Development and Psychometric Evaluation of the TOGETHER Family‐Reported Experience Measure of Nurse‐Facilitated Family Engagement in Adult Acute Care

BACKGROUND: Family engagement improves outcomes, shortens hospital stays, and enhances patient and family experiences, yet remains inconsistently enacted despite nurses' pivotal role. Existing instruments focus on paediatrics or critical care, measure activation rather than enacted engagement, or lack robust psychometric evidence. No family-reported measure captures nurse-facilitated engagement in general adult acute care. OBJECTIVE: To develop and psychometrically evaluate a family-reported experience measure of nurse-facilitated family engagement in adult acute care. METHODS: A two-phase mixed-methods instrument development was completed. Phase 1 involved construct definition, item generation, expert review (content validity), and cognitive interviews. Phase 2 used a cross-sectional survey (n = 237) to test factor structure, reliability, and construct (convergent and discriminant) validity. RESULTS: TOGETHER (TOwards Gathering Evidence to evaluaTe in-Hospital family partnERships) is a 23-item scale. Structural analysis of the 20-item analytic core (three context-contingent items retained for content coverage but excluded a priori from factor modelling) supported a bifactor model comprising a general factor ('family partnerships') and two specific factors ('communication', 'collaboration'). Model fit was good (CFI = 0.992, RMSEA = 0.060), and total-score reliability was adequate (ω = 0.79). Specific factors were moderately correlated (r = 0.61). CONCLUSION: TOGETHER provides a total score for evaluation and monitoring of nurse-facilitated family engagement in adult acute care; domain-level patterns may be examined descriptively but lack sufficient reliability for standalone scoring. The present evidence applies to the English-language version only. Cross-site benchmarking, cross-group comparison, and cross-linguistic extension require further validation. PATIENT OR PUBLIC CONTRIBUTION: Family caregivers with lived experience collaborated as study investigators throughout the study. They contributed lived healthcare and caregiving experience as well as specialist expertise in person-centred care policy. Their involvement spanned study conduct, item development and manuscript preparation, including review of the final manuscript prior to submission. An additional group of people with lived experience provided their perspectives on the instrument during pretesting.