Practice Environment Scale of the Nursing Work Index (5 items version): Translation and validation in Greek

doi:10.21203/rs.3.rs-5153965/v1

Download PDF

Research Article

Practice Environment Scale of the Nursing Work Index (5 items version): Translation and validation in Greek

https://doi.org/10.21203/rs.3.rs-5153965/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background:Measuring nurse work environments is essential to address the nursing shortage.

Aim: To translate and validate the “Practice Environment Scale of the Nursing Work Index” (5 items version) in Greek.

Methods: Study population included 80 nurses in Greece. We performed our study during August 2024. We employed the forward-backward method to translate and adapt the “Practice Environment Scale of the Nursing Work Index” (PES-5) in Greek language. We examined the construct validity of the PES-5 by performing confirmatory factor analysis. We examined the concurrent validity of the PES-5 using the “Quiet Quitting Scale” (QQS), the single item burnout measure, and the single item turnover intention measure. We examined the reliability of the PES-5 by calculating Cronbach’s alpha.

Results: The PES-5 showed very good psychometric properties. Our confirmatory factor analysis confirmed the one-factor structure of the PES-5. Concurrent validity of the Greek version of the PES-5 was very good. We found a statistically significant negative correlation between PES-5 and QQS (r = -0.410, p-value < 0.001), and single item turnover intention measure (r = -0.227, p-value = 0.043). We found that the PES-5 had very good reliability since Cronbach’s coefficient alpha was 0.651.

Conclusions: The Greek version of the “Practice Environment Scale of the Nursing Work Index” is a reliable and valid tool to measure the nursing practice environment.

Nursing

Other Business

Social Work

Agricultural Engineering

Practice Environment Scale

practice

nursing environment

nurses

Quiet Quitting Scale

Greece

The nursing practice environment was conceptualized through the lens of organizational, occupational, and work sociology. This interdisciplinary approach highlights the complexities of organizing professional work that involves treating patients with fluctuating health conditions in intricate organizational settings. These factors form the foundation of the nursing practice environment phenomenon. An empirical tool for measuring the work environment would enable managers to address shortcomings and allow researchers to establish theoretical connections with quality, safety, and outcomes, while also providing comparative standards (Lake, 2002, 2007; Lake et al., 2019; Zangaro & Jones, 2019).

Recently, nurses are experiencing a burnout crisis primarily stemming from work environments characterized by excessive workloads and insufficient organizational backing and leadership (Alves, Oliveira, & Paro, 2019; Ystaas et al., 2023). The emotional labor inherent in nursing makes practitioners particularly vulnerable to burnout, moral distress, and compassion fatigue (P Galanis, Vraka, Fragkou, Bilali, & Kaitelidou, 2021).

For decades, healthcare systems worldwide have grappled with safety issues in patient care, including adverse events, medication errors, falls, and surgical mistakes. Research has identified healthcare environments as high-risk settings lacking a safety culture, resulting in prolonged hospital stays, disability, or even fatalities (Farokhzadian, Dehghan Nayeri, & Borhani, 2018; Ree & Wiig, 2019). The nursing profession and current healthcare landscape are inherently chaotic, and studies have shown that a positive safety culture emerges from credible and visible leaders who champion patient safety practices (Pronovost, Cleeman, Wright, & Srinivasan, 2016). It is crucial to recognize that nurses have the most frequent patient interactions, positioning nurse leaders as key influencers in shaping patient safety culture to achieve improved patient outcomes (Hendricks, Cope, & Baum, 2015; Murray, Sundin, & Cope, 2018).

The quality of the nursing work environment serves as an indicator of nurse satisfaction. A leader who engages staff, promotes teamwork, acknowledges good performance, and stimulates motivation can significantly impact the quality of work life (Gottlieb, Gottlieb, & Bitzas, 2021). Leadership style, which describes how leaders interact with others, can be broadly categorized into two main approaches: task-oriented and relational (Wong, Cummings, & Ducharme, 2013).

To our knowledge, no study until now has translated and validated the “Practice Environment Scale of the Nursing Work Index” (5 items version) (PES-5) (Lake et al., 2024) in Greek language. Therefore, the aim of our study was to translate and validate the PES-5 in Greek language.

Study design

Study population included 80 nurses in Greece. We collected our data in August 2024. We employed the forward-backward method to translate and adapt the PES-5 in Greek language (Petros Galanis, 2019).

The PES-5 includes 5 items and one factor. Example items are the following: “Administration that listens and responds to nurse concerns”, “A clear philosophy of nursing that pervades the patient care environment, and “A nurse manager who is a good manager and leader”. Answers are on a four-point Likert scale; completely disagree (1), disagree (2), agree (3), and completely agree (4). Total score on PES-5 ranges from 1 to 4. Higher scores indicate a better nursing practice environment.

We conducted confirmatory factor analysis to examine the construct validity of the PES-5 (Petros Galanis, 2013). We examined the reliability of the PES-5 by calculating Cronbach’s alpha.

We examined the concurrent validity of the PES-5 using the “Quiet Quitting Scale” (QQS) (Petros Galanis, Katsiroumpa, et al., 2023), the single item burnout measure (Hansen & Pit, 2016), and the single item turnover intention measure (Spector, Dwyer, & Jex, 1988). In particular, we used the Greek versions of QQS (P Galanis, Katsiroumpa, Vraka, Konstantakopoulou, et al., 2024; Petros Galanis, Katsiroumpa, et al., 2023) and single item burnout measure (P Galanis, Katsiroumpa, Vraka, Siskou, et al., 2024). We employed the QQS since several studies have showed that the phenomenon of quiet quitting is a new threaten for workers and especially nurses (P Galanis, 2023; Petros Galanis et al., 2024; Petros Galanis, Moisoglou, et al., 2023; Moisoglou et al., 2024).

Ethical considerations

We applied the guidelines of the Declaration of Helsinki to perform this study (World Medical Association, 2013). Additionally, the study protocol was approved by the Ethics Committee of Faculty of Nursing, National and Kapodistrian University of Athens (approval number; 494, approval date; April 2024).

Statistical analysis

We performed confirmatory factor analysis (CFA) to examine the construct validity of PES-5. In particular, we calculated chi-square/degree of freedom (x²/df); root mean square error of approximation (RMSEA); goodness of fit index (GFI); adjusted goodness of fit index (AGFI); Tucker–Lewis index (TLI); incremental fit index (IFI); normed fit index (NFI); comparative fit index (CFI) (Baumgartner & Homburg, 1996; Hu & Bentler, 1998). Acceptable value for x²/df is < 5, for RMSEA is < 0.10, and for all other measures in the CFA > 0.90. We used the AMOS version 21 (Amos Development Corporation, 2018) to conduct the CFA. We calculated Pearson’s correlation coefficient between PES-5, QQS, single item burnout measure, and single item turnover intention measure to examine the concurrent validity of the PES-5. P-values less than 0.05 were considered as statistically significant. We used the IBM SPSS 21.0 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) for the analysis.

Study population included 233 nurses. In our sample, percentage of females was 87.5% (n = 70) and percentage of males was 12.5% (n = 10). Mean age of participants was 41.4 years with a standard deviation of 9.1 years.

We performed confirmatory factor analysis to examine the structure of the “Practice Environment Scale of the Nursing Work Index” and we found that the Greek version of the scale had a four-factor structure as the original version (Fig. 1). Table 1 presents model fit indices for the confirmatory factor analysis of the PES-5. All indices indicated an acceptable three-factor model. In particular, x²/df was 1.100, RMSEA was 0.036, GFI was 0.978, AGFI was 0.908, TLI was 0.919, IFI was 0.992, NFI was 0.919, and CFI was 0.991. Moreover, standardized regression weights for the 12 items ranged from 0.45 to 0.62 (Fig. 1).

Table 1

Confirmatory factor analysis for the Greek version of the “Practice Environment Scale of the Nursing Work Index”.
Model	x²	df	x²/df	RMSEA	GFI	AGFI	TLI	IFI	NFI	CFI
5 items	4.401	4	1.100	0.036	0.978	0.908	0.919	0.992	0.919	0.991

We calculated Pearson’s correlation coefficient between PES-5, QQS, single item burnout measure, and single item turnover intention measure to examine the concurrent validity of the PES-5 (Table 2). We found a statistically significant negative correlation between PES-5 and QQS (r = -0.410, p-value < 0.001), and single item turnover intention measure (r = -0.227, p-value = 0.043). Cronbach’s coefficient alpha for PES-5 was 0.651.

Table 2

Pearson’s correlation coefficient between PES-5, QQS, single item burnout measure, and single item turnover intention measure.
Scale	PES-5
QQS
Correlation coefficient	-0.410
P-value	< 0.001
Single item burnout measure
Correlation coefficient	-0.079
P-value	0.486
Single item turnover intention measure
Correlation coefficient	-0.227
P-value	0.043

To our knowledge, this was the first study that translates and validates the “Practice Environment Scale of the Nursing Work Index” in a sample of nurses in Greece. We found that the PES-5 is a reliable and valid tool to measure nursing work environments.

In particular, we found that Cronbach’s coefficient alpha for the PES-5 was 0.651. Among others, two systematic reviews confirm our results (Lake, Rosenbaum, Sauveur, Buren, & Cho, 2023; Warshawsky & Havens, 2011). In particular, Lake et al. (2023) performed a systematic review and identified 38 articles in 35 countries. The PES-5 has been translated in 24 languages and 15 language variants. Translations have been mainly in European, Middle Eastern, and Southeast Asian languages. Cronbach’s coefficient alpha for the PES-5 ranged from 0.61 to 0.95 among studies. Among studies, 23 found that the PES-5 has very good psychometric properties, 8 found that the PES-5 has moderate psychometric properties, and 15 found that the PES-5 has low psychometric properties. Moreover, Warshawsky and Havens (2011) identified 37 articles in five countries through 10 practice settings. They found that the PES-5 have been translated into three languages.

Additionally, we found a statistically significant negative correlation between PES-5 and QQS, and single item turnover intention measure. A recent systematic review confirms our findings since several studies found significant correlations between the PES-5 and several nurse, patient, and organizational outcomes (Warshawsky & Havens, 2011)

Also, we performed confirmatory factor analysis to examine the structure of the “Practice Environment Scale of the Nursing Work Index” and we found that the Greek version of the scale had a one-factor structure as the original version. Our findings are supported from several other studies (Lake et al., 2023).

Our study had several limitations. We performed a cross-sectional study with a convenience sample of nurses to validate the PES-5 in Greek. Additionally, we examined several types of reliability and validity, but future studies should examine further the psychometric properties of the PES-5. For example, scholars should examine in the future the convergent validity and the criterion validity of the PES-5.

In conclusion, the Greek version of the “Practice Environment Scale of the Nursing Work Index” is a reliable and valid tool to measure nursing working environments.

Conflicts of interest: None

Funding: None

Alves PC, Oliveira ADF, Paro HBMDS (2019) Quality of life and burnout among faculty members: How much does the field of knowledge matter? PLoS ONE 14(3):e0214217. 10.1371/journal.pone.0214217
Baumgartner H, Homburg C (1996) Applications of structural equation modeling in marketing and consumer research: A review. Int J Res Mark 13(2):139–161. 10.1016/0167-8116(95)00038-0
Farokhzadian J, Dehghan Nayeri N, Borhani F (2018) The long way ahead to achieve an effective patient safety culture: Challenges perceived by nurses. BMC Health Serv Res 18(1):654. 10.1186/s12913-018-3467-1
Galanis P (2023) Quiet Quitting: A Significant Threat for Healthcare Industry or an Inevitable Reaction of the Healthcare Workers? Int J Caring Sci 16(2):512–513
Galanis P, Katsiroumpa A, Vraka I, Konstantakopoulou O, Moisoglou I, Gallos P, Kaitelidou D (2024) Quiet quitting among employees: A proposed cut-off score for the Quiet Quitting Scale. Archives Hellenic Med 41(3):381–387
Galanis P, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, Katsoulas T, Kaitelidou D (2024) The single item burnout measure is a reliable and valid tool to measure occupational burnout. Archives Hellenic Med 41(2):245–250
Galanis P, Vraka I, Fragkou D, Bilali A, Kaitelidou D (2021) Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. J Adv Nurs 77(8):3286–3302. 10.1111/jan.14839
Galanis P (2013) Validity and reliability of questionnaires in epidemiological studies. Arch Hellen Med 30(1):97–110
Galanis P (2019) Translation and cross-cultural adaptation methodology for questionnaires in languages other than Greek. Arch Hellen Med 36(1):124–135
Galanis P, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, Katsoulas T, Kaitelidou D (2024) Nurses quietly quit their job more often than other healthcare workers: An alarming issue for healthcare services. Int Nurs Rev under press. 10.1111/inr.12931
Galanis P, Katsiroumpa A, Vraka I, Siskou O, Konstantakopoulou O, Moisoglou I, Kaitelidou D (2023) The quiet quitting scale: Development and initial validation. AIMS Public Health 10(4):828–848. 10.3934/publichealth.2023055
Galanis P, Moisoglou I, Malliarou M, Papathanasiou IV, Katsiroumpa A, Vraka I, Kaitelidou D (2023) Quiet Quitting among Nurses Increases Their Turnover Intention: Evidence from Greece in the Post-COVID-19 Era. Healthcare 12(1):79. 10.3390/healthcare12010079
Gottlieb LN, Gottlieb B, Bitzas V (2021) Creating Empowering Conditions for Nurses with Workplace Autonomy and Agency: How Healthcare Leaders Could Be Guided by Strengths-Based Nursing and Healthcare Leadership (SBNH-L). J Healthc Leadersh 13:169–181. 10.2147/JHL.S221141
Hansen V, Pit S (2016) The Single Item Burnout Measure is a Psychometrically Sound Screening Tool for Occupational Burnout. Health Scope 5(2). 10.17795/jhealthscope-32164
Hendricks J, Cope V, Baum G (2015) Postgraduate nurses’ insights into the nursing leadership role. Do they intuitively link the role to patient safety? J Nurs Educ Pract 5(9):p72. 10.5430/jnep.v5n9p72
Hu L, Bentler PM (1998) Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychol Methods 3(4):424–453. 10.1037/1082-989X.3.4.424
Lake ET (2002) Development of the practice environment scale of the nursing work index. Res Nurs Health 25(3):176–188. 10.1002/nur.10032
Lake ET (2007) The Nursing Practice Environment. Med Care Res Rev 64(2suppl):104S–122S. 10.1177/1077558707299253
Lake ET, Gil J, Moronski L, McHugh MD, Aiken LH, Lasater KB (2024) Validation of a short form of the practice environment scale of the nursing work index: The PES-5. Res Nurs Health 47(4):450–459. 10.1002/nur.22388
Lake ET, Rosenbaum KEF, Sauveur C, Buren C, Cho P (2023) Translations of the Practice Environment Scale of the Nursing Work Index: A systematic review. Nurs Health Sci 25(3):365–380. 10.1111/nhs.13034
Lake ET, Sanders J, Duan R, Riman KA, Schoenauer KM, Chen Y (2019) A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes. Med Care 57(5):353–361. 10.1097/MLR.0000000000001109
Moisoglou I, Katsiroumpa A, Vraka I, Kalogeropoulou M, Gallos P, Prasini I, Galanis P (2024) Quiet Quitting Threatens Healthcare Organizations and Services: Alarming Evidence from a Cross-Sectional Study with Nurses in Greece. Int J Caring Sci 17(2):1115–1122
Murray M, Sundin D, Cope V (2018) The nexus of nursing leadership and a culture of safer patient care. J Clin Nurs 27(5–6):1287–1293. 10.1111/jocn.13980
Pronovost PJ, Cleeman JI, Wright D, Srinivasan A (2016) Fifteen years after To Err is Human: A success story to learn from. BMJ Qual Saf 25(6):396–399. 10.1136/bmjqs-2015-004720
Ree E, Wiig S (2019) Employees’ perceptions of patient safety culture in Norwegian nursing homes and home care services. BMC Health Serv Res 19(1):607. 10.1186/s12913-019-4456-8
Spector PE, Dwyer DJ, Jex SM (1988) Relation of job stressors to affective, health, and performance outcomes: A comparison of multiple data sources. J Appl Psychol 73(1):11–19. 10.1037/0021-9010.73.1.11
Warshawsky NE, Havens DS (2011) Global Use of the Practice Environment Scale of the Nursing Work Index. Nurs Res 60(1):17–31. 10.1097/NNR.0b013e3181ffa79c
Wong CA, Cummings GG, Ducharme L (2013) The relationship between nursing leadership and patient outcomes: A systematic review update. J Nurs Adm Manag 21(5):709–724. 10.1111/jonm.12116
World Medical Association (2013) World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving. Hum Subj JAMA 310(20):2191–2194. 10.1001/jama.2013.281053
Ystaas LMK, Nikitara M, Ghobrial S, Latzourakis E, Polychronis G, Constantinou CS (2023) The Impact of Transformational Leadership in the Nursing Work Environment and Patients’ Outcomes: A Systematic Review. Nurs Rep 13(3):1271–1290. 10.3390/nursrep13030108
Zangaro GA, Jones K (2019) Practice Environment Scale of the Nursing Work Index: A Reliability Generalization Meta-Analysis. West J Nurs Res 41(11):1658–1684. 10.1177/0193945918823779

The authors declare no competing interests.

Download PDF

Version 1

posted

You are reading this latest preprint version

Practice Environment Scale of the Nursing Work Index (5 items version): Translation and validation in Greek

Status:

Version 1

Abstract

Figures

Introduction

Methods

Study design

Ethical considerations

Statistical analysis

Results

Discussion

Declarations

References

Additional Declarations

Status:

Version 1