Academic journal article Journal of Nursing Measurement

Using Item Response Theory Models to Evaluate the Practice Environment Scale

Academic journal article Journal of Nursing Measurement

Using Item Response Theory Models to Evaluate the Practice Environment Scale

Article excerpt

Background and Purpose: The purpose of this article is to introduce different types of item response theory models and to demonstrate their usefulness by evaluating the Practice Environment Scale. Methods: Item response theory models such as constrained and unconstrained graded response model, partial credit model, Rasch model, and one-parameter logistic model are demonstrated. The Akaike information criterion (AIC) and Bayesian information criterion (BIC) indices are used as model selection criterion. Results: The unconstrained graded response and partial credit models indicated the best fit for the data. Almost all items in the instrument performed well. Conclusions: Although most of the items strongly measure the construct, there are a few items that could be eliminated without substantially altering the instrument. The analysis revealed that the instrument may function differently when administered to different unit types.

Keywords: item response theory; Practice Environment Scale (PES); Rasch model; graded response model; rating scale model; partial credit model

(ProQuest: ... denotes formulae omitted.)

The environment within which hospital nurses practice has long been recognized for its association with nurses' job satisfaction and turnover (Kramer & Hafner, 1989; McClure, Poulin, Sovie, & Wandelt, 1983) and more recently, for its contributions to patient outcomes. For example, more favorable work environments have been associated with lower patient mortality (Aiken, Clarke, Sloane, Lake, & Cheney, 2008; Kazanjian, Green, Wong, & Reid, 2005) and improved patient safety climate (Armstrong, Laschinger, & Wong, 2008). Aiken, Clark, and Sloane (2002) theorized that if nurses had adequate resources for patient care, the leadership support and authority to apply these resources to patient care, and good relationships with interprofessional colleagues that lead to enhanced teamwork, then hospitalized patients would receive higher quality care. Because these work environment attributes are associated with better patient and nurse outcomes, health care organization leaders should desire to improve the practice environment. To do this, they must have a suitable measure of this construct.

There are various instruments that measure the practice environment of hospital-based registered nurses (RNs), many of which have their roots in the early magnet hospital work of the 1980s and the subsequent development of the Nursing Work Index (NWI; Kramer & Hafner, 1989). The NWI captured the major facets of hospitals and units that were deemed good places to work because they attracted and retained a superior nursing workforce during a time of a serious nursing shortage. These early magnet hospitals attracted and retained nurses because they had superior practice environments characterized by nursing autonomy, authority, control over practice, and good working relationships with physicians (Kramer & Hafner, 1989). Empirical improvements to the NWI led to the development of the Revised NWI (NWI-R; Aiken & Patrician, 2000) and the Practice Environment Scale (PES; Lake, 2002). The NWI-R streamlined the response categories and devised conceptually formulated subscales: control, autonomy, and nurse-physician collaboration. The PES is a more parsimonious (31 items vs. 57) and contemporary rendition of the NWI-R. A confirmatory factor analysis of the PES yielded five subscales: nurse participation in hospital affairs; nursing foundations for quality of care; nurse manager ability, leadership, and support; staffing and resource adequacy; and collegial nurse-physician relationships (Lake, 2002). The PES asks nurses to what extent the 31 items characterize their current work environment. Nurses then respond on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). Scores are averaged for each of the subscale scores, and a composite score is obtained by averaging all subscales to represent a global assessment of the practice environment. …

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