Fig. 1

Simplified factor loading diagram of the bifactor ESEM model for the QNC scale, which includes a general factor and seven specific factors for individual items. Note Circles represent latent factors, and squares represent observed variables (scale items). Error terms were specified but not shown. Bold solid lines indicate target factor loadings, while dashed lines represent cross-loadings for non-target factors. Each item is influenced by both the general QNC factor and seven specific factors: patient satisfaction (PS), health promotion (HP), prevention of complications (PC), well-being and self-care (SC), functional readaptation (FR), nursing care organization (NCO), and responsibility and rigor (RR)