Factor structure of the geriatric care environment scale.

Area of Science:

• Geriatric nursing research
• Healthcare quality improvement
• Organizational psychology in healthcare

Background:

• Older adults represent a significant majority of adult hospital admissions.
• The Nurses Improving Care for Health System Elders (NICHE) program aims to enhance patient-centered care for older adults.
• The Geriatric Institutional Assessment Profile (GIAP) is utilized by NICHE hospitals to evaluate readiness and improvements in geriatric care.

Purpose of the Study:

• To determine the factorial structure of the 28-item Geriatric Care Environment Scale (GCES) within the GIAP.
• To validate the GCES using a sample of registered nurses (RNs).
• To assess the invariance of the GCES across RNs from four distinct hospital types.

Main Methods:

• Exploratory factor analysis was used to develop the a priori factor structure.
• Confirmatory factor analyses were employed to validate the factor model and examine invariance.
• Data from 9,400 staff RNs across 71 acute hospitals (1999-2004) were randomly split for cross-validation.

Main Results:

• The GCES demonstrated strong internal consistency (Cronbach's alpha = .93) and explained 55% of the total variance.
• Four factors emerged: Aging-Sensitive Care Delivery, Resource Availability, Institutional Values Regarding Older Adults and Staff, and Capacity for Collaboration.
• The four-factor model was validated and showed significant invariance across different hospital types, indicating consistent measurement properties.

Conclusions:

• The GCES is a reliable instrument for assessing RNs' perceptions of age-sensitive care principles.
• The scale effectively measures the organizational practice environment influencing geriatric care delivery.
• The findings support the use of the GCES for evaluating and improving geriatric care in diverse hospital settings.