Healthy Practice Environments Research Articles

Environmental Health Practice and Quality of Nursing Care: A Protocol for Systematic Review

Objectives: To systematically synthesize studies that analyze the relationship between a healthy practice environment and quality of nursing care in hospital settings; to identify the most commonly used instruments to assess nurses’ perceptions of a healthy practice environment; to identify the most commonly used instruments to assess nurses’ perceptions of quality of nursing care. Method: A systematic literature review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature search will be conducted in the principal databases. Review of international scientific articles published in the last ten years, accessed through the database of the Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, on nurses’ perceptions of the influence of the environment on healthy nursing practice and quality of care. Inclusion: Articles published after 2012 in Portuguese, Spanish, and English. The identified, selected, and included studies will be highlighted for the selection process using the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P). If possible, quantitative data will be pooled into a meta-analysis using the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument (MASTARI).

Virtue ethics in health care teams; its time has come: Review of the nursing virtue ethics literature.

To summarize and evaluate the nursing virtue ethics literature, examine how virtue ethics has been applied to health care teams, offer a new framework to guide understanding and development of virtuous health care teams and offer recommendations to nurse leaders. With the unprecedented levels of incivility and turnover in the post-COVID-19 world, virtue ethics may provide an innovative approach for nursing leaders working to rebuild healthy practice environments. An integrative review yielded articles from eight databases using PRISMA guidelines. Level of evidence and quality were assessed using the Johns Hopkins tools. Virtue ethics has been of interest to the health care community predominantly as a concept. Most articles focused on debating whether virtue ethics belongs in nursing. Virtue ethics offers a creative strategy for leaders to attract and retain nurses. There is a dearth of research on virtue ethics and nursing. One study empirically uncovered and validated a framework for virtue ethics in health care teams. To rebuild strong health care teams, nurse leaders can model virtue ethics using an empirically derived framework while coaching their teams to do the same. Doing so holds the promise of reengaging staff and rebuilding healthy practice environments.

Deborah Zimmermann, DNP, RN, NEA-BC, FAAN

Deborah Zimmermann, DNP, RN, NEA-BC, FAAN, is chair of the American Organization for Nursing Leadership (AONL) Foundation.

Creating the Framework for a Healthy Practice Environment.

The link between healthy work environments and patient safety, nursing satisfaction, and quality outcomes is well established, yet many nurses work in environments that are unsafe and uncivil. What are the essential elements that contribute to a healthy practice environment? How can we create roles and working conditions that enable nurses to be fulfilled and happy in their careers? This month's Magnet Perspectives column explores the relationship between a healthy practice environment and better outcomes and examines how the Journey to Magnet Excellence® leads to higher nurse satisfaction and retention, improved interdisciplinary collaboration, excellent patient care, and exemplary patient results.

Measuring hospital staff nurses perception on quality of the professional practice environment.

The purpose of this study was to determine construct validity of the Dutch Essentials of Magnetism II © instrument, designed to assess nursing practice environments, using hypotheses testing. Reduction in hospital length of stay and the number of inpatient beds increases care intensity. Educational levels and numbers of nursing staff in hospitals, however, do not match this increase, resulting in a strain on quality of care and patient safety. A possible answer to existing concerns about quality of care may be the creation of a productive and healthy practice environment, as this has an impact on the quality of care. Therefore, areas requiring improvement of the practice environment have to be defined. A cross-sectional, correlational study design. We determined construct validity with hypotheses testing by relating the Dutch Essentials of Magnetism II to the Dutch Practice Environment Scale of the Nursing Work Index. We formulated 15 hypotheses prior to data-analysis; 10 related to convergent validity and five related to discriminant validity. Data were collected from qualified nurses (N=259) on nine randomly selected hospital wards from March to April 2012. Response rate was 47% (n=121). Total scores of both instruments are strongly correlated (r=0·88). In total, 12 of 15 hypotheses (80%) were confirmed and three were rejected. The D-EOMII has satisfactory construct validity for measuring the nursing practice environment in hospitals and can be used by nurses, managers, health policy makers, hospitals and governments to assess and identify processes and relationships that are in need of improvement.

Nurse Managers Speak Out About Disruptive Nurse-to-Nurse Relationships.

The purpose of this study is to explore nurse managers' (NMs') perceptions regarding disruptive nurse-to-nurse relationships. Nurse managers play a pivotal role in creating and sustaining healthy practice environments. They must understand how to recognize and confront disruptive nurse relationships that can threaten the health of their units. A qualitative study design using researcher-participant interviews of 13 NMs from 5 institutions provided data regarding NMs' views on nurse relationships. Nurse managers reported how they became aware of disruptive nurse relationships, their strategies for dealing with those relationships, and the impact that confronting disruptive relationships had on them personally. Findings can be helpful to NMs who are faced with addressing disruptive nurse-to-nurse relationships as they endeavor to create and sustain healthy work environments.

It's all connected! Patient experience and healthy practice environments.

It's all connected! Patient experience and healthy practice environments.

It's all connected! Patient experience and healthy practice environments.

It's all connected! Patient experience and healthy practice environments.

Creating a Healthy Practice Environment: A Call to Action for Oncology Nurses.

When nurse researcher Marlene Kramer published Reality Shock: Why Nurses Leave Nursing in 1974, her seminal work launched a national discussion related to the distress felt by many baccalaureate-prepared novice nurses about leaving the academic setting and transitioning to the clinical setting. In particular, Kramer (1974) highlighted conflict between the values these new nurses had been taught in school and the reality of practicing as a professional nurse in a clinical setting. For example, in an educational setting, nursing students may focus on one or two patients at a time, whereas in the clinical setting, nurses must practice simultaneously with multiple patients with varied and numerous health deficits. This conflict is felt acutely by novice and experienced oncology nurses who are tasked with providing quality physical care, as well as emotional care and support to patients with cancer and their families .

Conflict in Practice-based Settings: Nature, Resolution and Education

In this masterclass we review the evidence regarding the nature of conflict within healthcare practice settings, discuss ways of preventing and resolving conflict, and consider how practice-based education, focusing on conflict and negotiation, may help learners achieve positive outcomes. Conflict is a serious state, which is often prolonged and arises from incompatibility or divergent interests and values. However, conflict may also be used as a productive force for change. Conflict has been included as a core competence for healthcare professionals in a number of competency frameworks because of the recognition that inter- and intra-professional conflict affect patient safety and outcomes, as well as having detrimental effects on staff morale, and on physical and mental health. We discuss how conflict may arise from several triggers – personal, professional and organisational. In particular, disparities in values may lead to conflict, while good communication is fundamental to optimal practice. The history of the development of the health professions includes many examples of conflict between professional groups. A healthy practice environment should encourage constructive conflict management, recognising that conflict will always arise. Early experiences of working and learning together represent important learning opportunities for students, enabling the development and practice of teamwork skills, as well as helping them to recognise and understand the different values, perspectives, roles and responsibilities of team members. Learning opportunities based on real-life scenarios and patient experiences provide a focus common to all professional groups, allowing students the opportunity to explore their differences and similarities. The key messages are: conflict occurs frequently in practice-based settings both inter- and intra-professionally, and learners need to be able to recognise and deal with conflict, including through negotiation.

Factors and outcomes in primary care physician retention in rural areas

Background: This paper examines factors influencing physicians’ decisions to practise in rural communities as well as the results of a programme focused on rural recruitment and retention. Methods: Data from two sources were analysed and discussed: 1) telephone interviews with 20 of 33 (61%) recently located rural physicians regarding practice and community factors influencing their practice decisions and 2) a database of 107 graduates of a rural medical education programme who have been in practice for at least three years to examine specialty choice and practice location(s), including moves from their original practice sites.Results: Most rural physicians in this study decided to practise in rural areas because of family ties. Eighty per cent of the physicians participating in the interviews mentioned no negative personal or family factors related to their community of practice. Outcome data on graduates from the rural medical education programme are encouraging. Over 70% opt for primary care and rural practice. Over 80% have remained in their original rural practice location. Conclusion: Keys to success in rural physician retention seem to include identifying and recruiting medical students of rural origin and focusing on a healthy practice environment. Policy makers need to work with local government, schools and employers to offer programmes that provide information on health careers in rural areas and begin to identify local youth for induction in rural health care. Keywords: retention; rural; primary care; physicians; workforce

The Opportunities of Stewardship

Nurse leadership involves stewardship. In the healthcare system, it will mobilize around true integration across provider settings and new models of care delivery that are driven by the changing needs of consumers while also tending to the fiscal soundness of the system. For the profession, the focus will be on refining the roles, creating positive and healthy practice environments, and upgrading regulation and standards to support the future work of the nurse. In stewardship of the self, nurse leadership will develop a sound cadre of future nurse leaders, engage in continual learning, and role model balance.

Role Stress and Career Satisfaction Among Registered Nurses by Work Shift Patterns

This study examined the variation in role stress and career satisfaction among hospital-based registered nurses (RNs) by shift length. Many hospitals have reorganized care delivery into 12-hour work shifts to improve RN recruitment, retention, and cost effectiveness. Yet little is known about the effects of 12-hour shifts on RN role stress and career satisfaction. As an unprecedented RN shortage approaches, factors that contribute to satisfying and healthy practice environments must be identified. This study used a descriptive cross-sectional research design. Five hundred RNs were randomly selected to receive a mailed questionnaire packet. Initial findings indicate RNs working 12-hour shifts were younger, less experienced, and more stressed than colleagues working 8-hour shifts. When differences in nursing experience were controlled, similar RN stress levels were found. Although overall career satisfaction was comparable between groups, significant differences were found in the areas of salary and professional status. Pay, autonomy, and professional status were the most important determinants of career satisfaction for all RN participants. These findings suggest that RNs may experience greater professional fulfillment when strategies are implemented that promote autonomous practice environments, provide financial incentives, and recognize professional status. Proactive decision-making may avert RN disillusionment and avoid other negative consequences that impact quality of care.