Psychometric Evaluation of the Medico-Legal Risk Awareness Scale (MLRA) for Clinical Nurses in Indonesia

Abstract

Medico-legal risk awareness is an important component of accountable nursing practice because nurses routinely undertake clinical activities that carry legal and professional responsibilities, including medication administration, documentation, informed consent, confidentiality, and incident reporting. However, validated instruments that specifically assess nurses’ awareness of medico-legal risks and integrate knowledge, responsibility, risk perception, and preparedness remain limited, particularly in the Indonesian context. This study aimed to develop and evaluate the psychometric properties of the Medico-Legal Risk Awareness (MLRA) scale among clinical nurses in Indonesia. A methodological cross-sectional study was conducted among 320 clinical nurses recruited from secondary and tertiary hospitals in Indonesia. The scale was developed through literature review, expert assessment, pilot testing, and psychometric evaluation. Content validity was assessed using the Content Validity Index (CVI), construct validity using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), and internal consistency using Cronbach’s alpha and composite reliability. The final 20-item MLRA scale comprised four domains: legal knowledge, legal responsibility and compliance, risk perception, and confidence and preparedness. The scale demonstrated excellent content validity (S-CVI/Ave = 0.92). EFA supported a four-factor structure explaining 68.4% of the total variance, with factor loadings ranging from 0.56 to 0.84. CFA demonstrated good model fit (CFI = 0.95, TLI = 0.94, RMSEA = 0.05, SRMR = 0.04). Overall internal consistency was excellent (Cronbach’s alpha = 0.91), while subscale coefficients ranged from 0.80 to 0.89 and composite reliability values exceeded 0.85. The findings provide evidence that the MLRA scale has satisfactory content validity, structural validity, and internal consistency for assessing medico-legal risk awareness among clinical nurses in Indonesia. The instrument may support nursing education, clinical governance, and research focused on legal accountability and risk management in nursing practice.