Foundations For Quality Of Care Research Articles

Dignity of older home-dwelling women nearing end-of-life: Informal caregivers' perception.

Background:Most older people wish to live in the familiar surroundings of their own home until they die. Knowledge concerning dignity and dignity loss of home-dwelling older women living with incurable cancer should be a foundation for quality of care within municipal healthcare services. The informal caregivers of these women can help increase the understanding of sources related to dignity and dignity lossAim:The aim of this study was to explore informal caregivers’ perceptions of sources related to dignity and dignity loss in end-of-life of older home-dwelling women with incurable cancer.Research design and method:The study was founded upon Gadamer’s philosophical hermeneutics. In-depth interviews with 13 informal caregivers were carried out, and four participant observations were performed during home meetings.Ethical consideration:The study was based on voluntary participation, informed consent, confidentiality and the opportunity to withdraw at any time. The Norwegian Social Science Data Services approved the study.Results:Three main sources important in preserving the older women’s dignity were identified: maintaining one’s self-concept, remaining hopeful and sustaining freedom of choice. We also identified three main sources that lead to dignity loss: Sensing loss of human value, experiencing absence of gentleness and feelings of being treated as an object.Discussion and final considerations:On the individual level, the opportunity to maintain one’s self-concept and control in life, preserved dignity, while feelings of existential loneliness led to dignity loss. On the relational level, being confirmed as worthy human beings promoted the women’s dignity, whereas dignity loss was related to uncaring behaviours from healthcare professionals. On the societal level, individual decisions concerning travel situations and the place to stay when nearing end-of-life were of crucial importance. Constituting these women’s living space, these perspectives should be emphasized in healthcare professionals’ educational training and in the municipal end-of-life care of these patients.

The relationships between nurses' work environments and emotional exhaustion, job satisfaction, and intent to leave among nurses in Saudi Arabia.

To examine relationships between components of nurses' work environments and emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia. A descriptive correlational study with cross-sectional data. Data were collected in 2017 from 497 Registered Nurses working in a large tertiary hospital in Riyadh, Saudi Arabia. Participants completed an online survey like that used in RN4Cast studies to measure nurses' perceptions of their work environments and nurse outcomes. Hierarchical linear regression and logistic regression were conducted to examine the relationships between components of nurses' work environments and nurse outcomes after controlling for nurse and patient characteristics. Nurse participation in hospital affairs was uniquely associated with all three nurse outcomes, whereas staffing and resource adequacy was associated with emotional exhaustion and job satisfaction, but not intent to leave. These two variables were also the components of the nursing practice environment that received the lowest ratings. Nurse manager ability, leadership and support of nurses, and nurse-physician relationships were associated with job satisfaction only. A nursing foundation for quality of care was not uniquely associated with any of the three outcomes. Finally, nurse emotional exhaustion and job satisfaction fully mediated the relationship between nurse participation in hospital affairs and intent to leave. Magnet-like work environments in Saudi Arabia are critical to recruiting and retaining nurses in a country with critical nursing shortages. This study addresses a gap in the literature regarding which components of the nurses' work environment are uniquely associated with emotional exhaustion, job satisfaction and intent to leave among nurses in Saudi Arabia. Study results will assist Saudi hospital administrators and nurse leaders to develop recruitment and retention strategies by focusing on those work environment components most associated with nurse outcomes: participation in hospital affairs and staffing and resource adequacy.

RN4CAST Study in Portugal: Validation of the Portuguese Version of the Practice Environment Scale of the Nursing Work Index

Objective: This study aims to validate the Portuguese version of the Practice Environment Scale of the Nursing Work Index (PES-NWI) and assess construct validity through exploratory and confirmatory factor analyses. Materials and Methods: This cross-sectional study validates the psychometric properties of the PES-NWI in Portugal. Exploratory factorial analysis is used to analyze the psychometric properties of the PES-NWI in a sample of 5,075 Portuguese nurses; the data sample covers all geographic regions in the country. Confirmatory factor analysis is performed to confirm the model’s data adequacy. Results: Factorial analysis explained 54.6 % of the variance and a five-dimension structure. The five factors identified were Nurse Participation in Hospital Affairs, Nurse Manager Ability, Leadership and Support of Nurses, Nursing Foundations for Quality of Care, Staffing and Resource Adequacy, and Nurse-Physician Relations. The confirmatory analysis showed that the five-factor model fit well with the data in the Portuguese context. Conclusion: In a Portuguese health context, the PES-NWI is a valid scale to access the nursing environment and improve working conditions.

Effects of nursing work environment on work-related outcomes among psychiatric nurses: A mediating model.

WHAT IS KNOWN ON THE SUBJECT?: The shortage of psychiatric nurses has become a focus problem attracting widespread concern. And the continuous improvement of quality of psychiatric care has always been a priority in psychiatric units. Previous studies about nurses from general hospitals indicated nursing work environment was a key factor affecting work-related outcomes, but little attention was paid to psychiatric nurses and few studies focused on the five specific dimensions of nursing work environment. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Nurse participation in hospital affairs was the dimension with the highest proportion of participants dissatisfied. Nursing work environment and all its five dimensions had significant effects on work-related outcomes, which were partly mediated by work engagement. For nurse-perceived quality of care, collegial nurse-physician relations showed the largest effect; while for turnover intention, the two dimensions of nurse participation in hospital affairs and nursing foundations for quality of care showed larger effects. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Corresponding measures should be taken to improve nursing work environment, especially in the aspect of nurse participation in hospital affairs by promoting nurses' ability to participate, arousing their motivation to participate and offering them more opportunities to participate. Harmonious collegial relationship should be built by creating an atmosphere of equality, respect and collaboration, and enhancing the communication between doctors and nurses. Nursing foundations for quality of care need to be further improved through setting appropriate rules and regulations to ensure the quality of care and offering more opportunities to support nursing staff's growth and development. ABSTRACT: Introduction With the increasing demand for high-quality psychiatric care, it is imperative to improve psychiatric nurses' work engagement and work-related outcomes. Nursing work environment has been identified as a protective factor in non-psychiatric nurses, but little was known about psychiatric nurses. Aims To identify the situation of nursing work environment, work engagement, nurse-perceived quality of care and turnover intention among psychiatric nurses, and examine the relationship among them. Methods A cross-sectional design was adopted. Questionnaire investigation was implemented among psychiatric nurses from 43 clinical units. Structural equation modelling and path analysis were used to examine the causal relationship among variables. Results The results showed 19.06% of participants were not satisfied with the overall work environment and 24.34% were not satisfied with the dimension of nurse participation in hospital affairs. Hypothesis testing results indicated that nursing work environment and its five dimensions had positive effects on nurse-perceived quality of care and negative effects on turnover intention, which were both partly mediated by work engagement. Discussion Supportive nursing work environment could improve nurses' work engagement, enhance nurse-perceived quality of care and reduce nurses' turnover intention. Implications for Practice Continuous efforts should be paid to the improvement of nursing work environment in psychiatric hospitals.

Analyzing the Impact of Practice Environment on Nurse Burnout Using Conventional and Multilevel Logistic Regression Models.

Background: Most of the previous studies on nursing practice environment and job burnout employed conventional analyses ignoring the impact of unit-level data clusters. This study addressed this gap by examining the effects of the nursing practice environments on dimensions of occupational burnout among a sample of Chinese nurses using multilevel logistic regression models and demonstrating the superiority of employing multilevel models over conventional models within this context. Methods: A proportionate stratified sampling method was applied in this cross-sectional study that invited 1,300 registered nurses (RNs) from nine clinical units of a large, academic hospital in urban China to complete the questionnaire. Nurse-reported information was obtained using the Practice Environment Scale of the Nursing Work Index (PES-NWI) and the Maslach Burnout Inventory (MBI). Findings: A total of 1,178 valid questionnaires were returned for a response rate of 90.62%. RNs generally perceived their nursing practice environment as favorable as measured by the PES-NWI. Approximately 40% of the respondents reported experiencing emotional exhaustion and depersonalization. The multivariate models indicated that nurse burnout was significantly associated with nurse participation in hospital affairs, nursing foundations for quality of care, and adequate staffing. In addition, our results illustrated the advantage of multilevel modeling over the conventional modeling for handling hierarchical data in terms of the accuracy of the estimates and the goodness-of-fit of the model. Conclusions/Application to Practice: These findings underscore the importance of measures aimed at enhancing nursing practice environments to prevent RNs from experiencing feelings of burnout and of considering multilevel analysis in future nursing research.

Perception of Nurses Work Environment in Tertiary Care Hospital in Saudi Arabia

Nursing practice environment excellence is crucial for the enhancement of health care system performance. Nurses need a work environment that makes them use the full expression of their skills and knowledge. The aim of this study was to assess the perception of nurses’ work environment in tertiary care hospital in Saudi Arabia. A descriptive cross-sectional correlation research design and a convenient sampling technique was used to recruit 541 bedside nurses and nursing administrators working in the hospital with a response rate of 98.5%. A self-report questionnaire consists of demographic Characteristics and the Nursing Practice Environment scale. The results indicated that the mean score of nurse participants in hospital affairs was 3.0 (SD 0.47), nursing foundation for quality of care was 3.1 (SD 0.45), nurse manager ability, leadership and support of nurse was 2.9 (SD 0.60), staffing and resources adequacy was 2.6 (SD 0.70) while the mean score of collegial nurse-physician relations was 2.9 (SD 0.57). The overall mean score of the Nursing Practice Environment scale was 2.9 (SD 0.47). This study can guide policy makers, administrators, nurse leaders and educators, to identify areas to improve nurses’ work environment; which could translate into significant improvement in patient outcomes.

Practice environment and work-related quality of life among nurses in a selected hospital in Zamboanga, Philippines: A correlational study

Background & Aim: Nurses often work in problematic work environments, characterized by various difficulties and stress-factors that can undermine nurses’ full capacity to provide excellent care. Also, the nurse practice environment can have an impact on the quality of work-life, nurse recruitment and retention, and quality patient outcomes. Thus, the study assessed the relationship between practice environment and work-related quality of life as perceived by nurses in a selected hospital in Zamboanga City, Philippines. Methods & Materials: A descriptive correlational design was used in the study, and the total population of nurses was recruited as participants. The Practice Environment Scale of the Nursing Work Index and Work-Related Quality of Life Scale were used to gather the needed data. Data were analyzed using mean, standard deviation, and Spearman rank-order correlation. Results: A total of 103 nurses were surveyed in the study. In the perceived practice environment scale, it was revealed that the nursing foundation for quality of care was the highest (M=3.01, SD=0.20) and staffing and resource adequacy was the lowest (M=2.56, SD=0.45). On the other hand, job career satisfaction was the highest (M=3.64, SD=0.57) and stress at work was the lowest (M=2.55, SD=0.22) in the perceived work-related quality of life scale. The study showed a significant relationship between the perceived practice environment and perceived work-related quality of life (rho=0.287, p=0.003). Conclusion: The study revealed that nurses have a favorable work-related quality of life and practice environment. However, formulating and enhancing programs for nurses such as incentive and professional development should be done as this can help foster and sustain a positive practice environment and job satisfaction.

Nursing Work Environment, Turnover Intention, Job Burnout, and Quality of Care: The Moderating Role of Job Satisfaction.

The purpose of this study was twofold: (a) to assess predictors of the turnover intention, burnout, and perceived quality of care among nurses working in Oman, and (b) to examine the potential moderating role of job satisfaction on the relationship between work environment and nurse turnover intention. A cross-sectional design was used to collect data from a sample of 207 nurses working in a public hospital in Muscat, Oman. An electronic survey was used to assess nurses' perceptions of work environment, burnout, job satisfaction, turnover intention, and quality of care. Participation in hospital affairs, a foundation for quality of care, and staffing adequacy were predictors of burnout among nurses and perceived quality of care. Logistic regression analysis revealed that working in a favorable environment was associated with less turnover intention, but only when job satisfaction was high. Improving nurse job satisfaction is a mechanism through which future interventions could enhance working conditions and promote better nurse retention. Organizational strategies are needed to increase nurse job satisfaction by empowering nurses to take more active roles in hospital affairs as a strategy to reduce turnover intention and enhance the quality of patient care.

Relationship between the nursing practice environment and the therapeutic relationship in acute mental health units: A cross-sectional study.

The therapeutic relationship constitutes the central axis of mental health nursing. The clinical practice environment has been empirically related to the quality of care. However, the relationship between the two constructs is unknown in the setting of mental health units. We aimed to examine whether the practice environment and nurses' characteristics influence the therapeutic relationship in mental health units. Through a cross-sectional design, data were collected via an online form completed by nurses in 18 mental health units. Linear regression was used to examine the relationship between the clinical practice environment and the therapeutic relationship. Questionnaires were completed by 198 participants. The mean age was 33.8 (SD 9.1) years, 71.7% were women, and only 20.2% had a specialist qualification in mental health. The therapeutic relationship was better when there was a more favourable practice environment (B: 3.111; 95% CI: 1.46-4.75). The most influential environment-related factor was the nursing foundations for quality of care (B: 2.124; 95% CI: 0.17-4.07). The factors associated with a high-quality therapeutic relationship were a more favourable practice environment and the presence of more foundations for quality nursing care, coupled with higher academic attainment and longer nursing experience. Institutions should take into account the importance of the nursing practice environment in mental health units. Aspects related to the quality of nursing foundations, such as training, the use of nursing language and taxonomy, and the existence of a common nursing philosophy, are influential for a high-quality therapeutic relationship.

Changing Culture to Drive Nurse Engagement and Superior Patient Experience

Brandon "Kit" Bredimus was the recipient of AONL's 2018 Pamela Austin Thompson Early Careerist Award. He helped to develop and implement the program detailed below, which improved nurse engagement and patient experience scores.

Development of a short questionnaire based on the Practice Environment Scale-Nursing Work Index in primary health care.

BackgroundProfessional nursing environments determine the quality of care and patient outcomes. Assessing the quality of environments is essential to improve and obtain better health outcomes. Simplifying and shortening the way to evaluate environments reliably is also important to help nurses better understand the strengths and weaknesses of their environments. In that sense, identifying essential elements of nursing environments would allow the construction of short assessment tools to improve such environments.ObjectiveTo construct a short tool to assess primary health care (PHC) nursing environments based on the Practice Environment Scale-Nursing Work Index (PES-NWI) questionnaire.MethodsObservational, cross-sectional, analytical study (data collection February–April 2015). Tool: PES-NWI (31 items). Population: PHC nurses (three health districts in Valencia, Spain) with more than 3 months in the organization. The nurses were asked to select the 10 elements of the questionnaire (items) that they considered key to facilitate and improve professional care, establishing as a final selection criterion that they obtain a global election >40%. Variables: sociodemographic and 31 questionnaire items. Analysis: descriptive statistics, reliability, multidimensional scaling (ALSCAL), factor analysis, multiple linear regression. Finally, we have analyzed the concordance between both measurements (TOP10 score on the full scale score) using the Bland–Altman method.ResultsStudy sample = 269 (Response rate = 80.29%). A total of 10 elements were identified based on selection frequency of the questionnaire PES-NWI. A factorial analysis explained 62.1% of variance, internal structure of three dimensions: (1) Participation in leadership and management, (2) Nursing foundations for quality of care, (3) Adequacy of resources, with Accumulate Variance explained: Component (1): 24%; Component (2): 43.1%; Component (3): 62.1%. Reliability (Cronbach’s Alpha) was 0.816 for short questionnaire, and >0.8 for all measurements. Stress = 0.184 and RSQ = 0.793. Bland–Altman method: the scaling tends to be 1.92 points higher (equivalent to a maximum deviation of 1.54%) than the full-scale PES-NWI score (max score on PES-NWI = 124 points).ConclusionsIt is possible to identify essential elements of environments to construct a short tool that simplifies the study of PHC environments. Conducting rapid studies of environments will provide managers with information about specific elements that require prioritization to enhance quality of care and safety.

Barriers and opportunities to improve the foundations for high-quality healthcare in the Mexican Health System.

This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. We found that QoC foundations, evaluation and improvement activities pose essential challenges for the Mexican health sector. Governance for QoC is weakly aligned across MoH, IMSS and ISSSTE. Each institution follows its own agenda of evaluation and improvement programmes and has distinct QoC indicators and information systems. The institutions share similar barriers to strengthening QoC: poor organizational structure at a facility level, scarcity of financial resources, lack of training in QoC for executive/managerial staff and health professionals and limited public participation. In conclusion, a stronger legal framework and policy dialogue is needed to foster governance by the MoH, to define and align health sector-wide QoC policies, and to set common goals and articulate QoC improvement actions among institutions. Robust QoC organizational structure with designated staff and clarity on their responsibilities should be established at all levels of healthcare. Investment is necessary to fund formal and in-service QoC training programmes for health professionals and to reinforce quality evaluation and improvement activities and quality information systems. QoC evaluation results should be available to healthcare providers and the population. Active public participation in the design and implementation of improvement initiatives should be strengthened.

Organizational readiness for implementing change in acute care hospitals: An analysis of a cross‐sectional, multicentre study

To assess nurse-reported organizational readiness for implementing change in acute care hospitals. An organization's success at implementing new policies and programmes depends largely on its stakeholders' readiness for change. Organizational readiness is a multilevel, multifaceted construct associated with staffing, leadership and quality of care. This is a secondary analysis of the cross-sectional multicentre "Matching Registered Nurse Services with Changing Care Demands" study. In 23 acute care hospitals across Switzerland, 1,833 nurses working in 124 units completed a survey between September 2015 and January 2016. Organizational readiness was measured with two subscales: "change commitment" and "change efficacy". Work environment factors were assessed using the Practice Environment Scale of the Nursing Work Index. Nurses were positive about implementing change in their hospitals. Intraclass correlation was higher at the unit level than at the hospital level for both change commitment and change efficacy. Nursing foundation for quality of care and supportive leadership were positively associated with readiness, change commitment and change efficacy. However, staffing and resource adequacy was positively associated only with change efficacy. No association was found with standardized staffing. While organizational readiness scores vary among hospitals and units, they are positively associated with supportive leadership and a foundation for quality of care. Further research should consider organizational readiness as an important factor of change and ultimately of the quality of care.

Ambiente da prática de enfermagem em unidades de terapia intensiva

Resumo Objetivo Analisar o ambiente da prática de enfermagem em unidades de terapia intensiva. Métodos Estudo descritivo, de abordagem quantitativa, realizado com 209 profissionais de enfermagem de três hospitais de ensino brasileiros. O ambiente da prática de enfermagem foi avaliado através da Practice Environment Scale. Os dados foram analisados descritivamente, assumindo nível de significância de 5% (p<0,05). O coeficiente Alfa de Cronbach foi utilizado para examinar a consistência interna dos construtos. Resultados Os profissionais de enfermagem consideraram desfavoráveis quatro das cinco dimensões do ambiente da prática profissional: participação dos enfermeiros na discussão dos assuntos hospitalares; fundamentos de enfermagem voltados para a qualidade do cuidado, habilidade, liderança e suporte dos coordenadores/supervisores de enfermagem aos enfermeiros/equipe de enfermagem; e adequação da equipe e de recursos. Apenas a dimensão relações colegiais entre profissionais de enfermagem e médicos apresentou avaliação positiva. Enfermeiros reconheceram mais fortemente atributos desfavoráveis no ambiente de prática do que técnicos de enfermagem. Conclusão O ambiente mostrou-se desfavorável para a prática dos profissionais de enfermagem. Esforços são necessários para tornar o ambiente de prática mais atrativo aos profissionais de enfermagem, e assim estimular melhorias na qualidade e na segurança da assistência prestada.

Study of ICU nurses' perception of the working environment and its impact on the intention of turnover

Objective To investigate the status quo of ICU nurses' working environment and its impact on their turnover intention. Methods A total of 388 nurses from 8 different intensive units in a class Ⅲ grade A in Sichuan province were surveyed by the general information questionnaire, the practice environment scale of the work index (PES-NWI) and the turnover intention sScale in September 2016. The correlation analysis and multivariate regression analysis were used to explore the effect of work environment on turnover intention. Results The average PES-NWI score was (97.38±13.89) . The domain of nursing foundations for quality of care had the highest score, whereas the score of the staffing and resource adequacy was the lowest. Different age, health condition, working years, ICU working years, working title, the numbers of night shift, and social support might affect the ICU nurses' perception of working environment. The average score of turnover intention among the participants was (14.67±3.46) . There was up to 71.4% (277/388) of nurses reported a high intention of turnover. There was a negative correlation between the nurses' perception of working environment and their turnover intention (r=-0.319, P<0.01) . Nursing work environment is one of the influencing factors of turnover intention, which can explain 10.2% of the variance. Conclusions Corresponding management strategies such as the modification of human and material resources can be adopted by decision-makers to improve the working environment, thus to minimize the likelihood of nurse turnover. Key words: Nurses; Intensive unit; Working environment; Turnover intention

Workplace bullying among nurses and their related factors in Japan: a cross-sectional survey.

To explore the association between workplace bullying and workplace environment factors among nurses in Japan. Workplace bullying among nurses is increasing globally and occurs more frequently than among other professions. However, there is little information on the impact of workplace environment factors on nurse bullying in Japan. A cross-sectional survey using a self-administered questionnaire. Participants were 1152 nurses recruited at seminars or training courses outside of their workplaces in Tokyo. Workplace bullying was measured using the Negative Acts Questionnaire-Revised. Participants were considered to have been 'bullied' if they reported experiencing at least one negative act on a daily or weekly basis. Workplace environment factors were measured using the Practice Environment Scale of the Nursing Work Index, which comprises five domains: nurse participation in hospital affairs; nursing foundations for quality of care; nurse manager ability, leadership and support of nurses; staffing and resource adequacy; and collegial nurse-physician relationships. A total of 898 (78·0%) questionnaires were returned, of which 825 (71·6%) were analysed. Altogether, 153 (18·5%) nurses were considered 'bullied.' The three most frequent negative acts reported as occurring on a weekly or daily basis were 'someone withholding information which affects your performance' (6·7%), 'being exposed to an unmanageable workload' (4·4%) and 'being shouted at or being the target of spontaneous anger (or rage)' (3·6%). Logistic regression analysis indicated that 'bullied' were associated with low scores on two work environment domains: nurse manager ability, leadership and support of nurses and staffing and resource adequacy. Effective nurse manager leadership and support as well as appropriate staffing management may positively influence workplace bullying among nurses in Japan. Authentic leadership styles and allowing nurses to easily request days off might also be important. Nurse managers' leadership may influence nurses' workplace bullying.

Survey on the relationship between nursing work environment and nurses' work values of tertiary public hospitals in Tianjin

Objective To analyze the relationship between nursing work environment and nurses' work values of tertiary public hospitals in Tianjin ,and provide a scientific basis for the development of nurses' work values. Methods The sample was 1 875 clinical nurses from 7 tertiary public hospitals in Tianjin, and investigated with Practice Environment Scale(PES)and Work Values Scale. Results The score of nurses' work values and each dimension(material work values, affective work values,cognitive work values)were different in different level of work environment, ＂better ＂work environments >mixedwork environments >＂poor ＂work environments(F=121.528, 38.555, 86.834, 136.816,P <0.01). The nursing work environment was positively correlated with work values(r=0.127-0.423, P<0.01). Foundation for quality of care and leadership of the head nurse could predict the nurse work values, and could explain 16.9% of the nurse work values(F=191.315,P <0.01). Conclusions By improving nursing work environment, especially in foundation for quality of care and leadership of the head nurse,can promote the development of nurses' work values. Key words: Nurse; Nursing work environment; Work value

Nurse perceptions of organizational culture and its association with the culture of error reporting: a case of public sector hospitals in Pakistan.

BackgroundThere is an absence of formal error tracking systems in public sector hospitals of Pakistan and also a lack of literature concerning error reporting culture in the health care sector. Nurse practitioners have front-line knowledge and rich exposure about both the organizational culture and error sharing in hospital settings. The aim of this paper was to investigate the association between organizational culture and the culture of error reporting, as perceived by nurses.MethodsThe authors used the “Practice Environment Scale-Nurse Work Index Revised” to measure the six dimensions of organizational culture. Seven questions were used from the “Survey to Solicit Information about the Culture of Reporting” to measure error reporting culture in the region. Overall, 309 nurses participated in the survey, including female nurses from all designations such as supervisors, instructors, ward-heads, staff nurses and student nurses. We used SPSS 17.0 to perform a factor analysis. Furthermore, descriptive statistics, mean scores and multivariable logistic regression were used for the analysis.ResultsThree areas were ranked unfavorably by nurse respondents, including: (i) the error reporting culture, (ii) staffing and resource adequacy, and (iii) nurse foundations for quality of care. Multivariable regression results revealed that all six categories of organizational culture, including: (1) nurse manager ability, leadership and support, (2) nurse participation in hospital affairs, (3) nurse participation in governance, (4) nurse foundations of quality care, (5) nurse-coworkers relations, and (6) nurse staffing and resource adequacy, were positively associated with higher odds of error reporting culture. In addition, it was found that married nurses and nurses on permanent contract were more likely to report errors at the workplace.ConclusionPublic healthcare services of Pakistan can be improved through the promotion of an error reporting culture, reducing staffing and resource shortages and the development of nursing care plans.

한국 정신간호영역에서의 간호업무환경 측정도구의 타당화 연구

Purpose: The purpose of this study was to test the reliability and the validity of the Practice Environment Scale of Nursing Work Index (PES-NWI) scale when applied to Korean psychiatric nurses working in the psychiatric hospital in Korea. Methods: Data from 224 psychiatric nurses working in the 6 psychiatric hospitals in Korea were analyzed using Cronbach's <TEX>${\alpha}$</TEX>, item total correlation, and exploratory factor analysis. Results: The Cronbach's <TEX>${\alpha}$</TEX> for the 27 items from the PES-NWI were .93, and the item total correlation coefficients ranged from .38 to .64. Six factors which explained 61.2 of variance in the perception of practice environment, emerged; nurse professional role and development, nurse manager ability, leadership, and support of nurses, staffing and resource adequacy, nursing foundation for quality of care, collegial nurse-physician relations, co-worker's ability and qualification. Five derived factors reconstructed, and two factors were renamed. Conclusion: Findings demonstrate that not all but 27 items from PES-NWI is a reliable and valid scale when applied to Korean psychiatric nurses working in Korea. Also findings indicate that Korean psychiatric nurses perceive practice environment differently than American nurses but have some point of similarities with Asian nurses working in the United States.

Differences in nursing practice environment among US acute care unit types: A descriptive study

BackgroundThe hospital nursing practice environment has been found to be crucial for better nurse and patient outcomes. Yet little is known about the professional nursing practice environment at the unit level where nurses provide 24-hour bedside care to patients. ObjectivesTo examine differences in nursing practice environments among 11 unit types (critical care, step-down, medical, surgical, combined medical–surgical, obstetric, neonatal, pediatric, psychiatric, perioperative, and emergency) and by Magnet status overall, as well as four specific aspects of the practice environment. DesignCross-sectional study. Settings5322 nursing units in 519 US acute care hospitals. MethodsThe nursing practice environment was measured by the Practice Environment Scale of the Nursing Work Index. The Practice Environment Scale of the Nursing Work Index mean composite and four subscale scores were computed at the unit level. Two statistical approaches (one-way analysis of covariance and multivariate analysis of covariance analysis) were employed with a Tukey-Kramer post hoc test. ResultsIn general, the nursing practice environment was favorable in all unit types. There were significant differences in the nursing practice environment among the 11 unit types and by Magnet status. Pediatric units had the most favorable practice environment and medical–surgical units had the least favorable. A consistent finding across all unit types except neonatal units was that the staffing and resource adequacy subscale scored the lowest compared with all other Practice Environment Scale of the Nursing Work Index subscales (nursing foundations for quality of care, nurse manager ability, leadership, and support, and nurse–physician relations). Unit nursing practice environments were more favorable in Magnet than non-Magnet hospitals. ConclusionsFindings indicate that there are significant variations in unit nursing practice environments among 11 unit types and by hospital Magnet status. Both hospital-level and unit-specific strategies should be considered to achieve an excellent nursing practice environment in all hospital units.