Date of Conferral

8-17-2026

Date of Award

August 2026

Degree

Ph.D.

School

Nursing

Advisor

Cara Krulewitch

Abstract

Near-fatal strangulation (NFS) is a time-critical clinical presentation associated with elevated risk of stroke, delayed airway compromise, and future intimate partner homicide, yet no validated instrument existed to assess nurses' NFS-specific knowledge or self-efficacy. The purpose of this cross-sectional study, guided by Bandura's social cognitive theory and Benner's novice to expert theory, was to develop and pilot test the Nurses' Near-Fatal Strangulation Self-Efficacy Scale (NFS-SES) and to examine whether knowledge and self-efficacy predicted nurses' willingness to conduct an NFS assessment. A convenience sample of 150 registered nurses in emergency, labor and delivery, and obstetric emergency departments completed the NFS-SES, a knowledge assessment, and a willingness vignette. The NFS-SES demonstrated high internal consistency (α = .97, ω = .98), a bidimensional factor structure explaining 64.6% of variance, and known-groups validity favoring trained nurses (d = 1.02). Knowledge and self-efficacy were weakly correlated (r = .29, p < .001), and knowledge significantly predicted willingness (OR = 4.36, p = .002); self-efficacy did not remain a unique predictor. Emergency department nurses reported substantially higher self-efficacy than labor and delivery nurses (d = 0.91), revealing a preparedness gap in obstetric practice. Recommendations include further development and validation of the tool through multi-site confirmatory factor analysis. Additionally, NFS-specific obstetric training should be developed. This work supports positive social change by strengthening healthcare's contribution to violence prevention and survivor safety.

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