VALIDATION OF THE SCALE FOR THE ENVIRONMENT EVALUATION OF PROFESSIONAL NURSING PRACTICE FOR BRAZIL

Perondi, Alessandro Rodrigues; Trindade, Letícia de Lima; Ribeiro, Olga Maria Pimenta Lopes; Gomes, Jane Tavares; Menegaz, Jouhanna do Carmo; Santos, José Luís Guedes dos

doi:10.1590/1980-265X-TCE-2022-0298en

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Original Article • Texto contexto - enferm. 33 • 2024 • https://doi.org/10.1590/1980-265X-TCE-2022-0298en copy

VALIDATION OF THE SCALE FOR THE ENVIRONMENT EVALUATION OF PROFESSIONAL NURSING PRACTICE FOR BRAZIL

VALIDACIÓN DE LA SCALE FOR THE ENVIRONMENT EVALUATION OF PROFESSIONAL NURSING PRACTICE PARA SU USO EN BRASIL

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to perform the linguistic, cultural and validation adaptation of Scale for the Environment Evaluation of Professional Nursing Practice (SEE - Nursing Practice) for Brazil.

Method:

a methodological study with a sample of 291 nurses working in eight Brazilian hospitals. Data collection occurred from July to October 2021. Internal consistency of the instrument was evaluated by means of the Cronbach's alpha coefficient, and validity of the structure of the scale by domains was evaluated via exploratory factor analysis with extraction by principal components and Varimax rotation, as well as adequacy and measureability measures.

Results:

in the subscale of the Structure dimension, a 6-factor solution explained 63.1% of the total variance, consisting of 40 items, distributed in six factors. In the subscale of the Process dimension, the exploratory five-factor analysis explained 62% of the total variance and consisted of 33 items. The exploratory factor analysis of the Outcome dimension subscale indicated a two-factor solution that explained 67.7% of the total variance and consisted of 13 items. The subscales of SEE - Nursing Practice (Structure, Process and Outcome) obtained internal consistency values of 0.956, 0.929 and 0.937, respectively.

Conclusion:

the Brazilian version of SEE - Nursing Practice is a valid and reliable tool used to assess whether professional Nursing practice environments promote care quality.

DESCRIPTORS:
Nursing; Work environment; Professional practice; Hospitals; Validation studies

Factor 1: People management and service leadership
1	The nurse-manager guides the Nursing professionals in performance consistent with the quality standards of Nursing care.	0.570
2	The nurse-manager manages the knowledge and skills of the entire Nursing team so that the objectives defined are achieved.	0.650
3	The nurse-manager uses errors as learning opportunities.	0.673
4	The nurse-manager supports the Nursing team professionals in the difficulties that arise in their routine, even when in conflict with other professionals.	0.696
5	The nurse-manager values Nursing professionals' opinion and innovative ideas.	0.783
6	There is balance in the working hours and flexibility to change them.	0.587
7	The nurse-manager provides moments to reflect on the practice.	0.771
8	The nurse-manager creates conditions that enhance the professional development of the members from the Nursing team he/she leads.	0.767
9	The nurse-manager praises the commitment of the Nursing professionals in the team to continuously improve care quality.	0.781
10	Nurses have the opportunity to participate in the elaboration and implementation of the service's action plan.	0.651
Factor 2: Nurses' participation and involvement in the policies, strategies and functioning of the institution
11	The institution provides support/specialized services to Nursing professionals who are faced with problematic situations.†		0.529
12	The institution has a policy to encourage innovation and research in Nursing.		0.632
13	The institution promotes the participation of Nursing professionals in commissions/ working groups within the scope of continuous quality improvement.		0.452
14	The institution defines a safety culture for Nursing professionals.		0.502
15	The institution presents motivation strategies, as well as rewards and incentives for Nursing professionals.		0.686
16	The institutional training policy considers Nursing professionals' training needs.		0.695
17	The institution creates conditions for Nursing professionals to invest in relevant training for their professional development.†		0.735
18	The institution recognizes nurses' graduate training (residency, specialization, MSc, PhD).†		0.747
Factor 3: Conditions for the proper functioning of the service
19	The clinical equipment is adequate to the service needs.			0.738
20	The Information and Communication Technologies are adequate to the service needs.			0.598
21	Maintenance of all service infrastructures is approproate.			0.795
22	Maintenance of the service equipment is appropriate.			0.742
23	The space available in the service is adequate to the clients' needs.			0.782
24	The physical environment is pleasant and comfortable for Nursing professionals.			0.631
Factor 4: Organization and sustainability of the Nursing practice
25	The institution promotes the internal mobility of Nursing professionals across services, in order to alleviate professional shortages.				0.433
26	The service adopts an integration plan for newly hired Nursing professionals.				0.589
27	The service defines the theoretical Nursing models that should guide the professional practice.				0.582
28	There are protocols and procedures guiding the Nursing practice in the service.				0.718
29	The institution defines Nursing care quality indicators.†				0.518
30	At the institution, continuous quality improvement projects take into account the Nursing care quality standards.†				0.511
Factor 5: Institutional policy for professional qualification
31	There is involvement and participation of the team's nurses in audit processes.†					0.688
32	The nurse-manager offers feedback to Nursing professionals about the Nursing care indicators, audits and evaluative processes.†					0.601
33	In-service training has been planned with the collaboration of Nursing professionals.†					0.446
34	Nursing professionals are consulted for the selection of materials and equipment.†					0.474
35	The institution promotes the participation of Nursing professionals in the definition of internal policies.†					0.673
36	Nursing professionals are aware of the institution's strategic planning.†					0.501
Factor 6: Quality and safety of Nursing care
37	The service has an appropriate staffing of nursing technicians and assistants/clients.†						0.560
38	The service has an appropriate nurse/client ratio.†						0.587
39	In the service, the distribution of clients by nurses is defined according to care intensity, complexity and continuity.†						0.678
40	The Nursing work methodology adopted at the service promotes care quality and ensures safe practices.†						0.527
% Explained Variance (Total = 63.1)		15.0	13.0	10.6	8.0	7.9	6.1
α (Total = 0.956)		0.92	0.90	0.89	0.81	0.84	0.77

Factor 1: Collaboration and teamwork
1	Nurses demonstrate autonomy in decision-making about care.	0.540
2	Care plans for all clients are systematically updated by nurses.	0.552
3	Communication between team members is accurate and ensures adequate care planning.	0.658
4	The electronic information system responds to documentation needs and contributes to care continuity.	0.642
5	There are collaborative relationships between the different members of the health team.	0.757
6	The working relationship between physicians and Nursing professionals eases the assistance provided to the clients.	0.754
7	The nurses' clinical opinion is considered when planning the clients' discharge.	0.655
8	The teamwork that exists in the service among Nursing professionals allows responding to the care needs.†	0.696
9	Within the scope of the multiprofessional team, there is understanding and appreciation of the respective roles and responsibilities among the different professionals.†	0.614
10 ‡	Nursing professionals' practice is fundamentally centered on preventing complications.†	0.540
Factor 2: Strategies for ensuring care quality
11	There are moments when knowledge and experiences about customer assistance are shared in the team.		0.501
12	While delegating tasks to functionally dependent professionals, nurses perform appropriate supervision.		0.551
13	Nursing care supervision is a planned and systematized activity.		0.611
14	The assessment of Nursing care is performed based on the Nursing care quality standards.		0.562
15	There is reflection on the Nursing care quality indicators, so that the objectives defined are achieved.		0.680
16	There is reflection on Nursing care audits and evaluation processes, in order to promote improvement in care quality.		0.624
17	In the initial evaluation, nurses rigorously collect data relevant to the conception of Nursing care.†		0.509
18	Nurses promote client involvement in Nursing care planning.†		0.621
19	Nurses evaluate the outcomes of Nursing interventions.†		0.707
Factor 3: Autonomous practices in the professional practice
20	In the Nursing practice, there is a significant focus on human responses to real and potential problems.			0.604
21	Nurses show concern in valuing their interventions.			0.637
22	Nurses focus their attention on people's capabilities, to the detriment of a perspective centered on their replacement.			0.694
23	In potential clients, the nurses' practice is centered on the reconstruction of autonomy.			0.760
24	Assisting clients in the transition processes is the most important role of nurses.			0.680
25	In their professional practice, nurses adopt care models centered on the clients and, consequently, on care individualization.			0.587
26	When designing the care to be provided, nurses focus on the clients rather than on the disease process.			0.550
Factor 4: Theoretical and legal aids for the professional practice
27	The Nursing professionals' practice is based on theoretical Nursing frameworks.				0.716
28	Nursing professionals act in line with the regulatory instruments of the professional practice.				0.616
29	The Nursing team strives to sustain their professional practice on the best scientific evidence.				0.807
30	In the professional practice, nurses value knowledge of the Nursing domain.				0.722
Factor 5: Interdependence in the professional practice
31 ‡	The Nursing professionals' practice is fundamentally centered on managing signs and symptoms of the disease.					0.766
32 ‡	Nursing professionals are essentially focused on responding to prescriptions from other professionals, in a clear appreciation of interdependence.					0.842
33 ‡	Nursing professionals have the perception that, with the implementation of interdependent interventions, work is carried out.					0.777
% Explained Variance (Total = 62.0)		17.3	13.5	12.2	9.7	9.3
α (Total = 0.929)		0.85	0.91	0.87	0.82	0.82

Factor 1: Systematic evaluation of Nursing care and indicators
1	The safety culture is systematically monitored.	0.778
2	The quality of Nursing care is systematically monitored.	0.829
3	The clients’ satisfaction with the care provided is systematically monitored.	0.783
4	Nursing indicators are monitored, with a view to continuous quality improvement.	0.769
5	The indicators corresponding to the prevention of complications are systematically monitored.	0.823
6	The indicators corresponding to health gains are systematically monitored.	0.712
7	Missed care (care measures yet to be performed) is systematically monitored.	0.595
Factor 2: Systematic evaluation of nurses' performance and supervision
8	Nursing professionals' satisfaction is systematically monitored.		0.725
9	The nursing professionals' performance evaluation is precise and rigorous, revealing their real performance.		0.710
10	Nursing professionals' absenteeism is systematically monitored.		0.703
11	Occupational accidents involving Nursing professionals are systematically monitored.		0.504
12	Nurses' work overload is systematically monitored.		0.846
13	Nurses' turnover in the service is systematically monitored.		0.851
% Explained Variance (Total = 67.7)		35.9	31.8
α (Total = 0.937)		0.93	0.88

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Alessandro Rodrigues Perondi alessandroperondi@prof.unipar.br