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Campbell CM, Warshawsky N, Swiger PA, Li P, Olds D, Patrician PA. Evolution of an Instrument: Measuring the Nursing Work Environment: A Scoping Review. J Nurs Meas 2024; 32:47-57. [PMID: 37348888 DOI: 10.1891/jnm-2022-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Background and Purpose: The Nursing Work Index (NWI) was developed in the 1980s to measure the nursing work environment (NWE). Instruments descended from the NWI continue to measure the NWE today. The purpose of this review was to identify instruments derived from the NWI, examine how they have been used and revised, and evaluate their ability to capture elements of the current work environment. Methods: A scoping literature review. Results: Forty articles were included. Instruments developed from the NWI have been translated into numerous languages and administered to hundreds of thousands of nurses globally. Conclusions: The study of the NWE remains extensive throughout the world. Future research should examine the factorial structure of instrument adaptions and ensure that items are relevant to contemporary nursing practice.
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Affiliation(s)
| | | | | | - Peng Li
- University of Alabama, Birmingham, AL, USA
| | - Danielle Olds
- University of Missouri - Kansas City, School of Medicine & Saint Luke's Hospital, Kansas City, MO, USA
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Juanamasta IG, Aungsuroch Y, Fisher ML, Nuryani SNA, Ayuningsih NN. Translation and validation study of the Indonesian version of the practice environment scale of the nursing work index. Int J Nurs Sci 2023; 10:511-517. [PMID: 38020847 PMCID: PMC10667313 DOI: 10.1016/j.ijnss.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives This study aimed to translate and validate the Practice Environment Scale - Nursing Work Index (PES-NWI) among nurses in Indonesia. Methods A scale translation and cross-sectional validation study was conducted. The English version was translated into Indonesian, which involved five steps: forward translation, compare the translation, backward translation, compare the translation, and pilot testing with a dichotomous scale (clear or unclear). Thirty inpatient department nurses were involved in checking readability and understandability. A cross-sectional study was conducted from August to October 2022 at 17 hospitals across Indonesia, involving 350 nursing professionals. The validity test included structural validity and convergent validity. The internal consistency reliability was tested by Cronbach's α coefficient, item-total correlation, and composite reliability. Results Confirmatory factor analysis (CFA) showed an acceptable fit. The correlation of all dimensions was between 0.70 and 0.88, and all items had item loading higher than 0.6. Convergent validity of each dimension ranged from 0.61 to 0.74, internal consistencies with Cronbach's α coefficient was 0.97, corrected item-to-total correlation ranged from 0.62 to 0.85, and composite reliability of each dimension was higher than 0.89. Conclusions Good homogeneity and construct validity have been demonstrated for the Indonesian version of the PES-NWI, nursing management can use it to measure the work environment.
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Affiliation(s)
- I Gede Juanamasta
- Faculty of Nursing, Chulalongkorn University Bangkok, Thailand
- Nursing Program, STIKES Wira Medika Bali, Indonesia
| | | | - Mary L. Fisher
- Indiana University School of Nursing, Indianapolis, USA
- College of Nursing, University of Florida, Gainesville, USA
| | | | - Ni Nyoman Ayuningsih
- Quality Assurance Committee, Prof IGNG Ngoerah General Hospital, Bali, Indonesia
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Rodwell J, Hendry T, Johnson D. Analyzing and Validating a Structure for Measuring the Nurse Practice Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5266. [PMID: 37047883 PMCID: PMC10094027 DOI: 10.3390/ijerph20075266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/17/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
Nurse shortages pose a challenge in many countries and retaining existing nursing staff is crucial to addressing these shortages. To inform possible interventions aimed at retaining nurses, managers need a comprehensive understanding of the nature of the nurse practice environment. The scales from two of the main instruments used to assess nurses' practice environments are tested. A survey of an online panel obtained responses from 459 Australian nurses. Analyses determined a combination of items with good construct validity and improved predictive utility for outcomes of interest for individual nurses. By essentially combining the best items from each instrument, a more comprehensive representation of the nurse work environment is obtained with improved predictive utility. The resulting combined set of scales is recommended for analyses of the nurse working environment and uses a combined set of scales from each of the two source instruments, namely: nurse participation in hospital affairs, recognition, nursing process, peer work standards, nursing competence, orientation, managers, resources, nurse-physician collaboration, and positive scheduling climate. Future research can then build on that strong set of items with a validated structure and predictive utility to inform management and interventions.
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Affiliation(s)
- John Rodwell
- Department of Management and Marketing, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Thomas Hendry
- Department of Management and Marketing, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Dianne Johnson
- Griffith Business School, Griffith University, Brisbane, QLD 4111, Australia
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Validation of Psychometric Properties of the Nursing Work Index-Revised Scale in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094933. [PMID: 35564328 PMCID: PMC9102481 DOI: 10.3390/ijerph19094933] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/07/2022] [Accepted: 04/16/2022] [Indexed: 02/05/2023]
Abstract
The use of instruments designed to assess the nursing practice environment is crucial to improve the quality of nursing care, to anticipate problems and difficulties that may arise in organizations, and allow nurse managers to implement changes and improvements in key areas. In this study, we aimed to evaluate the psychometric properties of the Nursing Work Index—Revised Portuguese version (NWI-R-PT) scale. A quantitative, observational, descriptive, and cross-sectional study was conducted. Methods: The sample consisted of 767 nurses from 4 public Portuguese hospitals. Exploratory and confirmatory factor analysis techniques were used to test the distinct structural models. The scale’s accuracy was evaluated through internal consistency, using Cronbach’s alpha. Results: NWI-R-PT internal consistency was 0.91. The NWI-R-PT model with six factors, namely “Management Support,” “Professional Development,” “Fundamentals of Nursing,” “Nurse–Physician Relationship,” “Endowments,” and “Organization of Nursing Care,” was supported by exploratory and confirmatory factor analysis. The NWI-R-PT scale presents adequate goodness-of-fit indices concerning the final factorial model and the convergent validity. Conclusions: The NWI-R-PT scale has a competent and reliable structure. The scale’s validity is confirmed; therefore, it may be employed in all contexts in clinical practice, research, and nursing management. The NWI-R-PT is a useful and valid instrument to assess the nursing environment in hospitals, primary care, long-term care, and nursing homes. The scale has significance in improving the quality of nursing care and patient safety, the professional development of nurses, and organizational results.
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Martínez-Sabater A, Saus-Ortega C, Masiá-Navalon M, Chover-Sierra E, Ballestar-Tarín ML. Spanish Version of the Scale "Eventos Adversos Associados às Práticas de Enfermagem" (EAAPE): Validation in Nursing Students. NURSING REPORTS 2022; 12:112-124. [PMID: 35225898 PMCID: PMC8883960 DOI: 10.3390/nursrep12010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Healthcare carried out by different health professionals, including nurses, implies the possible appearance of adverse events that affect the safety of the patient and may cause damage to the patient. In clinical practice, it is necessary to have measurement instruments that allow for the evaluation of the presence of these types of events in order to prevent them. This study aims to validate the "Eventos adversos associados às práticas de enfermagem" (EAAPE) scale in Spanish and evaluate its reliability. The validation was carried out through a cross-sectional study with a sample of 337 nursing students from the University of Valencia recruited during the 2018-19 academic year. An exploratory factor analysis was carried out using principal components and varimax rotation. The factor analysis extracted two factors that explained 32.10% of the total variance. Factor 1 explains 22.19% and refers to the "adverse results" of clinical practice (29 items), and factor 2 explains 9.62% and refers to "preventive practices" (24 items). Both factors presented high reliability (Cronbach's alpha 0.902 and 0.905, respectively). The Spanish version of the EAAPE is valid and reliable for measuring the perception of adverse events associated with nursing practice and the presence of prevention measures.
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Affiliation(s)
- Antonio Martínez-Sabater
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 València, Spain; (A.M.-S.); (M.L.B.-T.)
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 València, Spain;
- Grupo Investigación en Cuidados (INCLIVA), Hospital Clínico Universitario de Valencia, 46010 València, Spain
| | - Carlos Saus-Ortega
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 València, Spain;
- Nursing School “La Fe”, Generalitat Valenciana, 46026 València, Spain
| | | | - Elena Chover-Sierra
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 València, Spain; (A.M.-S.); (M.L.B.-T.)
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 València, Spain;
- Internal Medicine, Consorcio Hospital General Universitario de Valencia, 46014 València, Spain
| | - María Luisa Ballestar-Tarín
- Nursing Department, Facultat d’Infermeria i Podologia, Universitat de València, 46010 València, Spain; (A.M.-S.); (M.L.B.-T.)
- Nursing Care and Education Research Group (GRIECE), GIUV2019-456, Nursing Department, Universitat de Valencia, 46010 València, Spain;
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Sansó N, Vidal-Blanco G, Galiana L, Oliver A. Development and Psychometric Validation of the Brief Nurses' Practice Environment Scale and Its Relation to Burnout Syndrome and Job Satisfaction: A Study in Spanish Nurses. Front Public Health 2021; 9:621991. [PMID: 34485208 PMCID: PMC8416244 DOI: 10.3389/fpubh.2021.621991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/05/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: Nursing environment is a vast concept that traditionally has included a wide range of job characteristics and has been related to burnout and job satisfaction. For its measurement, the Practice Environment Scale of the Nursing Work Index (PESNWI) stands out. However, shorter instruments are needed. The purpose of the study is to develop and test the Brief Nurses' Practice Environment (BNPE) Scale. Methods: The BNPE Scale was developed and tested in a sample of 210 Spanish nurses (data collection 2018). Results: Cronbach's alpha was 0.702. The confirmatory factor analysis (CFA), with an excellent fit, offered evidence of internal validity. Regarding validity, the BNPE Scale predicted both burnout and job satisfaction. Finally, evidence pointed out a cutoff score of <12 for low levels of practice environment and a cutoff score of >15 for higher levels in practice environment. Conclusions: The BNPE Scale is a short, easy-to-use measure that could be employed in major batteries assessing the quality of healthcare institutions.
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Affiliation(s)
- Noemí Sansó
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain.,Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | | | - Laura Galiana
- Department of Methodology for the Behavioral Sciences, University of Valencia, Valencia, Spain
| | - Amparo Oliver
- Department of Methodology for the Behavioral Sciences, University of Valencia, Valencia, Spain
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Validation of the Psychometric Properties of the Practice Environment Scale of Nursing Work Index in Primary Health Care in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126422. [PMID: 34198495 PMCID: PMC8296248 DOI: 10.3390/ijerph18126422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 12/03/2022]
Abstract
Studies related to the work environment in primary health care are scarce in the literature. The present study aimed to validate the psychometric properties of the Practice Environment Scale of Nursing Work Index (PES-NWI) in primary health care (PHC) and to evaluate its construct validity through exploratory and confirmatory factor analyses in a sample of Portuguese nurses. A quantitative, cross-sectional, and validation study design was implemented. Methods: The sample consisted of 1059 nurses from the PHC units of all 55 health center groups (HCGs) in mainland Portugal, 15 health centers in the Autonomous Region of Madeira, and 6 health centers in the Autonomous Region of the Azores. The study tested different structural models using exploratory and confirmatory factor analysis techniques. The reliability of the scale was tested by determining Cronbach’s alpha coefficient. Results: The internal consistency of the PES-NWI was 0.91. Exploratory and confirmatory factor analyses were performed on the PES-NWI model in PHC with five factors: NPOA, NFQC, NMALSN, SRA, and CNPR. The results show that the scale presents acceptable fit quality indexes in the final factorial solution and adequate convergent validity. Conclusion: The PES-NWI in PHC has an adequate, robust, and reliable five-factor structure. The scale is valid and can be used in clinical practice, nursing management, and PHC research.
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Danno CH, Esteves LSF, Bohomol E. Quality improvement programs and the professional nursing practice environment: an integrative review. Rev Bras Enferm 2021; 74:e20200108. [PMID: 33787784 DOI: 10.1590/0034-7167-2020-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the knowledge produced regarding the practice environment in hospitals with quality improvement programs. METHODS integrative literature review performed in the Latin American and Caribbean Literature in Health Sciences databases, US National Library of Medicine/National Institutes of Health, Web of Science, Scopus and CINAHL, consisting in 10 articles. RESULTS data were presented and discussed using categories: Measures for the professional nursing practice environment; Hospital accreditation as an improvement program; Nursing autonomy, interpersonal relationship between nurse and doctor and the nurse as a manager and leader. FINAL CONSIDERATIONS it was possible to analyze that the influence of quality improvement programs can be considered as favorable in the professional nursing practice environment. The survey also brings contributions to administration in implementing strategies aiming at continuous improvement in the environment characteristics.
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Affiliation(s)
| | | | - Elena Bohomol
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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9
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Rodríguez-García MC, Márquez-Hernández VV, Granados-Gámez G, Aguilera-Manrique G, Gutiérrez-Puertas L. Undergraduate nurses' perception of the nursing practice environment in university hospitals: A cross-sectional survey. J Nurs Manag 2020; 29:477-486. [PMID: 33051929 DOI: 10.1111/jonm.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the psychometric properties of the Practice Environment Scale of the Nursing Work Index (PES-NW) among undergraduate nurses and to compare their perceptions of the nursing practice environment by academic year and unit type. BACKGROUND Despite the fact that nursing students develop most of their undergraduate learning and training in the nursing practice environment, their perception about it has not been considered to date. METHODS The psychometric properties were analysed on a sample of 180 undergraduate nurses. Data collection was carried out in 2018. Data were analysed using percentages, frequencies, mean, standard deviation and Mann-Whitney U test. Factor structure was evaluated with exploratory factor analysis, and reliability was evaluated with Cronbach's alpha. RESULTS Psychometric analysis showed an adequate construct validity and reliability for the PES-NWI. Cronbach's Alpha was 0.884. Undergraduate nurses perceived most hospitals as favourable, scoring the 'Nurse-physician relationships' factor highest and 'Staffing and resource adequacy' factor lowest. CONCLUSION The PES-NWI is a valid and reliable instrument that could be applied in future research to explore nursing students' perceptions of the nursing practice environment. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers are responsible for supervising and ensuring that the nursing practice environment at university hospitals meets the necessary criteria to support the workplace learning of undergraduate nurses.
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Affiliation(s)
| | - Verónica V Márquez-Hernández
- Department of Nursing, Physiotherapy and Medicine, Universidad de Almería, Almería, Spain.,Research Group for Health Sciences CTS-451, Almería, Spain
| | - Genoveva Granados-Gámez
- Department of Nursing, Physiotherapy and Medicine, Universidad de Almería, Almería, Spain.,Research Group for Health Sciences CTS-451, Almería, Spain
| | - Gabriel Aguilera-Manrique
- Department of Nursing, Physiotherapy and Medicine, Universidad de Almería, Almería, Spain.,Research Group for Health Sciences CTS-451, Almería, Spain
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10
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Cho H, Han K. Associations Among Nursing Work Environment and Health-Promoting Behaviors of Nurses and Nursing Performance Quality: A Multilevel Modeling Approach. J Nurs Scholarsh 2018; 50:403-410. [DOI: 10.1111/jnu.12390] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hyeonmi Cho
- Research Assistant; Chung-Ang University Graduate School Department of Nursing; Seoul South Korea
| | - Kihye Han
- Lambda Alpha-at-Large , Associate Professor; Chung-Ang University Red Cross College of Nursing; Seoul South Korea
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11
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Pahlevan Sharif S, Ahadzadeh AS, Sharif Nia H. Mediating role of psychological well-being in the relationship between organizational support and nurses’ outcomes: A cross-sectional study. J Adv Nurs 2017; 74:887-899. [DOI: 10.1111/jan.13501] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Hamid Sharif Nia
- School of Nursing and Midwifery Amol; Mazandaran University of Medical Sciences; Sari Iran
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12
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Swiger PA, Patrician PA, Miltner RS(S, Raju D, Breckenridge-Sproat S, Loan LA. The Practice Environment Scale of the Nursing Work Index: An updated review and recommendations for use. Int J Nurs Stud 2017. [DOI: 10.1016/j.ijnurstu.2017.06.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Lee SE, Scott LD. Hospital Nurses' Work Environment Characteristics and Patient Safety Outcomes: A Literature Review. West J Nurs Res 2016; 40:121-145. [PMID: 27586440 DOI: 10.1177/0193945916666071] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This integrative literature review assesses the relationship between hospital nurses' work environment characteristics and patient safety outcomes and recommends directions for future research based on examination of the literature. Using an electronic search of five databases, 18 studies published in English between 1999 and 2016 were identified for review. All but one study used a cross-sectional design, and only four used a conceptual/theoretical framework to guide the research. No definition of work environment was provided in most studies. Differing variables and instruments were used to measure patient outcomes, and findings regarding the effects of work environment on patient outcomes were inconsistent. To clarify the relationship between nurses' work environment characteristics and patient safety outcomes, researchers should consider using a longitudinal study design, using a theoretical foundation, and providing clear operational definitions of concepts. Moreover, given the inconsistent findings of previous studies, they should choose their measurement methodologies with care.
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Üzar Özçetin YS, Hiçdurmaz D. Approaches of intensive care nurses towards sensory requirements of patients. J Clin Nurs 2015; 24:3186-96. [PMID: 26299449 DOI: 10.1111/jocn.12965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to identify the approaches used by nurses to address the sensory requirements of patients to respond to the concerns and needs in this area. BACKGROUND Preventing sensory problems is very important for intensive care nurses as these problems may cause various additional health problems in intensive care patients; however, no study has evaluated the approaches used by nurses in this respect. DESIGN The study was conducted as a descriptive study in all internal medicine intensive care units at hospitals located within the borders of the metropolitan municipality in the capital city of Turkey. METHOD Data were collected using case forms that were developed through expert opinions to identify the approaches of nurses for the sensory requirements of patients. The study was conducted with 95 nurses who agreed to be involved in the study of the 107 internal medicine intensive care nurses in the research population. RESULTS Most of the nurses (86.3%) who took part in this study indicated that intensive care patients had sensory requirements, but 80% clarified that their priority was to maintain life support and to meet their physiological needs. Almost all of the nurses were able to accurately identify the specific sensory problems of the six different ones in cases that were assigned to them. However, this ratio decreased when identifying the proper approach for the given sensory requirement. CONCLUSIONS Nurses were able to identify sensory requirements of patients, but they do need support in deciding the appropriate management approach. This study may fill the gap in the literature regarding the approaches of nurses towards sensory requirements and to provide contribution for future research. RELEVANCE TO CLINICAL PRACTICE To help intensive care patients with sensory problems, nurses should routinely assess patients' psychology and should do appropriate interventions.
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Affiliation(s)
| | - Duygu Hiçdurmaz
- Psychiatric Nursing Department, Hacettepe University Faculty of Nursing, Ankara, Turkey
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15
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Sumathi GN, Kamalanabhan TJ, Thenmozhi M. Impact of work experiences on perceived organizational support: a study among healthcare professionals. AI & SOCIETY 2015. [DOI: 10.1007/s00146-013-0509-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Testing the Nursing Worklife Model in Canada and Australia: a multi-group comparison study. Int J Nurs Stud 2014; 52:525-34. [PMID: 25468280 DOI: 10.1016/j.ijnurstu.2014.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 11/23/2022]
Abstract
STUDY AIM To test a model derived from the Nursing Worklife Model linking elements of supportive practice environments to nurses' turnover intentions and behaviours in Canada and Australia. BACKGROUND With the worldwide shortage of nurses, retaining nurses within fiscally challenged health care systems is critical to sustaining the future of the nursing workforce and ultimately safe patient care. The Nursing Worklife Model describes a pattern of relationships amongst environmental factors that support nursing practice and link to nurse turnover. This model has been tested in north American settings but not in other countries. METHODS A secondary analysis of data collected in two cross-sectional studies in Canadian and Australian hospitals (N=4816) was conducted to test our theoretical model. Multigroup structural equation modelling techniques were used to determine the validity of our model in both countries and to identify differences between countries. RESULTS The hypothesized model relationships were supported in both countries with few differences between groups. Components of supportive professional practice work environments, particularly resources, were significantly linked to nurses' turnover intentions and active search for new jobs. Leadership played a critical role in shaping the pattern of relationships to other components of supportive practice environments and ultimately turnover behaviours. CONCLUSION The Nursing Worklife Model was shown to be valid in both countries, suggesting that management efforts to ensure that features of supportive practice environments are in place to promote the retention of valuable nursing resources.
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Kang JH, Kim CW, Lee SY. Nurse-perceived patient adverse events and nursing practice environment. J Prev Med Public Health 2014; 47:273-80. [PMID: 25284199 PMCID: PMC4186549 DOI: 10.3961/jpmph.14.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/12/2014] [Indexed: 11/09/2022] Open
Abstract
Objectives: To evaluate the occurrence of patient adverse events in Korean hospitals as perceived by nurses and examine the correlation between patient adverse events with the nurse practice environment at nurse and hospital level. Methods: In total, 3096 nurses working in 60 general inpatient hospital units were included. A two-level logistic regression analysis was performed. Results: At the hospital level, patient adverse events included patient falls (60.5%), nosocomial infections (51.7%), pressure sores (42.6%) and medication errors (33.3%). Among the hospital-level explanatory variables associated with the nursing practice environment, ‘physician- nurse relationship’ correlated with medication errors while ‘education for improving quality of care’ affected patient falls. Conclusions: The doctor-nurse relationship and access to education that can improve the quality of care at the hospital level may help decrease the occurrence of patient adverse events.
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Affiliation(s)
- Jeong-Hee Kang
- Department of Nursing Science, Gyeongju University, Gyeongju, Korea
| | - Chul-Woung Kim
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea ; Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang-Yi Lee
- Department of Health Policy and Management, Jeju National University School of Medicine, Jeju, Korea
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18
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Relationships among Work Environment, Job Satisfaction and Turnover Intention of Nurses in an Emergency Department. ACTA ACUST UNITED AC 2014. [DOI: 10.14370/jewnr.2014.20.1.29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Roch G, Dubois CA, Clarke SP. Organizational Climate and Hospital Nurses' Caring Practices: A Mixed-Methods Study. Res Nurs Health 2014; 37:229-40. [DOI: 10.1002/nur.21596] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Geneviève Roch
- Faculty of Nursing; Université Laval, and Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Centre; 1050 Avenue de la Médecine Quebec Quebec, Canada G1V 0A6
| | - Carl-Ardy Dubois
- Faculty of Nursing; University of Montreal; Montreal Quebec Canada
| | - Sean P. Clarke
- Ingram School of Nursing; McGill University; Montreal Quebec Canada
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20
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Content validity of the Spanish version of the Practice Environment Scale of the Nursing Work Index. Appl Nurs Res 2013; 26:e5-9. [DOI: 10.1016/j.apnr.2013.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/19/2013] [Accepted: 08/28/2013] [Indexed: 11/21/2022]
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Hutchinson M, Jackson D. Hostile clinician behaviours in the nursing work environment and implications for patient care: a mixed-methods systematic review. BMC Nurs 2013; 12:25. [PMID: 24094243 PMCID: PMC3851604 DOI: 10.1186/1472-6955-12-25] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is a sizeable body of evidence regarding the nature of hostile behaviours among clinicians in the nursing workplace, what is less clear is the nature of the relationship between these behaviours and patient care. To inform the development of appropriate intervention strategies we examine the level of evidence detailing the relationships between hostile clinician behaviours and patient care. METHODS Published qualitative and quantitative studies that examined hostile clinician behaviours and patient care were included. Quality assessment, data extraction and analysis were undertaken on all included studies. The search strategy was undertaken in July and August 2011 and comprised eight electronic databases (CINAHL, Health Collection (Informit), Medline (Ovid), Ovid Nursing Full Text, Proquest Health and Medicine, PsycInfo, Pubmed and Cochrane library) as well as hand searching of reference lists. RESULTS The search strategy yielded 30 appropriate publications. Employing content analysis four themes were refined: physician-nurse relations and patient care, nurse-nurse bullying, intimidation and patient care, reduced nurse performance related to exposure to hostile clinician behaviours, and nurses and physicians directly implicating patients in hostile clinician behaviours. CONCLUSIONS Our results document evidence of various forms of hostile clinician behaviours which implicate nursing care and patient care. By identifying the place of nurse-nurse hostility in undermining patient care, we focus attention upon the limitations of policy and intervention strategies that have to date largely focused upon the disruptive behaviour of physicians. We conclude that the paucity of robustly designed studies indicates the problem is a comparatively under researched area warranting further examination.
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Affiliation(s)
- Marie Hutchinson
- School of Health and Human Sciences, Southern Cross University, PO Box 157, Lismore 2780, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology, PO Box 123, Broadway Sydney, Australia
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Kim CW, Lee SY, Kang JH, Park BH, Park SC, Park HK, Lee KH, Yi YJ, Jeong BG. Application of revised nursing work index to hospital nurses of South Korea. Asian Nurs Res (Korean Soc Nurs Sci) 2013; 7:128-35. [PMID: 25030250 DOI: 10.1016/j.anr.2013.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/16/2013] [Accepted: 06/21/2013] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Based on the Revised Nursing Work Index (NWI-R), this research aimed to develop a Korean Hospital General Inpatient Unit-Nursing Work Index (KGU-NWI). This study also aimed to compare the common points and differences between the subfactors of the KGU-NWI and the subfactors from previous studies. METHODS Based on opinions from 3,151 nurses in Korean hospital general inpatient unit, this research used 57 items of NWI-R and the principal axis factor analysis for deriving subfactors. We evaluated the convergent validity through factor analysis and the content validity of KGU-NWI in terms of the association between nurses' job outcome and the subfactors derived. RESULTS Six subfactors and 26 items for KGU-NWI were derived from NWI-R. Among them, 'physician-nurse relationship', 'adequate nurse staffing' and 'organizational support and management of hospital' were the same with results from previous studies. In addition, two subfactors, 'participation of decision-making processes' and 'education for improving quality of care', which were similar with results from previous Korean studies, were newly added by using Korean hospital cases. In contrast to previous Korean studies, a unique subfactor this study found was 'nursing processes'. This research confirmed that the six subfactors were highly correlated with job satisfaction, intention to leave, and quality of health care, which represented a nurse's job outcome. CONCLUSION KGU-NWI including six subfactors and 26 items is an applicable instrument to investigate nurse work environment in Korean hospital general inpatient unit.
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Affiliation(s)
- Chul-Woung Kim
- Department of Preventive Medicine, College of Medicine, Research Institute for Medical Sciences, Chungnam National University, Daejeon, South Korea
| | - Sang-Yi Lee
- Department of Health Policy and Management, School of Medicine, Jeju National University, Jeju, South Korea.
| | - Jeong-Hee Kang
- Department of Public Health, Chungnam National University, Daejeon, South Korea
| | - Bo-Hyun Park
- Department of Nursing, Kimcheon Science College, Gimcheon, South Korea
| | - Sang-Chul Park
- The Department of Future Strategy for Government, The Korea Institute of Public Administration, Seoul, South Korea
| | - Hyeung-Keun Park
- Department of Health Policy and Management, School of Medicine, Jeju National University, Jeju, South Korea
| | - Keon-Hyung Lee
- Askew School of Public Administration and Policy, Florida State University, Tallahassee, USA
| | - Yun-Jeong Yi
- Department of Nursing Science, College of Nursing, Gachon University, Incheon, South Korea
| | - Baek-Geun Jeong
- Institute of Health Sciences, Department of Preventive Medicine, College of Medicine, Gyeongsang National University, Jinju, South Korea
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Anzai E, Douglas C, Bonner A. Nursing practice environment, quality of care, and morale of hospital nurses in Japan. Nurs Health Sci 2013; 16:171-8. [DOI: 10.1111/nhs.12081] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Eriko Anzai
- School of Nursing; Queensland University of Technology; Brisbane Queensland Australia
| | - Clint Douglas
- School of Nursing; Queensland University of Technology; Brisbane Queensland Australia
| | - Ann Bonner
- School of Nursing; Queensland University of Technology; Brisbane Queensland Australia
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Van Bogaert P, Clarke S, Wouters K, Franck E, Willems R, Mondelaers M. Impacts of unit-level nurse practice environment, workload and burnout on nurse-reported outcomes in psychiatric hospitals: A multilevel modelling approach. Int J Nurs Stud 2013; 50:357-65. [DOI: 10.1016/j.ijnurstu.2012.05.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 04/20/2012] [Accepted: 05/03/2012] [Indexed: 11/26/2022]
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Kwon JO, Kim EY. Impact of Unit-level Nurse Practice Environment on Nurse Turnover Intention in the Small and Medium Sized Hospitals. ACTA ACUST UNITED AC 2012. [DOI: 10.11111/jkana.2012.18.4.414] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hinno S, Partanen P, Vehviläinen-Julkunen K. The professional nursing practice environment and nurse-reported job outcomes in two European countries: a survey of nurses in Finland and the Netherlands. Scand J Caring Sci 2011; 26:133-43. [PMID: 22032723 DOI: 10.1111/j.1471-6712.2011.00920.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The working environment of nurses is receiving international interest, because there is a growing consensus that identifying opportunities for improving working conditions in hospitals is essential to maintain adequate staffing, high-quality care, nurses' job satisfaction and hence their retention. Thus, the aim of this study was to investigate the relationship between nurse work environment characteristics and nurse-reported job outcomes in hospital settings in Finland and the Netherlands and to compare these results. A comparative cross-sectional nurse survey was conducted. Data were collected from the two countries randomly sampling the countries' National Nurses Association' membership databases. In this paper, the results from Registered Nurses working in hospital settings are used. In total, 869 hospital nurses participated: 535 from Finland and 334 from the Netherlands with the response rate of 44.9 and 33.4%, respectively. Fifty-five items from the Nursing Work Index-Revised were used as a main tool for the practice environment. Exploratory factor analysis was used to identify a set of internally consistent subscales. Further, logistic regression analysis and T-tests were used. Three practice environment characteristics were identified: adequacy of resources, supportiveness of management and assurance of care quality via collaborative relationships. Favourable evaluations of the adequacy of resources and supportiveness of management were positively correlated with nurse-assessed quality of care and job-related positive feelings and negatively correlated with intentions to leave a unit, organization or the entire profession. In neither of the participating countries were adverse incidents affecting nurses related to nurses' evaluations of their current professional practice environment. Compared with Finland, in the Netherlands, RN appears to evaluate the majority of work environment characteristics more positively; nevertheless, to some extent, the results were uniform as adequacy of resources and supportiveness of management were main predictors for nurse-reported job outcomes considered.
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Affiliation(s)
- Saima Hinno
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.
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BAE SUNGHEUI. Assessing the relationships between nurse working conditions and patient outcomes: systematic literature review. J Nurs Manag 2011; 19:700-13. [DOI: 10.1111/j.1365-2834.2011.01291.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cho SH, Mark BA, Yun SC, June KJ. Differences in intensive care unit work environments among and within hospitals using subscales and a composite measure of the Revised Nursing Work Index. J Adv Nurs 2011; 67:2637-48. [DOI: 10.1111/j.1365-2648.2011.05713.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cortelyou-Ward KH, Unruh L, Fottler MD. The effect of work environment on intent to leave the nursing profession: a case study of bedside registered nurses in rural Florida. Health Serv Manage Res 2011; 23:185-92. [PMID: 21097730 DOI: 10.1258/hsmr.2010.010008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this research was to explore the effect work environment has on the intent to leave the profession for rural hospital bedside registered nurses (RNs). Subscales of autonomy, control over the practice setting, nurse-physician relationship and organizational support were incorporated into the analysis to determine which aspects of work environment directly affect the intent to leave the profession. An explanatory cross-sectional survey was distributed to 259 direct care bedside RNs employed at a rural system-affiliated hospital in Central Florida between February 2007 and June 2007. Anonymity was assured. A questionnaire containing demographic questions, the Nursing Work Index-Revised and Blau's intent to leave scale was distributed to all direct care nurses. A 32.8% response rate was achieved for a total of 85 complete and usable surveys. Data analysis shows that the work environment in general is negatively related to intent to leave. In addition, each of the four subscales was also negatively related to the intent to leave the profession. The results of this study support several recommendations for practice and education, including the promotion of professional practice environments, fostering inter-departmental relationships, and increasing the managerial training of RN managers.
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Abstract
BACKGROUND Although the Practice Environment Scale of the Nursing Work Index has been endorsed as a gauge of the quality of the nursing practice environment by several organizations in the United States promoting healthcare quality, there is no literature describing its use in different practice settings and countries. OBJECTIVE The purpose of this study was to inform research by describing the modifications and use of the scale in a variety of practice settings and countries. METHODS The Cumulative Index to Nursing and Allied Health Literature and the PubMed databases were searched for the years 2002-2010 to identify 37 research reports published since 2002 describing use, modification, and scoring variations in different practice settings and countries. RESULTS The scale was modified for 10 practice settings in five countries and translated into three languages. Composite scores ranged from 2.48 to 3.17 (on a 1-4 scale). The Staffing and Resource Adequacy subscale most often scored lowest. A new Nursing Information Technology subscale has been developed. New scoring methods to identify the favorability of practice environments are described. Over time, the nature of the research conducted using the measure has changed. Overall, most publications report significant associations between scale scores and multiple nurse, patient, and organizational outcomes. DISCUSSION Scale use is growing across different clinical settings and countries. Recommendations for future research use include reducing scale length, using consistent scoring methods, considering the impact of various modifications on the basis of cultural and clinical setting nuances, and using the measure in longitudinal and intervention research designs.
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Working conditions of nurses and absenteeism: Is there a relationship? An empirical analysis using National Survey of the Work and Health of Nurses. Health Policy 2010; 97:152-9. [DOI: 10.1016/j.healthpol.2010.04.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 04/07/2010] [Accepted: 04/24/2010] [Indexed: 11/15/2022]
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Slater P, O'Halloran P, Connolly D, McCormack B. Testing of the Factor Structure of the Nursing Work Index-Revised. Worldviews Evid Based Nurs 2010; 7:123-34. [DOI: 10.1111/j.1741-6787.2009.00158.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rochefort CM, Clarke SP. Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units. J Adv Nurs 2010; 66:2213-24. [PMID: 20626479 DOI: 10.1111/j.1365-2648.2010.05376.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses' perceptions of care rationing, job outcomes, and quality of care. BACKGROUND International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. METHODS Over a 6-month period in 2007-2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). RESULTS A total of 339 nurses (61.3%) completed questionnaires. Overall, 18.6% were dissatisfied with their job, 35.7% showed high emotional exhaustion, and 19.2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. CONCLUSION Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units.
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Van Bogaert P, Clarke S, Roelant E, Meulemans H, Van de Heyning P. Impacts of unit-level nurse practice environment and burnout on nurse-reported outcomes: a multilevel modelling approach. J Clin Nurs 2010; 19:1664-74. [DOI: 10.1111/j.1365-2702.2009.03128.x] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kutney-Lee A, Lake ET, Aiken LH. Development of the Hospital Nurse Surveillance Capacity Profile. Res Nurs Health 2009; 32:217-28. [PMID: 19161172 DOI: 10.1002/nur.20316] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Better patient outcomes are often achieved through effective surveillance, a primary function of nurses. The purpose of this article is to define, operationalize, measure, and evaluate the nurse surveillance capacity of hospitals. Nurse surveillance capacity is defined as the organizational features that enhance or weaken nurse surveillance. It includes a set of registered nurse (staffing, education, expertise, experience) and nurse practice environment characteristics. Empirical referents were extracted from existing survey data from 9,232 nurses in 174 hospitals. Using a ranking methodology, a Hospital Nurse Surveillance Capacity Profile was created for each hospital. Greater nurse surveillance capacity was significantly associated with better quality of care and fewer adverse events. The profile may assist administrators to improve nurse surveillance and patient outcomes.
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Affiliation(s)
- Ann Kutney-Lee
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA
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Frequencies of falls in Swiss hospitals: Concordance between nurses’ estimates and fall incident reports. Int J Nurs Stud 2009; 46:164-71. [DOI: 10.1016/j.ijnurstu.2008.09.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 09/11/2008] [Accepted: 09/12/2008] [Indexed: 11/17/2022]
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Van Bogaert P, Clarke S, Vermeyen K, Meulemans H, Van de Heyning P. Practice environments and their associations with nurse-reported outcomes in Belgian hospitals: development and preliminary validation of a Dutch adaptation of the Revised Nursing Work Index. Int J Nurs Stud 2009; 46:54-64. [PMID: 18789437 PMCID: PMC2845973 DOI: 10.1016/j.ijnurstu.2008.07.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 07/24/2008] [Accepted: 07/28/2008] [Indexed: 11/22/2022]
Abstract
AIM To study the relationship between nurse work environment, job outcomes and nurse-assessed quality of care in the Belgian context. BACKGROUND Work environment characteristics are important for attracting and retaining professional nurses in hospitals. The Revised Nursing Work Index (NWI-R) was originally designed to describe the professional nurse work environment in U.S. Magnet Hospitals and subsequently has been extensively used in research internationally. METHOD The NWI-R was translated into Dutch to measure the nurse work environment in 155 nurses across 13 units in three Belgian hospitals. Factor analysis was used to identify a set of coherent subscales. The relationship between work environments and job outcomes and nurse-assessed quality of care was investigated using logistic and linear regression analyses. RESULTS Three reliable, consistent and meaningful subscales of the NWI-R were identified: nurse-physician relations, nurse management at the unit level and hospital management and organizational support. All three subscales had significant associations with several outcome variables. Nurse-physician relations had a significant positive association with nurse job satisfaction, intention to stay the hospital, the nurse-assessed unit level quality of care and personal accomplishment. Nurse management at the unit level had a significant positive association with the nurse job satisfaction, nurse-assessed quality of care on the unit and in the hospital, and personal accomplishment. Hospital management and organizational support had a significant positive association with the nurse-assessed quality of care in the hospital and personal accomplishment. Higher ratings of nurse-physician relations and nurse management at the unit level had significant negative associations with both the Maslach Burnout Inventory emotional exhaustion and depersonalization dimensions, whereas hospital management and organizational support was inversely associated only with depersonalization scores. CONCLUSION A Dutch version of the NWI-R questionnaire produced comparable subscales to those found by many other researchers internationally. The resulting measures of the professional practice environment in Belgian hospitals showed expected relationships with nurse self-reports of job outcomes and perceptions of hospital quality.
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Affiliation(s)
- Peter Van Bogaert
- Department of Nursing, University Hospital Antwerp, Operating Room, Wilrijkstraat 10, B-2650 Edegem, Belgium
| | - Sean Clarke
- University of Pennsylvania School of Nursing, Center of Health Outcomes and Policy Research, United States
| | | | | | - Paul Van de Heyning
- Faculty of Medicine, Department Otolaryngology and Communication Disorders, University Hospital Antwerp, Belgium
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Effect of Empowerment on Professional Practice Environments, Work Satisfaction, and Patient Care Quality. J Nurs Care Qual 2008; 23:322-30. [PMID: 18431259 DOI: 10.1097/01.ncq.0000318028.67910.6b] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schubert M, Glass TR, Clarke SP, Aiken LH, Schaffert-Witvliet B, Sloane DM, De Geest S. Rationing of nursing care and its relationship to patient outcomes: the Swiss extension of the International Hospital Outcomes Study. Int J Qual Health Care 2008; 20:227-37. [PMID: 18436556 DOI: 10.1093/intqhc/mzn017] [Citation(s) in RCA: 241] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore the association between implicit rationing of nursing care and selected patient outcomes in Swiss hospitals, adjusting for major organizational variables, including the quality of the nurse practice environment and the level of nurse staffing. Rationing was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Additional data were collected using an adapted version of the International Hospital Outcomes Study questionnaire. DESIGN Multi-hospital cross-sectional surveys of patients and nurses. SETTING Eight Swiss acute care hospitals PARTICIPANTS Nurses (1338) and patients (779) on 118 medical, surgical and gynecological units. MAIN OUTCOME MEASURES Patient satisfaction, nurse-reported medication errors, patient falls, nosocomial infections, pressure ulcers and critical incidents involving patients over the previous year. RESULTS Generally, nurses reported rarely having omitted any of the 20 nursing tasks listed in the BERNCA over their last 7 working days. However, despite relatively low levels, implicit rationing of nursing care was a significant predictor of all six patient outcomes studied. Although the adequacy of nursing resources was a significant predictor for most of the patient outcomes in unadjusted models, it was not an independent predictor in the adjusted models. Low nursing resource adequacy ratings were a significant predictor for five of the six patient outcomes in the unadjusted models, but not in the adjusted ones. CONCLUSION As a system factor in acute general hospitals, implicit rationing of nursing care is an important new predictor of patient outcomes and merits further study.
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Affiliation(s)
- Maria Schubert
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
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Hurst K. UK ward design: Patient dependency, nursing workload, staffing and quality—An observational study. Int J Nurs Stud 2008; 45:370-81. [PMID: 17097658 DOI: 10.1016/j.ijnurstu.2006.09.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2006] [Revised: 09/09/2006] [Accepted: 09/16/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are important relationships between ward design, patient welfare and staff activity in the literature but studies seem not to have tested all the variables. Whether ward designs influence nursing structures, processes and outcomes, therefore, has not been fully answered. While studies provide helpful guidance, nursing efficiency and effectiveness implications are speculative. OBJECTIVES To improve nursing efficiency and effectiveness by capitalizing on the best ward design features. SETTING A database consisting of 375 UK wards, constructed for other research and development purposes, was revisited and reconfigured for the present study. The database was updated between 2003 and 2004. PARTICIPANTS Of 390 wards approached, 375 generated usable data. METHOD Patient dependency, nursing activity, workload, nursing quality and staffing data in the original database were obtained using mainly non-participation observation methods. Later, wards were classified in eight ways and differences between ward types examined. RESULTS Patient dependency did not stand out in any ward type but as the literature predicted, direct patient care was higher in Nightingale wards. Racetrack ward nursing activity was also close to idyllic. Bay wards, owing to their greater occupancy peaks and troughs, had a propensity to generate heavier workloads. Time-out and down-time were not excessive in any ward type, and it is likely that ward leadership may be compensating for some variables' negative effects. Racetrack wards were considerably less-well staffed and grade-mix dilute and consequently the cheapest. Quality scores were higher in Nightingale wards-nurses' greater observation capability was a significant factor. Wards' central-core configurations also influenced nursing efficiency and effectiveness. CONCLUSIONS Racetrack wards have an edge over other ward designs. However, replicating Nightingale conditions by, for example, equalising occupancy, throughput and staffing and maximising nurses' substations, could engender similar outcomes elsewhere.
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Affiliation(s)
- Keith Hurst
- Leeds University Health Sciences and Public Health and Research Institute, Health and Social Care Policy Group, Fairbairn House, UK.
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Mark BA, Hughes LC, Belyea M, Chang Y, Hofmann D, Jones CB, Bacon CT. Does safety climate moderate the influence of staffing adequacy and work conditions on nurse injuries? JOURNAL OF SAFETY RESEARCH 2007; 38:431-46. [PMID: 17884430 PMCID: PMC2062533 DOI: 10.1016/j.jsr.2007.04.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 12/19/2006] [Accepted: 04/25/2007] [Indexed: 05/17/2023]
Abstract
PROBLEM Hospital nurses have one of the highest work-related injury rates in the United States. Yet, approaches to improving employee safety have generally focused on attempts to modify individual behavior through enforced compliance with safety rules and mandatory participation in safety training. We examined a theoretical model that investigated the impact on nurse injuries (back injuries and needlesticks) of critical structural variables (staffing adequacy, work engagement, and work conditions) and further tested whether safety climate moderated these effects. METHOD A longitudinal, non-experimental, organizational study, conducted in 281 medical-surgical units in 143 general acute care hospitals in the United States. RESULTS Work engagement and work conditions were positively related to safety climate, but not directly to nurse back injuries or needlesticks. Safety climate moderated the relationship between work engagement and needlesticks, while safety climate moderated the effect of work conditions on both needlesticks and back injuries, although in unexpected ways. DISCUSSION AND IMPACT ON INDUSTRY: Our findings suggest that positive work engagement and work conditions contribute to enhanced safety climate and can reduce nurse injuries.
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Abstract
Improvements in nurses' practice environments are essential to retain nurses and keep patients safe. The pace of improvements can accelerate if evidence is translated clearly for researchers, managers, and policymakers. This article evaluates the utility of published multidimensional instruments to measure the nursing practice environment. The assessment criteria are theoretical relevance, ease of use, and dissemination. This article also synthesizes the research that has used these instruments. Seven instruments and 54 studies are evaluated. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is proposed as the most useful instrument. Its content, length, and dissemination best satisfy the set of criteria. Researchers should use the PES-NWI to generate consistent and comparable evidence; expand the content to reflect all conceptual domains; develop a short form; test the instrument in different care settings; expand the evidence of the practice environment's influence on patient outcomes; and test interventions for practice environment improvements.
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Affiliation(s)
- Eileen T Lake
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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McCusker J, Dendukuri N, Cardinal L, Katofsky L, Riccardi M. Assessment of the work environment of multidisciplinary hospital staff. Int J Health Care Qual Assur 2005; 18:543-51. [PMID: 16335619 DOI: 10.1108/09526860510627229] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this article is to investigate the performance of scales to assess the work environment of hospital professional staff, other than nurses or physicians. DESIGN/METHODOLOGY/APPROACH A survey was conducted among professional (non-nursing or medical) staff at a 300-bed urban, university-affiliated Canadian hospital. A total of 24 work environment items were adapted from a scale previously validated among nursing staff. Scales were developed based on a principal components analysis, and were compared among four groups of staff. The relationships between the scales and the following measures were then explored using univariate and multivariate analyses: satisfaction with the work environment, perceived quality of patient care, perceived frequency of patient/family complaints, work-related injuries, and verbal abuse of staff. FINDINGS The survey response rate was 154/200 (76.6 percent). Four scales were identified (with corresponding Cronbach's alpha), assessing the following aspects of the work environment: supervisory support (0.88), team-work (0.84), professionalism (0.77), and interdisciplinary relations (0.64). In multivariate analyses, there were significant differences between the job groups in all four scales. One or more of the scales was significantly associated with overall satisfaction, perceived quality, and adverse incidents, even after adjustment for other staff characteristics. RESEARCH LIMITATIONS/IMPLICATIONS Limitations include: the cross-sectional design, subjective measurement of quality of care, small sample sizes in some groups of staff, and the single study site. PRACTICAL IMPLICATIONS The scales developed in this study may be used by managers to assess hospital staff perceptions of the work environment. ORIGINALITY/VALUE The four proposed scales appear to measure meaningful aspects of the working environment that are important in determining overall satisfaction with the work environment and are related to quality of care.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St Mary's Hospital Center, Montreal, Canada
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