Impact of performance obstacles on intensive care nurses' workload, perceived quality and safety of care, and quality of working life

Health Services Research, April, 2009 by Ayse P. Gurses, Pascale Carayon, Melanie Wall

Measures

To collect data, we used 61 items from a 98-item questionnaire (Appendix), which was developed and pilot-tested (Gurses 2005). The questionnaire was designed to measure performance obstacles, workload, perceived quality and safety of care, and QWL constructs as well as the demographic and background variables. Whenever appropriate, interitem reliability was assessed by Cronbach's [alpha] (Table 1).

Performance Obstacles. Twenty-six items were included in the questionnaire to measure performance obstacles; 21 had a dichotomous scale, and 5 had a semantic differential response format. A semantic differential response format measures respondents' reactions to a concept in terms of ratings on bipolar scales defined with contrasting adjectives at each end (Heise 1970). Accompanying a patient during intrahospital transport was an obstacle because a primary nurse cannot complete any tasks in her unit while accompanying a patient for transport. Upon her return, she may have an accumulated workload because the filling nurses typically concentrate only on the most critical patient tasks. Additionally, most hospitals do not have a formal, standardized handoff process for the primary nurse to give and receive information on the patient that did not go to an intrahospital transport, which may negatively affect quality and safety of care.

Through exploratory principal components factor analysis with promax rotation (Dillon and Goldstein 1984) and face validity decision making, the 26 items were combined to create measures for the 12 dimensions of the performance obstacles construct. For the dimensions indicated by the factor analysis, scales were created by summing items, and interitem reliability was assessed. For the dimensions involving items not necessarily correlated but that together defined a meaningful construct, an index was created by summing up the items (Diamantopoulos and Winklhofer 2002). Some single items were used alone to represent their own dimension (Table 1).

Workload. Workload was measured by a validated adaptation of a well-known scale (Caplan et al. 1975) measuring quantitative workload. The scale had four items, measuring the amount and pace of nurses' work assignments and had adequate interitem reliability (Tablel) (Nunnally 1978).

Perceived Quality and Safety of Care. This construct was measured by three scales. The first one measured nurses' own assessments of the overall quality of care they provided, the second measured the level of detailed nursing care provided (Bertram, Hershey, Opila, and Quirin 1990), and the third measured the perceived safety of care nurses provided (Nieva and Sorra 2003; Singer et al. 2003). All but the perceived safety of care scale had adequate interitem reliability (Table 1) (Nunnally 1978).

QWL. Nine items were used to measure QWL. Eight were developed based on the Profile of Mood States (McNair, Lorr, and Droppleman 1971) and the pilot study of the questionnaire (Gurses 2005). The ninth was a single item on job satisfaction (Quinn et al. 1971), which was not included in further analyses due to its low variance. A principal component factor analysis with promax rotation of the remaining eight items resulted in a correlated two-factor solution (fatigue and overall stress) that explained 72 percent of the total variance. Scales associated with each factor were created by averaging out the items loading on respective factors and both had satisfactory interitem reliability (Table 1) (Nunnally 1978).