The Development and Pilot Testing of an Instrument to Measure Nurses' Working Environment: The Nursing Context Index

Background: Evidence shows that adopting a person-centered approach to nursing alters the work environment, reduces anxiety levels among nurses in the long term, promotes teamwork among staff, and increases job satisfaction. However, few studies have attempted to quantify the outcomes from the adoption of person-centered nursing. The lack of outcome measurement is in part influenced by the lack of a standardized instrument to measure person-centered nursing. Aims: The aim of this study was to develop an instrument (the Nursing Context Index) to inform the development of person-centered nursing and outcomes arising. Methods: The Nursing Context Index (NCI) was developed through three stages. Stage 1 involved a systematic literature review to identify the key characteristics that needed to be considered in the instrument. Stage 2 involved the identification and selection of items for inclusion in the instrument identified through focus group discussions. A 19-construct instrument was developed. Face validity and content validity were gauged. In Stage 3, a pilot study (n = 23) was conducted to test the instrument. Measures of internal consistency were ensured using Cronbach's alpha. Criterion-related validity of the instrument was ensured through comparison between factors contained in the instrument. Results: Findings show that the NCI is an accurate representation of the factors influenced by a clinical setting's progression to person-centered nursing. The factors were deemed appropriate to the clinical settings, and possessed face and content validity. Initial statistical findings confirm the validity and usability of the NCI. Implications and Conclusions: The process used for the development and testing of the instrument was found to be effective. The NCI was deemed to be an effective measure of factors influenced by the implementation of person-centered nursing and would help in redressing a scarcity of quantitative evidence to examine the benefits of nurses working in a person-centered manner.