The Psychometric Properties and the Development of the Indicators of Quality Nursing Work Environments in Taiwan

臺灣優質護理職場環境指標之建構

10.1097/jnr.0000000000000106

林秋芬(Chiou-Fen Lin)；盧美秀(Meei-Shiow Lu)；黃秀英(Hsiu-Ying Huang)

護理職場環境 ； 主成份分析 ； 指標 ； 護理人力短缺 ； nursing work environments ； indicator ； principal component analysis ； nursing shortage

The Journal of Nursing Research

24卷1期（2016 / 03 / 01）

9 - 20

英文

背景：臺灣2012年各醫院護理人力平均缺額率9%，遠遠高於文獻所稱人力短缺的5%，造成許多醫院因此關病房或減床。但台灣領證的護理師執業率僅60.4%，相較於加拿大、美國明顯偏低，乃因台灣的護理職場環境不良，造成護理人員不願意就業。目的：建構臺灣的優質護理職場環境指標，並進行信、效度檢定。方法：採用多元研究法進行，分2階段6步驟。階段1：組織專家群、文獻查證、七次的專家座談會及六次的護理部主任焦點團體討論，以發展符合臺灣現況的優質護理職場環境指標內容初稿。階段2：進行專家效度檢測，舉辦3場公聽會及問卷調查，共發出427份，有效問卷381 份，進行表面效度、建構效度、及內部一致性信度檢測。結果：本研究所完成之臺灣優質護理職場環境指標共有8個構面、65項內容。8個構面分別為：安全執業環境（16 項）、人力質與量（4 項）、薪資與福利（7 項）、專業分工與團隊合作（7項）、工作簡化（5項）、資訊化（5項）、人才培育與專業發展（9項），以及支持與關懷（12 項）等。整體指標因素負荷量為77.57%。結論／實務應用：本研究完成之「優質護理職場環境指標」，可做為評核護理職場環境優劣之標準，未來可以進行醫院調查，了解臺灣護理職場環境的現況及作為進一步措施的結果衡量方法。

Background: The nursing shortage in medical institutions in Taiwan averaged 9% in 2012, considerably higher than the 5% indicated in the literature. As a result, many hospitals have been forced to close wards or reduce beds. Despite the acute need, the percentage of registered nurses who are employed as nurses in Taiwan (60.4%) is considerably lower than those in Canada or the United States. This low rate may be because of the poor working environment for nurses in Taiwan. Purpose: This study aimed to develop a set of nursing work environment quality indicators for Taiwan and to test the reliability and validity of the resulting survey tool. Methods: Multiple methods were used in this study. In Phase 1, we organized an expert panel, reviewed the literature, and conducted seven rounds of expert panel discussion and six focus group discussions with nursing directors. The goal was to draft indicators representing a quality nursing work environment to fit current conditions in Taiwan. In Phase 2,we conducted an expert review for content validity, held three public hearings, and conducted a survey. Four hundred twenty-seven questionnaires were sent out, with 381 returned. The goal was to test the content validity, construct validity, and internal consistency reliability. Results: The study produced a set of indicators of a quality nursing work environment with eight dimensions and 65 items. The content validity index for importance and suitability dimensions were 1.0,whereas the internal consistency was 0.91. The eight dimensions were safe practice environment (16 items), quality and quantity of staff (four items), salary and welfare (seven items), professional specialization and teamwork (seven items), work simplification (five items), informatics (five items), career development (nine items), and support and caring (12 items). The overall load for the indicators was 77.57%. Conclusions/Implications for Practice: The developed indicators may be used to evaluate the quality of nursing work environments. Furthermore, the indicators may be used in hospital surveys to establish baseline conditions and for outcome research that measures improvement in nursing work environments after interventions.

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