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J Nurs Scholarsh. 2011 Dec;43(4):421-5. doi: 10.1111/j.1547-5069.2011.01414.x. Epub 2011 Sep 19.

Development and psychometric exploration of the professional practice environment assessment scale.

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  • 1Nursing Research & Innovations, Nursing Institute, Cleveland Clinic, Cleveland, OH, USA.



Development of the Professional Practice Environment Assessment Scale (PPEAS) was based on the assumptions that a positive professional practice environment is more than and different from the absence of negative, abusive, or disrespectful behaviors by physicians; a positive professional practice environment improves patient outcomes as well as nurse and physician satisfaction; and a positive professional practice environment is characterized by mutual respect, understanding of roles, collaborative decision making, effective communication, and beliefs in the importance of nurse-physician relationships on patient outcomes. The PPEAS is intended as both a research tool and a method of assessing and monitoring changes in an organization's professional practice environment as it relates specifically to the impact the nurse and physician relationship has on the professional practice environment. The purpose of this study was to examine the psychometric properties of the PPEAS and determine if it was a valid and reliable instrument for assessing the positive attributes of the professional practice environment.


A large acute care facility in the Midwestern section of the United States provided the setting for this psychometric study. The sample (N= 1,332) consisted of 801 nurses and 531 physicians.


Psychometric examination, which included principal component analysis with varimax rotation and assessment of internal consistency, was conducted to validate the reliability and validity of the PPEAS.


Analysis identified a four-factor solution. The four factors were classified as positive physician characteristics (five items), positive nurse characteristics (three items), collaborative decision making (two items), and positive beliefs in the value of the nurse-physician relationship (three items). Cronbach's α for the entire scale was .86, with subscales ranging from .73 to .89.


Findings from this analysis support our model and provide evidence of the usefulness of this scale for assessing the presence of a positive professional practice environment. Using the total score, organizations can examine the status of their professional practice environment and examine changes in the environment over time. Subscale analysis can identify specific areas where the organization performs well and those areas in need of improvement.


The professional practice environment has been implicated as a variable that impacts patient outcomes. The absence of negative physician behaviors is an inadequate measure for assessing the positive attributes of the professional practice environment. Instruments for assessing the professional practice environment typically looked at the presence of negative physician behaviors or examined a single aspect of the nurse-physician relationship. This article provides a theoretical framework that can be used to guide both practice and research. The PPEAS was developed within a theoretical framework that can be adapted to a variety of settings, cultures, and countries. The PPEAS is a valid and reliable instrument that can be used to assess the professional practice environment in a variety of settings.

© 2011 Sigma Theta Tau International.

[PubMed - indexed for MEDLINE]
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