title: Factor structure of the geriatric care environment scale.
abstract: BACKGROUND
  Older adults comprise approximately 60% of all adult, nonobstetric hospital admissions. Nurses Improving Care for Health System Elders (NICHE) is a national program aimed at system improvement to achieve patient-centered care for older adults. The NICHE hospitals use the Geriatric Institutional Assessment Profile (GIAP) to assess their institutional readiness to provide quality care to older adults and to document improvement in geriatric care delivery.
  
  
  OBJECTIVE
  To explore the factorial structure of the 28-item Geriatric Care Environment Scale (GCES) of the GIAP, test its validity with a sample of staff registered nurses (RNs), and evaluate its invariance across 4 groups of RNs who worked at 4 different types of hospitals.
  
  
  METHODS
  Staff RNs (N = 9,400) at 71 acute hospitals, who responded to the GIAP from 1999 to 2004, were split randomly into 2 groups for cross-validation. A 3-step data analysis was completed. The a priori factor structure was developed using exploratory factor analysis. The obtained factor model was validated, and its invariance by types of hospitals was examined by confirmatory factor analyses.
  
  
  RESULTS
  The GCES is internally consistent (Cronbach's alpha = .93) and accounts for approximately 55% of the total variance. The 4 factors extracted from the exploratory factor analysis are Aging-Sensitive Care Delivery, Resource Availability, Institutional Values Regarding Older Adults and Staff, and Capacity for Collaboration. The 4-factor structured model is validated in a half-randomly selected sample (normed fit index [NFI] = .931, nonnormed fit index [NNFI] = .933, comparative fit index [CFI] = .939, root-mean-square error of approximation [RMSEA] = .058) and does not vary significantly across the 4 groups of RNs who worked at the 4 different types of hospitals (NFI = .969, NNFI = .975, CFI = .976, RMSEA = .027).
  
  
  CONCLUSIONS
  The GCES is a reliable measure of RN perception of how care provided to older adults reflects age-sensitive principles and the organizational practice environment that supports or hinders care delivery.
authors.affiliation: Hartford Institute for Geriatric Nursing, New York University College of Nursing, USA. hk489@nyu.edu
authors.forename: Hongsoo
authors.initials: H
authors.lastname: Kim
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Capezuti
authors.forename: Marie
authors.initials: M
authors.lastname: Boltz
authors.forename: Susan
authors.initials: S
authors.lastname: Fairchild
authors.forename: Terry
authors.initials: T
authors.lastname: Fulmer
authors.forename: Mathy
authors.initials: M
authors.lastname: Mezey
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009720:Nurse Clinicians; D009730:Nursing Assessment / Q000592:standards* / Q000706:statistics & numerical data; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital; D010555:Personality Inventory; D015995:Prevalence; D011594:Psychometrics; D015203:Reproducibility of Results; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology