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BACKGROUND: The Nursing Work Index (NWI) provided the foundation for three published instruments, each presented as a valid measure of the nursing practice environment. Aiken and Patrician [Aiken, L. H., chi2 = 939.12, p <.001, df = 50; Lake, chi2 = 17,872.73, p <.001, df = 319; Estabrooks et al., chi2= 38,590.29, p <.001). This lack of model fit with the data raises questions about the validity of these instruments as measures of the nursing practice environment. DISCUSSION: The nursing practice environment is complex and has been examined inadequately by factor-analytic approaches, largely because insufficient attention has been paid to implicit underlying theory. The development and testing of robust theory using powerful research methods available to examine causal relationships in complex theoretical models will advance understanding of constructs such as the nursing practice environment.
Cummings et al. (Wed,) studied this question.