Using item response theory to develop a shortened practice environment scale of the nursing work index.

The 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI) has been frequently used globally to measure the nurse work environment. However, due to its length and subsequent respondent burden, a more parsimonious version of the PES-NWI may be desirable. Item response theory (IRT) is a statistical technique that assists in decreasing the number of items in an instrument without sacrificing reliability and validity. Two separate samples of nurses in the United States (one called the "internal data source" and the other called "external data source"; sample sizes = 843 and 722, respectively) were analyzed. The internal data source was randomly split into training (n = 531) and validating data sets (n = 312), while a separate whole external data source was used as the final validating data set. Using IRT with training data, we removed nine items; two additional items were removed based on recommendations from a previous study. Confirmatory factor analyses supported the validity of the measurement model with the 20-item of PES-NWI in both internal and external validation data sources. The correlations among subscales between 31- and 20-item versions were high magnitude for five subscales in both validation data sets (τ = 0.84-0.89). Ultimately, we identified a 20-item version of the PES-NWI which demonstrated adequate validity and reliability properties while decreasing data collection burden yet maintaining a similar factor structure to the original instrument. Additional research may be necessary to update the items themselves on the PES-NWI.

How nurses' job characteristics affect their self-assessed work environment in hospitals- Slovenian use of the practice environment scale of the nursing work index.

BACKGROUND: Nurses' work environment influences nursing practice. Inappropriate working conditions are the result of underdeveloped workplace infrastructure, poor work organisation, inadequate education, and inappropriate staffing norms. The aim of this study was to describe and examine the predictors that affect nurses' work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI). METHODS: The validation of the PES-NWI was made. Nurse-reported job characteristics were used as independent variables. The sample included 1,010 nurses from adult surgical and medical units at 10 Slovenian hospitals. The Nurse Forecasting (RN4CAST) protocol was used. Permission to conduct the study was obtained from the National Medical Ethics Committee. RESULTS: The PES-NWI mean (2.64) was low, as were job and career satisfaction at 2.96 and 2.89, respectively. The PES-NWI can be explained in 48% with 'Opportunities for advancement', 'Educational opportunities', 'Satisfaction with current job', 'Professional status', 'Study leave', and 'Level of education'. A three-factor solution of PES-NWI yielded eight distinct variables. CONCLUSIONS: The obtained average on the Nursing Work Index was one of the lowest among previously conducted surveys. Nurses should be recognized as equals in the healthcare workforce who need to be empowered to develop the profession and have career development opportunities. Inter-professional relations and equal involvement of nurses in hospital affairs are also very important. TRIAL REGISTRATION: This is a non-intervention study - retrospectively registered.

The Relationship Between Nursing Practice Environment and Innovative Behavior in the Al-Madinah Region, Saudi Arabia: A Descriptive Study.

Background and objective A positive and supportive practice environment is essential for inspiring innovation in nursing. Innovative behaviors (IBs) could motivate nurses to devise solutions in several domains, such as identifying and solving workplace problems, building new work methods, delivering their services efficiently and effectively, adopting new medical technology advancements, and leading the change process to face current challenges in healthcare. In this study, we aimed to investigate the relationship between the nursing practice environment (NPE) and IB in the Al-Madinah region of Saudi Arabia. Methods A quantitative, descriptive, cross-sectional correlational design was employed for the study. The convenience sample consisted of 330 bedside nurses working in five general hospitals in the Al-Madinah region who voluntarily completed a self-report questionnaire consisting of queries related to demographic and professional characteristics, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and the Innovative Behavior Inventory (IBI). The collected data were analyzed using descriptive statistics and Pearson's correlation. Results Based on the study findings, the NPE was favorable. The overall PES-NWI mean score was 2.62 ± 0.50, and the mean scores of four of the five subscales were >2.50. The collegial nurse-physician relations subscale was perceived as the most favorable (2.87 ± 0.59), while staffing and resource adequacy was perceived as unfavorable (2.35 ± 0.65). The overall IBI mean score was 3.53 ± 0.56, indicating that nurses had a moderate level of agreement on IB. The highest mean score in IB was in the idea search domain (3.72 ± 0.77), while it was lowest in the implementation of starting activities domain (3.11 ± 0.86). Conclusions The correlation between the NPE and IB was positive and statistically significant. However, the correlation of the staffing and resources adequacy subscale in relation to subscales of idea search, overcoming obstacles, and innovation output did not reach statistical significance. Healthcare organizations should incorporate the principles of work innovation and healthy nursing work environments into their core values and enhance and nurture them through strategic management.

An Exploratory Study of the Associations Between the Hospital Work Environment and Implementation of Baby-Friendly Hospital Policy.

A descriptive, cross-sectional study design was used to explore the relationships between the hospital work environment and implementation of the Baby-Friendly USA Ten Steps Policy in an urban hospital. Nurses reported the degree to which the Ten Steps policy was implemented, perceptions of the unit work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI), and self-efficacy related to the implementation of the policy. Results suggest that the work environment and the implementation of breastfeeding policy have separate and independent effects on nurse self-efficacy. Robust nursing leadership focused on education and skill development for clinicians, and focused on post-hospital care for patients and families are important contributory factors to successful breastfeeding policy implementation.

Nurses' ehealth literacy and associations with the nursing practice environment.

AIM: To report on ehealth literacy levels in nurses and to explore its associations with the nursing practice environment. BACKGROUND: Nurses increasingly use the Internet and associated technologies to seek health-relevant information and manage their health. INTRODUCTION: High ehealth literacy is a predictor of better health outcomes in diverse populations but its levels and work-related determinants have not been adequately explored in direct-care nurses. METHODS: The sample for this cross-sectional study consisted of 200 staff nurses and nursing assistants in Greece. Participants reported during February-March 2019 their sociodemographic and work-related characteristics on a self-administered questionnaire which included the "electronic Health Literacy Scale"-eHEALS, and the "Practice Environment Scale of the Nursing Work Index"-PES-NWI. Crude and adjusted logistic regressions were performed. FINDINGS: In adjusted models, participants that scored higher on the "Collegial nurse-physician relationships" and "Nurse participation in hospital affairs" dimensions of the clinical environment had higher odds of reporting better ehealth literacy. The lowest item score in eHEALS was related to not being able to make health decisions using Internet information. DISCUSSION: Nurses' ehealth literacy was positively associated with some dimensions of the hospital practice environment. Nurses reported higher ehealth literacy scores in comparison to other studies; however, they were not confident in distinguishing reliable health information from Internet sources. This is quite alarming because it can directly impair the ability of nurses to provide relevant and up-to-date evidence-based care. CONCLUSION: This is the first study to report internationally on the positive associations of a good working environment with nurses' ehealth literacy levels. IMPLICATIONS FOR NURSING AND NURSING POLICY: Nursing policy should address the ehealth literary of nurses and integrate it into continuing professional education initiatives. Special focus should be put on nurses' ambiguity in distinguishing which ehealth information is reliable and can guide nursing practice. This should be combined with efforts to improve the nursing clinical environment and increase nurses' participation in hospital decisions.

The relationship between the nursing practice environment and five nursing-sensitive patient outcomes in acute care hospitals: A systematic review.

AIM: To synthesize the available evidence on the relationship between the nursing practice environment in acute care hospitals and five selected nursing-sensitive patient outcomes (mortality, medication error, pressure injury, hospital-acquired infection and patient fall). DESIGN: A quantitative systematic review of literature was conducted using the PRISMA reporting guidelines (PROSPERO: CRD42020143104). METHODS: A systematic review was undertaken up to October 2020 using: CINAHL, MEDLINE and Scopus. The review included studies exploring the relationship between the nursing practice environment in adult acute care settings and one of five selected patient outcomes using administrative data sources. Studies were published in English since 2000. RESULTS: Ten studies were included. Seven studies reported that a favourable nursing practice environment reduced the likelihood of mortality in acute care hospitals, but estimates of the effect size varied. Evidence on the association between the nursing practice environment and medication administration error, pressure injury and hospital-acquired infection was mixed.

Examining the measurement invariance of the Practice Environment Scale-Nursing Work Index in the United States.

The increasingly diverse nursing workforce in the United States often creates challenges for researchers in meaningfully interpreting survey data from large samples of nurses with heterogeneous cultural backgrounds. Considering this, the purpose of this study was to determine the measurement invariance of the Practice Environment Scale-Nursing Work Index (PES-NWI) between registered nurses (RNs) reporting as Asian/Pacific Islander and those reporting as White. Data from the National Database of Nursing Quality Indicators®, collected in 2018 from RNs (N = 27,619) providing direct patient care, were used in this study. Multi-group confirmatory factor analysis was used to determine measurement invariance. Interpretation of the fit indices across models (configural, metric, and scalar) provides support for measurement invariance of the PES-NWI across the two groups. There is empirical support for pooling PES-NWI data and comparing it across these two groups.

Work Environment and Workload of Staff Nurses in Level 2 Hospitals at Cavite, Philippines

@#One of the greatest healthcare challenges for today's generation is the improvement of the nursing work environment. Despite the challenges brought by the unhealthy working environment and high workload demand, Filipino nurses stood up high in maintaining professionalism towards their work. The goal of this study is to determine the relationship between the work environment and the workload of staff nurses in level 2 hospitals in Cavite, Philippines. Quantitative non-experimental descriptive correlational design was used, and the standardized questionnaires namely: Practice Environment Scale of the Nursing Work Index (PES-NWI) and NASA Task Load Index (NASA-TLX) were used to gather data from 70 respondents. Results showed that majority were female, belonging to Millennial age (23-38 years old), had baccalaureate degree in Nursing, with a gross monthly salary of Php 15,000.00- 19,999.00, being in the institution for more than 6 months to 5 years, and have an average nurse to patient ratio of 11.30. Their level of work environment was favorable in all subscales with a composite score of 3.13 (SD= 0.570). Their perceived workload was high, with a mean score of 71.24 (SD= 12.78). Likewise, nurse to patient ratio had a significant relationship with nurse manager ability, leadership, and support of nurses (X2= 94.26, p= <.001) and staffing and resource adequacy (X2= 75.06, p= 0.002). Moreover, significant relationships among the variables of age and physical demand (p= .004), length of institutional experience and physical demand (p <0.001), educational attainment and performance (p= .018), educational attainment and effort (p= .005), and length of institutional experience and effort (p= .001). Last, there is no statistically significant correlation between the overall work environment and the overall workload of nurses (r= -.084, p= .491). These findings underscore the importance of measures aimed at enhancing the work environment and workload of staff nurses to prevent further challenges among them.

RN4CAST Study in Portugal: Validation of the Portuguese Version of the Practice Environment Scale of the Nursing Work Index / Estudio RN4CAST en Portugal: validación de la versión portuguesa de la escala del entorno de práctica del índice de trabajo de enfermería / Estudo RN4Cast em Portugal: validação da versão portuguesa da escala do ambiente de prática do índice de trabalho de enfermagem

ABSTRACT Objective: This study aims to validate the Portuguese version of the Practice Environment Scale of the Nursing Work Index (PES-NWI) and assess construct validity through exploratory and confirmatory factor analyses. Materials and Methods: This cross-sectional study validates the psychometric properties of the PES-NWI in Portugal. Exploratory factorial analysis is used to analyze the psychometric properties of the PES-NWI in a sample of 5,075 Portuguese nurses; the data sample covers all geographic regions in the country. Confirmatory factor analysis is performed to confirm the model's data adequacy. Results: Factorial analysis explained 54.6 % of the variance and a five-dimension structure. The five factors identified were Nurse Participation in Hospital Affairs, Nurse Manager Ability, Leadership and Support of Nurses, Nursing Foundations for Quality of Care, Staffing and Resource Adequacy, and Nurse-Physician Relations. The confirmatory analysis showed that the five-factor model fit well with the data in the Portuguese context. Conclusion: In a Portuguese health context, the PES-NWI is a valid scale to access the nursing environment and improve working conditions.

RESUMEN Objetivo: este estudio tiene como objetivo validar la versión portuguesa de la escala del entorno de práctica del índice de trabajo de enfermería (PES-NWI, por sus siglas en inglés) y evaluar la validez de los constructos mediante análisis factorial exploratorio y confirmatorio. Materiales y métodos: el presente estudio transversal valida las propiedades psicométricas de la PES-NWI en Portugal. El análisis factorial exploratorio se utilizó para analizar las propiedades psicométricas de la PES-NWI en una muestra de 5 075 enfermeras portuguesas; la muestra de datos abarcaba todas las regiones geográficas del país. Se realizó un análisis factorial confirmatorio para corroborar la adecuación de los datos del modelo. Resultados: un análisis factorial explicó el 54.6 % de la varianza y una estructura de cinco dimensiones. Los cinco factores identificados fueron la participación de la enfermera en los asuntos hospitalarios; la capacidad del gerente de enfermería, el liderazgo y el apoyo de las enfermeras; los fundamentos de la enfermería para la calidad de la atención; la adecuación del personal y de los recursos y las relaciones entre la enfermera y el médico. El análisis confirmatorio mostró que el modelo de cinco factores se ajustaba bien a los datos en el contexto portugués. Conclusión: en el contexto de salud portugués, la PES-NWI es una escala válida para acceder al entorno de enfermería y mejorar las condiciones de trabajo.

RESUMO Objetivo: o objetivo deste estudo é validar a versão portuguesa da escala do ambiente de prática do índice de trabalho de enfermagem (PES-NWI, por sua sigla em inglês) e avaliar a validade dos constructos mediante análise fatorial exploratória e confirmatória. Materiais e métodos: este estudo transversal valida as propriedades psicométricas da PES-NWI em Portugal. A análise fatorial exploratória foi utilizada para analisar as propriedades psicométricas da PES-NWI em uma amostra de 5 075 enfermeiras portuguesas; a amostra de dados abrangia todas as regiões geográficas do país. Foi realizada uma análise fatorial confirmatória para corroborar a adequação dos dados do modelo. Resultados: uma análise fatorial explicou 54,6 % da variância e uma estrutura de cinco dimensões. Os cinco fatores identificados foram a participação da enfermeira nos assuntos hospitalares; a capacidade do gerente de enfermagem, a liderança e o apoio das enfermeiras; os fundamentos da enfermagem para a qualidade da atenção; a adequação do pessoal e dos recursos e das relações entre a enfermeira e o médico. A análise confirmatória mostrou que o modelo de cinco fatores se ajustava bem aos dados no contexto português. Conclusões: no contexto de saúde português, a PES-NWI é uma escala válida para acessar o ambiente de enfermagem e melhorar as condições de trabalho.

Reliability and validity of the practice environment scale of the nursing work index for Japanese hospital nurses.

AIMS: The aim of this study was to examine the reliability and validity of the Practice Environment Scale of the Nursing Work Index (PES-NWI) for hospital nurses in Japan. DESIGN: A cross-sectional mail survey. METHODS: Participants in this study were 1,219 full-time ward nurses from 27 hospitals in Japan, using 31 items of the Japanese version of the PES-NWI questionnaire, from December 2008-March 2009. Construct validity, criterion-related validity and internal consistency of the PES-NWI were tested. RESULTS: The PES-NWI showed reliable internal consistency. The five-factor structure was supported by confirmatory factor analysis. The PES-NWI correlated significantly with job satisfaction, burnout and the nurses' intention to stay on the job, supporting criterion-related validity.

The Practice Environment Scale of the Nursing Work Index: An updated review and recommendations for use.

OBJECTIVES: The Practice Environment Scale of the Nursing Work Index (PES-NWI) is an instrument, which measures the nursing practice environment - defined as factors that enhance or attenuate a nurse's ability to practice nursing skillfully and deliver high quality care. The purpose of this paper is to provide an updated review of the Practice Environment Scale of the Nursing Work Index's use to date and provide recommendations that may be helpful to nursing leaders and researchers who plan to use this instrument. DESIGN: A narrative review of quantitative studies. DATA SOURCES: PubMed, EMBASE, and the Cumulative Index to Nursing & Allied Health Literature were searched to identify relevant literature using the search terms, Practice Environment Scale of the Nursing Work Index and PES-NWI. REVIEW METHODS: Studies were included if they were published in English between 2010 and 2016 and focused on the relationship between the Practice Environment Scale of the Nursing Work Index and patient, nurse, or organizational outcomes. Data extraction focused on the reported survey scores and the significance and strength of the reported associations. RESULTS: Forty-six articles, from 28 countries, were included in this review. The majority reported significant findings between the nursing practice environment and outcomes. Although some modifications have been made, the instrument has remained primarily unchanged since its development. Most often, the scores regarding staffing and resource adequacy remained the lowest. CONCLUSION: The frequency of use of this instrument has remained high. Many researchers advocate for a move beyond the study of the connection between the Practice Environment Scale and nurse, patient, and organizational outcomes. Research should shift toward identifying interventions that improve the environment in which nurses practice and determining if changing the environment results in improved care quality.

How Factor Analysis Results May Change Due to Country Context.

PURPOSE: To present how factor analysis results of a Practice Environment Scale of the Nursing Work Index (PES-NWI) translation changed due to country context. DESIGN: Validity and reliability analysis of a cross-culturally adapted, Polish translation of the PES-NWI came from a cross-sectional, national survey that included 2,605 registered nurses working in surgical (50.4%) and medical (49.6%) units of 30 Polish hospitals. METHODS: Exploratory factor analysis (EFA) using the principal component analysis (PCA) method with varimax rotation and confirmatory factor analysis (CFA) was used to examine factor structure of the instrument in the Polish context. Zero-order and partial Pearson correlation coefficients were used to establish the range of variance shared by the dimensions of the Polish version. The Cronbach's alpha coefficient determined internal consistency reliability. The internal consistency of the scale was also tested based on Kline's criterion. FINDINGS: The PCA conducted in the sample of Polish nurses extracted six factors, explaining together 56% of the total variance. The varimax rotation, however, restricted results to five factors, explaining 52.7% of the total variance and generating a factor structure closer to that based on previous studies. The CFA model, based on a PCA solution with five nonorthogonal factors, fitted data better than the theoretically driven model. CONCLUSIONS: Dimensions of the PES-NWI nurses' work environments remain conceptually consistent in Poland, but load differently. Health system or nursing profession factors related to the country context are potential explanations for these differences. CLINICAL RELEVANCE: When using a translation of the Practice Environment Scale of the Nursing Work Index-Revised to examine the influences of work environment quality on nursing and patient outcomes, it is important to consider contextual differences when using results to inform policy.

Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings.

OBJECTIVES: This paper summarises and critically reviews strategies identified in the literature which support retention of nurses by the creation and enhancement of positive practice environments in the clinical setting. DESIGN: Literature review. DATA SOURCES: A literature search was undertaken in February 2012 of major healthcare-related databases, Cinahlplus, Medline, and Proquest. REVIEW METHODS: The keywords "nurs* AND practice AND environment" were used in the first instance. Additional keywords "retention strategies" were also searched. Abstracts were reviewed and articles which potentially outlined strategies were identified. Reference lists were scanned for other potential articles. Articles in languages other than English were excluded. Lake's Practice Environment Scale of the Nursing Work Index provided a framework from which to assess the strategies. RESULTS: Thirty-nine papers reported strategies for creating a positive practice environment. Only two articles reported on a pre-test post-test evaluation of the proposed strategy. Strategies included: empowering work environment, shared governance structure, autonomy, professional development, leadership support, adequate numbers and skill mix and collegial relationships within the healthcare team. CONCLUSIONS: Creating positive practice environments enhances nurse retention and facilitates quality patient care. Managers and administrators should assess and manage their practice environments using a validated tool to guide and evaluate interventions.

Nursing practice environment, quality of care, and morale of hospital nurses in Japan.

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.