Effects of the nursing practice environment, nurse staffing, patient surveillance and escalation of care on patient mortality: A multi-source quantitative study.

BACKGROUND: A favourable nursing practice environment and adequate nurse staffing have been linked to reduced patient mortality. However, the contribution of nursing care processes such as patient surveillance and escalation of care, on patient mortality is not well understood. OBJECTIVE: The aim of this study was to investigate the effect of the nursing practice environment, nurse staffing, missed care related to patient surveillance and escalation of care on 30-day inpatient mortality. DESIGN: A multi-source quantitative study including a cross-sectional survey of nurses, and retrospective data extracted from an audit of medical and admission records. SETTING(S): A large tertiary teaching hospital (600 beds) in metropolitan Sydney, Australia. METHODS: Data on the nursing practice environment, nurse staffing and missed care were obtained from the nursing survey. Patient deterioration data and patient outcome data were collected from the medical and admission records respectively. Logistic regression models were used to examine the association between the nursing practice environment, patient deterioration and 30-day inpatient mortality accounting for clustering of episodes within patients using generalised estimating equations. RESULTS: Surveys were completed by 304 nurses (84.5 % female, mean age 34.4 years, 93.4 % Registered Nurses) from 16 wards. Patient deterioration data was collected for 30,011 patient deterioration events and 63,847 admitted patient episodes of care. Each additional patient per nurse (OR = 1.22, 95 % CI = 1.04-1.43) and the presence of increased missed care for patient surveillance (OR = 1.13, 95 % CI = 1.03-1.23) were associated with higher risk of 30-day inpatient mortality. The use of a clinical emergency response system reduced the risk of mortality (OR = 0.82, 95 % CI = 0.76-0.89). A sub-group analysis excluding aged care units identified a 38 % increase in 30-day inpatient mortality for each additional patient per nurse (OR = 1.38, 95 % CI = 1.15-1.65). The nursing practice environment was also significantly associated with mortality (OR = 0.79, 95 % CI: 0.72-0.88) when aged care wards were excluded. CONCLUSIONS: Patient mortality can be reduced by increasing nurse staffing levels and improving the nursing practice environment. Nurses play a pivotal role in patient safety and improving nursing care processes to minimise missed care related to patient surveillance and ensuring timely clinical review for deteriorating patients reduces inpatient mortality. TWEETABLE ABSTRACT: Patient mortality can be reduced by improving the nursing practice environment & increasing the number of nurses so that nurses have more time to monitor patients. Investing in nurses results in lower mortality and better outcomes. #PatientSafety #NurseStaffing #WorkEnvironment #Mortality.

The influence of psychological resilience and nursing practice environment on nurses' moral courage: A cross-sectional study.

AIM: To determine the relationship between psychological resilience, nursing practice environment, and moral courage of clinical nurses and also the factors influencing moral courage. DESIGN: Cross-sectional study. METHODS: 586 nurses from a general hospital were selected by convenience sampling method in January 2023. The general information questionnaire, Nurses' Moral Courage Scale (NMCS), Resilience Scale, and Practice Environment Scale (PES) were measured. Hierarchical linear regression analysis was used to explore the influencing factors of clinical nurses' moral courage. RESULTS: Nurses' average moral courage score was 79.00 (69.00, 91.00). The nurses' moral courage was positively correlated with psychological resilience and nursing practice environment. Multivariate linear regression analysis showed that psychological resilience and nursing practice environment entered the regression equation, accounting for 23.4% of the total variation. Psychological resilience and nursing practice environment are the main factors affecting the moral courage of clinical nurses. Nursing managers should conduct moral courage training, develop a decent nursing practice environment, pay attention to the psychological emotions of nurses, and actively build a safe, open, and supportive atmosphere for moral behaviour.

Organizational characteristics of nursing practice environments related to registered nurses' professional autonomy and job satisfaction in two Finnish Magnet-aspiring hospitals: structural equation modeling study.

BACKGROUND: Nurses are leaving their profession because of poor personal job satisfaction, heavy workload, and unfavorable work environments with low professional autonomy. Professional autonomy involves the possibility to influence one's work and have a sense of control - the ability to contribute to a workplace culture and influence how decisions are made. This study explores registered nurses' perceptions of the nursing practice environment, using the Nursing Work Index-Revised (NWI-R), and its relationships with professional autonomy and job satisfaction. METHODS: A cross-sectional study along with instrument re-validation was conducted using a web-based survey for nurses in two Magnet-aspiring hospitals in Finland in September 2021 (n = 586). Structural equation modeling was used to find out the relationships of the NWI-R components with professional autonomy and job satisfaction. RESULTS: Principal component analysis and confirmatory factor analysis supported seven components with 34 items. Collegial nurse-doctor relationships, organization's quality standards, and nursing involvement and expertise sharing (means of 3.23, 2.96, and 2.66, respectively) demonstrated a favorable nursing practice environment; professional nursing standards, nurse management and leadership, staffing and resource adequacy, and professional advancement (means of 2.38, 2.18, 2.15, and 2.13, respectively) demonstrated an unfavorable nursing practice environment. The presented model (RMSEA 0.068, CFI 0.987, TLI 0.946) indicated that nursing involvement and expertise sharing, organization's quality standards, nurse management and leadership, and collegial nurse-doctor relationships were related to professional autonomy. Nurse management and leadership, staffing and resource adequacy, and organization's quality standards were related to job satisfaction. Moreover, professional autonomy was related to job satisfaction. CONCLUSION: Nurses' professional autonomy is important due to its relationship with job satisfaction. When factors that increase professional autonomy are taken into account and attention is paid to the promotion of autonomy, it is possible to improve nurses' job satisfaction. These issues cannot be solved at the unit level; investment is needed at the organizational and political levels. The results introduce nurses, managers, researchers, and stakeholders to improvements in the nursing practice environment toward an organizational culture where nurses may utilize their professional autonomy to its full potential.

The moderating role of just culture between nursing practice environment and oncology nurses' silent behaviors toward patient safety: A multicentered study.

BACKGROUND: Patient safety is a critical part of healthcare delivery that must be prioritized to guarantee optimal patient outcomes. Oncology nursing is a specialized area of nursing that demands great focus on patient safety because of the high-risk nature of this patient group. Nurses play an important role in ensuring that patients receive safe and effective care. However, the nursing practice environment can have a substantial impact on how nurses respond to patient safety problems. A just culture can promote open communication and identify potential safety issues, whereas a culture of silence can have a negative impact on patient outcomes. OBJECTIVE: Firstly, assess the relationship between the nursing practice environment and oncology nurses' silent behavior towards patient safety. Secondly, the interaction effect of just culture as a moderator in this relationship. METHOD: A cross-sectional, correctional research design was employed. Data was collected from 303 nurses working at the oncology departments of five hospitals in Egypt using three questionnaires. Data was analyzed using SPSS-PROCESS Macro (v4.2). RESULTS: There was a moderate, negative, and significant correlation between the nurse practice environment and silent behavior of nurses towards patient safety. The interaction effect of just culture with nurse practice environment strengthens this relationship, thus enhancing errors reporting. CONCLUSIONS: This study emphasized on the importance of creating a just culture that facilitates open communication and eliminating the potential hazards result from nurses' silence. Thus, oncology nurses must be encouraged to report issues related to patient safety.

How nursing practice environments limit implicit rationing of care and nurse-assessed adverse events: the role of flow at work.

BACKGROUND: The nursing practice environment is beneficial in curbing implicit rationing of nursing care and adverse patient events. However, the underlying mechanisms of these relationships remain unexplored. AIM: To test whether flow at work mediates the relationship between the nursing practice environment, implicit rationing of nursing care, and nurse-assessed adverse patient events. METHODS: This cross-sectional study involved 231 nurses from five hospitals in Port Said, Egypt. The participants completed Arabic-translated versions of the Practice Environment Scale of the Nursing Work Index, the Work-Related Flow Inventory, the Perceived Implicit Rationing of Nursing Care instrument, and the Adverse Patient Events scale. Structural equation modeling was used to test the hypothetical model. RESULTS: The favorable nursing practice environment positively predicted nurses' flow at work (ß = 0.64, p < 0.001), while inversely predicting implicit rationing of nursing care (ß = -0.23, p = 0.014) and adverse patient events (ß = -0.35, p < 0.001). Nurses' flow at work inversely predicted implicit rationing of nursing care (ß = -0.30, p = 0.002) and adverse patient events (ß = -0.29, p = 0.002). Moreover, nurses' flow at work acted as a mediator, linking the nursing practice environment to the rationing of nursing care and adverse patient events, with 500 bootstrap results for the indirect effects (ß = -0.24, p = 0.001, 95% CI: -0.43 to -0.09; and ß = -0.44, p = 0.003, 95% CI: -0.79 to -0.16, respectively). CONCLUSION: Nurses working in a favorable nursing practice environment are more likely to experience flow at work, limiting implicit rationing of nursing care and adverse patient events. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing administrators should strive to create a healthy nursing practice environment to foster nurses' flow and thereby reduce the frequency of implicit rationing of nursing care and adverse patient events.

Factors related to intensive care unit Nurses' work engagement: A web-based survey.

A questionnaire survey on the personal and work factors related to work engagement among intensive care unit nurses concerning their recovery experiences and the nursing practice environment was conducted using a web-based tool. Two individual factors (demographics and experience on recovery from job stress) and four work factors (work employment type, nursing method, COVID-19 nursing experience, and nursing practice environment) were surveyed. Data from 244 participants were obtained, and survey items were analyzed using a multiple regression analysis with work engagement as the dependent variable. The results show that 3-5 years of nursing experience is significantly associated with lower work engagement. Conversely, certifications for higher-level and specialized nursing, mastery experience such as learning new things, 1-9 days/month of COVID-19 nursing experience, and suitable nursing practice environment were significantly associated with higher work engagement. These factors are considered important for improving the work engagement of intensive care unit nurses.

Antecedents and Outcomes of Work Engagement among Psychiatric Nurses in Japan.

While previous studies have examined antecedents and outcomes of work engagement among general nurses, studies among psychiatric nurses remain limited. This study aimed to explore the antecedents (i.e., job crafting and nursing practice environment) and outcomes (i.e., strength-oriented care attitudes, mental health, and turnover intention) of work engagement among psychiatric nurses in Japan. This cross-sectional study included 309 nurses from three psychiatric hospitals in Japan (valid response rate: 60.4%). Data collection using the self-administered questionnaire took place from July to August 2021. We performed Structural Equation Modeling to examine the directional relationships among variables. Job crafting (ß = 0.57, p < 0.01) and nursing practice environment (ß = 0.23, p = 0.01) exhibited positive effects on work engagement. Work engagement had positive effects on strength-oriented care attitudes (ß = 0.15, p = 0.04) and mental health (ß = 0.37, p < 0.01) as well as negative effects on intention to resign from their profession as a nurse (ß = -0.17, p = 0.01). Job crafting and a healthier nursing practice environment could help enhance work engagement. Higher work engagement could contribute to improving strength-oriented care attitudes, mental health, and intention to resign from their profession as a nurse.

Current situation and influencing factors of the nursing practice environment in five tertiary general hospitals in Shenzhen: a cross-sectional study.

Objective: This study investigates the current situation and influencing factors of the nursing practice environment in Shenzhen, China, and provides suggestions for improving it. Background: Nursing shortage is an urgent global problem and also of concern in China. Studies have shown that better work environments are related to high job satisfaction and better patient outcomes. Methods: The 37-item Practice Environment Scale was used to assess the nursing practice environment. Respondents were 1116 nurses from five general tertiary hospitals in Shenzhen. Results: The mean satisfaction score for the nursing practice environment was 3.63 ± 0.72 (where 5 is the highest possible score). Position, being a specialist nurse, choice of nursing major, educational attainment, and night shifts significantly affected nurses' working environment satisfaction. Conclusion: The practice environment of nurses was satisfactory. We recommend reducing the workload and encouraging nurses to complete specialist training, and supporting nurses to expand their roles in hospitals and society to improve the nursing practice environment.

Ambiente de prática de enfermagem e a intenção de saída dos enfermeiros dos serviços de urgência hospitalar / Nursing practice environment and nurses' intention to leave hospital emergency services

A escassez de enfermeiros em Serviços de Urgência é um problema atual e afeta diretamente o Serviço Nacional de Saúde. Ambientes de Prática de Enfermagem desfavoráveis surgem, na bibliografia, associados a elevadas taxas de rotatividade e respetivo comprometimento da qualidade dos cuidados prestados, condicionando o desempenho das organizações de saúde. Os gestores de saúde devem, assim, perceber quais os fatores que podem mitigar este problema e desenvolver estratégias capazes de reter enfermeiros. Para melhor estudar este fenómeno, definiu-se como questão de investigação: "Qual a relação entre o Ambiente de Prática de Enfermagem e a Intenção de Saída dos Enfermeiros dos Serviços de Urgência Hospitalares?", tendo-se desenvolvido um estudo do tipo quantitativo, observacional/descritivo, transversal, que utilizou como instrumento de colheita de dados, a escala de Intenção de Turnover e a escala de Ambiente de Prática de Enfermagem NWI-R-PT. Estas escalas foram aplicadas entre os meses de fevereiro e abril de 2022, obtendo-se uma amostra de 63 enfermeiros, com uma média de idades de 32 anos, pertencentes aos Serviços de Urgência pediátrico e geral. Os resultados obtidos neste estudo mostram que os enfermeiros destes Serviços de Urgência, avaliam, globalmente, os seus Ambientes de Prática de Enfermagem como favoráveis, observando-se uma percentagem baixa de intenção de saída. Mesmo assim, na análise dos dados, foi encontrada uma correlação significativa entre a intenção de saída e a idade (p < 0,05), associando, assim, os enfermeiros mais novos, com menor tempo de experiência profissional e tipo de vínculo mais instável a uma maior percentagem na intenção de saída. Estes mesmos enfermeiros identificam, ainda, a dimensão do desenvolvimento profissional como sendo a menos favorável em termos de Ambiente de Prática de Enfermagem nos Serviços de Urgência

The shortage of nurses in Emergency Services is a current problem and directly affects the National Health Service. In the bibliography, unfavorable Nursing Practice Environments appear to be associated with high turnover rates and respective impairment of the quality of care provided, conditioning the performance of health organizations. Health managers must understand which factors can mitigate this problem and develop strategies to retain nurses. In order to better study this phenomenon, the following research question was defined: "What is the relationship between the Nursing Practice Environments and the Intention of Nurses to Leave Hospital Emergency Services?" having developed a quantitative, observational/descriptive, cross-sectional, used the turnover intention scale and the Nursing Practice Environments NWI-R-PT scale as data collection instruments. These scales were applied between February and April 2022, obtaining a sample of 63 nurses with an average age of 32 years belonging to the pediatric and general Emergency Services. The results of this study show that the nurses of these Emergency Services, globally, evaluate their Nursing Practice Environments as favorable, observing a low percentage of intention to leave. The data analysis found a significant correlation between the intention to leave and age (p < 0.05), thus associating younger nurses with less professional experience and a more unstable type of bond with a higher percentage of intention to leave. These same nurses also identify the dimension of professional development as being the least favorable in terms of Nursing Practice Environments in the Emergency Services.

The Relationship Between Nursing Practice Environment and Innovative Behavior in the Al-Madinah Region, Saudi Arabia: A Descriptive Study.

Background and objective A positive and supportive practice environment is essential for inspiring innovation in nursing. Innovative behaviors (IBs) could motivate nurses to devise solutions in several domains, such as identifying and solving workplace problems, building new work methods, delivering their services efficiently and effectively, adopting new medical technology advancements, and leading the change process to face current challenges in healthcare. In this study, we aimed to investigate the relationship between the nursing practice environment (NPE) and IB in the Al-Madinah region of Saudi Arabia. Methods A quantitative, descriptive, cross-sectional correlational design was employed for the study. The convenience sample consisted of 330 bedside nurses working in five general hospitals in the Al-Madinah region who voluntarily completed a self-report questionnaire consisting of queries related to demographic and professional characteristics, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and the Innovative Behavior Inventory (IBI). The collected data were analyzed using descriptive statistics and Pearson's correlation. Results Based on the study findings, the NPE was favorable. The overall PES-NWI mean score was 2.62 ± 0.50, and the mean scores of four of the five subscales were >2.50. The collegial nurse-physician relations subscale was perceived as the most favorable (2.87 ± 0.59), while staffing and resource adequacy was perceived as unfavorable (2.35 ± 0.65). The overall IBI mean score was 3.53 ± 0.56, indicating that nurses had a moderate level of agreement on IB. The highest mean score in IB was in the idea search domain (3.72 ± 0.77), while it was lowest in the implementation of starting activities domain (3.11 ± 0.86). Conclusions The correlation between the NPE and IB was positive and statistically significant. However, the correlation of the staffing and resources adequacy subscale in relation to subscales of idea search, overcoming obstacles, and innovation output did not reach statistical significance. Healthcare organizations should incorporate the principles of work innovation and healthy nursing work environments into their core values and enhance and nurture them through strategic management.

A influência do ambiente de prática de enfermagem nos cuidados omissos e na individualização dos cuidados / The influence of the nursing practice environment on missed care and individualized care / La influencia del ambiente de la práctica de enfermería en los cuidados omitidos y en la individualización de los cuidados

Resumo Enquadramento: O ambiente de prática de enfermagem (APE) influencia a qualidade dos cuidados de saúde, a prática de cuidados centrados na pessoa e a segurança dos doentes. Concretamente, prestar cuidados seguros engloba não deixar cuidados omissos. Objetivo: Analisar a influência do APE nos cuidados omissos e na individualização dos cuidados. Metodologia: Estudo quantitativo, descritivo e correlacional, desenvolvido em três serviços de internamento de um hospital de oncologia em Portugal. A perceção dos enfermeiros acerca do APE foi avaliada pela Practice Environment Scale of the Nurse Work Index, sendo-lhes também solicitado que identificassem os cuidados omissos do último turno por falta de tempo. A perceção das pessoas internadas acerca da individualização dos cuidados prestados foi avaliada recorrendo à Individualized Care Scale Patient. Resultados: Participaram 66 enfermeiros e 40 pessoas internadas. O APE global foi avaliado como desfavorável. O serviço com ambiente no limiar favorável reportou menos cuidados omissos. As pessoas internadas perceberam os cuidados como sendo individualizados. Conclusão: O APE identificado pode colocar em causa a qualidade dos cuidados prestados.

Abstract Background: The nursing practice environment (NPE) influences the quality of care, person-centered care, and patient safety. More specifically, providing safe care includes not leaving care left undone. Objective: To analyze the influence of the NPE on missed care and individualized care. Methodology: A quantitative, descriptive, and correlational study was conducted in three inpatient wards of an oncology hospital in Portugal. Nurses' perceptions of the NPE were assessed using the Practice Environment Scale of the Nurse Work Index. Nurses were also asked to identify types of care missed during their last shift due to lack of time. Inpatients' perceptions of individualized care were assessed using the Individualized Care Scale Patient. Results: The sample consisted of 66 nurses and 40 inpatients. The overall NPE was rated as unfavorable. The ward with an environment in the favorable threshold reported less missed care. Inpatients perceived care as individualized. Conclusion: The identified NPE may call into question the quality of care.

Resumen Marco contextual: El ambiente de la práctica de la enfermería (APE) influye en la calidad de los cuidados de salud, en la práctica de los cuidados centrados en la persona y en la seguridad del paciente. En concreto, proporcionar cuidados seguros implica no dejar cuidados omitidos. Objetivo: Analizar la influencia del APE en los cuidados omitidos y la individualización de los cuidados. Metodología: Se trata de un estudio cuantitativo, descriptivo y correlacional desarrollado en tres unidades de hospitalización de un hospital oncológico de Portugal. La percepción de los enfermeros sobre el APE se evaluó mediante la Practice Environment Scale of the Nurse Work Index, y también se les pidió que identificaran los cuidados omitidos en el último turno por falta de tiempo. La percepción de los pacientes internos sobre la individualización de los cuidados se evaluó mediante la Individualized Care Scale Patient. Resultados: Participaron 66 enfermeros y 40 pacientes internos. El conjunto del APE fue evaluado como desfavorable. El servicio con un ambiente en el umbral favorable notificó menos cuidados omitidos. Los pacientes internos perciben los cuidados como algo individualizado. Conclusión: El APE identificado puede poner en peligro la calidad de los cuidados prestados.

A Conceptual Model of Nurses' Turnover Intention.

The World Health Organisation predicts a lack of 15 million health professionals by 2030. The lack of licenced professionals is a problem that keeps emerging and is carefully studied on a global level. Strategic objectives aimed at stimulating employment, improving working conditions, and keeping the nurses on board greatly depends on identifying factors that contribute to their turnover. The aim of this study was to present a conceptual model based on predictors of nurses' turnover intention. Methods: A quantitative, non-experimental research design was used. A total of 308 registered nurses (RNs) took part in the study. The Multidimensional Work Motivation Scale (MWMS) and Practice Environment Scale of the Nursing Work Index (PES-NWI) were used. Results: The conceptual model, based on the binary regression models, relies on two direct significant predictors and four indirect significant predictors of turnover intention. The direct predictors are job satisfaction (OR = 0.23) and absenteeism (OR = 2.5). Indirect predictors that affect turnover intention via job satisfaction are: amotivation (OR = 0.59), identified regulation (OR = 0.54), intrinsic motivation (OR = 1.67), and nurse manager ability, leadership and support of nurses (OR = 1.51). Conclusions: The results of the study indicate strategic issues that need to be addressed to retain the nursing workforce. There is a need to ensure positive perceptions and support from managers, maintain intrinsic motivation, and promote even higher levels of motivation to achieve satisfactory levels of job satisfaction.

Status and associations of nursing practice environments in intensive care units: A cross-sectional study in China.

OBJECTIVE: The objective of this study is to investigate the status and associations of nursing practice environments in intensive care units of tertiary hospitals and provide suggestions for improvement. BACKGROUND: Nursing shortage is an urgent global problem and a concern in China. Intensive care unit nurses have been reported to have one of the highest rates of burnout; however, their comprehensive perceptions of nursing practice environments have not yet been examined. METHODS: The Nursing Practice Environment Scale was used to conduct a questionnaire-based survey of 1,523 intensive care unit nurses from 22 tertiary hospitals in China. The data collection was conducted in 2020. RESULTS: The overall score for the nursing practice environment was 77.042 ± 19.682 (where 100 was the highest possible score). The three highest scoring dimensions were quality management, clinical nursing professionalism and professional improvement, whereas the three lowest-scoring dimensions were hospital management participation, remuneration package and social status. Educational background, position, gender and hospital type were significantly associated with nurses' satisfaction with the working environment. CONCLUSION: Chinese nurses in the intensive care units of tertiary hospitals reported relatively satisfactory nursing practice environments, but the scale scores in dimensions such as hospital management participation, remuneration package and social status remained low. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding the status and associations of the nursing practice environment in intensive care units provides evidence that new policies are needed. Furthermore, managers are responsible for supervising and ensuring that nursing practice environments meet the criteria necessary to improve job satisfaction.

Associations among professional quality of life dimensions, burnout, nursing practice environment, and turnover intention in newly graduated nurses.

BACKGROUND: Professional quality of life affects nurses' well-being and the quality of care. However, little attention is paid to the relationships among professional quality of life dimensions, burnout, nursing practice environment, and intention to leave this job in newly graduated nurses. AIMS: To assess the levels of professional quality of life dimensions and turnover intention, to examine the predictors for turnover intention, and to explore the mediating roles of professional quality of life dimensions on the associations between these predictors and turnover intention in Chinese newly graduated nurses. METHODS: This was a cross-sectional study with 315 newly graduated nurses selected from five tertiary hospitals and five secondary hospitals in Sichuan province, China. Multiple regression analysis was used to examine the effects of demographic characteristics and work-related factors on intention to leave this job. Structural equation modeling technique was performed to explore the mediating effect of each domain of professional quality of life on the relationships between the predictors and turnover intention. RESULTS: The prevalence of average levels of burnout, secondary traumatic stress, and compassion satisfaction was 43.2%, 57.1%, and 81.3%, respectively. Moreover, 43.8% and 0.6% of the participants reported high and exceptionally high intention to leave this job. Nursing practice environment, social support, and empathy indirectly and significantly affected turnover intention via the mediating roles of burnout and compassion satisfaction, respectively. However, no significant mediating effect of secondary traumatic stress was found between these predictors and turnover intention. LINKING EVIDENCE TO ACTION: Perceptions of greater nursing practice environment, social support, and empathy result in lower turnover intention via reducing burnout and facilitating compassion satisfaction. Strategies such as developing a supportive work and family environment, and cultivating empathic capacity can be effective methods to mitigate against intention to leave this job in newly graduated nurses.

The impact of a participatory intervention on the therapeutic relationship in mental health nurses: A multicentre study.

AIMS: To evaluate the effects of an intervention aimed at improving the therapeutic relationship, using the participatory-action research method, in terms of improving the quality of the nurse-patient therapeutic relationship. DESIGN: A single-group pre-post research design. METHODS: Quantitative data were collected between January 2018 and June 2019 using an online form completed by nurses from 18 mental health units (N = 95). Data were collected before and after the intervention, which consisted of the design, implementation and evaluation of strategies to improve the therapeutic relationship through participatory-action research involving nurses. The Working Alliance Inventory-Short, Interpersonal Reactivity Index, Evidence-Based Practice Questionnaire and Practice Environment Scale of the Nursing Work Index were used. The Wilcoxon rank-sum test was used together with the Spearman's correlation coefficient. Two multiple linear regressions models were constructed. RESULTS: Overall, the intervention improved the nurse-patient therapeutic relationship. In addition, the results revealed that, above all, the improvement in evidence-based practice along with a decrease in nurses' personal distress were the factors associated with the improvement of the nurse-patient therapeutic relationship. CONCLUSION: In mental health units, the therapeutic nurse-patient relationship can be improved through participatory interventions that include the implementation of evidence-based practices. IMPACT: This research examined the effects of an intervention aimed at improving the therapeutic relationship among nurses working at mental health units using participatory action research. The results show that the therapeutic relationship can be improved through participatory methods where evidence-based practice is implemented and enhanced among nurses, since a better therapeutic relationship along with reduced staff discomfort are determining factors that influence the quality of the therapeutic relationship. Institutional managers should promote participatory group interventions to enable nurses to develop evidence-based aspects of the therapeutic relationship together with expanding personal aspects and self-knowledge.

The relationship between the nursing practice environment and five nursing-sensitive patient outcomes in acute care hospitals: A systematic review.

AIM: To synthesize the available evidence on the relationship between the nursing practice environment in acute care hospitals and five selected nursing-sensitive patient outcomes (mortality, medication error, pressure injury, hospital-acquired infection and patient fall). DESIGN: A quantitative systematic review of literature was conducted using the PRISMA reporting guidelines (PROSPERO: CRD42020143104). METHODS: A systematic review was undertaken up to October 2020 using: CINAHL, MEDLINE and Scopus. The review included studies exploring the relationship between the nursing practice environment in adult acute care settings and one of five selected patient outcomes using administrative data sources. Studies were published in English since 2000. RESULTS: Ten studies were included. Seven studies reported that a favourable nursing practice environment reduced the likelihood of mortality in acute care hospitals, but estimates of the effect size varied. Evidence on the association between the nursing practice environment and medication administration error, pressure injury and hospital-acquired infection was mixed.

A cross-sectional exploration of emergency department nurses' moral distress, ethical climate and nursing practice environment.

INTRODUCTION: Moral distress is a common phenomenon among nurses that leads to physical and emotional problems and affects job retention, job satisfaction, and quality of care. AIM: To explore relationships between moral distress, ethical climate, and nursing practice environment among a sample of ED nurses and determined significant predictors of moral distress in organizational environments. METHODS: A cross-sectional descriptive and correlational survey was performed on 237 nurses in emergency departments (EDs) from five hospitals in Taiyuan, mainland China. RESULTS: Statistically significant negative and moderate correlations were found between the level of moral distress and ethical climate for the overall evaluation and 10 subscale scores and the overall evaluation of the nursing practice environment. The nurse-physician collaboration, ethical climate, and monthly income were statistically significant predictors of the level of moral distress (change in R2 = 17.9%, 5.5%, and 5.6%, respectively). CONCLUSIONS: Perceptions of a more positive ethical climate and healthier nursing practice environment resulted in lower moral distress levels experienced by ED nurses. Poor nurse-physician collaboration is a pivotal factor accounting for ED nurses' moral distress.

Nursing practice environment, resilience, and intention to leave among critical care nurses.

BACKGROUND: Retaining experienced critical care nurses (CCNs) remains a challenge for health care organizations. Nursing practice environment and resilience are both seen as modifiable factors in ameliorating the impact on CCNs' intention to leave and have not yet been explored in Malaysia. AIMS AND OBJECTIVES: To assess the association between perceived nursing practice environment, resilience, and intention to leave among CCNs and to determine the effect of resilience on intention to leave after controlling for other independent variables. DESIGN: This was a cross-sectional survey. METHODS: The universal sampling method was used to recruit nurses from adult and paediatric (including neonatal) critical care units of a large public university hospital in Malaysia. Descriptive analysis and χ2 and hierarchical logistic regression tests were used to analyse the data. RESULTS: A total of 229 CCNs completed the self-administrated questionnaire. Of the nurses, 76.4% perceived their practice environment as being favourable, 54.1% were moderately resilient, and only 20% were intending to leave. The logistic regression model explained 13.1% of variance in intention to leave and suggested that being single, an unfavourable practice environment, and increasing resilience were significant predictors of nurses' intention to leave. CONCLUSION: This study found that an unfavourable practice environment is a strong predictor of intention to leave; however, further exploration is needed to explain the higher likelihood of expressing intention to leave among CCNs when their resilience level increases. RELEVANCE TO CLINICAL PRACTICE: Looking into staff allocation and equality of workload assignments may improve the perception of the work environment and help minimize intention to leave among nurses.

Desarrollo y validación del instrumento ENLASA-Enfermería para la evaluación de un entorno laboral saludable en el ámbito hospitalario / Development and validation of the ENLASA-Nursing instrument for the assessment of a healthy work environment in the hospital setting

El entorno laboral de los profesionales de enfermería es un área temática de gran interés para organizaciones internacionales en salud, organizaciones profesionales internacionales y locales, académicos, investigadores y directores o gerentes de enfermería, por la mediación o el impacto que estos entornos pueden tener en los resultados personales y profesionales de los enfermeros, en la calidad de la atención que se brinda a los pacientes y en los resultados de las organizaciones proveedoras de servicios de salud. Por lo anterior, existe el gran desafío de establecer entornos laborales saludables para mejorar la práctica de los enfermeros. Para promover la investigación empírica de los entornos laborales saludables de los enfermeros de práctica asistencial en el ámbito hospitalario, se desarrolló el instrumento ENLASA-Enfermería empleando un diseño de métodos mixtos secuencial exploratorio de tres fases. En la primera fase se adelantó la definición del concepto y la identificación de sus características, iniciando con una sub-fase de revisión teórica, continuando con una subfase de abordaje cualitativo con enfermeros y finalmente una sub-fase analítica para interconectar los hallazgos teóricos y cualitativos. En la segunda fase se generó un banco de ítems organizado en dos dimensiones (parte A: componentes estructurales organizacionales y parte B: dimensión de procesos organizacionales) que fue sometido a una revisión por expertos para estimar la validez facial y de contenido, y posteriormente se realizó una prueba piloto con una muestra de 22 enfermeros. Finalmente, en la tercera fase se aplicó el instrumento a una muestra de 307 enfermeros clínicos del ámbito hospitalario de diferentes municipios y ciudades de Colombia, con lo cual se realizó una evaluación de las propiedades métricas en términos de validez de constructo y confiabilidad. Los resultados obtenidos permitieron clasificar cada una de las partes de ENLASAEnfermería como satisfactorias en términos de validez facial y de contenido con índices globales superiores a 0,80 en las variables evaluadas por cada parte; con consistencia interna satisfactoria (Alfa de Cronbach parte A: 0,930 y parte B: 0,944) y con una estructura interna que permitió reconocer los elementos conceptuales de un entorno laboral saludable que respaldan su contenido. Se concluyó que ENLASA-Enfermería es un instrumento válido y confiable, prometedor para la investigación y la evaluación de los entornos laborales saludables de enfermeros clínicos en el ámbito hospitalario en Colombia.

The work environment of nursing professionals is a subject area of great interest to international health organizations, international and local professional organizations, academics, researchers and nursing directors or managers due to the mediation or the impact that these environments may have in the results of the professionals nursing, in the quality of care provided to patients and in the results of health service provider organizations. Therefore, there is the great challenge of establishing healthy work environments to improve the practice of professionals nursing. To promote empirical research on healthy work environments for nurses in care practice in the hospital setting, the ENLASA-Nursing instrument was developed using a three-phase exploratory sequential mixed methods design. In the first phase, the definition of the concept and the identification of its characteristics were advanced, starting with a sub-phase of theoretical review, continuing with a subphase of qualitative approach with nurses and finally an analytical sub-phase to interconnect the theoretical findings and qualitative. In the second phase, a bank of items organized in two dimensions (part A: organizational structural components and part B: organizational processes dimension) was generated, which was subjected to a review by experts to estimate facial and content validity and subsequently carried out a pilot test with a sample of 22 nurses. Finally, in the third phase, the instrument was applied to a sample of 307 clinical nurses from the hospital environment of different municipalities and cities in Colombia, with which an evaluation of the metric properties in terms of construct validity and reliability was carried out. The results obtained allowed classifying each of the parts of ENLASA-Nursing as satisfactory in terms of facial validity and content with indices global above 0.80 in the variables evaluated; with satisfactory internal consistency (Cronbach's Alpha part A: 0,930 and part B: 0,944) and with an internal structure that demonstrated relationships between items, subdimensions and dimensions, confirming the existence of the healthy work environment construct measured by the instrument. It was concluded that ENLASA-Nursing is a valid and reliable instrument, promising for the research, establishment and evaluation of healthy work environments of clinical nurses in the hospital setting in Colombia.

The Moderating Effect of Nursing Practice Environment on the Relationship between Clinical Nurses' Sleep Quality and Wellness.

This study examined the moderating effect of nursing practice environment on the relationship between clinical nurses' sleep quality and wellness. The wellness of clinical nurses is a direct outcome of individual-level health behaviors and organizational environmental factors. This study was a cross-sectional analysis. Participants were clinical nurses recruited using convenience sampling. The Nurse Practice Environment Scale, Wellness Index, and Pittsburgh Sleep Quality Index, Korean version (PSQI-K) were used. Data collected from 1874 nurses were analyzed using descriptive statistics and hierarchical multiple regression analyses. A total of 95.3% of the participants were women, and the mean age was 28.8 years. Further, 42.4% of the participants had a nursing career of 5 years or longer. The mean score for nursing practice environment was 2.24 and the mean PSQI-K score was 9.39. Nurses with less than 1 year of experience reported lower wellness scores. The wellness scores decreased with poorer sleep quality, and a more positive evaluation of the nursing practice environment predicted higher levels of wellness. Nursing practice environment had a moderating effect on the negative association of nurses' poor sleep quality with their wellness. Regarding management, individual strategies for nurses' well-being and organizational improvement policies may improve the nursing work environment.