title: The Psychometric Properties and the Development of the Indicators of Quality Nursing Work Environments in Taiwan.
abstract: BACKGROUND
  The nursing shortage in medical institutions in Taiwan averaged 9% in 2012, considerably higher than the 5% indicated in the literature. As a result, many hospitals have been forced to close wards or reduce beds. Despite the acute need, the percentage of registered nurses who are employed as nurses in Taiwan (60.4%) is considerably lower than those in Canada or the United States. This low rate may be because of the poor working environment for nurses in Taiwan.
  
  
  OBJECTIVE
  This study aimed to develop a set of nursing work environment quality indicators for Taiwan and to test the reliability and validity of the resulting survey tool.
  
  
  METHODS
  Multiple methods were used in this study. In Phase 1, we organized an expert panel, reviewed the literature, and conducted seven rounds of expert panel discussion and six focus group discussions with nursing directors. The goal was to draft indicators representing a quality nursing work environment to fit current conditions in Taiwan. In Phase 2, we conducted an expert review for content validity, held three public hearings, and conducted a survey. Four hundred twenty-seven questionnaires were sent out, with 381 returned. The goal was to test the content validity, construct validity, and internal consistency reliability.
  
  
  RESULTS
  The study produced a set of indicators of a quality nursing work environment with eight dimensions and 65 items. The content validity index for importance and suitability dimensions were 1.0, whereas the internal consistency was 0.91. The eight dimensions were safe practice environment (16 items), quality and quantity of staff (four items), salary and welfare (seven items), professional specialization and teamwork (seven items), work simplification (five items), informatics (five items), career development (nine items), and support and caring (12 items). The overall load for the indicators was 77.57%.
  
  
  CONCLUSIONS
  The developed indicators may be used to evaluate the quality of nursing work environments. Furthermore, the indicators may be used in hospital surveys to establish baseline conditions and for outcome research that measures improvement in nursing work environments after interventions.
authors.affiliation: 1PhD, RN, Associate Professor, School of Nursing, National Taipei University of Nursing and Health Sciences, and Consultant, Department of Nursing, Shuang Ho Hospital, Taipei Medical University 2MSN, RN, Endowed Professor, College of Nursing, Taipei Medical University, and President, National Union of Nurses' Associations, ROC 3PhD, RN, Supervisor, Taipei Cancer Center, and Adjunct Assistant Professor, School of Nursing, Taipei Medical University.
authors.forename: Chiou-Fen
authors.initials: CF
authors.lastname: Lin
authors.forename: Meei-Shiow
authors.initials: MS
authors.lastname: Lu
authors.forename: Hsiu-Ying
authors.initials: HY
authors.lastname: Huang
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002170:Canada; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000523:psychology* / Q000592:standards*; D011594:Psychometrics; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013624:Taiwan; D014481:United States; D017132:Workplace / Q000523:psychology* / Q000592:standards*