Nursing Care Needs Assessment Scale for Women with Infertility

Abstract

The Nursing Care Needs Assessment Scale for Women with Infertility is an empirically derived, multidimensional psychometric instrument designed to quantify the specific clinical, technical, informational, and emotional support requirements of women undergoing medical treatments for infertility. While contemporary reproductive psychology instruments historically emphasize the detection and quantification of negative psychological states—such as generalized infertility-related stress, clinical anxiety, and depression—the Nursing Care Needs Assessment Scale intentionally pivots toward actionable, patient-centered nursing interventions within assisted reproductive technology (ART) environments. Developed and psychometrically validated by Jummi Park, Nayeon Shin, and Kyungmi Lee in South Korea, the scale systematically evaluates the holistic care ecology necessary for women navigating demanding procedures such as in vitro fertilization (IVF) and intrauterine insemination (IUI).

The validated instrument comprises an 18-item final structure, refined through rigorous exploratory factor analysis from an initial candidate pool of 55 preliminary items. Structural validation established a robust four-factor architecture accounting for 66.0% of the total variance: (1) physical and psychological nursing care needs (24.2% of variance explained), (2) needs for information regarding treatment, (3) needs for infertility-related understanding and concern, and (4) supportive needs. Responses are recorded on a 4-point Likert scale ranging from 1 (“not at all necessary”) to 4 (“very necessary”), yielding total composite scores between 18 and 72, alongside granular subscale scores. Psychometric evaluation in a clinical cohort of 250 women undergoing fertility treatment demonstrated exceptional internal consistency reliability, with an overall Cronbach's alpha of .92 and individual subscale coefficients ranging from .88 to .91. Criterion-related validity was confirmed via a statistically significant positive correlation (r = .63) with the Infertility Policy Needs Scale. By addressing clinical blind spots across physical symptom management, injection self-administration, psychological distress, and social systems navigation, this instrument serves as a critical diagnostic and evaluative tool for reproductive health nurses, clinical psychologists, and health policy researchers seeking to optimize therapeutic outcomes and mitigate treatment discontinuation.

Keywords

infertility, nursing care needs, needs assessment, assisted reproductive technology, women's health, psychometrics, scale development, health psychology, in vitro fertilization, patient-centered care, reproductive endocrinology, clinical nursing assessment

Authors

The Nursing Care Needs Assessment Scale for Women with Infertility was conceptualized, developed, and psychometrically validated by a collaborative team of distinguished nurse scientists and clinical scholars specializing in women's reproductive health and nursing methodology:

• Jummi Park, PhD, RN (Lead and Corresponding Author): Professor and senior researcher in maternal-child and women's health nursing. Affiliated with academic nursing institutions in South Korea. Institutional email contact: [email protected]. Dr. Park has published extensively on nursing interventions, clinical competency in reproductive healthcare, and the design of psychosocial support systems for women experiencing reproductive disruptions.
• Nayeon Shin, PhD, RN: Nurse researcher specializing in reproductive health dynamics, clinical nursing protocol design, and quantitative scale development for vulnerable female patient populations.
• Kyungmi Lee, PhD, RN: Scholar and clinical investigator focusing on gynecological nursing, healthcare needs assessment, and patient education architectures within specialized obstetric and fertility clinical settings.

Purpose

Infertility represents a complex, multi-system biological condition defined clinically by the failure to achieve a successful clinical pregnancy following 12 months or more of regular, unprotected sexual intercourse. Beyond its biological etiology, the therapeutic management of infertility—particularly through advanced assisted reproductive technologies such as controlled ovarian hyperstimulation, transvaginal oocyte retrieval, intracytoplasmic sperm injection (ICSI), and embryo transfer—imposes an overwhelming physical, affective, interpersonal, and economic burden on women. Despite technological advancements in reproductive endocrinology, standard clinical care has historically prioritized biomedical parameters (e.g., serum estradiol levels, endometrial thickness, fertilization rates, embryo grading) while treating patient psychosocial experience as an ancillary concern.

The primary clinical objective of the Nursing Care Needs Assessment Scale for Women with Infertility is to operationalize and standardize the identification of unmet patient requirements directly within the clinical workflow. Women undergoing fertility care navigate rigorous medication regimens requiring precise subcutaneous or intramuscular hormonal injections, severe adverse somatic symptoms (e.g., ovarian enlargement, severe abdominal distension, pelvic cramping, nausea, fatigue), and acute psychological vulnerability associated with procedure outcomes and the persistent fear of treatment failure. Healthcare providers frequently face clinical ambiguity regarding the exact domain of support a patient requires at any given phase of the treatment cycle: does the individual necessitate technical injection counseling, immediate post-retrieval somatic symptom stabilization, empathic de-escalation of existential grief, or partner-inclusive communication strategies? This instrument eliminates subjective guesswork, providing reproductive health nurses with an objective metric to formulate tailored, phase-specific nursing care plans.

For clinical administrators and nursing researchers, the instrument provides an empirical baseline to evaluate institutional care quality, audit nursing intervention efficacy, and justify the deployment of specialized fertility nurse coordinators. Furthermore, the tool assists healthcare organizations in mitigating treatment dropout rates. Epidemiological research in reproductive medicine demonstrates that psychological distress, poor provider communication, and perceived lack of somatic support constitute primary drivers of premature treatment discontinuation among couples with favorable biological prognoses. By systematically identifying and resolving unmet care needs before they escalate into treatment cessation, the instrument directly enhances therapeutic persistence and patient satisfaction.

Psychological Construct

The construct of nursing care needs within the context of female infertility is defined as the operational requirements for professional clinical interventions, educational guidance, physical symptom mitigation, and psychosocial support perceived by the patient as essential to maintain physiological equilibrium, psychological integrity, and treatment adherence. Unlike static personality traits or general psychiatric symptoms, nursing care needs represent a dynamic, transactional phenomenon that emerges at the intersection of medical intervention, somatic vulnerability, individual coping reserves, and healthcare system responsiveness.

The scale operationalizes this multifaceted construct across four distinct yet interconnected theoretical sub-dimensions:

1. Physical and Psychological Nursing Care Needs

This core dimension evaluates the convergence of somatic side effects and acute emotional distress directly precipitated by fertility protocols. Pharmacological regimens utilizing gonadotropins, GnRH agonists, and progesterone produce significant physiological side effects, including ovarian hyperstimulation syndrome (OHSS), local injection site reactions, systemic fatigue, headache, and severe abdominal bloating. Simultaneously, the invasive nature of procedures such as oocyte pick-up induces procedural anxiety and physical pain. This subscale measures the patient's requirement for active nursing surveillance, pharmacological pain protocols, comfort-oriented nursing maneuvers, and rapid empathetic interventions to stabilize acute anticipatory anxiety, feelings of bodily betrayal, and somatic discomfort.

2. Needs for Information Regarding Treatment

Assisted reproductive technology is characterized by intense procedural complexity and high cognitive load. Patients are required to comprehend complex hormonal chronologies, adhere strictly to time-sensitive medications (such as human chorionic gonadotropin “trigger” injections timed within narrow 30-minute windows), and decipher complex diagnostic laboratory values and pelvic sonograms. This subscale assesses the necessity for structured, unambiguous clinical education delivered by nursing personnel. It evaluates the demand for actionable guidance regarding medication self-administration mechanisms, physical signs mandating emergency clinical contact, procedural walkthroughs prior to interventions, and realistic communication regarding diagnostic benchmarks.

3. Needs for Infertility-Related Understanding and Concern

This dimension addresses broader cognitive and health literacy needs regarding the foundational etiology of reproductive pathology. Infertility diagnoses often precipitate profound cognitive dissonance, self-blame, and identity disruption. Patients frequently struggle to integrate biological explanations with their personal concepts of health and femininity. This subscale captures the requirement for nurses to provide non-judgmental, scientifically grounded explanations of diagnostic terms, reproductive physiological processes, and clinical options, thereby demystifying the medical diagnosis and dismantling guilt-inducing myths regarding the patient's lifestyle, personal history, or moral culpability.

4. Supportive Needs

Infertility rarely occurs in psychological isolation; it exerts acute systemic pressure on marital partnerships, extended family relationships, and social functioning. Women frequently experience social isolation, stigmatization, and unsolicited, intrusive inquiries from family members and social networks. Concurrently, the rigorous logistical demands of repeated clinical visits strain marital dynamics. The supportive needs subscale quantifies the patient's requirement for structural and emotional scaffolding orchestrated by the healthcare team. This includes fostering partner involvement during clinical consultations, providing marital stress de-escalation strategies, facilitating access to professional mental health counselors and specialized support groups, and establishing an accessible, continuous communication conduit with the nursing unit throughout the entire treatment trajectory.

Theoretical Framework

The architectural design and construct operationalization of the Nursing Care Needs Assessment Scale are anchored in several seminal paradigms from nursing science, health psychology, and transactional stress theory.

Peplau's Theory of Interpersonal Relations

Hildegard Peplau's psychodynamic nursing model posits that nursing is an educative, therapeutic, and interpersonal process that functions collaboratively when a shared health need is identified. Peplau articulated four sequential phases of the nurse-patient relationship: orientation, identification, exploitation, and resolution. In the context of fertility care, the scale serves as a clinical mechanism for the orientation and identification phases. When a woman enters the assisted reproduction setting, her psychological ambiguity and somatic helplessness require the nurse to function flexibly across multiple interpersonal roles: as a resource person (providing treatment facts), a teacher (instructing on injection mechanics), a counselor (validating grief and procedural fear), and an active surrogate/advocate (protecting bodily dignity during invasive procedures). The scale operationalizes these varied interpersonal roles into measurable clinical indices.

Watson's Theory of Human Caring

Jean Watson's Philosophy and Theory of Transpersonal Caring emphasizes that healing occurs within a transpersonal caring relationship that transcends mere curative medical techniques. Watson's 10 “Caritas Processes” highlight the promotion of transpersonal teaching-learning, the creation of a healing environment at all levels (physical, psychological, spiritual), and the systematic assistance with basic human needs while preserving the patient's dignity. Infertility treatments run the risk of becoming mechanized, technological exercises that objectify the female body into an oocyte production vessel. The scale operationalizes Watsonian caring theory by measuring the patient's need for authentic human empathy, compassionate presence, privacy, and unconditional positive regard during physically invasive procedures.

Lazarus and Folkman's Transactional Model of Stress and Coping

Under Richard Lazarus and Susan Folkman's model, psychological stress is experienced when environmental demands exceed an individual's cognitive and behavioral resources, threatening well-being. Cognitive appraisal involves primary appraisal (evaluating the threat of treatment failure or somatic harm) and secondary appraisal (evaluating available coping resources). The Nursing Care Needs Assessment Scale evaluates the external coping resources provided by the clinical environment. When nursing professionals deliver timely information, manage pain, and provide psychosocial validation, they actively augment the patient's secondary appraisal mechanisms, converting an unmanageable crisis into a manageable health challenge.

Orem's Self-Care Deficit Nursing Theory

Dorothea Orem conceptualized nursing as an agency designed to overcome deficits where a patient's self-care agency cannot meet therapeutic self-care demands. Women undergoing fertility protocols face extraordinary therapeutic self-care requisites: complex self-administered pharmacotherapy, symptom monitoring for dangerous conditions like OHSS, and behavioral adaptations. When these requisites surpass the individual's technical or emotional capacities, a self-care deficit emerges. The scale functions as a diagnostic tool to pinpoint precisely where self-care deficits occur across informational, somatic, and psychosocial domains, directing targeted nursing agency to restore patient self-efficacy.

Validity

The psychometric validation of the Nursing Care Needs Assessment Scale for Women with Infertility was conducted in South Korea, adhering to established methodological standards for health measurement instruments.

Content and Face Validity

Scale construction commenced with the generation of an initial 55-item preliminary item pool derived from qualitative interviews with infertile women, extensive reviews of assisted reproductive clinical guidelines, and empirical literature on infertility stress (e.g., the Fertility Problem Inventory and the Fertility Quality of Life [FertiQoL] tool). Content validity was formally evaluated using the Content Validity Index (CVI) methodology articulated by Lynn (1986). An expert panel comprising reproductive endocrinologists, women's health nursing professors, fertility clinic nurse managers, and health psychologists evaluated each item for clinical relevance, clarity, and representativeness. Items demonstrating an item-level CVI (I-CVI) below .80 were systematically revised or eliminated. Following expert review, cognitive debriefing and face validity testing were conducted with a cohort of infertile women to ensure linguistic clarity, cultural congruence, and unambiguous comprehension of all items.

Construct and Structural Validity

Construct validity was examined empirically using an exploratory factor analysis (EFA) framework on data gathered from 250 married women undergoing active fertility treatments across four specialized reproductive medicine hospitals in Seoul, South Korea. The sampling adequacy was confirmed via a Kaiser-Meyer-Olkin (KMO) value of .93, well above the recommended .80 threshold, and a statistically significant Bartlett's Test of Sphericity (p < .001), indicating robust data correlation matrices suitable for factor extraction. Using maximum likelihood extraction with varimax orthogonal rotation, items were evaluated against stringent psychometric retention criteria: factor loadings ≥ .40, communalities ≥ .30, and absence of significant cross-loadings across divergent dimensions. Through iterative refinement, 37 items exhibiting low discrimination, poor loadings, or conceptual redundancy were excised, yielding an 18-item final instrument across four distinct factors that collectively explained 66.0% of the total variance.

Criterion-Related and Convergent Validity

To establish criterion-related validity, the scale was evaluated alongside the Infertility Policy Needs Scale for Infertile Women. A statistically significant, robust positive correlation was documented (r = .63, p < .001). This finding provides theoretical convergence: patients who perceive an elevated demand for immediate, direct clinical and nursing care concurrently demonstrate higher advocacy for structural, economic, and policy-level healthcare interventions. The magnitude of this correlation demonstrates convergent validity without excessive collinearity, establishing that the scale captures a distinct clinical care domain separate from macroeconomic or policy-level concerns.

Reliability

The scale demonstrates excellent internal consistency reliability across its overall structure and individual subscales:

• Total Scale Internal Consistency: The overall 18-item instrument yielded a Cronbach's alpha coefficient of .92, well exceeding the recognized academic benchmark of .80 for clinical assessment tools and reflecting high conceptual coherence without redundant items.
• Subscale Alpha Coefficients: Each of the extracted dimensions demonstrated high internal consistency:
• Physical and Psychological Needs: Cronbach's α = .91
• Needs for Information Regarding Treatment: Cronbach's α = .90
• Needs for Infertility-Related Understanding and Concern: Cronbach's α = .88
• Supportive Needs: Cronbach's α = .88
• Measurement Precision: The high reliability indices confirm a low Standard Error of Measurement (SEM), indicating that observed scores closely reflect the true score of the respondent across clinical settings.

Factor Analysis

The structural dimensionality of the instrument was established through rigorous exploratory factor analysis. The initial 55-item draft was administered to a clinical sample of 250 married women undergoing infertility interventions (mean age = 36.4 years; age range = 20–50 years). Data suitability was confirmed via the Kaiser-Meyer-Olkin measure (KMO = .93) and Bartlett's Test of Sphericity (χ² = 3412.8, p < .001).

Factor Extraction and Variance Distribution

Exploratory factor analysis using maximum likelihood estimation and varimax orthogonal rotation isolated four clear dimensions with eigenvalues exceeding 1.0, satisfying the Kaiser-Guttman criterion and scree plot inflection analysis:

• Factor 1: Physical and psychological nursing care needs (6 items). Eigenvalue = 4.36, accounting for 24.2% of the total variance. This factor captures the greatest proportion of variance, confirming that somatic symptom management and direct psychological comfort represent the primary care priority for women undergoing treatment.
• Factor 2: Needs for information regarding treatment (5 items). Eigenvalue = 3.12, accounting for 17.3% of the total variance. Focuses on procedural mechanics, hormonal schedules, side effects, and warning signs.
• Factor 3: Needs for infertility-related understanding and concern (4 items). Eigenvalue = 2.45, accounting for 13.6% of the total variance. Reflects educational requirements surrounding diagnostic terms, biological causes, and clinical procedures.
• Factor 4: Supportive needs (3 items). Eigenvalue = 1.95, accounting for 10.9% of the total variance. Addresses partner integration, marital strain mitigation, and social support.

Collectively, the four-factor model accounts for 66.0% of the cumulative variance in nursing care needs, demonstrating structural parsimony and clinical comprehensiveness.

Instrument / Measurement Tool

The structural, operational, and clinical administration specifications of the instrument are detailed below:

• Test Type: Standardized self-report multidimensional assessment questionnaire.
• Format: 18 items, 4-point Likert scale (1 = not at all necessary to 4 = very necessary).
• Response Scale Options:
  • 1 = Not at all necessary
  • 2 = Slightly necessary
  • 3 = Necessary
  • 4 = Very necessary
• Target Population: Adult female medical patients (ages 20–50) diagnosed with primary or secondary infertility, actively undergoing clinical evaluation or assisted reproductive treatments (such as ovarian stimulation, intrauterine insemination, or in vitro fertilization).
• Administration Modality: Self-administered paper-and-pencil or secure electronic clinical questionnaire (tablet, patient portal).
• Administration Time: Approximately 5 to 10 minutes.
• Scoring Formula: Scores are calculated by summing all items to produce a total score ranging from 18 to 72, or by calculating the mean score across the entire instrument (range 1.00 to 4.00). Subscale scores are derived by summing or averaging the items specific to each sub-dimension. Higher scores indicate greater perceived need for nursing care interventions.
• Reverse-Scored Items: None. All items are positively phrased toward care needs.

Permissions & Fee and Test Year

The Nursing Care Needs Assessment Scale for Women with Infertility was published in 2020 in the Korean Journal of Women Health Nursing. The original research was published as an open-access academic article under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC), permitting non-commercial academic, clinical, and educational utilization provided the original authors and publication venue are properly cited.

For official research adaptation, clinical trials, or cross-cultural translation projects, researchers are advised to correspond directly with the corresponding author, Dr. Jummi Park ([email protected]), to obtain formal consent and request the original Korean-language scale instruments.

References

• Allan, H. (2013). The anxiety of infertility: The role of the nurses in the fertility clinic. Human Fertility, 16(1), 17–21. https://doi.org/10.3109/14647273.2013.778423
• Boivin, J., & Gameiro, S. (2015). Evolution of psychology and counseling in infertility. Fertility and Sterility, 104(2), 251–259. https://doi.org/10.1016/j.fertnstert.2015.05.035
• Boivin, J., Takefman, J., & Braverman, A. (2011). The fertility quality of life (FertiQoL) tool: Development and general psychometric properties. Human Reproduction, 26(8), 2084–2091. https://doi.org/10.1093/humrep/der171
• Costello, A. B., & Osborne, J. (2005). Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research, and Evaluation, 10(7), 1–9. https://doi.org/10.7275/jyj1-4868
• Denton, J., Monach, J., & Pacey, A. (2013). Infertility and assisted reproduction: Counselling and psychosocial aspects. Human Fertility, 16(1), 1–2. https://doi.org/10.3109/14647273.2013.781335
• DeVellis, R. F. (2012). Scale development: Theory and applications (3rd ed.). SAGE Publications.
• Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th ed.). Prentice Hall.
• Hwang, N. M. (2013). Factors related to the depression of infertile women. Health and Social Welfare Review, 33(3), 161–187. https://doi.org/10.15709/hswr.2013.33.3.161
• Kim, M. O. (2016). Relationship between infertility stress and quality of life of infertile women: Based on the moderating and mediating effects of sexual satisfaction. Journal of the Korean Society of Maternal and Child Health, 20(2), 140–151. https://doi.org/10.21896/jksmch.2016.20.2.140
• Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). Guilford Press.
• Lee, E., Moon, S., Cho, S., Oh, Y., Chun, M., Kim, S., & Lee, J. (2010). Psychometric evaluation of a need scale for cancer patients undergoing follow-up care. Journal of Korean Academy of Nursing, 40(4), 551–561. https://doi.org/10.4040/jkan.2010.40.4.551
• Lim, J., & Lee, J. (2014). Direction and support level of the fertility welfare policy in South Korea. Journal of Population Ageing, 7(2), 115–141. https://doi.org/10.1007/s12062-014-9098-3
• Luk, B. H., & Loke, A. Y. (2016). A review of supportive interventions targeting individuals or couples undergoing infertility treatment: Directions for the development of interventions. Journal of Sex & Marital Therapy, 42(6), 515–533. https://doi.org/10.1080/0092623X.2015.1074133
• Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382–386. https://doi.org/10.1097/00006199-198611000-00017
• Martínez-Pampliega, A., Cormenzana, S., Martín, S., & Navarro, L. (2019). Marital functioning and treatment outcome in couples undergoing assisted reproduction. Journal of Advanced Nursing, 75(2), 338–347. https://doi.org/10.1111/jan.13844
• Mourad, S., Nelen, W., Akkermans, R., Vollebergh, J., Grol, R., & Hermens, R. (2010). Determinants of patients' experiences and satisfaction with fertility care. Fertility and Sterility, 94(4), 1254–1260. https://doi.org/10.1016/j.fertnstert.2009.07.990
• Newton, C. R., Sherrard, W., & Glavac, I. (1999). The Fertility Problem Inventory: Measuring perceived infertility-related stress. Fertility and Sterility, 72(1), 54–62. https://doi.org/10.1016/S0015-0282(99)00164-8
• Park, J., Shin, N., & Lee, K. (2020). Nursing Care Needs Assessment Scale for Women with Infertility. Korean Journal of Women Health Nursing, 26(1), 81–91. https://doi.org/10.4069/kjwhn.2020.03.31.1
• Park, J., Shin, N., Lee, K., & Choi, J. (2019). Development of Nurses' Practical Educational Needs Scale for Women with Infertility. Korean Journal of Women Health Nursing, 25(1), 99–111. https://doi.org/10.4069/kjwhn.2019.25.1.99
• van Empel, I. W., Nelen, W. L., Tepe, E. T., van Laarhoven, E. A., Verhaak, C. M., & Kremer, J. A. (2010). Weaknesses, strengths and needs in fertility care according to patients. Human Reproduction, 25(1), 142–149. https://doi.org/10.1093/humrep/dep362

Items of the Scale