Systematic review of interventions to improve nurses’ work environments

Positive Nursing Practice Environment: A Concept Analysis

Background/Objectives: In recent years, research has increasingly highlighted the significance of nursing practice environments, linking positive settings with enhanced job satisfaction, professional autonomy, and care quality. Such environments can decrease turnover, stress, and costs while improving patient safety. Despite this extensive literature, there is limited consensus on defining a 'positive nursing practice environment', highlighting the need for a systematic analysis to advance understanding and application. This study aims to explore and clarify the concept of a 'Positive Nursing Practice Environment'. Methods: This study applied Walker and Avant's approach for concept analysis, conducting a comprehensive database search to gather relevant evidence. To review the available evidence on the concept of nursing practice environments, we followed the methodology proposed by JBI for scoping reviews. Results: The inclusion of 166 studies meeting the criteria provided a broad understanding of the topic, revealing 10 key attributes of a 'positive nursing practice environment' and identifying various antecedents and consequences affecting clients, nurses, and institutions. Conclusions: The concept analysis of a 'Positive Nursing Practice Environment' offers valuable insights into nurses' working conditions, systematically identifying characteristics that impact professionals, patients, and institutions. This analysis lays the groundwork for future research and practical improvements in nursing practice environments. This study was not registered.

Nursing Practice Environments in Hospitals: A Comparative Study between Portugal and Brazil

Background: Assessing the elements of nursing practice environments is crucial, as investing in their improvement will enhance outcomes for nurses, patients, and organizations. Moreover, comparing practice environments from different countries improves the definition of cross-cutting guidelines that can be applied in various contexts. Thus, this study aims to evaluate nursing practice environments in hospitals in Portugal and Brazil. Methods: A multicenter and cross-sectional study was conducted in eight Portuguese and eight Brazilian hospitals. Five hundred eighty-two nurses completed a survey regarding their sociodemographic and professional attributes, as well as the Scale for the Environments Evaluation of Professional Nursing Practice. The data were subjected to comparative analyses between the two countries. We adhered to ethical requirements in both participating countries. Results: In Brazil, the Structure, Process, and Outcome components were considered favorable to the quality of care and well-being of nurses. In Portugal, nurses considered the Structure and Outcome components favorable and the Process component very favorable. Statistically significant differences were found between the two countries in several dimensions of the three subscales. The Structure and Outcome components scored significantly better in hospitals in Brazil, and the Process component scored better in Portuguese hospitals. Conclusions: These conclusions underscore the urgent need for investment in continuous training and a culture of evaluation that promotes continuous improvement. Additionally, promoting the involvement and participation of nurses could simultaneously contribute to the development of more sustainable health systems.

Development and Validation of the "Program to Promote Positive Nursing Practice Environments": Modified Delphi Study

Positive nursing practice environments benefit clients, professionals, and institutions, specifically for professionals, by improving professional visibility, recognition, retention intentions, well-being, commitment, job satisfaction, and reducing stress and burnout. Clients experience better quality care, safety, satisfaction, engagement, and fewer care omissions. Institutions favored reduced absenteeism and turnover, improved efficiency, lower costs, and better health outcomes. This study aimed to document the development of the "Program to Promote Positive Nursing Practice Environments" and analyze expert perceptions to reach a consensus. Using a two-round modified online Delphi technique with 22 experts, we examined perspectives on the program's goals, duration, organization, and content. Initial feedback showed agreement on the program's duration but mixed opinions on the number and length of sessions due to concerns about participant workload and fatigue. Adjustments led to a strong consensus and positive feedback on the program's coverage of essential nursing practice environment constructs. The program includes sessions on client, professional, and institutional dynamics, focusing on key attributes and outcomes for fostering positive nursing environments. By equipping nurses with knowledge and skills, the program aims to enhance work environments effectively. These findings provide a substantial advancement in the field, offering a robust framework for future initiatives.

Exploring palliative care practice and learning needs of allied health professionals in the Loddon Mallee region of Victoria: a cross-sectional survey

Objectives The objectives of this study were to examine the roles and needs of allied health professionals (AHPs) working in public healthcare settings in rural and regional Victoria, Australia in providing components of palliative care in their routine practice. Methods A cross-sectional study was conducted between March and May 2023. Surveys were collected from AHPs working in public healthcare settings in the Loddon Mallee region of Victoria, Australia. Clinicians reported on the frequency of provision of care to patients with terminal illness, and their self-reported skill and confidence in providing interventions to patients with palliative care needs. Results In total, 121 clinicians completed the survey. Almost every respondent reported they had provided care to patients with a terminal illness, with 41% of clinicians providing this care daily or weekly. The respondents were confident carrying out generalist interventions such as maintaining physical function but reported lower confidence in managing common symptoms of terminal illness such as loss of appetite, swallowing difficulties and changing communication needs. Two-thirds of respondents had not undertaken any training specific to palliative care, with many unaware of how to access palliative care-specific training. Conclusion AHPs in rural and remote areas regularly provide care to patients with terminal illness. As the number of patients seen in non-specialist palliative care settings is likely to increase in rural and regional areas, the low self-reported confidence in providing common components of care, and the low uptake of palliative care-specific training must be addressed to ensure AHPs can provide high-quality care to people with terminal illness.

Scale for the environments evaluation of professional nursing practice-shortened version: Psychometric evaluation

AIM

The aim of this study is to test the validity and reliability of the shortened version of the Scale for the Environments Evaluation of Professional Nursing Practice (SEE-Nursing Practice).

METHODS

This methodological, cross-sectional study was conducted between September and December 2022. The original version of the SEE-Nursing Practice was administered in questionnaire format across 17 hospitals. Exploratory and confirmatory factor analyses were conducted to identify relevant items for the new shortened version of the scale and evaluate its construct validity.

RESULTS

The study involved 1713 registered nurses from various regions of Portugal. From the exploratory factor analysis, the SEE-Nursing Practice was condensed to 59 items and 3 subscales. In the structure subscale, 14 items were removed, and the remaining 29 items distributed over four factors; in the process subscale, 18 items were removed, and the remaining 19 items organized into three factors; in the outcome subscale, 2 items were removed, and the remaining 11 items distributed over two factors. The Cronbach's alpha for the three subscales exceeded 0.90, indicating high reliability. Confirmatory factor analyses provided support for the validity of the 59-item model.

CONCLUSION

The shortened version of the SEE-Nursing Practice shows adequate validity and reliability, reducing the burden associated with its longer version.

How can strategies based on performance measurement and feedback support changes in nursing practice? A theoretical reflection drawing on Habermas' social perspective

Strategies based on performance measurement and feedback are commonly used to support quality improvement among nurses. These strategies require practice change, which, for nurses, rely to a large extent on their capacity to coordinate with each other effectively. However, the levers for coordinated action are difficult to mobilize. This discussion paper offers a theoretical reflection on the challenges related to coordinating nurses' actions in the context of practice changes initiated by performance measurement and feedback strategies. We explore how Jürgen Habermas' theory of Communicative Action may shed light on the issues underlying nurses' collective actions and self-determination in practice change and the implications for the design of strategies based on performance measurement and feedback. Based on this theory, we propose differences between communicative and functional coordination according to the nature of the actions and the purposes involved. The domains of action underlying these coordination processes, which Habermas referred to as the lifeworld and the system, are then used to draw a parallel with aspects of nursing practice. Further exploration of these concepts allows us to consider the tensions between the demands of the system and the self-determination of nurses within their practice.

Participatory management effects on nurses' organizational support and moral distress

RESEARCH QUESTION/AIM/OBJECTIVES

Providing care for hospitalized children causes moral distress to nurses. Employee participation in discovering and solving the everyday problems of the workplace is one of the ways to hear the voices of nurses. This study aimed to evaluate the effect of participatory management programs on perceived organizational support and moral distress in pediatric nurses.

RESEARCH DESIGN

A quasi-experimental study.

PARTICIPANTS AND RESEARCH CONTEXT

The present study was conducted on 114 pediatric nurses in Iran. Data were collected using the Perceived Organizational Support Scale and the Moral Distress Scale of nurses. The intervention included implementing a participatory management program in three treatment departments that were randomly selected and it lasted 4 months. Participatory management was at the level of problem-solving with a focus on investigating, solving, and correcting issues and problems of work shifts and departments concerning the physical environment, equipment of the department, improvement of work processes, and team cooperation. In the control group, ordinary organizational approaches to problem-solving were used.

ETHICAL CONSIDERATIONS

This study was approved by the Ethics Committee of Mashhad School of Nursing and Midwifery. Informed consent was obtained from the study participants.

FINDINGS/RESULTS

Based on the results, both groups were homogenous before the intervention in terms of moral distress and perceived organizational support. The results showed that the moral distress mean scores in the intervention group decreased from 1.45 (0.52) to 1.03 (0.37) after the intervention. Also, the score of the perceived organizational support was 2.12 (1.2) increased after the intervention to 2.68 (1.10) in the intervention group.

CONCLUSIONS

It was found that the participation of nurses in the problem-solving process to solve daily workplace issues can be effective in increasing their perceived organizational support and reducing their moral distress.

Effectiveness of intervention programs aimed at improving the nursing work environment: A systematic review

BACKGROUND

The nursing work environment can be compromised due to workload, stress and many other issues. A good nursing work environment is needed to for the health and wellbeing of nurses and therefore measures are developed to improve nursing work environment.

AIM

To determine whether measures designed to improve the work environment for nursing professionals are effective.

METHODOLOGY

Online research in the Medline, Scopus, Web of Science, ERIC, CINHAL, PsycINFO, and American Doctoral Dissertations databases, along with manual search, was carried out. Primary experimental studies made up of intervention and control groups were included, with pre-/post-measure evaluation in the nursing team, based on the effects of the interventions. Risk of bias was calculated using the Cochrane tool.

RESULTS

A total of 1997 studies were examined; 19 clinical trials met the inclusion criteria. A total of 1427 nurses participated in the selected studies. The fields of application of the interventions were personal and environmental. Out of the fields targeting individuals, three methodologies were identified: cognitive-behavioral techniques, stress management, channeling anxiety and physical well-being; and those aimed at environmental fields: aromatization and organization. The most evaluated characteristic was teamwork, and the most analyzed symptom was stress. Most of the interventions concluded with at least one significant improvement.

CONCLUSIONS

Interventions aimed at enhancing the work environment are effective ways of increasing job satisfaction. The heterogeneity of the data did not allow us to determine which intervention is the most effective. The combination, type, and duration are variables that affect efficacy.

IMPLICATION FOR NURSING AND NURSING POLICY

This systematic review provides resources for improving the work environment that affects nursing staff, other professionals, and patients. Encouraging a healthy atmosphere leads to excellence in care and improved safety.

Informal carers' experiences with their children's care during hospitalization in Italy: Child HCAHPS results from RN4CAST@IT-Ped cross-sectional study

PURPOSE

To examine informal carers' experiences during their child's hospitalization and evaluate the associations with care received and care context.

DESIGN AND METHODS

What is described in this article is only a part of the larger study, RN4CAST@IT-Ped, a multicenter cross-sectional study, with multi-level data collection through convenience sampling, the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to collect data from informal carers of pediatric patients, applying the "top box" approach.

RESULTS

Nine hospitals, 1472 nurses, and 635 children's parents were involved. A correlation was found between patient safety and satisfaction outcomes and nursing staff characteristics. Adequate workloads for nurses improved carers' assessment of their experience in the hospital.

CONCLUSION

Adequate staffing management could significantly improve informal carers' satisfaction with the care provided to their children during hospitalization.

PRACTICE IMPLICATIONS

Children's informal carers greatly value the care they receive in pediatric hospitals. Adequate workloads for nurses improve carers' overall evaluation of the care their children receive during hospitalization. Nursing management should consider improving these aspects to ensure high-quality care in children's hospitals.

Workplace interventions focusing on how to plan, organize and design the work environment in hospital settings: A systematic review

BACKGROUND

Occupational Health Service (OHS) is a service that should support employers and employees with their work environment. Previous research indicates the need for deeper knowledge about the effect of workplace interventions with a focus on planning, organizing and designing the workplace to improve work conditions in hospital settings.

OBJECTIVE

The aim was to evaluate the outcomes, workplace interventions and intervention strategies in hospital settings.

METHODS

A systematic literature review was conducted. CINAHL, MEDLINE, PsycInfo, Scopus, and Web of Science Core Collection were searched in September 2021. The Mixed Methods Appraisal Tool was used to evaluate the quality of the included studies. Study results are presented through a narrative synthesis. A protocol for this study was registered on the Open Science Framework.

RESULTS

Twenty-six studies, published between 2010 and 2021, were included. These included randomized controlled trials (RCTs), non-RCTs, and mixed methods reports with moderate to good quality. The results support the use of workplace interventions to improve work conditions, health, and well-being in hospital settings. Combinations of different interventions, tailored to the specific organization, were used. Important intervention strategies commonly used in the start-up, evaluation, and intervention of successful workplace interventions, were identified. Using a pragmatist complexity approach in workplace interventions can improve outcomes by providing clear intervention strategies and combinations of tailored interventions, related to context specific problems.

CONCLUSION

OHS support in workplace interventions with clear intervention strategies will contribute to improve work conditions, health and well-being in hospital settings.

Nursing Development should Now Become a Priority for Health Systems in Europe

The vast majority of European countries are struggling to embrace nursing as a profession and as a science. There are still not enough nurses with bachelor's degrees and advanced practical skills, and clinical specialisations for nurses are being developed at the master's level. Attention should be paid to recognising nurses as an equal healthcare workforce who need to be empowered to advance their profession and be provided with professional development opportunities. Changes needed include improving pay and working conditions, providing opportunities to improve skills and professional recognition, empowering nurses to deliver care, and harnessing the power of technology to better support nurses. The declining interest in nursing education and the often stereotypical and condescending view of the role and work of nurses on the healthcare team should be a warning signal to all who are working on healthcare reform.

How nurses' job characteristics affect their self-assessed work environment in hospitals- Slovenian use of the practice environment scale of the nursing work index

BACKGROUND

Nurses' work environment influences nursing practice. Inappropriate working conditions are the result of underdeveloped workplace infrastructure, poor work organisation, inadequate education, and inappropriate staffing norms. The aim of this study was to describe and examine the predictors that affect nurses' work environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI).

METHODS

The validation of the PES-NWI was made. Nurse-reported job characteristics were used as independent variables. The sample included 1,010 nurses from adult surgical and medical units at 10 Slovenian hospitals. The Nurse Forecasting (RN4CAST) protocol was used. Permission to conduct the study was obtained from the National Medical Ethics Committee.

RESULTS

The PES-NWI mean (2.64) was low, as were job and career satisfaction at 2.96 and 2.89, respectively. The PES-NWI can be explained in 48% with 'Opportunities for advancement', 'Educational opportunities', 'Satisfaction with current job', 'Professional status', 'Study leave', and 'Level of education'. A three-factor solution of PES-NWI yielded eight distinct variables.

CONCLUSIONS

The obtained average on the Nursing Work Index was one of the lowest among previously conducted surveys. Nurses should be recognized as equals in the healthcare workforce who need to be empowered to develop the profession and have career development opportunities. Inter-professional relations and equal involvement of nurses in hospital affairs are also very important.

TRIAL REGISTRATION

This is a non-intervention study - retrospectively registered.

Evaluating the Effect of Supported Systematic Work Environment Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Study

BACKGROUND

The work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction, and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees.

OBJECTIVE

The aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction, and patient safety during and following the COVID-19 pandemic in a medical ward setting.

METHODS

A mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden will be performed.

RESULTS

The mixed methods evaluation of the quality improvement project received funding from Futurum-Academy for Health and Care, Jönköping County Council and Region Jönköping County, and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021.

CONCLUSIONS

The study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment, and employee health, staff turnover, patient satisfaction, and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers, and society as a whole.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34152.

Advanced practice nurse work environments and job satisfaction and intent to leave: Six-state cross sectional and observational study

AIMS

To explore the relationship between nurse practitioner work environment and nurse practitioner outcomes (job satisfaction and intent to leave) in the United States.

DESIGN

The study used a cross-sectional survey design to collect survey data from primary care nurse practitioners in six states in the United States.

METHODS

We sent mail surveys to 5689 eligible nurse practitioners in Arizona, New Jersey, Washington, Pennsylvania, California and Texas. The mail also contained an online link. Participants could complete either the paper or online questionnaire. In total, 1244 participants completed the survey in 2018-2019. The work environment was measured using the Nurse Practitioner-Primary Care Organizational Climate Questionnaire comprised of four subscales: Nurse Practitioner-Administration Relations, Nurse Practitioner-Physician Relations, Independent Practice and Support and Professional Visibility. Global items measured job satisfaction and intent to leave. We used mixed-effect proportional-odds cumulative logit models to assess the association between work environment and job satisfaction and intent to leave.

RESULTS

Overall, 90% of participants were either very satisfied or somewhat satisfied with their job and 22% reported intent to leave their job in 1 year. With a one-unit increase in the organizational-level Nurse Practitioner-Administration Relations score, the odds of having a higher job satisfaction level increased by about four times and the odds of intent to leave job decreased by about 60%. A higher organizational-level Nurse Practitioner-Physician Relations score was significantly associated with higher job satisfaction and lower odds of intent to leave.

CONCLUSION

Improvements in work environments may improve nurse practitioner job satisfaction and retention.

IMPACT

This study examined the relationship between work environment, job satisfaction and turnover intention of nurse practitioners. Better work environment is associated with higher job satisfaction and lower turnover intention. Findings have implications for clinical leadership who can take actions to create better work environments to increase the nurse practitioner workforce capacity.

Strengthening Healthy Work Environment Outcomes Via Interprofessional Direct Care Champion Roles

OBJECTIVE

To provide an organization-wide, systematic approach to creating and sustaining healthy work environments (HWEs) through frontline interprofessional staff education and coaching engagement.

BACKGROUND

HWE has been an overarching concept in the organization's nursing professional practice model since 2014; however, few practice settings routinely translated survey findings to improve the work environment's health via local interprofessional direct care team members.

METHODS

The program used a participatory approach where HWE champions committed to participate in centralized professional development activities and local quality improvement initiatives to bolster the health of area work environments.

RESULTS

Fifty-one champions representing 44 practice settings participated in the professional development program. Mean HWE scores for all standards increased from year 1 to 2, with 15 practice settings seeing categorical improvement. Meaningful recognition and true collaboration were the standards most often targeted for improvement.

CONCLUSION

The HWE champion role appears to be a promising strategy for engaging frontline interprofessional staff in the assessment and implementation of initiatives to improve the health of work environments.

Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes and job satisfaction among nurses

BACKGROUND

As an important organisational feature, the nurse work environment has been associated with increased work effectiveness, reduced patient safety issues and improved care quality. However, the mechanism underlying this association remains unexplored.

AIM

This study aims to assess the mediating role of interprofessional collaboration in the relationships between nurse work environment, select patient safety outcomes and job satisfaction.

METHODS

This cross-sectional, descriptive study used five standardized scales and included 881 clinical nurses employed in select teaching hospitals in Oman.

RESULTS

Nurses who worked in teaching hospitals in Oman perceived their work environment as highly favourable. Nurse work environment was directly and indirectly associated with nurse-assessed quality of care, adverse patient events and job satisfaction, through interprofessional collaborations.

CONCLUSION

Findings of the study suggest that enhancing nurse work environments can be a potential strategy to foster interprofessional collaboration and improve job satisfaction and patient safety outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisational strategies to improve patient safety outcomes and job satisfaction in nurses can be facilitated by improving nurses' work conditions and enhancing interprofessional collaboration through supportive leadership, theory-driven approaches, obtaining hospital accreditation/certification and relevant workplace policies.

Comparing the Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire with technical measurements of physical workload in certified nursing assistants in a medical ward setting

The Certified Nursing Assistant (CNA) is an important part of the workforce in hospitals and nursing homes, whose work includes heavy and repetitive work tasks including patient manual handling. The Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire is an Occupational Health Service method for evaluation of the work environment. The aim of this study is to compare the SMET questionnaire with technical measurements of physical workload in CNAs in a medical ward setting. 16 CNA's participated voluntarily to 8 h of measurements during one workday. Physical workload was measured with surface electromyography and inclinometers, and the work environment was evaluated with the SMET questionnaire during the same working day. Spearman's rho was used in the statistical correlation analysis between measurements. This study shows strong, statistically significant correlations between the items in the SMET questionnaire and measured physical workload, n CNAs.

A mixed methods study of an organization's approach to the COVID-19 health care crisis

Background

Healthcare emergency can increase work-related stress and reduce nurses’ job satisfaction and quality of life. Managerial decisions and proactive interventions implemented to react to the emergency ensure the best patient outcomes.

Purpose

The purpose of this study was to verify whether a proactive organizational approach can limit nurses’ work-related stress and help preserve their job satisfaction and quality of life during a health emergency.

Methods

A longitudinal mixed methods study was conducted. Data were collected before and after the transformation into a SARS-CoV-2 Hospital and the implementation of organizational interventions. Focus groups were conducted to investigate quantitative data.

Findings

After the implementation of interventions and as the pandemic progressed, work-related stress decreased and job satisfaction and quality of life increased.

Discussion

Through proactive organization, even during an emergency, nurses are prepared for working, and work-related stress due to changes is reduced. Nurses are motivated and satisfied with their organization and management, and quality of life increases.