The HDR CARE Scale, Inpatient Version: A validated survey instrument to measure environmental affordance for nursing tasks in inpatient healthcare settings

Renae K Rich; Francesqca E Jimenez; Cheryl Bohacek; Alexandra Moore; Abigail J Heithoff; Deborah M Conley; Jeri Brittin

doi:10.1371/journal.pone.0258815

The HDR CARE Scale, Inpatient Version: A validated survey instrument to measure environmental affordance for nursing tasks in inpatient healthcare settings

PLoS One. 2021 Oct 20;16(10):e0258815. doi: 10.1371/journal.pone.0258815. eCollection 2021.

Authors

Renae K Rich¹, Francesqca E Jimenez², Cheryl Bohacek³, Alexandra Moore³, Abigail J Heithoff¹, Deborah M Conley⁴, Jeri Brittin⁵

Affiliations

¹ Research, HDR Architecture, Inc., Omaha, Nebraska, United States of America.
² Research, HDR Architecture, Inc., Seattle, Washington, United States of America.
³ Oncology, Methodist Hospital, Omaha, Nebraska, United States of America.
⁴ Geriatrics, Methodist Hospital, Omaha, Nebraska, United States of America.
⁵ Research, HDR Architecture, Inc., Boise, Idaho, United States of America.

Abstract

Rigorous healthcare design research is critical to inform design decisions that improve human experience. Current limitations in the field include a lack of consistent and valid measures that provide feedback about the role of the built environment in producing desirable outcomes. Research findings about nurses' efficiency, quality of care, and satisfaction related to inpatient unit designs have been mixed, and there was previously no validated instrument available to quantitatively measure nurses' ability to work efficiently and effectively in their environment. The objective of this study was to develop, refine, and validate a survey instrument to measure affordance of the care environment to nurse practice, based on various aspects of their work in inpatient units. The HDR Clinical Activities Related to the Environment (CARE) Scale Inpatient Version was developed using item design, refinement, and reliability and validity testing. Psychometric methods from classical test theory and item response theory, along with statistical analyses involving correlations and factor analysis, and thematic summaries of qualitative data were conducted. The four-phase process included (1) an initial pilot study, (2) a content validation survey, (3) cognitive interviews, and (4) a final pilot study. Results from the first three phases of analysis were combined to inform survey scale revisions before the second pilot survey, such as a reduction in the number and rewording of response options, and refinement of scale items. The updated 9-item scale showed excellent internal consistency and improved response distribution and discrimination. The factor analysis revealed a unidimensional measure of nurse practice, as well as potential subscales related to integration, efficiency, and patient care. Within the healthcare design industry, this scale is much needed to generate quantitative and standardized data and will facilitate greater understanding about the aspects of an inpatient healthcare facility that best support nurses' ability to provide quality patient care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Factor Analysis, Statistical
Female
Health Facilities
Health Services Research
Humans
Inpatients
Male
Middle Aged
Nursing Care / standards*
Patient Satisfaction / statistics & numerical data*
Pilot Projects
Psychometrics / methods*
Surveys and Questionnaires

Grants and funding

This work was funded in part by the Academy of Architecture for Health 2019 Research Grant. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. HDR, Inc. provided support in the form of salaries for authors RKR, FEJ, AJH, and JB, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.