Factors predicting quality of nursing care among nurses in tertiary care hospitals in Mongolia

Perception of Nursing Activities That Contribute to the Quality of Care: Validity and Reliability of the French Version

Background and Purpose: Measuring nurses' perceptions of the activities contributing to the quality of care needs to be emphasized, providing visibility to professional practice and their contributions to achieving health quality. This study aimed to translate, validate, and culturally adapt the "Perception of Nursing Activities that Contribute to the Quality of Care" scale to provide a reliable instrument to assist nurse managers in measuring nurses' perceptions of their activities in French reality. Methods: A quantitative, descriptive, and cross-sectional study, in two phases, was conducted: first, by translation and cultural adaptation, and second, through the validation of the scale. Results: The factor structure of the final version was reduced to 22 items. Content and construct validity and reliability were supported by internal consistency (coefficient alpha = .913). Conclusions: The results show that the final version is a reliable and valid instrument, showing a high potential to be used in research and clinical practice.

Exploring nurses' experiences: Abandoning the profession and migrating for improved opportunities

AIM

This study explores nurses' experiences in migration for employment and professional abandonment in Barcelona (Spain).

METHODS

Employing a mixed-design approach comprising 1) a qualitative descriptive phenomenological study, followed by 2) a subsequent cross-sectional study, 20 and 225 nurses participated in each study, respectively. Qualitative data, gathered through 4 focus group discussions, underwent inductive thematic analysis, following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines, while quantitative data were descriptively analyzed.

FINDINGS

Three qualitative themes emerged: 1) Migration motives, such as improved job opportunities, permanent contracts, continuous training, and professional recognition; 2) Reasons for leaving or contemplating leaving the profession, including excessive workload, lack of recognition, limited development, and exhaustion; 3) Nurses' needs, encompassing more staffing, improved remuneration, permanent contracts, flexible schedules, greater autonomy, and career growth. The cross-sectional study revealed a 13.5 % professional abandonment rate at some point across all demographics and seniority levels. Migration trends varied by professional experience, with younger nurses seeking better conditions and opportunities elsewhere.

CONCLUSIONS

Multifactorial causes underlie job migration and professional abandonment, necessitating comprehensive interventions to improve nurses' working and professional conditions.

Educational training and nursing professional self-perception in Mongolia: A prospective observational pre-post design study

AIMS

To determine whether professional self-perception of nurses in Mongolia improves following an educational intervention and to identify differences in scores among participant subgroups.

DESIGN

A prospective observational pre-post design.

METHODS

Using a convenience sample of 67 nurses in Mongolia in 2019, the Nursing Professional Values Scale-3 instrument was used pre- and post-intervention. Independent and paired sample t-tests were conducted. Data were analysed using IBM SPSS 28.0.1.1 and Stata/SE 16.1. This study complied with the STROBE checklist.

RESULTS

Of the 67 nurses, 92.0% were female, mean age was 32.15 years (SD 8.96), 70.0% held a bachelor's degree, 58.0% had 5 or more years' nursing experience and 51.0% were members of a professional nursing organization. After participating in the educational training, nurses reported higher overall professional self-perception as well as across subscales: activism, professionalism and caring.

CONCLUSION

Considering the nursing shortage in lower-middle-income countries, it is important to recognise the influence of nurses' professional self-perception on nursing retention. This study highlights the significant role continuing educational opportunities play in increasing nurses' professional self-perception. It is imperative to explore ways of improving this perception and focusing on subgroups of nurses to help guide the use of limited resources. Further research is necessary to include nurses in other areas of Mongolia.

IMPLICATION FOR THE PROFESSION

Accurately assessing nursing professional self-perception and providing educational opportunities could improve nursing professional self-perception, nursing satisfaction, patient safety and nursing retention in lower-middle-income countries.

IMPACT

What problem did the study address? This study meets the need for current study on the nursing professional self-perception of nursing from the perspective of nurses in Mongolia. It addresses the dangerous nursing shortage in Mongolia by determining if an educational intervention could improve nursing professional self-perception and thus improve nursing job satisfaction and retention. What were the main findings? Mongolian nurses in this study scored in the top quartile of the NPVS-3, indicating a baseline high NPSP. Educational intervention (including translated oral education and written clinical pathways) significantly improved the nurses' professional self-perception. Nurses were eager for training in other clinical and leadership topics. Where and on whom will the research have an impact? This research can be impactful for nurses, nurse leaders and policy makers in low- and lower-middle-income countries. Specifically for nurses in Mongolia, with increasing technologies and services such as cardiac catheterization laboratories becoming available, more education in these nursing specialty areas is imperative. Professional Nursing Organizations are poised to foster more educational offerings to their members and to increase membership. Nursing education provided by international volunteer nurses with Non-Governmental Organizations can improve NPSP in nurses in LMICs.

REPORTING METHOD

This study complied with the STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Delegating care as a double-edged sword for quality of nursing care: a qualitative study

BACKGROUND

Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care.

METHODS

This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985).

RESULTS

In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword".

CONCLUSIONS

The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

The role of organizational culture and communication skills in predicting the quality of nursing care

AIMS

This study aims to identify the level of nursing care quality and examine its predictors considering nurses' demographic data, organizational culture, and communication skills.

BACKGROUND

Quality of care is a determinant of the sustainability of any healthcare organization. Therefore, it is imperative to understand how factors may contribute to the quality of nursing care. Limited research is available on the interaction between the concepts of quality of nursing care, communication skills, and organizational culture.

METHODS

A cross-sectional multi-site correlational design was used in this study. A convenience sample of 200 nurses from four Jordanian hospitals was recruited. Data was collected using self-reported questionnaires. Descriptive statistics, Pearson correlations, and multiple regression were performed to achieve the study's aims.

RESULTS

The majority of the nurses in this study were females with bachelor's degrees. Age ranged between 22 and 53 years whereas experience ranged from 1 to 30 years. Communication skills significantly predicted the quality of nursing care; however, organizational culture was not a significant predictor of the quality of nursing care. Nevertheless, Pearson r correlation results revealed a significant correlation between organizational culture and communication skills (r = 0.57, p < 0.05).

CONCLUSION

Nurses and organizational managers can increase the level of quality of nursing care by investing in programs that target improving nurses' communication skills. Providing a good environment in the hospital can increase communication skills between staff members, ultimately increasing the quality of nursing care. Further studies are recommended to elaborate and further uncover concerns related to the current research.

Translations of the Practice Environment Scale of the Nursing Work Index: A systematic review

Since 2002, the Practice Environment Scale of the Nursing Work Index has been used worldwide to evaluate nurse work environments. High quality translations in different languages can help advance science and inform practice globally. The study purposes were to conduct a systematic review of published translations of the instrument and to assess their linguistic equivalence and psychometric performance. We conducted a comprehensive search, a quality assessment and synthesis of linguistic equivalence, reliability, and validity data. Studies published through July 2021 were identified in the CINAHL, LILACS, EMCare, and Scopus databases. Thirty-eight publications were selected, comprising 46 translations into 24 languages and 15 language variants, and 35 countries. Translations are in predominantly European, Southeast Asian, and Middle Eastern languages. Two-thirds of the translations reflected medium to high fulfillment of translation quality criteria. The GRADE ratings, reflecting satisfactory fulfillment of cross-cultural equivalence and psychometric properties, were predominantly high (n = 23), then low (n = 15), then moderate (n = 8). The identified translations will support the advancement of global science and the improvement of nurses' work environments.

The Nursing Practice Environment and Patients' Satisfaction with Nursing Care in a Hospital Context

Nursing, being a profession in health, aims to improve the quality of the response to patients' demands, which have repercussions on the attitudes, behaviors and performance of nurses.

BACKGROUND

The aim of the study was to evaluate the relationships among the nursing practice environment, nurse-patient interactions and patients' satisfaction with nursing care in a hospital context.

METHODS

The study applied a descriptive analysis. Based on the initial exploration of the data, we decided to perform a simple linear regression of the dimensions of the scales.

RESULTS

The latent variables and interactions between the different dimensions of the three constructs (the nursing practice environment (PES-NWI), nurse-patient interactions (NPIS-22-PT) and patients' satisfaction in the hospital context (SAPSNC-18)) were submitted to confirmatory analysis. The model was statistically significant, with a good fit with the data (χ2/gl = 128.6/41 (0.000); GFI = 0.900; AGFI = 0.831; TLI = 0.910; CFI = 0.907; RMSEA = 0.102).

CONCLUSIONS

The study showed favorable rates of overall satisfaction on the part of patients, such as the nurses' skills in dealing with their illness/health situation, ability to solve problems in a timely manner, responsiveness to patients' needs and technical competence.

Nurses' evidence-based practice competence and hospital practice environment after specific training under the Best Practice Spotlight Organization® Programme. A cross sectional study

BACKGROUND

Barriers to implementing training strategies for the improvement of evidence-based practice competence of nurses in hospital practice environments still persist.

OBJECTIVE

The aim of the study was to evaluate the impact of a specific training within the framework of the Best Practice Spotlight Organization® programme, on nurses' evidence-based practice competence and the practice environment in two hospitals.

DESIGN

This is a observational cross-sectional study assessing evidence-based practice competence and perceptions of Practice Environments.

PARTICIPANTS

The study sample were 204 nurses working at medical and surgical inpatient units at two hospitals involved in the Best Practice Spotlight Organization® programme.

METHODS

The study was conducted from February 2020 to May 2020. Three questionnaires were used to collect data: a sociodemographic/occupational questionnaire, a questionnaire exploring evidence-based practice skills, and a questionnaire exploring nurses' perceptions of their hospital practice environments.

RESULTS

A total of 204 nurses participated. They were classified into two groups: those who had received specific training within the framework of the programme, called trained-champions (n = 66), and those who had not yet received training, control group (n = 138). The trained-champions exhibited better evidence-based practice competence values than the control group in all dimensions (p < 0.001), with a higher difference in means in the "Utilisation" dimension (-0.80; CI:-0.99,-0.60) and the "Knowledge" dimension (-0.63; CI:-0.88,-0.38). Trained-champions also had a more positive perception of the practice environments than the controls in all dimensions (p ≤ 0.001). The largest differences in means were in the "Participation" dimension (-0.48; CI:-0.66,-0.31) and in the "Leadership" dimension (-0.41; CI:-0.59,-0.23).

CONCLUSIONS

Specific EBP training within the framework of the Best Practice Spotlight Organization® programme has succeeded in nurses (trained-champions) obtaining better EBP competence than others without this training. This could have contributed to increase nurses' abilities to integrate evidence into decision making in their clinical practice, while positively influencing them to perceive their PEs more favorably.

Exploring the relationship between midwives' work environment, women's safety culture, and intent to stay

BACKGROUND

The shortage of midwives is a concern for healthcare systems as it compromises the quality maternity care. Various studies argue that a favorable work environment increases nurses' job satisfaction and intention to continue working at their current workplace.

AIM

To analyze the work environment and its relationship with women's clinical safety culture and midwives' intention to stay in their current job and the midwifery profession.

METHODS

A cross-sectional, correlational study was performed on N = 218 midwives working in Spain. Standardized instruments were used, including The Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Hospital Survey on Patient Safety Culture (HSOPSC). Descriptive and bivariable statistics were used. The study followed the STROBE guidelines.

RESULTS

The work environment in the labor wards was mixed, according to the PES-NWI classification. The mean total score of the PES-NWI significantly and positively correlated with the mean total score of the HSOPSC (rs = 0.498, p < 0.001), indicating that as the quality of midwives' work environment increased, women's clinical safety increased. Significant correlations were observed between the midwives' intent to stay in the hospital where they work and features of women's safety culture.

CONCLUSION

The results of this study showed significant relationships between the work environment, women's safety culture, and midwives' intentions to leave their job/profession. Creating a favorable working environment could be a potentially effective strategy that encourages improvement in the women's safety culture in healthcare organizations and greater intention of midwives to stay at their current job.

Measures of Nursing Environment Multidimensionality and Patient Centricity Using Importance-Performance Map Analysis

Background: The nursing environment has become a consideration for an organization in improving service quality, especially in the implementation of patient-centred care. The various dimensions make it necessary to know which sectors need to be prioritized. However, there is still limited research that is more specific in linking the dimensions to become more operational.  Purpose: This study aimed to analyze the relationship between nursing environment dimensions and patient centricity through the Importance-Performance Map Analysis (IPMA).Methods: A quantitative survey with a cross-sectional approach was conducted in June 2022 to test the conceptual framework on the population obtained from non-managerial inpatient nurses who worked for above two years in a general hospital in East Java, Indonesia. The constructs were measured using a set of indicators in The Practice Environment Scale of the Nursing Work Index (PES-NWI) and Patient Centricity. During the data collection, a total sampling technique was performed, resulting in 89 respondents being acquired. The data were analyzed through partial least squared structural equation modelling (PLS-SEM).Results:  At the construct level, the mean total effect and performance were 0.192 and 56.302, respectively. From the IPMA chart, it was found that the construct in the right lower quadrant with the largest total effect value but not having adequate performance was nursing manager ability (total effect: 0.294, performance: 34.563), making it a construct with the highest importance and requiring priority for improvement among all dimensions.Conclusion: The nursing environment dimensions have to get attention to achieve patient centricity in inpatient ward nurses, where nursing manager ability is the dimension that has the most vulnerable performance. Leadership development is needed for the head nurse of the inpatient unit to strengthen the ability to lead and change the culture in nurturing subordinates so that kinship between nursing professionals can be established.

What really matters for patient safety: Correlation of nurse competence with international patient safety goals

Background

Optimal level of nurse competence is imperative for patient safety and quality of care. A research gap exists in empirical evidence for associating nurses’ competencies with patient safety.

Purpose

The primary purpose of this study was to measure the association between general ward nurses' competencies with international patient safety goals.

Method

Correlational research design was adopted. Stratified random sampling was used to recruit (n  =  182) nurses working in two JCIA accredited and non-JCIA hospitals. Data were collected using the Competency Inventory for Registered Nurses and International Patient Safety Goals. The research was approved by the Institutional review board and ethics committee.

Findings

The regression analysis showed enhancement of patient safety with an improvement in nurse competencies R2  =  0.238. Nurse competencies showed a moderate positive association with an overall patient safety such as critical thinking and research aptitude (r  =  0.420, P – Value < 0.001), teaching coaching (r  =  0.469, P- Value <0.01), professional development (r  =  0.436, P – Value < 0.001), legal and ethical practices (r  =  0.434, P –Value < 0.001), interpersonal relationships (r  =  0.430, P –Value < 0.001), Leadership (r  =  0.400, P –Value < 0.001), and Clinical Care (r  =  0.541, P –Value < 0.001). Moreover, experience and professional education show positive association with both, patient safety and nurses’ competencies.

Conclusion

Nurses’ clinical competencies are crucial to enhance patient safety. Personal and professional attributes affect the competencies of nurses and patient safety. Hospital management should take mandatory steps to ensure improving nurses’ competencies for better patient safety.

Workload and quality of nursing care: the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion by using structural equations modeling approach

Background

Nursing workload and its effects on the quality of nursing care is a major concern for nurse managers. Factors which mediate the relationship between workload and the quality of nursing care have not been extensively studied. This study aimed to investigate the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and quality of nursing care.

Methods

In this cross-sectional study, 311 nurses from four different hospitals in center of Iran were selected by convenience sampling method. Six self-reported questionnaires were completed by the nurses. The data were analyzed by SPSS version 16. Structural equation modeling was used to determine the relationships between the components using Stata 14 software.

Results

Except direct and mutual relationship between workload and quality of nursing care (P ≥ 0.05), the relationship between other variables was statistically significant (P < 0.05). The hypothesized model fitted the empirical data and confirmed the mediating role of implicit rationing of nursing care, job satisfaction and emotional exhaustion in the relationship between workload and the quality of nursing care (TLI, CFI > 0.9 and RMSEA < 0.08 and χ²/df < 3).

Conclusion

Workload affects the quality of the provided nursing care by affecting implicit rationing of nursing care, job satisfaction and emotional exhaustion. Nurse managers need to acknowledge the importance of quality of nursing care and its related factors. Regular supervision of these factors and provision of best related strategies, will ultimately lead to improve the quality of nursing care.

Sustainability of Nursing Leadership and Its Contributing Factors in a Developing Economy: A Study in Mongolia

The sustainability of nursing leadership is a very important problem. Every country continually strives to find the best ways to advance in nurse management and patient care services. Nursing leadership is most desirable in the delivery of health care services. Since there is limited information about leadership skills in Mongolia, to solve the problem of the sustainability of nursing leadership, we carried out this study to explore factors contributing to the sustainability of nursing leadership and their correlation relatively to nurse managers in healthcare institutions. A sample of 205 nurse managers from all forms of health facilities participated in this study. The data were analyzed by descriptive, correlation, and multiple linear regression models using SPSS 19 version. The linear combination of the five independent variables was significantly related to the dependent variable (nurse leadership). Both the behavior and problem-solving are significant regressors of the dependent variable. The correlation analysis significance of the independent study variables, two were found to have a significant effect on nursing leadership: behavior and performance of nurses significantly and positively effect nursing leadership. The transformational role and nurse leadership produced a significantly positive Correlation coefficients give a direction of causation in the relationships of variables, and the multiple linear regression analysis says that two of the variables, namely, behavior and problem-solving, positively contribute to nursing leadership, two of the variables namely, work environment and performance nurse manager do not support; however, variable transformational ability majorly contributes to the sustainability of nursing leadership.

Quality of nursing care in Saudi's healthcare transformation era: A nursing perspective

BACKGROUND

The Kingdom of Saudi Arabia corporates performance improvement strategies in health sector to transform hospital operations and instituting a culture of quality through performance improvement initiatives. Quality of nursing care (QNC) is a concern for nursing professionals and administration. Donabedian's 'Quality-of-Care' framework plays a vital role in transforming nursing care and determining appropriate intervention development and implementation plans.

AIM

To explore the nurses' perception for the QNC and find their perspectives in achievements and gaps by adopting the Donabedian model.

METHODS

A cross-sectional study was conducted on a convenience sample of 639 nurses from a tertiary hospital in Saudi Arabia using Karen-personnel instrument for measuring QNC. The achievements and gaps in nursing care quality determined by redistributing Karen statements to the three dimensions of the Donabedian structure, process and outcome model.

FINDINGS

The nurses' overall perception of the QNC was positive. According to the Donabedian model, the nurses focussed on care procedures (i.e., process-oriented) and required resources (i.e., structure-oriented), although the transformation era requires nurses' performance to focus on the outcome dimension.

CONCLUSION

To activate the vital roles of nurses in accomplishing health transformation initiatives, there should be collaborative efforts among nursing managers, educators and policy-makers to sustain quality of structure, process and outcome-oriented nursing care and be more outcome-oriented.

Association between work-related psychological empowerment and quality of nursing care among critical care nurses

AIM

This study aimed to examine the association between work-related psychological empowerment and quality of nursing care in Jordanian critical care nurses.

BACKGROUND

Nurses' work-related empowerment is the essential element to enhance nurses' quality of care. There are few studies about this area among critical care nurses.

METHODS

A cross-sectional design was used, and data were collected from critical care registered nurses (N = 480) from different health sectors.

RESULTS

The mean scores of work-related psychological empowerment and quality of nursing care were 5.22 (SD = 0.92) and 3.75 (SD = 0.62), respectively. The nurses had agreement level of psychological empowerment and very good level of quality of nursing care. There was a positive relationship between quality of nursing care and psychological empowerment.

CONCLUSION

The need to enhance work psychological empowerment is necessary to improve quality of nursing care.

IMPLICATION FOR NURSING MANAGEMENT

The results reflect the need for policy-makers and nursing managers to develop and implement strategies to promote psychological empowerment to provide high quality of nursing care among critical care nurses.

Satisfação e insatisfação no trabalho de profissionais em hospital universitário

RESUMO Estudo descritivo de abordagem qualitativa com objetivo de identificar aspectos geradores de satisfação e insatisfação no trabalho de profissionais de saúde de um hospital universitário. Participaram do estudo 52 profissionais da clínica cirúrgica e do serviço de emergência. A coleta de dados foi realizada por meio de entrevista individual semiestruturada, e os achados submetidos à análise temática, com o auxílio do software Atlas.ti. A pesquisa seguiu todos os cuidados éticos. Os resultados foram organizados em duas categorias analíticas: satisfação e insatisfação no trabalho. Condições de trabalho, relações no trabalho e percepções sobre o modo de trabalhar foram temas articuladores presentes nas duas categorias, revelando a dialética desses aspectos e indicando que condições objetivas e a forma como os trabalhadores lidam com elas influenciam o desfecho. Hospital como espaço de formação e trabalho foi relacionado unicamente com a satisfação, sinalizando um caminho promissor para gestores hospitalares e professores. Evidenciou-se a necessidade de investir nas condições de trabalho, organizar democraticamente os processos de trabalho e fomentar boas relações de trabalho. Os achados sinalizam um nicho de investigação importante e abrangente, com vistas a contribuir para formulação de políticas públicas e para a orientação de intervenções nos hospitais universitários.

The role of teamwork in the implicit rationing of nursing care: A systematic mixed-methods review

AIM

To systematically evaluate the role of teamwork in implicit rationing care and how to improve teamwork.

BACKGROUND

The implicit rationing of nursing leads to adverse effects for both patients and nurses. Therefore, how to reduce it has attracted increasing research attention. How teamwork may be an important factor in reducing implicit rationing care has become a focus of research.

METHODS

Data between May 2000 and May 2020 were collected from five databases. The study was guided by the framework of a mixed studies review.

RESULTS

Seventeen studies were chosen for review regarding efficient teamwork to reduce implicit rationing care. The following seven subthemes with positive effects that improve teamwork and reduce implicit rationing care were formed: (a) improving knowledge and skills; (b) promoting effective communication; (c) building mutual trust; (d) reducing turnover intention; (e) reasonable staffing; (f) division of responsibilities; and (g) cultivating team consciousness.

CONCLUSIONS

Teamwork can decrease implicit care and is influenced by many factors, but the intervention is singular. In the future, teamwork can be further improved to reduce implicit care.

IMPLICATIONS FOR NURSING MANAGEMENT

With more intervention research in the future, leadership and team-oriented roles can be used to complete all the care needed.

Influence of nurse managers' toxic leadership behaviours on nurse-reported adverse events and quality of care

AIM

To assess the impact of toxic leadership behaviours among nurse managers on nurse-reported adverse events and quality of care.

BACKGROUND

Toxic leadership, a form of ineffective leadership, is increasingly becoming rampant in the field of nursing and has been strongly linked to poor nurse job outcomes including job dissatisfaction, higher stress levels, and increased turnover intention. To date, no studies have been conducted to examine how this type of leadership behaviours affects patient outcomes and care quality.

METHODS

A multicentre, cross-sectional study. This study involved a sample of 1,053 registered nurses working in 20 hospitals in the Philippines. Three standardized scales were deployed, including the Toxic Leadership Behaviors of Nurse Managers Scale, the Adverse Patient Events Scale and the single-item quality-of-care-measure.

RESULTS

Overall, nurses (96.2%) appraised the quality of care of their respective units as 'good to excellent' and cited complaints from patients and their families as the most commonly reported adverse events. Toxic leadership behaviours in nurse managers were strongly associated with increased nurse-reported adverse events including reports of complaints (β = .619; p < .001) and verbal mistreatment from patients and their families (β = .407; p < .001), patient falls (β = .834; p < .001), health care-associated infections (β = .629; p < .001) and errors in administering medication (β = .708; p < .001) and with decreased quality of care (β = -.216; p < .001).

CONCLUSION

Nurses who experience working under a nurse manager exhibiting toxic behaviours reported an increased frequency of nurse-reported adverse events and poorer quality of care in the unit.

IMPLICATIONS FOR NURSING MANAGEMENT

Organizational measure to reduce the occurrence of adverse events and enhance the quality of care provided in medical units may include intervention to develop positive leadership practices among nurse managers.

Classification and evaluation of the environment of the professional nursing practice in a teaching hospital

OBJECTIVE

to classify and evaluate the environment of the professional nursing practice in a teaching hospital.

METHOD

a cross-sectional study conducted with 188 nurses from a teaching hospital in the state of São Paulo, SP, Brazil. A questionnaire with sociodemographic and professional data and the Brazilian version of the Practice Environment Scale were used to classify and evaluate the environment of the professional nursing practice. Data was analyzed using Student's t-test, analysis of variance, Mann-Whitney, and Kruskal-Wallis tests with a significance level of 5% (p<0.05). The internal consistency of the instrument was evaluated using Cronbach's alpha.

RESULTS

the score's mean for the Brazilian version of the Practice Environment Scale was 2.54, and the participants considered two of the five subscales as unfavorable for the practice, namely: subscale 1, "Nurse Participation in Hospital Affairs" (2.37), and subscale 4, "Staffing and Resource Adequacy" (2.23).

CONCLUSION

the environment of the professional nursing practice has been classified as mixed, being evaluated with favorable conditions for the nursing practice, but the participation and involvement of nurses in hospital matters and the adequacy of resources to provide quality care need improvements.

The nurse outcomes and patient outcomes following the High-Quality Care Project

BACKGROUND

There have been many single cross-sectional studies on nurse or patient outcomes. However, long-term evidence on improving nurse and patient outcomes is still limited. The High-Quality Care Project is a national project in China for improving nurse and patient outcomes by implementing primary nursing.

AIM

(1) To assess the long-term changes in nurse and patient outcomes in the context of the High-Quality Care Project. (2) To explore the potential influences of primary nursing on nurse and patient outcomes based on this study and broader existing evidence.

METHODS

The data of two cross-sectional studies were used for analysis. The two cross-sectional studies were conducted before (2009) and after (2016) the High-Quality Care Project. A total of 1376 nurses and 904 patients from 40 units of 10 tertiary hospitals were surveyed. Reliable and validated instruments were used to measure nurse and patient outcomes. Multilevel modelling was the main method for data analysis.

RESULTS

Nurses in 2016 were more satisfied than nurses in 2009 with most dimensions of nurse work environment and job satisfaction. However, they were not more satisfied with burnout, global job satisfaction or intention to leave their job. Nurses in 2016 also reported better quality of patient care and patient safety while their patients reported higher patient satisfaction.

CONCLUSION

The analysis of our results based on existing evidence indicates that primary nursing could be considered as a potentially effective way to improve nurse work environment and patient outcomes. More studies with rigorous study design from micro perspectives would be useful to further explore the direct effects of primary nursing on nurse or/and patient outcomes.

IMPLICATIONS FOR NURSING AND NURSING POLICY

Policymakers, healthcare service leaders and nurse managers should make efforts to provide multi-level supports to cultivate an encouraging environment for nurses to practice primary nursing, because the implementation of primary nursing may improve the nurse work environment and patient outcomes. Furthermore, improving nurse participation in hospital affairs and developing nursing discipline and education for increasing nursing staff resource and nurses' capacity - which all need policy and management supports - are crucial to further improve nurse and patient outcomes.

Instruments for assessing professional nursing practice environments: An integrative review

ABSTRACT Objective: To identify the instruments used to evaluate the professional nursing practice environments in the hospital context. Method: An integrative review, whose research process was conducted independently by two researchers in the period from July to August 2019 in the CINHAL, PubMed and SciELO databases. Results: Based on the inclusion and exclusion criteria, 53 studies published between 2009 and 2019 were considered for analysis. Ten instruments and three thematic areas were identified: instruments for the assessment of the nursing professional practice environments; implications of the use of instruments for the assessment of nursing professional practice environments; limitations of the instruments for the assessment of nursing professional practice environments. Conclusion: Despite the relevance of the instruments identified, this integrative review provides contributions that support the need to use specific tools to assess the nursing practice environments that include the structure, process and outcome components.

Influence of workplace incivility on the quality of nursing care

AIMS AND OBJECTIVES

To examine the influence of workplace incivility on the quality of nursing care.

BACKGROUND

Recent evidence describes workplace incivility as a serious concern in the healthcare setting worldwide. Exposure to workplace incivility can alter a nurse's behaviour, thought process and perspective towards the nursing profession. However, there is insufficient evidence to determine whether workplace incivility might be associated with the quality of nursing care in Saudi Arabia.

DESIGN

A quantitative and cross-sectional study.

METHOD

A survey was carried out amongst 378 nurses in two government hospitals in Saudi Arabia from February 2018-May 2018 using the Nurse Incivility and quality of nursing care scales. Multivariate multiple regression was performed to investigate the influence of the uncivil experiences of nurses from different sources on the different aspects of quality of nursing care. The study adhered to STROBE guideline (see Appendix S1).

RESULTS

The overall mean of the quality of nursing care scale was 3.14 (SD = 0.66) from a scale of 1-5, with patient satisfaction receiving the highest mean dimension (mean = 3.27, SD = 0.72) and health promotion the lowest mean dimension (mean = 3.08, SD = 0.74). Experience in the present hospital and the hospital were associated with the overall quality of nursing care. General and nurse incivility exerted a multivariate effect on overall quality of nursing care and its different dimensions.

CONCLUSION

General incivility and nurse incivility were found to negatively impact quality of nursing care and its different dimensions.

RELEVANCE TO CLINICAL PRACTICE

Stronger policies geared towards eliminating workplace incivility should be implemented as uncivil acts can lead to poor quality of nursing care. Nurse administrators and nurses should be pro-active in recognising, preventing, approaching, reporting and intervening with uncivil acts in the hospital to protect these workers from these types of behaviours and avoid their negative impacts on patient care.

Psychometric evaluation of the Nurse Competence Scale: A cross-sectional study

Measuring nurses' competence for practice is critical for quality and safety improvement in nursing care and patient outcomes. While the Nurse Competence Scale is a widely used international measure of the generic nursing competence of nurses in various career stages, it has not been used in Thailand. This study involved the forward-backward translation of the scale into Thai and evaluation of its psychometric properties with 571 nurses at one public and one private hospital in Chiang Mai, Thailand. Participants also completed a demographic form. The content validity analysis revealed that the item-level content validity index (I-CVI) was .90, and the scale-level content validity index (S-CVI/Average) was .91. The principal component analysis with varimax rotation demonstrated that the six factor structure accounted for 58.45% of the total variance. The Mann-Whitney U-test showed a significant difference between low and high work experience groups for all six factors, providing further support for the scale's construct validity. The reliability analysis showed an acceptable level of Cronbach's alphas in six factors ranging from .82 to .88. In conclusion, the Thai version demonstrated promising psychometric properties, but requires further testing with nurses in different settings before use in practice.