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Validation of AACN's Healthy Work Environment Assessment Tool-Team
Jean Anne Connor1, Jason Thornton2, Patricia Dwyer3
1Jean Anne Connor is director of nursing research, Cardiovascular, Critical Care and Perioperative Patient Services, Boston Children's Hospital, and an assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts.
Background:
In 2024, the American Association of Critical-Care Nurses (AACN) updated the Healthy Work Environment Assessment Tool (HWEAT), renamed HWEAT-Team.
Objective:
Validating HWEAT-Team for interprofessional use.
Methods:
This was a multisite, descriptive, nonexperimental correlation survey study. A demographics survey, the HWEAT, the HWEAT-Team, and the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture 2.0 (H-SOPS 2.0) were administered via REDCap to interprofessional staff across 11 pediatric intensive care units. Responses were aggregated as overall mean score and a score for each standard. Test-retest reliability and internal consistency were assessed. Construct validity was measured by correlating HWEAT, HWEAT-Team, and AHRQ H-SOPS 2.0 overall scores. Differences in HWEAT-Team scores by health care role also were examined.
Results:
Among 733 participants (39% response rate), the overall HWEAT-Team mean score was 4.01. Test-retest reliability indicated a Spearman correlation coefficient of 0.85 overall score (range for standards, 0.68-0.80) and internal consistency revealed a Cronbach α of 0.78 (range, 0.71-0.91). Convergent validity between the HWEAT and HWEAT-Team revealed a correlation coefficient of 0.86 overall score (range for standards, 0.60-0.73), and for the HWEAT-Team and AHRQ H-SOPS 2.0, a correlation coefficient of 0.46. Direct care registered nurses rated the work environment less positively than physicians did for the Effective Decision-Making (P = .02) and Meaningful Recognition (P = .03) standards.
Conclusions:
The HWEAT-Team was reliable, valid, and supportive of interprofessional use. Active evaluation of care environments is essential to support clinical excellence and achievement of optimal patient outcomes. Understanding differences across health care roles can guide targeted improvements.
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