title: Essential elements of the nursing practice environment in nursing homes: Psychometric evaluation.
abstract: OBJECTIVE
  To develop and psychometrically test the Essentials of Magnetism II in nursing homes.
  
  
  BACKGROUND
  Increasing numbers and complex needs of older people in nursing homes strain the nursing workforce. Fewer adequately trained staff and increased care complexity raise concerns about declining quality. Nurses' practice environment has been reported to affect quality of care and productivity. The Essentials of Magnetism II © measures processes and relationships of practice environments that contribute to productivity and quality of care and can therefore be useful in identifying processes requiring change to pursue excellent practice environments. However, this instrument was not explicitly evaluated for its use in nursing home settings so far.
  
  
  METHODS
  In a preparatory phase, a cross-sectional survey study focused on face validity of the essentials of magnetism in nursing homes. A second cross-sectional survey design was then used to further test the instrument's validity and reliability.
  
  
  METHODS
  Psychometric testing included evaluation of content and construct validity, and reliability. Nurses (N = 456) working at 44 units of three nursing homes were included.
  
  
  RESULTS
  Respondent acceptance, relevance and clarity were adequate. Five of the eight subscales and 54 of the 58 items did meet preset psychometric criteria.
  
  
  CONCLUSIONS
  All essentials of magnetism are considered relevant for nursing homes. The subscales Adequacy of Staffing, Clinically Competent Peers, Patient Centered Culture, Autonomy and Nurse Manager Support can be used in nursing homes without problems. The other subscales cannot be directly applied to this setting.
  
  
  CONCLUSIONS
  The valid subscales of the Essentials of Magnetism II instrument can be used to design excellent nursing practice environments that support nurses' delivery of care. Before using the entire instrument, however, the other subscales have to be improved.
authors.affiliation: Dutch Nurses' Association, Utrecht, The Netherlands.
authors.forename: Brigitte Johanna Maria
authors.initials: BJM
authors.lastname: de Brouwer
authors.affiliation: National Health Care Institute, Vianen, The Netherlands.
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Kaljouw
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.affiliation: Centre for Health Services and Nursing Research, KU Leuven, Leuven, Belgium.|Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.|Department of Public Health, Uppsala University, Uppsala, Sweden.
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D009735:Nursing Homes; D009736:Nursing Process; D011594:Psychometrics; D011787:Quality of Health Care; D015203:Reproducibility of Results; D017132:Workplace
keywords: environment; factor analysis; nursing home care; psychometric testing; workforce issues