title: Performance obstacles of nurses in intensive care units of Greek National Health System hospitals.
abstract: BACKGROUND
  Nurses in intensive care units confront various challenges and problems during their everyday work that adversely affect performance and patient safety. Despite their importance, performance obstacles have been studied extensively only in the USA, with no validated instrument being available in the Greek setting for their measurement.
  
  
  OBJECTIVE
  To develop a questionnaire that quantifies the obstacles nurses of intensive care units (ICUs) of Greek hospitals might be facing and examine its properties; to assess if such obstacles existed in selected Greek National Health System hospitals.
  
  
  METHODS
  A questionnaire was developed and administered to nurses who were working in intensive care units in Thessaloniki. Exploratory factor analysis was applied, and the reliability, validity and ceiling and floor effects of the constructed scales were evaluated. The potential influence of socio-demographic characteristics on scale scores was assessed by independent sample t-tests and analysis of variance (ANOVA). Summated mean and median scores were computed.
  
  
  RESULTS
  Two hundred and five nurses participated with a response rate of 65·3%. Resulting scales were 'Space Adequacy', 'Staff Collaboration', 'Materials' Suitability', 'Time Inefficiencies' and 'Psychological Aggravation'. Cronbach's alpha values ranged between 0·67 and 0·86. Multi-trait analysis confirmed construct validity. Ceiling effects were reasonable, whereas floor effects took acceptable values with the exception of the 'Materials' Suitability' scale. The medians of the scales ranged from 1·50 to 3·33. In terms of the measurement of performance obstacles per se, we found that considerable problems exist in the ICUs in all dimensions. Specifically, the suitability of hospital materials, the lack of appropriate spaces and facilities design and psychological distress were recorded as the most serious.
  
  
  CONCLUSIONS
  The questionnaire is a promising tool that can be exploited in the health care system to assess the obstacles faced by intensive care nursing staff. In fact, there is considerable room for performance improvement in hospitals in Northern Greece.
  
  
  CONCLUSIONS
  Nursing administrators and health care policy makers should administer the questionnaire in all Greek hospitals in order to quantify performance obstacles and identify potential managerial remedies.
authors.affiliation: Assistant Professor of Health Care Management & Health Economics, Department of Business Administration, University of Macedonia, Thessaloniki, Macedonia, Greece.
authors.forename: Vassilis H
authors.initials: VH
authors.lastname: Aletras
authors.affiliation: Intensive Care Unit, AHEPA General Hospital, Thessaloniki, Macedonia, Greece.
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Kallianidou
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003422:Critical Care / Q000458:organization & administration / Q000523:psychology; D003441:Crowding; D005260:Female; D006115:Greece; D006272:Health Facility Environment; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000523:psychology*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology
keywords: Intensive care unit; Nurses; Performance obstacles; Questionnaire; Validation