐ Efficacy: Their Role in Enhancing Leader Development Efforts. New Directions

for Student Leadership, Spring(149), 73-84. https://doi.org/10.1002/yd.20163

This article is protected by copyright. All rights reserved.

 Northouse, P. G. (2016). Leadership : theory and practice (7 ed.). Los Angeles: Sage

Publications.
Accepted Article
Nunnally, J. C., & Bernstein, I. H. (1967). Psychometric theory (3 ed. Vol. 226). New York:

McGraw-Hill New York.

Ovayolu, O., Ovayolu, N., & Karadag, G. (2014). Workplace bullying in nursing. Workplace

Health and Safety, 62(9), 370-374. https://doi.org/10.3928/21650799-20140804-04

Perry, S. M. (2018). The influence of authentic leadership on safety climate in nursing.

Journal of Nursing Management, 26(4), 493-493. https://doi.org/10.1111/jonm.12557

Polit, D. F., Beek, C. T., & Owen, S. V. (2007). Is the CVI an acceptable indicator of content

validity? Appraisal and recommendations. Research in Nursing and Health, 30(4),

459-467. https://doi.org/10.1002/nur.20199

Read, E. A., & Laschinger, H. K. (2015). The influence of authentic leadership and

empowerment on nurses' relational social capital, mental health and job satisfaction

over the first year of practice. Journal of Advanced Nursing, 71(7), 1611-1623.

https://doi.org/10.1111/jan.12625

Redman, B. A., & Fry, S. T. (2003). Ethics and human rights issues experienced by nurses in

leadership roles. Nursing Leadership Forum, 7(4), 150-156.

Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of

structural equation models: Tests of significance and descriptive goodness-of-fit

measures. Methods of Psychological Research Online, 8(2), 23-74.

Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy scale. In J. Weinman, S.

Wright, & M. Johnston (Eds.), Measures in health psychology: A user’s portfolio.

Causal and control beliefs. Winsor: NFER-NELSON.

This article is protected by copyright. All rights reserved.

 Seibert, S. E., Sargent, L. D., Kraimer, M. L., & Kiazad, K. (2017). Linking Developmental

Experiences to Leader Effectiveness and Promotability: The Mediating Role of

Accepted Article
Leadership Self-Efficacy and Mentor Network. Personnel Psychology, 70(2), 357-

397. https://doi.org/10.1111/peps.12145

Smith, C. M., & Johnson, C. S. (2018). Preparing Nurse Leaders in Nursing Professional

Development: Theories Applied to Leadership in Nursing Professional Development.

Journal for Nurses in Professional Development, 34(1), 38-40.

https://doi.org/10.1097/nnd.0000000000000404

Sousa, V. D., & Rojjanasrirat, W. (2011). Translation, adaptation and validation of

instruments or scales for use in cross-cultural health care research: a clear and user-

friendly guideline. Journal of Evaluation in Clinical Practice, 17(2), 268-274.

https://doi.org/10.1111/j.1365-2753.2010.01434.x

Stewart, L., & Usher, K. (2010). The impact of nursing leadership on patient safety in a

developing country. Journal of Clinical Nursing, 19(21-22), 3152-3160.

https://doi.org/10.1111/j.1365-2702.2010.03285.x

Streiner, D. L., Norman, G. R., & Cairney, J. (2015). Health measurement scales: a practical

guide to their development and use (5th ed.): Oxford University Press.

Sullivan, G. M. (2011). A primer on the validity of assessment instruments. Journal of

Graduate Medical Education, 3(2), 119-120. https://doi.org/10.4300/jgme-d-11-

00075.1

Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach's alpha. International Journal

of Medical Education, 2, 53-55. https://doi.org/10.5116/ijme.4dfb.8dfd

This article is protected by copyright. All rights reserved.

 Waite, R., McKinney, N., Smith-Glasgow, M. E., & Meloy, F. A. (2014). The embodiment of

authentic leadership. Journal of Professional Nursing, 30(4), 282-291.

Accepted Article
https://doi.org/10.1016/j.profnurs.2013.11.004

Walumbwa, F. O., Avolio, B. J., Gardner, W. L., Wernsing, T. S., & Peterson, S. J. (2008).

Authentic Leadership: Development and Validation of a Theory-Based

Measure. Journal of Management, 34(1), 89-126.

https://doi.org/10.1177/0149206307308913

Watson, C. B., Chemers, M. M., & Preiser, N. (2001). Collective efficacy: A multilevel

analysis. Personality and Social Psychology Bulletin, 27(8), 1057-1068.

https://doi.org/10.1177%2F0146167201278012

Weaver, K. (2007). Ethical sensitivity: state of knowledge and needs for further research.

Nursing Ethics, 14(2), 141-155. https://doi.org/10.1177%2F0969733007073694

Weir, J. P. (2005). Quantifying test-retest reliability using the intraclass correlation

coefficient and the SEM. The Journal of Strength & Conditioning Research, 19(1),

231-240.

Wiwanitkit, V. (2016). Nurse Harassment: A Forgotten Issue. Nursing and Midwifery

Studies, 5(1), e32371. https://doi.org/:10.17795/nmsjournal32371

Wong, C., & Cummings, G. (2009). Authentic leadership: a new theory for nursing or back to

basics? Journal of Health Organization and Management, 23(5), 522-538.

https://doi.org/10.1108/14777260910984014

Wong, C., Spence Laschinger, H., & Cummings, G. (2010). Authentic leadership and nurses'

voice behaviour and perceptions of care quality. Journal of Nursing Management,

18(8), 889-900. https://doi.org/10.1111/j.1365-2834.2010.01113.x

This article is protected by copyright. All rights reserved.

 Wong, C. A., & Laschinger, H. K. (2013). Authentic leadership, performance and job

satisfaction: the mediating role of empowerment. Journal of Advanced Nursing,

Accepted Article
69(4), 947-959. https://doi.org/10.1111/j.1365-2648.2012.06089.x

World Health Organization. (2016). Global strategy on human resources for health:

workforce 2030. Retrieved from

http://www.who.int/hrh/resources/global_strategy_workforce2030_14_print.pdf?ua=1

World Health Organization. (2017). Research Tools: Process of translation and adaptation of

instruments. Retrieved from

http://www.who.int/substance_abuse/research_tools/translation/en/

Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., . . . Larijani, B.

(2013). The code of ethics for nurses. Iranian Journal of Public Health, 42(Supple1),

1.

This article is protected by copyright. All rights reserved.

 Table 1. Sociodemographic characteristics of the study sample
Accepted Article
N (%)
Gender
Female 3249 (98.5)
Male 50 (1.5)
Place of residence
Countryside 937 (28.4)
Village (population up to 50 thousand) 686 (20.8)
Small town (51-200 thousand 739 (22.4)
inhabitants)
Large town (201-500 thousand 440 (13.3)
inhabitants)
City >500 thousand inhabitants 497 (15.1)
Education
Secondary medical 911 (27.6)
Bachelor's degree 1019 (30.9)
Master's degree 1355 (41.1)
Ph.D. 14 (0.4)
Specialisation
Conservative nursing 931 (28.2)
Anaesthesiological nursing 508 (15.4)
Surgical nursing 338 (10.2)
Oncological nursing 296 (9.0)
Psychiatric nursing 286 (8.7)
Operating room nursing 269 (8.2)
Geriatric nursing 242 (7.3)
Cardiological nursing 215 (6.5)
Other 214 (6.5)
Place of work1
Municipal hospital 1328 (33.0)
Clinical hospital 739 (18.4)
Home care 640 (15.9)
GP outpatient clinic 254 (6.3)
Specialised outpatient clinic 206 (5.1)
Environmental care 184 (4.7)
Other 669 (16.6)

1
the study participants could indicate more than one place of work

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 Table 2. Pattern matrix after direct oblimin rotation
Accepted Article
Factor loading
Relationa
Item Statement Moral Self-
l
processin awarenes
transpare
g s
ncy
ALSAQ_1 I can list my three greatest weaknesses 0.156 0.706 0.028
ALSAQ_2 My actions reflect my core values 0.216 0.700 0.099
ALSAQ_4 I openly share my feelings with others 0.137 0.396 0.524
ALSAQ_5 I can list my three greatest strengths 0.167 0.737 0.182
ALSAQ_6 I do not allow group pressure to control me 0.181 0.476 0.201
ALSAQ_7 I listen closely to the ideas of those who
0.465 0.329 0.298
disagree with me
ALSAQ_8 I let others know who I truly am as a
0.181 0.173 0.763
person
ALSAQ_9 I seek feedback as a way of understanding
0.148 0.003 0.775
who I really am as a person
ALSAQ_1 I do not emphasize my own point of view
0.582 0.187 0.158
1 at the expense of others.
ALSAQ_1 I accept the feelings I have about myself
0.575 0.316 0.134
3
ALSAQ_1 My morals guide what I do as a leader
0.660 0.261 0.064
4
ALSAQ_1 I listen very carefully to the ideas of others
0.752 0.135 0.194
5 before making decisions
ALSAQ_1 I admit my mistakes to others
0.751 0.083 0.168
6

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 Table 3. Goodness of fit of models to collected data
Accepted Article
Original Modified
Fit indices Good model fit model model
ALSAQ1 ALSAQ-P2
Goodness-of-fit index (GFI Jöreskog) close to 1.00 0.934 0.971
Adjusted goodness-of-fit index (AGFI) close to 1.00 0.909 0.957
Root mean square error of
approximation (RMSEA Steigera- 0.05 or smaller 0.074 0.054
Linda)
Akaike Information Criterion (AIC) lower AIC 0.548 0.211

1
four-factor model with 16 items according to the assumptions described by Walumbwa et al.
(2008)
2
three-factor model with 13 items obtained after removing 3, 10 and 12 items

Table 4. The share of the variance explained by the first principal component

The share of variance explained

1
Subscale Kaiser criterion by the first principal component
(%)
1 2.89; 0.74 48.1
2 2.02; 0.82 50.6
3 1.66; 0.78 55.4

1
eigenvalue of 1 and 2 factor, respectively

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 Table 5. ALSAQ-P internal consistency assessment
Standard Correlation
Items Mean
deviation item-total
Accepted Article
ALSAQ_1 4.0 0.94 0.43
ALSAQ_2 3.9 0.87 0.51
ALSAQ_4 3.8 1.02 0.47
ALSAQ_5 4.0 0.91 0.54
ALSAQ_6 3.5 1.03 0.40
ALSAQ_7 3.9 0.85 0.54
ALSAQ_8 3.7 0.96 0.48
ALSAQ_9 3.6 0.97 0.36
ALSAQ_11 3.8 0.93 0.47
ALSAQ_13 3.9 0.86 0.53
ALSAQ_14 3.9 0.89 0.52
ALSAQ_15 4.0 0.82 0.57
ALSAQ_16 4.0 0.81 0.52

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 Table 6. Test-retest reliability of ALSAQ-P
Accepted Article
Measure of Agreement Levels of
Item
Weighted Kappa agreement1

ALSAQ_1 0.551 Moderate

ALSAQ_2 0.769 Substantial
ALSAQ_4 0.962 Excellent
ALSAQ_5 1.000 Excellent
ALSAQ_6 0.551 Moderate
ALSAQ_7 0.871 Excellent
ALSAQ_8 0.774 Substantial
ALSAQ_9 0.763 Substantial
ALSAQ_11 0.909 Excellent
ALSAQ_13 0.538 Moderate
ALSAQ_14 0.863 Excellent
ALSAQ_15 0.851 Excellent
ALSAQ_16 0.747 Substantial

1
weighted Kappa: 0.41-0.60 moderate; 0.60-0.80 substantial; >0.80 excellent

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 Table 7. Pearson's r coefficients of correlation (for all correlations P<0.05 (two-tailed test))
Accepted Article
ALSAQ-P

Moral processing Self-awareness Relational transparency Total

GSES 0.38 0.39 0.30 0.44

MFQ: Fairness/reciprocity 0.32 0.27 0.21 0.34
MFQ: Ingroup/loyalty 0.26 0.21 0.25 0.30
MFQ: Authority/respect 0.23 0.19 0.24 0.27
MFQ: Purity/Sanctity 0.29 0.22 0.22 0.31

GSES – General Self-Efficacy Scale; MFQ – Moral Foundations Questionnaire

Table 8. Ranges of ALSAQ-P scores for the low, medium and high level

ALSAQ-P
Level Moral Relational
Self-awareness Total
processing transparency
Minimum 6 4 3 13
Low <21 <14 <8 <43
Medium 21-27 14-18 8-12 43-57
High >27 >18 >12 >57
Maximum 30 20 15 65

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