Nursing Practice Environment Research Articles

Perception of the professional nursing environment in Primary Care in the Valencian Community, in departments with public and private management

Nursing practice environments (NPE) improve the quality of care, satisfaction and heath results; there are no studies that compare the Primary Health Care (PHC) environments according to their management model. Our aim is to estimate and compare the perception of the quality of the NPE in the PHC in Health Departments (HD) of the Valencian Community (Spain) with management model public or indirect-private (Administrative concession). Transversal study on PHC nurses from three HD, one with direct public management and two with indirect-private management. The Practice Environment Scale-Nursing Work Index questionnaire, validated in Spain, was administered. Sociodemographic and professional variables were recorded. Variables related to test score were analyzed by multiple linear regression. Two hundred and sixty-nine answers (80.3%). All HD perceived NPE quality in a positive way, both globally and for the different dimensions (except D4). Indirect private management model HD obtained higher global scores, the same tendency was observed for D1 and D2, and the opposite for D4. Global score was related to age, professional experience, being a coordinator and management model; only the age of the nurses and being a coordinator showed a significant relationship with the score in the multivariate regression model. The NPE of the PHC of the Valencian Community are of good quality, without significant differences according to different management models of the HD. Being a coordinator and, particularly, the age of the nurses are variables that are independently related to the global score obtained.

Quality and safety of the nurse practice environment: Implications for management commitment to a culture of safety.

The Philippines experiences several challenges pertaining to the quality of the practice environment (PE) and nursing quality safety (NQS) among nurses. Although there is already considerable empirical data on PE effects on NQS, there is still little overall information on the association between these variables. This survey study examined the contribution of nurses' perceptions of their PE on their perception of their PE's quality of safety among hospital nurses in the Philippines. This survey was conducted in two government hospitals and two private hospitals in the Philippines. A total of 374 nurses selected from two selected government hospitals and two private hospitals in the Philippines using a convenience sample technique. Data were collected using a self-administered questionnaire focusing on the PE and NQS among nurses. The overall PE mean score of nurses is 3.07 (SD = 0.159) while the overall mean score of their NQS is 3.97 (SD = 0.702). NQS was higher in female nurses compared with male nurses (M = 2404 vs 4.16). Nurses assigned to emergency departments (F = 1.04, [df = 11], and P = .025) presented higher perceived NQS compared with those in other departments. Nurses report moderate PE and higher NQS. Sex and emergency room department are significantly associated with NQS. Health care services have an obligation to ensure strong PE, as an important factor in regard to nursing management and affecting the QNS.

A Special Message to Students and Graduates About Publishing in a Journal

The Journal of Excellence in Nursing and Healthcare Practice (JENHP) was created to promote innovations, translation, and dissemination of evidence supporting improved outcomes in the nursing practice environment. The journal welcomes manuscripts focusing on topics such as national and international workforce issues, quality improvement projects, evidenced-based practice initiatives, nursing research studies, interprofessional practice, educational issues, improvements in technology, innovative practice problem solutions, and the impact of social change in society. Although we accept submissions from all types of researchers, both new and experienced, one central purpose of this journal is to provide an outlet for research conducted by students. Hence, individuals from doctoral, master’s, and baccalaureate programs are especially welcomed to submit manuscripts based on scholarly projects or papers completed while in or after graduating from an accredited program.

Greek hospital environments

PurposeThe purpose of this paper is three-fold: first, to assess nurse satisfaction levels with working environment (known as favourability) in five Greek public hospitals using the practice environment scale (PES); second, to compare perceptions among nurses employed in surgical and medical departments; and third, to examine relationships between perceptions and nurse educational level and experience.Design/methodology/approachIn total, 532 nurses from five major public hospitals in Greece completed the PES. Descriptive statistics, t-tests and Spearman correlations were employed to analyse the data.FindingsNurses perceived their work settings as unfavourable in all five hospitals, with collegial nurse–physician relations emerging as the only positive factor. Compared to medical wards, surgical departments emerged as slightly more positive working environments. Work department notwithstanding, in some cases, education and experience levels affected their perceptions on management, poor care quality, limited nurse involvement in hospital affairs and nursing shortage.Practical implicationsHospital managers do not provide sufficient support for Greek nurses in their working environments.Originality/valueThe authors attempted to evaluate nursing practice environments in Greek hospitals, viewed from nurse perspectives. The authors identified insufficient support for nurses’ working in these hospitals.

The nursing practice environment and nurses’ satisfaction in the obstetrics hospital context: a scoping review

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].

Nurse Decision Making in Acute Care.

Effective nurse decision making is essential for best patient outcomes in the acute care nurse practice environment. The purpose of this study was to explore acute care RNs' perceptions of clinical decision making for a patient who experienced a clinical event. Clinical events include changes in patient condition and are manifested by fever, pain, bleeding, changes in output, changes in respiratory status, and changes in level of consciousness. Naturalistic decision making framework supported the exploration of important contextual factors associated with decision making, provided new information for nursing science, and served as the conceptual framework for this research. Data collected from interviews of 20 acute care nurses were analyzed using qualitative content analysis. The emergent categories included Awareness of Patient Status, Experience and Decision Making, Following Established Routine, Time Pressure, Teamwork/Support From Staff, Goals, Education, Resources, Patient Education, Consideration of Options to Meet Goals, and Nursing Roles. Acute care nurses incorporated a wide variety of complex factors when decision making. This study sought to improve understanding of the factors nurses found important to their decision making for the potential development of improved decision support in the electronic health record.

Impact of Coping Strategies on Nurses' Well-Being and Practice.

To examine the mechanisms of coping strategies on nurses' psychological well-being, practice environments and safety attitudes. A cross-sectional study design was used. Structural equation modeling was performed to analyze the results. Five hundred clinical nurses were randomly selected from a large group of 1,500 from a medical center with 1,350 beds in Taipei, Taiwan, from July to October 2015. Self-report questionnaires were administered to measure coping strategies (Brief COPE), psychological well-being (Ryff's Psychological Well-being Scale), nurses' practice environments (Practice Environment Scale of the Nursing Work Index), and safety attitudes (Safety Attitudes Questionnaire). Of the 500 participants who gave written consent, 474 (94.8%) filled out the questionnaire. Results showed that using more approach-oriented coping strategies and fewer avoidant coping strategies was associated with greater psychological well-being. Psychological well-being was directly associated with quality of nurses' practice environments and safety attitudes. The impact of psychological well-being on safety attitudes was mediated significantly by the quality of the practice environment. The use of approach-oriented coping strategies was significantly predictive of positive psychological well-being, a good practice environment, and good safety attitudes. This study found a distinct pathway for the relationships between clinical nurses' psychological well-being, practice environment, and safety attitudes. Psychological well-being in clinical nurses was higher for those with more approach-oriented coping strategies. Psychological well-being directly impacted safety attitudes, which mediated nurses' practice environments. The practical implications of the results suggest that interventions designed to promote positive psychological well-being may help improve nurses' practice environments, which, in turn, may result in better safety attitudes and nursing care outcomes.

Factors predicting quality of nursing care among nurses in tertiary care hospitals in Mongolia

An increasing nursing shortage, high workloads and poor working environments are affecting the quality of nursing care in many countries including Mongolia. To explore the level of quality of nursing care, nursing competency and nursing practice environment, as well as the predictability of nurses' personal factors, nursing competency and nursing practice environment on quality of nursing care as perceived by nurses in Mongolia. We collected data from 346 registered nurses, randomly selected and working in seven general public tertiary care hospitals in the capital city of Ulaanbaatar, and four regions of Mongolia. Instruments used were the Good Nursing Care Scale, the Competency Inventory for Registered Nurses and the Practice Environment Scale of Nursing Work Index. Data were analysed using descriptive statistics and multiple regression analysis. The overall quality of nursing care and nursing competency was perceived to be at a high level, whereas nursing practice environment was at a favourable level. Nursing competency and nursing practice environment were found as significant predictors of nursing care quality, while personal factors were found as non-significant predictors. Improving nursing competency and practice environment enhances the quality of nursing care. However, a study limitation is that self-reporting may not have reflected the accuracy of variables. Findings provide important evidence for the use of measures and strategies to enhance the quality of nursing care by improving nursing competency and the nursing practice environment. Policymakers, administrators and nurses need to work together to develop and implement policies to enhance and support the competency and practice environments of the Mongolian nurses.

Student nurses' career motivation toward gerontological nursing: A longitudinal study

BackgroundThe intensity of student nurses' motivation toward a certain career can influence their behaviors for career choice and decision making. However, little is known about the career motivation among student nurses toward gerontological nursing and their influencing factors. ObjectivesThe objectives of this study were to examine student nurses' career motivation toward gerontological nursing and to explore potential predictors using Bandura's reciprocal determinism. DesignA longitudinal design was used in this study. Settings and participantsA total of 305 student nurses were recruited from six hospitals in Shandong province, and they completed the questionnaires over three stages. MethodsStudent nurses' career motivation toward gerontological nursing, geriatrics attitudes, aging anxiety, empathy, and clinical practice environment were measured using the motivation questionnaire, the Geriatrics Attitudes Scale, the Anxiety about Aging Scale, the Interpersonal Reactivity Index, and the clinical practice environment questionnaire, respectively. Measurements were performed at the first month, fourth month, and seventh month of student nurses' clinical practice. A series of Pearson correlation, multiple linear regression, and generalized estimating equations were applied to analyze the data. ResultsAmong 305 student nurses, the mean scores for career motivation toward gerontological nursing over three stages were 66.11 (SD = 8.98), 67.55 (SD = 8.53) and 66.78 (SD = 9.51), sequentially. There were significant differences in scores for career motivation over time (P < 0.05) and the lowest score was observed at the first month. Geriatric attitudes, aging anxiety, empathy, clinical practice environment and stage of clinical practice were notable predictors of student nurses' career motivation toward gerontological nursing. ConclusionsStudent nurses' career motivation toward gerontological nursing needs to be improved, especially at the first month of clinical practice. Targeted interventions should cultivate positive geriatric attitudes, relieve anxiety about aging, promote empathy, and enrich the clinical practice environment to improve student nurses' career motivation toward gerontological nursing.

Best organizational practices that foster scholarly nursing practice in Magnet® hospitals.

For nurses to become leaders in the transformation of the future health care delivery system, they need organizational support to develop a scholarly nursing practice across a full career trajectory. The purpose of this qualitative study was to describe best organizational practices that support the development and growth of a scholarly nursing practice throughout a nurse's full career progression. Thirty-two senior nurse leaders from American Nurses Credentialing Corporation Magnet® hospitals were interviewed. Questions focused on strategies used in the workplace to support nurses' growth and development of a scholarly nursing practice. Content analysis was used to analyze data. The following themes emerged: The Organization Creates and Sustains a Core Culture Supportive of Scholarly Nursing Practice; Expectations for Professional Development; Resources that Support Scholarly Nursing Practice; and Power of the Senior Nurse Leader. Nursing culture in the institutions led by our participants had a significant and influential impact on the overall organizational culture. A nursing culture that embraces a scholarly nursing practice environment is one that is tightly integrated with an overall institutional culture that supports nursing. Senior nurse leaders were the driving force behind the development of a culture that supports scholarly nursing practice.

Sharon Pappas, PhD, RN, NEA-BC, FAAN

Sharon Pappas, PhD, RN, NEA-BC, FAAN (seated, center), is chief of the Nurse Executive Team for Emory Healthcare in Atlanta, Georgia.

Practice Environment Scale of the Nursing Work Index: A Reliability Generalization Meta-Analysis

A healthy work environment is a critical factor in nurse satisfaction, retention, and patient outcomes. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the most commonly used instrument to measure the nursing practice environment. This study uses meta-analysis to examine the reliability generalization of the PES-NWI. A meta-analysis of 51 studies representing a total of 80,563 subjects was conducted. The mean score reliability for the PES-NWI based on 38 studies (n = 68,278) was .922 (p < .05). The Mean Weighted Effect Size was stronger for studies conducted in the United States versus non-U.S. (.946 vs. .907). For studies rated high and moderate quality, the mean score reliability was .911 and .946, respectively. Scores on the PES-NWI are reliable for measuring the nursing practice environment across samples in the United States and non-U.S. countries.

Bullying in the nursing work environment: integrative review.

To evaluate the studies that approach bullying in the nursing practice environment. Integrative review, conducted between April and December 2018, by combining the descriptors "bullying/bullying" AND "nursing/nursing/nurse" AND "workplace/workplace". We identified 224 studies of which 38 met the inclusion criteria. The studies on nursing bullying presented three main approaches related to the prevalence in nursing practice, the repercussions for health and professional development, and the construction of theoretical models for bullying and nursing work environment variables. Bullying is a negative behavior present in the nursing practice environment and has a direct impact on professional performance, impairing general health and professional performance. Despite being a behavior with recognized negative potential in the work environment, few studies propose effective actions to prevent or control this phenomenon in health institutions.

The effect of job satisfaction, absenteeism, and personal motivation on job quitting: A survey of Croatian nurses

Previous studies point to many inconsistencies regarding the determinants of job quitting. This study focuses on the impact of nurses’ job satisfaction, work motivation, nursing practice environment, personal characteristics and absenteeism on their intention to leave the job. An anonymous survey was performed on a sample of Croatian registered nurses. The results indicate that nurses’ job dissatisfaction, combined with a higher rate of absenteeism, represents a clear indication of their future turnovers. Nursing practice environment and personal motivation do not have a significant direct effect on the Intention to leave the job, but do have an indirect one through job satisfaction.

Effects of critical thinking and nursing practice environment on clinical decision making among nurses

Effects of critical thinking and nursing practice environment on clinical decision making among nurses

The Effects of Nursing Practice Environment and Peer Group Caring Interaction on Retention Intention among Small and Medium-sized Hospital Nurses

The Effects of Nursing Practice Environment and Peer Group Caring Interaction on Retention Intention among Small and Medium-sized Hospital Nurses

Effect of a Nursing Practice Environment on Nursing Job Performance and Organizational Commitment: Focused on the Mediating Effects of Job Embeddedness

Effect of a Nursing Practice Environment on Nursing Job Performance and Organizational Commitment: Focused on the Mediating Effects of Job Embeddedness

Effects of Compassion Competence, Professional Self-concept, and Nursing Practice Environment on Caring Behaviors of Clinical Nurses in a Tertiary Hospital

Effects of Compassion Competence, Professional Self-concept, and Nursing Practice Environment on Caring Behaviors of Clinical Nurses in a Tertiary Hospital

Correlation between voice behavior and nursing practice environment among nurses

Objective To explore the influence of voice behavior of nurses on nursing practice environment so as to provide a reference for clinical nursing managers to improve nursing practice environment. Methods From January to May 2017, we selected 300 nurses from three ClassⅢ Grade B hospitals in Ningbo City as subjects by convenience sampling. The questionnaire survey was carried out with the Voice Behavior Scale (VBS) and the Practice Environment Scale of the Nursing Work Index (PES-NWI) to understand the status of nurses' voice behavior and nursing practice environment and to explore the correlation between them. A total of 300 questionnaires were sent out and 292 valid questionnaires were collected with 97.3% for the recovery rate. Results Among 292 nurses, the total score of PES-NWI was (76.67±13.34) . Nurses' voice behavior had a positive correlation with the nursing practice environment (r=0.328, P<0.01) . Hierarchical regression analysis showed the main influencing factors of nursing practice environment of nursing included promotive voice behavior and prohibitive voice behavior after controlling demographic variables. Conclusions The voice behavior of nurses remains to be improved and has preferences. Clinical managers should formulate targeted intervention according to the deficiencies of nurses' voice behavior to improve nursing practice environment. Key words: Nurses; Voice behavior; Nursing practice environment

Quality of End-of-Life Care and Its Association with Nurse Practice Environments in U.S. Hospitals.

The purpose of this study is twofold: (1) to describe the quality of end-of-life care in US hospitals from the perspective of hospital nurses; and (2) to evaluate the relationship between the nurse practice environment and end-of-life care quality. Cross-sectional analysis of multiple linked secondary data sources. A total of 12,870 direct care registered nurses in 491 acute-care hospitals. Measures of end-of-life care quality and nurse practice environment were derived from the 2016 RN4CAST-US survey of nurses. Nurses reported on end-of-life care quality for patients for whom death within a year would not be surprising. Nurse practice environment was measured using the Practice Environment Scale of the Nursing Work Index, a National Quality Forum validated scale. Most nurses gave their hospitals an unfavorable evaluation of end-of-life care overall (58%) and said patients often experience painful procedures that were unlikely to change their outcome (53%). The best predictor of poor quality was the nurse practice environment. Nurses in the best environments were 55% less likely than nurses in poor environments to rate their hospital's overall end-of-life care quality unfavorably (odds ratio = 0.45; 95% confidence interval = 0.39-0.52; P < .001). Quality of end-of-life care in US hospitals is imperfect and is significantly worse in hospitals with poor nurse practice environments than in hospitals with the best environments. This study reinforces the importance of nurses in providing high-quality end-of-life care. J Am Geriatr Soc 67:302-308, 2019.