Instrument development to measure nursing work intensification

This is a methodological study carried out in five of the eight steps proposed by DeVellis. I - Determine clearly what it is you want to measure; II – Generate an item pool; III - Determine the format of the measurement; IV - Have initial item pool reviewed by experts; V - Consider inclusion of validation items. Data production took place in the second half of 2021. Participants were 18 nursing workers in the exploratory step (elaboration of items), 12 PhD holders who made up the committee of judges/experts and 43 nursing workers in the pre-testing step. Data processing occurred mainly by calculating the Content Validity Index.

Results

The instrument is organized into 60 items, arranged in seven domains: Interface with work; Pace and demands of work; Conditions for work; Interprofessional relationships; Institutional aspects; Repercussions of work on worker health; Patients’ clinical conditions. The Content Validity Index ranged from 0.44 to 1.00, with items with a value lower than 0.80 being excluded. In pre-testing with the target population, this measure varied from 0.90 to 1.00. The instrument in its complete formation presented an overall assessment of 0.95.

Conclusion

The instrument was considered valid by the committee of judges/experts and by the target population, constituting an innovative tool to be used to measure nursing work intensification.

Work; Intensification of work; Worker’s health; Validation study

Version I	Judges’ comments	CVI	Version II	CVI
Domain 1 - Relationship between worker and work.	Change the domain name to “Interface with work”.	0.94	Interface with work.	1.00
I feel overwhelmed with my work activities.	No comments.	1.00	I feel overwhelmed with my work activities.	1.00
I feel valued and I believe that the work I do contributes to the quality of care provided in this sector.	I suggest breaking this item into two.	0.83	I feel valued in this unit/institution.	1.00
I feel safe while carrying out my tasks.	No comments.	0.91	I have confidence to carry out my activities.	1.00
I am satisfied with the work I do in this unit.	No comments.	0.91	I feel satisfied with the work I do in my unit.	1.00
I need to exert a lot of emotional burden to carry out my tasks.	My job requires....	0.91	My work requires a great emotional burden to carry out my activities.	1.00
Domain 2 - Work rhythm/routine/demands	Delete the bars. It is scattered and does not favor subsequent analysis.	0.94	Pace and demands of work.	1.00
Excessive work interferes with the quality of my actions.	No comments.	1.00	Excessive work interferes with the quality of my activities.	1.00
I need to reorganize/readjust my time to complete all work activities.	No comments.	0.91	I need to reorganize my time to complete all work activities.	1.00
My job requires me to work most of the time standing and/or walk a lot.	No comments.	1.00	My job requires me to stand most of the time and/or walk a lot.	1.00
I consider the number of workers to be adequate during my work shift.	No comments.	1.00	The number of workers is adequate during my work shift.	1.00
Item 30 - consumable materials (catheters, gauze, gloves...), makes it difficult to carry out my work.	I suggest not specifying the materials.	0.91	The quality of the materials makes it difficult to carry out my work.	1.00
There are interpersonal conflicts at my workplace.	I suggest including “among the workers” at the end of the sentence.	0.91	At my workplace, there are interpersonal conflicts between workers.	1.00
In this institution, issues that favor the quality of care are discussed.	Replace “quality of care” with “quality of work/care practice”.	0.91	Issues that favor quality of work/care practice are discussed here.	1.00
Domain 6 - Repercussions of work on my health	No comments.	0.97	Repercussions of work on worker health.	1.00
Work makes me very stressed.	Delete the word “very”.	1.00	Work makes me stressed.	1.00

Domains	CVI
Domain I – Interface with work	1.00
1. I have difficulty solving problems that arise at work.	0.91
2. I feel overwhelmed with my work activities.	1.00
3. I feel valued in this unit/institution*.	1.00
4. The work I do contributes to quality of care in this unit/institution.	0.83
5. I feel powerless in the face of the activities to be carried out.	1.00
6. I have confidence to carry out my activities*.	1.00
7. I feel satisfied with the work I do in my unit*.	1.00
8. My work requires a great emotional burden to carry out my activities.	1.00
Domain II - Pace and demands of work	1.00
9. The pace of work in this sector is intense.	1.00
10. I have the feeling that, during my work, “time flies”.	0.83
11. I have enough time to carry out my activities*.	1.00
12. There is enough time to take breaks and rest at work*.	1.00
13. At my work, there is an appropriate place to take breaks and rest*.	1.00
14. I need to extend my work shift to finish my activities.	0.83
15. Excessive work interferes with the quality of my activities.	1.00
16. Norms and routines facilitate the development of work activities in the unit*.	0.91
17. I need to resolve unforeseen events that happen during my work shift.	0.95
18. I need to reorganize my time to complete all work activities.	1.00
19. I perform activities repetitively.	1.00
20. I perform different activities simultaneously.	1.00
21. My work requires a lot of physical effort.	1.00
22. My job requires me to stand most of the time and/or walk a lot.	1.00
23. My work requires a diversity of knowledge.	0.91
Domain III - Working conditions	0.97
24. The number of workers is adequate during my work shift*.	1.00
25. I consider the environment in which I work to be healthy*.	0.83
26. Consumable materials are insufficient to carry out my work.	1.00
27. The quality of materials makes it difficult to carry out my work.	1.00
28. The equipment is insufficient to provide patient care.	0.91
29. Inadequate maintenance of equipment makes my activities difficult.	0.83
30. Excessive noise in this sector interferes with my work.	1.00
31. Inadequate temperature in this sector interferes with my work.	1.00
32. Inadequate lighting in this sector interferes with my work.	1.00
Domain IV - Interprofessional relationships	0.97
33. At my workplace, there are interpersonal conflicts between workers.	1.00
34. There is effective collaboration between workers in this unit*.	0.91
35. Communication between nursing workers is effective*.	0.91
36. Communication between multidisciplinary staff workers is effective*.	0.91
37. I have difficulties in work relationships.	0.83
Domain V - Institutional aspects	0.97
38. Issues that favor quality of work/care practice* are discussed here.	1.00
39. Managers support my daily efforts*.	0.91
40. I have the possibility to participate in decision-making processes*.	0.83
41. There is flexibility regarding work shifts in this unit*.	0.91
42. In my workplace there is a strong demand for results.	1.00
43. I feel pressured by my superiors to carry out all the activities during work shift.	0.83
44. I have feedback regarding the performance of my activities*.	0.91
45. In this institution, I have access to professional training/qualification*.	0.91
46. In this institution, there is an incentive to exercise professional autonomy*.	0.91
47. Issues that favor workers’ quality of life* are valued here.
Domain VI - Repercussions of work on worker health	0.97
48. Work makes me stressed.	1.00
49. I have pain as a result of activities carried out at work.	0.91
50. The activities I carry out favor the occurrence of workplace accidents.	0.91
51. I have needed medical treatment as a result of my work activities.	0.83
52. My work favors the occurrence of psycho-emotional illnesses.	0.83
53. My work favors the occurrence of physical illnesses.	0.91
54. I have changes in my sleep pattern due to work activities.	0.83
55. My work has a negative impact on my social/family life.	0.83
Domain VII - Patients’ clinical conditions	0.97
56. There is a high patient turnover in this unit.	1.00
57. In my work, the degree of patient dependence is high.	1.00
58. My work requires the use of technological resources that are difficult to use.	0.97
59. I need to decide which patients I should see as a priority.	0.97
60. I treat more serious patients than is recommended for my workplace.	0.97

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[1] Corresponding author: Éder Luís Arboit E-mail: earboit@unicruz.edu.br