Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type


Degree Name





Margaret Lunney

Subject Categories



Confirmatory factor analysis; HCAHPS; Nursing; Nursing theory; Patient experience; Peplau


Patients' experiences in hospitals are important indicators of quality. Patients' opinions about their experiences in hospitals are significantly associated with their opinions of those hospitals' nursing services. Nurses in the US have traditionally focused on patients' experiences, and Peplau's (1952/1991) theory of interpersonal relations is early evidence of that focus. This study tested Peplau's (1952/1991) theory of interpersonal relations in nursing using confirmatory factor analysis (CFA) on data from 12,436 patient experience surveys. Two hypotheses were supported: (a) patient experience data (i.e. responses on the Consumer Assessment of Healthcare Providers and Systems - Hospital [HCAHPS] survey) collected from patients in one large, academic hospital system during the year 2013 showed a good fit to a two-factor model based on Peplau's (1952/1991) theory and (b) these same data showed an excellent fit to the original latent factors established by the Centers for Medicare and Medicaid (CMS). One hypothesis was not supported: the two-factor model based on Peplau's (1952/1991) theory was not comparable to the original HCAHPS factor structure produced with the same data. Data from the CFA indicated adjustments to the proposed two factor model, and ancillary analyses of a three factor model were conducted using the same patient-experience data and the same CFA methods. The more theoretically accurate three-factor model was an excellent fit to the data and, in generalized linear regressions, made significant contributions to prediction of patients' overall evaluations of their hospital experiences. The research supports that hospital leaders should: (a) assist nurses to assume greater ownership of elements measured by the HCAHPS survey and (b) provide supportive environments for nurses to allow for this expanded practice.

Included in

Nursing Commons