Using the ARTIC-35 to Measure Nurses' Attitudes Related to Trauma-Informed Care

Abstract

Background and PurposeTrauma-informed care (TIC) acknowledges the lasting effects of trauma on individuals. The Attitudes Related to Trauma-Informed Care (ARTIC-35) scale was developed to examine healthcare providers' attitudes related to TIC. Here, we present an item-level analysis of the ARTIC-35 scale for use with nurses and compare our findings to the current ARTIC-35 structure.MethodsPrincipal components analysis, qualitative inter-item analysis, and qualitative intra-item analysis of the ARTIC-35.FindingsOur principal component analysis structure supported a nine-factor solution, inter-item qualitative analysis structure supported five subscales, and intra-item qualitative analysis identified 13 acceptable items and 22 items requiring revision for use with nurses.DiscussionWhen used with nurses, there are important considerations regarding scale validity and challenges with the design of the original ARTIC-35 scale.

Trauma-Informed Care Education Initiative Explores Impact on Perinatal Nurse Secondary Traumatic Stress and Workforce Challenges

“…One ARTIC scale version has been critiqued over concerns about the clarity of some of the dichotomous scales 60. The nature of the scale’s design does require close attention to each question, and a lack of clarity could skew results in either direction.…”

“…55 One researcher critiques the ARTIC scale 35-question version for use with nurse participants due to a lack of clarity around some of the dichotomous Likert scales and an unreliable factor analysis. 60 The ARTIC scale 45question version, which was used in this evaluation, adds 2 additional subscales addressing personal and system supports of TIC. 55 Internal consistency for this sample was calculated as α = .811, which falls into an acceptable range of reliability, although at lower levels than initially calculated by researchers during the development of the ARTIC scale.…”

“…In a dichotomous scale, 2 contradictory beliefs or attitudes are juxtaposed for each question and respondents are asked to choose their response on a continuum between these 2 opposite endpoints from 1 to 7 55. One researcher critiques the ARTIC scale 35-question version for use with nurse participants due to a lack of clarity around some of the dichotomous Likert scales and an unreliable factor analysis 60. The ARTIC scale 45-question version, which was used in this evaluation, adds 2 additional subscales addressing personal and system supports of TIC 55.…”

“…One ARTIC scale version has been critiqued over concerns about the clarity of some of the dichotomous scales.- 60 The nature of the scale's design does require close attention to each question, and a lack of clarity could skew results in either direction. While internal consistency was adequate for this sample, further research could explore this scale independently with perinatal nurses to understand their responses in the perinatal care context.…”

Development of a Questionnaire for Measuring Trauma-Informed Care of Nurses Working with Traumatically Injured Patients

“…For example, the tool of foundational knowledge about trauma-informed care were used in assessing the diverse range of trauma knowledge, 16 the Attitude Related to Trauma-Informed Care scale (ARTIC) was used in education or various human service organizations. 19 , 28 Currently, it seemed necessary to design a validated tool meant to evaluate the nurses’ trauma knowledge, attitude and effectiveness to integrate the trauma-informed approach into practice towards TIC in the field of traumatic injury.…”