Practice Environment Scale of the Nursing Work Index: A Reliability Generalization Meta-Analysis

Abstract

A healthy work environment is a critical factor in nurse satisfaction, retention, and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most commonly used instrument to measure the nursing practice environment. This study uses meta-analysis to examine the reliability generalization of the PES-NWI. A meta-analysis of 51 studies representing a total of 80,563 subjects was conducted. The mean score reliability for the PES-NWI based on 38 studies ( n = 68,278) was .922 ( p < .05). The Mean Weighted Effect Size was stronger for studies conducted in the United States versus non-U.S. (.946 vs. .907). For studies rated high and moderate quality, the mean score reliability was .911 and .946, respectively. Scores on the PES-NWI are reliable for measuring the nursing practice environment across samples in the United States and non-U.S. countries.

Instruments for assessing professional nursing practice environments: An integrative review

“…Although the NWI-R is composed of 57 items, 15 of these items were distributed in three dimensions: autonomy (5 items); control over the practice environment (7 items), and relationship between nurses and physicians (3 items). Lee H et al, 2019 (9) China Nursing Practice Environment Scale: Chinese Version Ulrich B et al, 2019 (10) USA Healthy Work Environment Scale Zangaro G and Jones K, 2019 (11) USA Practice Environment Scale of the Nursing Work Index…”

“…Given its robustness, the use of PES-NWI has been widely disseminated, including several validation studies for different cultures (15,22,37,41,60) . Following a meta-analysis, the authors (11) concluded that the PES-NWI is a reliable instrument for assessing the nursing practice environments in the USA, as well as in other countries.…”

“…Following the included studies, it was also verified that, internationally, NWI-R and PES-NWI are the most used instruments. In the perspective of the authors, the evaluation of the characteristics of the practice environment, using NWI-R and PES-NWI, provides support for the development of a set of relationships between essential components of the professional nursing practice, whose objective is to create better working conditions (23) , allowing, simultaneously, identifying which environments are favorable or unfavorable for safety and quality of care (17) , as well as the satisfaction and retention of nurses (11) .…”

“…The problem is that NWI-R and all its derivatives measure structural characteristics of units, but not the work processes or the nursing practices (39) . In addition to NWI-R, PES-NWI, according to some authors (11,41) , is another of the most used instruments to measure the environments of the nursing practice, and its use in several languages and in different cultural contexts has led to several methodological studies (15,22,37,41,60) . Following the comparison between the different versions of the original PES-NWI, it was verified that the factor analysis of the instrument varied between different countries due to differences in the organization of the health systems and in the infrastructures (37) .…”

“…Despite the widespread use of PES-NWI, and the existence of a revised version, there is shortage of publications that address the need for modifications of the instrument (15) . As mentioned by some authors, although it is reliable to measure the environments of the nursing practice, the instrument could benefit from being updated, in order to accurately reflect the current environment of the professional nursing practice, with regard, for example, to using the technology and to providing an increasingly complex care (11) . In addition, according to some authors, the measures most frequently used to assess work environments were developed more than 20 years ago and, in addition to the lack of robust psychometric tests, there is a limited theoretical component that boosted their development (57) .…”