Environmental Risk Assessing Instrument–Occupational Low Back Pain in Nurses (ERAI-N)

Abstract

The Environmental Risk Assessing Instrument—Occupational Low Back Pain in Nurses (ERAI-N) is an 18-item psychometric tool developed in 2023 by Zhang, Liu, and Yuan. Its primary function is to quantify and measure environmental risk factors contributing to occupational low back pain (LBP) specifically among nurses working in the Intensive Care Unit (ICU) setting. The instrument is designed for use by clinical administrators to facilitate targeted risk mitigation strategies.

The scale development was rigorously guided by the principles of human factors theory. Initially, 27 items were generated through a qualitative phase involving focus group interviews and an extensive literature review. Expert review, utilizing the Delphi method, refined the instrument to 20 items, which were further screened in a pre-investigation conducted in tertiary medical institutions in China. The final instrument, consisting of 18 items, demonstrated strong psychometric properties, including high reliability and a robust five-factor structure confirmed via Confirmatory Factor Analysis (CFA).

Keywords

Occupational Low Back Pain, Intensive Care Unit Nurses, Risk Assessment, Environmental Risk Factors, Atmosphere of Safe Culture, Equipment, Guideline, Space, Belief, Organizational Climate, Working Conditions, Health Care Personnel Measures, Hospital Environment.

Authors

Zhang, Lihui, Liu, Yangyang, Yuan, Su’e

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Purpose

The central purpose of the ERAI-N is to provide clinical administrators and occupational health specialists with a standardized, evidence-based tool for assessing and managing environmental hazards associated with musculoskeletal injury in high-risk nursing environments, specifically the Intensive Care Unit.

By focusing specifically on environmental and organizational factors, the scale enables tertiary hospitals to identify deficiencies in physical space, equipment availability, safety culture, and institutional guidelines that contribute directly to the prevalence of low back pain among nursing staff, thereby informing preventative interventions.

Construct

The ERAI-N measures the construct of Environmental Risk Factors for Occupational Low Back Pain in Nurses. This construct is operationalized through five distinct yet correlated dimensions that reflect both physical and organizational aspects of the working environment that impact nurse biomechanics and safety behaviors.

These five dimensions, validated through factor analysis, are: Space, relating to the physical layout and maneuverability; Equipment, concerning the availability and suitability of patient handling aids; Belief, relating to institutional policies and training; Guideline, pertaining to established safe work procedures; and Atmosphere of Safe Culture, reflecting the collective safety commitment of the team.

Validity

The validity of the ERAI-N was established through robust assessment of both content and construct validity.

Content Validity: Content validity was ensured through rigorous expert review using the Delphi method. The resulting item-level Content Validity Index (CVI) scores ranged from 0.89 to 1.0, significantly exceeding the generally accepted threshold of 0.78, indicating high relevance and clarity of the items as judged by experts in the field.

Construct Validity: Construct validity was assessed using Confirmatory Factor Analysis (CFA). The final adjusted model confirmed the hypothesized five-factor structure, demonstrating acceptable model fit indices (e.g., CFI = 0.904, RMSEA = 0.071), thereby supporting the theoretical structure of the scale in measuring the latent construct of environmental risk.

Reliability

The ERAI-N demonstrates strong reliability across multiple statistical tests, assuring both internal consistency and temporal stability.

Internal Consistency: Measures of internal consistency were high. The Cronbach’s alpha scores for the five individual factors ranged from 0.793 to 0.982, and the overall scale achieved an excellent score of 0.963. Additional reliability coefficients, including McDonald’s omega (0.866 to 0.986) and Guttman split-half scores (0.708 to 0.928), further supported the robust homogeneity of the items within their respective factors.

Test-Retest Reliability: Stability over time was confirmed using the Intraclass Correlation Coefficient (ICC). Factor ICC scores ranged from 0.616 to 0.924, while the scale’s overall ICC was exceptionally high at 0.994, suggesting that the instrument is highly stable when administered repeatedly.

Factor Analysis

The scale structure was validated through a Confirmatory Factor Analysis (CFA) conducted on the data collected from ICU nurse administrators. The initial CFA model did not meet the desired goodness-of-fit thresholds (IFI and CFI were below 0.9), necessitating model adjustments based on theoretical considerations and modification indices.

Following the deletion of two items and subsequent adjustments, the final five-factor hypothesized model achieved an acceptable fit. Key goodness-of-fit indices for the final model were: the chi-square statistic and degrees of freedom ratio (χ²/df) = 3.943; Root Mean Square Error of Approximation (RMSEA) = 0.071; Incremental Fit Index (IFI) = 0.905; and Comparative Fit Index (CFI) = 0.904. All standardized factor loadings were statistically significant (p < 0.001) and ranged from 0.567 to 0.974, exceeding the standard acceptable threshold of 0.40. The five retained factors are: Space, Equipment, Belief, Guideline, and Atmosphere of safe culture.

Instrument

Test Type: Original instrument development

Format: This instrument is an inventory/questionnaire consisting of 18 items, scored using a 5-point Likert-type scale. Response options range from 1 (very inconsistent) to 5 (very consistent).

Language Available: English

Population Group: Human

Age Group: Adulthood (18 yrs & older)

Population Details: The measure was administered to ICU nurse administrators working in tertiary general hospitals located in China.

Test Methodology: Test Validity, Construct Validity, Content Validity, Test Reliability, Internal Consistency, Test-Retest Reliability, Factor Analysis, Confirmatory Factor Analysis.

Keywords

Nurses, Occupational Low Back Pain, Risk Assessment, Hospital Environment, Ergonomics, Likert Scale, Intensive Care Unit, Psychometrics.

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Authors

Zhang, Lihui

• Affiliation: Teaching and Research Section of Clinical Nursing Xiangya Hospital of Central South University

• Email: No data is Available

Liu, Yangyang

• Author ORCID Identifier: http://orcid.org/0000-0003-1756-4788

• Affiliation: Xiangya Nursing School, Central South University

• Email: No data is Available

Yuan, Su’e

• Affiliation: Teaching and Research Section of Clinical Nursing Xiangya Hospital of Central South University

• Email addresses: [email protected]

• Correspondence Address: Yuan, Su’e: [email protected]

Permissions & Fee and Test Year

Permissions: May be used for Research/Teaching.

Web Site: https://creativecommons.org/licenses/by/4.0/

Commercial: No

Fee: No

Test Year: 2023

Reference’s

Zhang, L., Liu, Y., & Yuan, S. (2023). Environmental risk assessment of low back pain in ICU nurses: An instrument development study. Journal of Nursing Management, 2023, Article 3649293. DOI: https://doi.org/10.1155/2023/3649293

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Items of the Environmental Risk Assessing Instrument–Occupational Low Back Pain in Nurses (ERAI-N)

The ERAI-N consists of 18 items distributed across five factors. The full list of test items is available in the source reference article, specifically in Table 5 on page 7. Each item is rated using a Likert-type scale with five response options: very inconsistent = 1, not very consistent = 2, uncertain = 3, fairly consistent = 4, and very consistent = 5.

The following table preserves the original scale items: