The practice environment of primary care nurses: A cross-sectional study of five health care districts in San Paulo, Brazil

Challenges in the nurse practice environment greatly affect nurse work outcomes. This study investigated the relationship between nurse practice environment and work outcomes in the Philippines. This cross-sectional survey involved 549 hospital nurses in the Philippines in 2018. The nurse practice environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Four self-report scales were used to measure work outcomes: job satisfaction, job burnout, job stress and nurse-assessed quality of care. Multiple linear regression analysis was used to analyse the data. Significant relationships were found between nurse and organizational characteristics and nurse practice environment. Further, multivariate regression analysis revealed that the nurse practice environment had a significant and positive relationship with perceived quality of care and a significant and negative relationship with job burnout and job stress. A favourable work environment significantly reduced job burnout and job stress and improved the quality of patient care. With considerable migration abroad, a favourable nurse practice environment may engage a better nurse workforce in the country and subsequently reduce migration. Managers must focus on developing good nurse practice environments that will improve professional work outcomes and quality patient care.

BackgroundNursing practice environment has impact on the quality of nursing care and on patients’ and nurses’ outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients’ outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal.MethodsWe conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing.ResultsNurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients’ safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients’ safety.ConclusionsThe perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses’ outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

To investigate impacts of practice environment factors and burnout at the nursing unit level on job outcomes and nurse-assessed quality of care in acute hospital nurses. Prior research has consistently demonstrated correlations between nurse practice environments and nurses' job satisfaction and health at work, but somewhat less evidence connects practice environments with patient outcomes. The relationship has also been more extensively documented using hospital-wide measures of environments as opposed to measures at the nursing unit level. Survey. Data from a sample of 546 staff nurses from 42 units in four Belgian hospitals were analysed using a two-level (nursing unit and nurse) random intercept model. Linear and generalised linear mixed effects models were fitted including nurse practice environment dimensions measured with the Revised Nursing Work Index and burnout dimensions of the Maslach Burnout Inventory as independent variables and job outcome and nurse-assessed quality of care variables as dependent variables. Significant unit-level associations were found between nurse practice environment and burnout dimensions and job satisfaction, turnover intentions and nurse-reported quality of care. Emotional exhaustion is a predictor of job satisfaction, nurse turnover intentions and assessed quality of care as well besides various nurse work practice environment dimensions. Nurses 'ratings of unit-level management and hospital-level management and organisational support had effects in opposite directions on assessments of quality of care at the unit; this suggests that nurses' perceptions of conditions on their nursing units relative to their perceptions of their institutions at large are potentially influential in their overall job experience. Nursing unit variation of the nurse practice environment and feelings of burnout predicts job outcome and nurse-reported quality of care variables. The team and environmental contexts of nursing practice play critical roles in the recruitment and retention of nurses, and as well as in the quality of care delivered. Widespread burnout as a nursing unit characteristic, reflecting a response to chronic organisational stressors, merits special attention from staff nurses, physicians, managers and leaders.

The HEALTHQUAL model: Evaluating the Quality of Health Service in the Federal District, Brazil

Associations Between Patient Perceptions of Communication, Cure, and Other Patient-Related Factors Regarding Patient-Reported Quality of Care Following Surgical Resection of Lung and Colorectal Cancer

Review questions/objectives The objective of this systematic review is to synthesise the best available evidence on the impact of the effectiveness of delegation interventions by the registered nurse (RN) to the unlicensed assistive personnel (UAP) and their impact on quality of care, patient satisfaction, and RN staff satisfaction. Inclusion criteria Types of participants The review will consider studies that include RNs and unlicensed assistive personnel in any patient care setting where delegation by the RN to the UAP occurs. For the purposes of this systematic review we will use the following definitions: Registered nurse: A person that has graduated from a nursing program and has been licensed to practice. Unlicensed assistive personnel: Persons that are in a position to assist the RN under the registered nurse’s direct supervision. Activities are generally restricted to patient care activities delegated to them by the RN based on the nursing process. Types of interventions This review will consider studies that evaluate the effectiveness of delegation interventions by the RN to the UAP and their impact on quality of care, patient satisfaction, and RN staff satisfaction. For the purposes of this systematic review we will use the following definition: RN-UAP delegation: “Entrusting the performance of a selected nursing task to an individual who is qualified, competent, and able to perform such tasks. The nurse retains the accountability for the total nursing care of the individual”. Comparator The comparator is to that of usual nursing cares delivery. Types of outcomes The outcomes to be examined are quality of care, patient satisfaction, and RN staff satisfaction measured by validated and reliable tools. Validated and reliable measurement tools are considered measurement tools that have been previously tested and found to have acceptable psychometric properties. TRUNCATED AT 350 WORDS

Background: Nurse practice environment has been identified as an important factor in improving the quality and safety of hospital care. However, there are few studies that assess the characteristics of the hospital work environment and its impact on patient outcomes. The aim of the study: To evaluate the characteristics of the nurse’s practice environment regarding the quality of patient care as perceived by staff nurses. Subject and methods: Research design, quantitative design, non-experimental descriptive was utilized. Setting: This research was carried out in four governmental hospitals in Port Said city. Subjects included (300) of staff nurses who are working at previous hospitals to participate in research study dealing with characteristics of nurse’s practice environment regarding the quality of patient care. The tool of data collection: the one tool was used to collect data which aimed to measures eight characteristics of the work environment and quality of patient care. Results: It revealed that the highest level of agreement score (75.7%) for characteristics of the nursing practice environment scale on the unit level was for supportive nurse manager relationships, followed by working with other nurses who are clinically competent while 17.5% of studied nurses reported agreement regarding support for education in nursing work environment. Conclusion: There were the means differences between characteristics of practice environment tool and demographic variables as well as quality patient care at units’ levels from nurse’s perceptions. Overall response mean scores for the nurse was a very high quality of patient care as perceived by staff nurses. Recommendation: Implement continuous training for nurse’s managers about enhancing effective communication by creating an environment which permits to express ideas empower and encourage staff nurses to participate in decision-making and problem-solving process.

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.

Both nurses' well-being and quality of care are top priorities of the healthcare system. Yet, there is still a gap in understanding the extent and how authentic leadership influences them. This information is needed to inform the development of effective interventions, organizational practices, and policies. Thus, this study aimed to test the mechanism by which nurses' perception of their managers' authentic leadership impacts nurses' well-being and perception of quality of care, given the role of the nursing practice environment and nurses' psychological capital. A cross-sectional design was used. This study recruited a random sample of 680 nurses from six hospitals in Saudi Arabia. A final sample of 415 completed the surveys, with a response rate of 61%. Structural equation modeling was performed to test the hypothesized model. The study showed that nurses' perceptions of authentic leadership in their managers positively and directly affect their perceptions of quality of care but do not directly affect nurses' well-being. Both the nursing practice environment and psychological capital fully mediated the relationship between authentic leadership and nurses' well-being. However, the nursing practice environment partially mediated the relationship between authentic leadership and perceptions of quality of care. The findings contribute to understanding the crucial role of authentic leaders' style in nurses' well-being and quality of care through its positive impact on the nursing practice environment and psychological capital. Designing interventions and policies that specifically target nursing managers' authentic leadership style has implications for enhancing nurses' well-being and the quality of patient care. Institutional measures are needed to help leaders practice an authentic leadership style to create a positive nursing practice environment and cultivate nurses' psychological capital, both of which contribute to nurses' well-being and attaining a better quality of care. Further work is required to highlight the outcomes of implementing an authentic leadership style relevant to other leadership styles.

To examine nursing care left undone and its relationship with the nursing practice environment and perceived quality of nursing care in small Australian rural hospitals. Nurses in small rural hospitals often work with few resources, limited backup and staff shortages. The relationship between this rural practice environment and care left undone has not been fully explored. A descriptive cross-sectional survey. Over half participants (n=241, 62.9%) reported having left some activities undone on their most recent shift. There were moderately significant correlations between care left undone and nursing practice environment and overall quality of care. Nurses who reported leaving care left undone had statistically significant lower perceptions of the nursing practice environment than those who had no care left undone. Nursing care activities are being left undone in rural hospitals. Both care left undone and quality of nursing care may be affected by the nursing practice environment. To maximize care quality, rural hospital managers must consider the prevalence of care left undone and may use this information as a predictor of both patient outcomes and staffing and resource requirements. Given the challenges of rural hospitals, rural nurse managers can use this evidence to support their requests for increased staffing and resources.

The impact of the nurse practice environment, workload, and professional support on job outcomes and standards of care at primary health care clinics in South Africa: A structural equation model approach

Aim: To measure impact of nurses’ practice environment, organizational commitment on job satisfaction and intent to leave in hospitals of Pakistan. Study Design: Cross sectional survey; Convenience sampling. Methods: Sample of 240 nurses were drawn from private and public sector hospitals. Nurses’ practice environment (Aiken, Clarke, & Sloane, Hospital Staffing, Organisation and Quality Care: Crossnational Findings, 2002), organizational commitment (Mowday, Steers, & Porter, 1979) , job satisfaction (Carbonell & Escudero, 2013) and intent to leave (Zopaitis, Constanti, & Theocharous, 2014) were used as instruments of measurement. Results: Nurse Practice environment with estimate of 0.176 has no significant effect on job satisfaction as the p value was 0.43 which was statistically insignificant ant 0.05. Hospital nurses’ organizational commitment with estimate of 0.043 has no significant effect on job satisfaction as was 0.526 which was statistically insignificant at 0.05. Job satisfaction with estimate of 0.254 has a significant effect on intent to leave as the p value was 0.007 which was statistically significant at 0.05. Hence, it is claimed that job satisfaction has significant impact on intent to leave. Conclusion: The study is integral to have in the field of occupational health psychology and to make sure that nurses are satisfied in their work whether employed in private or public hospitals. Keywords: nurse practice environment, organizational commitment, job satisfaction, intent to leave, nursing, Pakistan

Aim: To measure impact of nurses’ practice environment, organizational commitment on job satisfaction and intent to leave in hospitals of Pakistan. Study Design: Cross sectional survey; Convenience sampling. Methods: Sample of 240 nurses were drawn from private and public sector hospitals. Nurses’ practice environment (Aiken, Clarke, & Sloane, Hospital Staffing, Organisation and Quality Care: Crossnational Findings, 2002), organizational commitment (Mowday, Steers, & Porter, 1979) , job satisfaction (Carbonell & Escudero, 2013) and intent to leave (Zopaitis, Constanti, & Theocharous, 2014) were used as instruments of measurement. Results: Nurse Practice environment with estimate of 0.176 has no significant effect on job satisfaction as the p value was 0.43 which was statistically insignificant ant 0.05. Hospital nurses’ organizational commitment with estimate of 0.043 has no significant effect on job satisfaction as was 0.526 which was statistically insignificant at 0.05. Job satisfaction with estimate of 0.254 has a significant effect on intent to leave as the p value was 0.007 which was statistically significant at 0.05. Hence, it is claimed that job satisfaction has significant impact on intent to leave. Conclusion: The study is integral to have in the field of occupational health psychology and to make sure that nurses are satisfied in their work whether employed in private or public hospitals. Keywords: nurse practice environment, organizational commitment, job satisfaction, intent to leave, nursing, Pakistan

Introduction: The Nursing Practice Environment (NPE) influences the quality of nursing care delivery [1–3], and is predictive of nursing care outcomes associated with professional retention, burnout, intention to leave the organization and job satisfaction (JS). Nurses JS and burnout are strongly associated with the quality of nursing care, patient safety, mortality and patient perception of hospital care [4–6]. The aim of this scoping review is to map and analyze the scientific evidence on the influence of NPE on the JS of nurses and nurses specialists in obstetrics in hospital context. Materials and methods: A total of 255 articles were identified, which, after filtering according to the inclusion and exclusion criteria, resulted in 31 articles. The first step consisted of the research carried out in the electronic databases CINAHL and MEDLINE with the following keywords: nurs * , nursing practice environment, Professional satisfaction in hospital context of obstetrics. In the second step all the indexed terms were used, in ScienceDirect. In the third step, the list of bibliographic references of the identified articles was analyzed in order to research additional studies. As inclusion criteria we considered all studies with nurses of all different categories but in the context of obstetrics. Quantitative, qualitative studies, systematic reviews of the literature and reviews of the literature were included in Portuguese, English and Spanish. The research timeframe comprised January 2012 through June 2017. Data extraction and analysis of the studies were based on the criteria of the Joanna Briggs Institute. Results: There were five thematic categories that reflect the existence of the influence of the NPE in the JS and which are: a) Evaluation of the NPE and JS; b) Dimensions of the NPE; c) Factors with influence on JS; d) Evidence of association between the NPE and JS; e) Evidence of association of the NPE and JS with other variables of organizational behavior. Discussion and conclusions: There is a current worldwide concern with the NPE and the nurses’ JS which is a turnover major factor in these professionals. JS is associated with several organizational, professional and personal variables with negative influence associated with work, such as stress and burnout. NPE has a positive indirect effect in JS through team/work group cohesion, multidisciplinarity, lack of organizational resources/constraints, working conditions/increased workload, labor discrimination, benefits and rewards, lack of clarity in nurses’ responsabilities, patients and doctors’ perceptions, poor leadership skills, promotion and professional development opportunities, distributive justice, negative affectivity. Nurses’ JS is strongly associated with NPE, which is the main factor that affects JS. NPE factors have an indirect positive effect on JS through several variables. Additionally, NPE characteristics have a significant influence on burnout and quality of care and, together with JS, on nurses’ intention to leave [2,4,5,7].

IntroductionThe standardized mortality ratio (SMR) is commonly used to assess the overall quality of care by comparing the observed hospital mortality with the mortality predicted by statistical models. If the observed deaths are less than the predicted, the overall quality of care can be considered high; in the opposite case, it is low.AimThe aim of the study was to assess the overall quality of care in an intensive care unit (ICU) during the period of 2012 to 2017. We also reported our experience and lessons learned throughout the surveillance period.MethodsA retrospective study design was adopted. Healthcare-associated infections (HAI–ICU) protocol v1.1 was used in a major ICU for a period of 6 years. All patients admitted to the ICU during the surveillance period were included in the study. The SMR was measured.ResultsDuring the 6-year period, 1067 patients were admitted and remained hospitalized for more than 48 hours; 207 patients' discharge status was reported as “death”, compared to 309 deaths predicted based on the SAPS II score. The overall mean observed mortality rate during the study period was 19.4%, as opposed to 28.95% for the predicted mortality. The overall mean SMR was 0.62 (IQR 0.49-0.82). Difficulties were faced due to the lack of surveillance software, but they were overcome by the use of a freely available web-based form.ConclusionsThe overall quality of ICU care is considered to correspond to high-quality standards, since standardized mortality rates during the study period were lower than one. The use of the web-based form as an alternative solution to the surveillance software performed well in terms of recording data.