Validation of Nurse Practitioner Primary Care Organizational Climate Questionnair

描述（由申请人提供）：政策制定者，卫生保健组织和卫生专业人员呼吁扩大初级保健的护士从业人员队伍，以确保美国公众及时获得服务。然而，有效的护士执业初级保健实践存在许多障碍，包括组织层面的障碍，并且缺乏可靠和有效的工具来衡量组织气候，以确定这些障碍，从护士执业的角度。护士执业初级保健组织气候问卷（NP-PCOCQ）正在开发通过文献综述，调查现有的工具，护士执业焦点小组的数据，内容验证和预测试。五个领域的组织气氛感知的护士从业者提出：a）自治，B）专业地位，c）授权，d）合议，和e）政策。每个NP-PCOCQ分量表测量一个组织气候领域，通过项目要求护士从业者对他们的看法进行4分制评分，从强烈反对到强烈同意。本研究的目的是检验NP-PCOCQ的心理测量学特性，并进一步完善和验证这一调查工具。具体目的包括：（1）利用验证性因素分析，检验各分量表上的项目是否测量了预期的结构，以拟合来自护理从业人员的数据。2)利用项目反应理论模型进一步考察和建立该量表的结构效度。将采用横断面调查设计，样本来自马萨诸塞州健康质量合作伙伴马萨诸塞州提供者数据库的执业护士。样本将包括在马萨诸塞州初级保健机构执业的执业护士（n=713）。每名执业护士将收到一份邮件调查，沿着说明书和知情同意书，解释研究目的、他们作为参与者的权利以及他们回答的保密性和匿名性。他们将被要求完成调查，并将其返回给研究小组。将启动明信片提醒和第二次邮寄，以提高答复率。将使用SPSS、LISREL和MULTIPLE统计软件进行数据录入和数据分析。将使用验证性因子分析对每个组织气候领域的单独模型进行估计，以证明每个分量表中的测量如何测量预期结构。然后利用项目反应理论中的Samejima分级反应模型，对每个项目的特征进行研究。这些分析程序将评估判别式、收敛性和结构有效性，并将产生样本不变参数。NP-PCOCQ可用于不同的执业护士群体，以进行有意义的比较，组织气候的实践地点和国家，增加工具的实用性。 公共卫生相关性：该研究通过开发一种调查工具来测量初级保健环境中的组织气候，以确定影响护士从业者为美国公众提供及时，高质量和安全护理的能力的组织气候属性，从而对公共卫生做出了重大贡献。

DESCRIPTION (provided by applicant): Policy makers, health care organizations, and health professionals are calling for expansion of nurse practitioner workforce in primary care to assure timely access for the American public. However, many obstacles to effective nurse practitioner primary care practice exist, including barriers at the organizational level, and there is lack of reliable and valid instruments to measure organizational climates to identify those barriers from nurse practitioners' perspectives. The Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ) is being developed through literature review, investigation of existing instruments, nurse practitioner focus group data, content validation, and pretesting. Five domains underlying organizational climate perceived by nurse practitioners are proposed: a) autonomy, b) professional status, c) empowerment, d) collegiality, and e) policy. Each NP-PCOCQ subscale measures one organizational climate domain through items asking nurse practitioners to rate their perceptions on a 4-point scale from strongly disagree to strongly agree. The purpose of this study is to examine the psychometric properties of NP-PCOCQ, and further refine and validate this survey instrument. Specific aims include 1) To examine whether the items on each subscale measure the intended construct fitting the data from nurse practitioners utilizing confirmatory factor analysis. 2) To further investigate and establish construct validity of the instrument through using item response theory models. A cross-sectional survey design with a sample of nurse practitioners from the Massachusetts Health Quality Partners Massachusetts Provider Database will be used. The sample will include nurse practitioners practicing in primary care settings in Massachusetts (n=713). Each nurse practitioner will receive a mail survey along with a cover letter and consent form explaining the study purpose, their rights as participants, and the confidentiality and anonymity of their responses. They will be asked to complete the survey and return it to the research team. Post card reminders and second mailing will be initiated to increase the response rate. SPSS, LISREL, and MULTILOG statistical software will be used for data entry and data analysis. Separate models will be estimated using confirmatory factor analysis for each organizational climate domain to demonstrate how the measures in each subscale measure the intended construct. Then using Samejima's Graded Response model in Item Response Theory the characteristics of each individual item will be investigated. These analytical procedures will assess the discriminant, convergent, and construct validity, and will produce sample invariant parameters. NP-PCOCQ may be used with various groups of nurse practitioners for conducting meaningful comparisons of organizational climates across practice sites and states increasing the utility of the instrument. PUBLIC HEALTH RELEVANCE: The study contributes significantly to public health by developing a survey instrument to measure organizational climates in primary care settings to identify organizational climate attributes that impact nurse practitioners' abilities to provide timely, high quality, and safe care to the American public.