Intensive Care Unit Nurse-Physician Questionnaires (ICU-NPQ)

National Center for Interprofessional Practice and Education's picture
Submitted by National Center... on Sep 6, 2016 - 11:12am CDT

Shortell S.M.
Rousseau D.M.
Gillies R.R.
Devers K.J.
Simons T. L.

This collection of parallel instruments was designed to assess leadership, organizational culture, communication, coordination, problem solving / conflict management, and team cohesiveness among nurses and physicians working in Intensive Care Units (ICUs). The instruments collect individual perceptions that may be aggregated to the ICU unit level; results may be used to diagnose organization and team issues for improvement. The measures were based on a theoretical model which posits that (a) organizational factors shape (b) managerial processes, which then (c) either encourage or impede team cohesion, which (d) thereby impacts ICU performance.  The measures were validated on a sample of 42 ICUs and over 1,700 respondents including nurses, physicians, unit ward clerks, and top management team members.  Findings were largely in support of the theoretical model. 

Link to Resources
Descriptive Elements
Who is Being Assessed or Evaluated?: 
Instrument Type: 
Self-report (e.g., survey, questionnaire, self-rating)
Source of Data: 
Health care trainees
Health care providers, staff
Organizational records
Instrument Content: 
Reported perceptions, experiences of working relationships, teamwork
Organizational environment, culture
Organizational outcomes of care (e.g., provider satisfaction, nurse turnover)
Notes for Content: 

Item scales were developed to measure all four major components of the theoretical model.

The organizational component of the model had two areas:

  • Leadership (ability of nurse and physician leaders to set high standards, communicate goals, respond to changing needs and to unit members’ needs and perspectives)
  • Culture (team satisfaction orientation vs. people security orientation vs. task security orientation) 

The managerial component contained three areas:

  • Communication (openness, accuracy of information, timeliness, understanding, effectiveness of between-shift communication, and satisfaction)
  • Coordination (written plans and schedules, treatment protocols, policies and procedures, efforts and interactions, between unit coordination and relationships)
  • Problem Solving - four different modes (open/collaborative, arbitration, avoidance, and forcing).

The outcome of positive organizational and managerial processes was measured by a single scale for Team Cohesion.

Perceived Unit Effectiveness includes perceptions of absolute technical quality, and team ability to meet family needs.

Instrument Length: 

The original instrument which constituted the basis for the validity research contains 86 items, and took about 45 minutes to complete.  A shortened version for nurses was developed and takes about 20 minutes to complete.

Item Format: 
A variety of different Likert-type, 5-point scales were developed with different continuums, depending on the item: "agreement", "comparison," "likelihood," and "satisfaction."
Self-administered questionnaires on service.
None described, but simple averaging by item and by section (construct) implied.
None described
Open access (available on this website)
Notes on Access: 

A shortened version of the Nurse Questionnaire is attached.  For all of the instruments, contact the author.

Psychometric Elements: Evidence of Validity
Extensive literature review and theoretical basis in the health services research literature.
Response Process: 
The authors conducted a series of pilot studies to test item wording and content. In so doing, they recognized the need to have separate (but parallel) instruments for nurses and physicians, because questions had to be asked somewhat differently in order to achieve the same meaning. The researchers also learned the importance of testing within-group (i.e., nurse-nurse) as well as between-group (i.e., nurse-physician) relations. Thus, they elaborated the instrument to measure, for example, openness of communication between physicians, as well as communication between physicians and nurses. Similar dyad distinctions were made for other constructs (e.g., accuracy of information received), and for all four problem-solving approaches. After collecting and reviewing the data, the authors also revised a few items with low reliability.
Internal Structure: 
Cronbach’s alpha reliability coefficients were obtained for each of 28 factors and item scales. Resulting coefficients varied from a low of r = 0.68 to a high of r = 0.88. Factor analysis was performed on 48 items from the organizational culture inventory measuring team satisfaction, people security, and task security. Results confirmed three principal factors with high internal consistency and item loadings all above 0.40 and Eigenvalues well above 1.
Relation to Other Variables: 
Perceptions of the organizational culture were collected through a survey of ward clerks and members of the hospital’s top management team. These perceptions were used to examine the correlation organizational characteristics, managerial processes, and outcomes. According to their theory, ICUs with high scores in organizational characteristics, and specifically a culture that was oriented toward team satisfaction, would also score higher in managerial processes (i.e., coordination, communication and conflict resolution), as well as the desired performance outcomes of team cohesiveness and perceived unit effectiveness (convergent validity). According to their theory, ICUs with negative organizational cultures were those in which superficially smooth relationships and unquestioned obedience to authority were the norm (“person-security”), and those in which rigid conformity to tasks (“task security”) cultivated perfectionistic, competitive, and mistrustful behavior. The authors theorized that units high in either person-security or task-security scores would score lower on managerial processes and outcomes (discriminant validity). This turned out to be largely the case, as shown by a pattern of correlations among respondents’ answers. Responses for items measuring positive nurse and physician leadership, for example, were positively correlated with those measuring high team satisfaction (r = 0.49), better ICU coordination (r = 0.52), better communication (r = 0.40), more open problem solving (r = 0.47), higher team cohesion (r = 0.49), higher perceived technical quality of care (r = 0.48), higher perceived family satisfaction (r = 0.32), and lower nurse turnover (r = -0.29). The converse pattern was also true: low leadership scores and ICUs with strong person-security and task-security cultures were negatively correlated with desired processes and outcomes. What makes these correlations important is not just their magnitude, but their overall pattern which corresponded to the theoretical model. To further confirm these quantitative findings, the authors completed in-depth follow-up interviews with nine ICUs, randomly selected based on their overall ratings (high, medium, low). In addition to speaking with nurse and physician leaders and a sample of nurses (all shifts), other staff (e.g., respiratory therapists), and administrators, the authors spent time observing team interactions during patient rounds, patient care, and shift changes.
None described