Nursing Practice Environment Research Articles

Decision fatigue among clinical nurses during the COVID-19 pandemic.

Aims and objectivesThe purpose of this study was to report the psychometric properties, including validity and reliability, of the decision fatigue scale (DFS).BackgroundDecision fatigue may impair nurses’ ability to make sound clinical decisions and negatively impact patient care. Given the negative impact of the COVID‐19 pandemic on psychological well‐being and the workplace environment, decision fatigue may be even more apparent among clinical nurses. Valid assessment of this condition among clinical nurses may inform supportive interventions to mitigate the negative sequelae associated with states of decision fatigue.DesignThis study was a secondary analysis of a parent study using a cross‐sectional descriptive design.MethodsA convenience sample of 160 staff nurses was recruited online from across the United States. Participants completed a demographic questionnaire and subjective measures of decision fatigue, nursing practice environment scale and traumatic stress. Exploratory factor analysis (EFA), correlation coefficients and internal consistency reliability coefficients were computed to examine the DFS’s validity and reliability within this sample.ResultsThe EFA yielded a single factor, 9‐item version of the DFS. The DFS scores were strongly correlated with traumatic stress and moderately correlated with the nursing practice environment, and the scale displayed appropriate internal consistency.ConclusionsThis is the first known study to provide evidence of the DFS’s validity and reliability in a sample of registered nurses working during the COVID‐19 pandemic. The results of this study provide evidence of a reliable and valid assessment instrument for decision fatigue that can be used to measure the burden of decision‐making among registered nurses.Relevance to clinical practiceGiven the relationship between traumatic stress and the nursing work environment, decision fatigue may be a modifiable target for interventions that can enhance the quality of decision‐making among clinical nurses.

Registered nurses\u2019 role experiences of caring for older stroke patients: a qualitative study

BackgroundWith China’s population ageing rapidly, stroke is becoming one of the major public health problems. Nurses are indispensable for caring for older patients with acute and convalescent stroke, and their working experiences are directly linked to the quality of care provided. The study aims to investigate registered nurses’ experiences of caring for older stroke patients.MethodsA qualitative descriptive design was adopted. Data were collected via semi-structured interviews with 26 registered nurses about their lived experiences of caring for older stroke patients. Thematic analysis was used to analyze the data.ResultsTwo main themes were identified. First, the nurses identified an obvious gap between their ideal role in elderly care and their actual practice. The unsatisfactory reality was linked to the practical difficulties they encountered in their working environment. Second, the nurses expressed conflicting feelings about caring for older stroke patients, displaying a sense of accomplishment, indifference, annoyance, and sympathy. Caring for older stroke patients also affects nurses psychologically and physically. The nurses were clear about their own roles and tried their best to meet the elderly people’s needs, yet they lack time and knowledge about caring for older stroke patients. The factors influencing their working experiences extend beyond the personal domain and are linked to the wider working environment.ConclusionsSustaining the nursing workforce and improving their working experiences are essential to meet the care needs of older people. Understanding nurses’ lived working experiences is the first step. At the individual level, nurse mangers should promote empathy, relieve anxiety about aging, and improve the job satisfaction and morale of nurses. At the institutional level, policymakers should make efforts to improve the nursing clinical practice environment, increase the geriatric nursing education and training, achieve a proper skill mix of the health workforce, and overall attract, prepare and sustain nurses regarding caring for older people in a rapidly aging society.

Relation between Magnet Forces and Nursing Practice Environment at Suez Canal University Hospitals

Relation between Magnet Forces and Nursing Practice Environment at Suez Canal University Hospitals

Nursing Practice Environment in Psychiatric Units: A Scoping Review.

The practice environment is a key element that influences the quality of psychiatric-mental health nursing care; however, little is known about it. For the current study, to explore the evidence on environmental factors influencing nursing practice in psychiatric inpatient units, a scoping review of primary research published between 2009 and 2019 was performed. PubMed, Web of Science, Scopus, and CINAHL databases were searched. Eleven articles were included. Main findings were: (a) the biomedical approach limits the development of the nursing model; (b) lack of opportunities, representation, and recognition of nurses in the organization; (c) greater support from managers for a greater perception of nurses' competence and therapeutic commitment; and (d) the need for a feeling of belonging to the team and the perception of emotional exhaustion, workload, and administrative tasks. Although psychiatric nurses have a slightly positive view of their practice environment, certain factors limit quality of care. The current review points to the need for nurses to have greater organizational support and the importance of promoting effective teamwork. Implications for mental health services include the need for support and recognition by managers, as well as the existence of a nursing model within the units. [Journal of Psychosocial Nursing and Mental Health Services, 59(11), 33-40.].

An Experience Developing Nursing Excellence Using the ANCC Magnet Recognition Program®

The American Nurses Credentialing Center (ANCC) manages Magnet Recognition Program® certification. Candidates for this certification are required to pass a review comprising six compulsory documents and 84 sets of written documents in five model components as well as an onsite appraisal. The Magnet Recognition Program® for medical institutes is currently regarded as the highest honor in the nursing field. The series of measures necessary to establish a Magnet-recognized hospital is described in this article. Our hospital began preparation for recognition in January 2016, with the application submitted in May 2017. The required measures include establishing a Professional Practice Model, Governance Council, and National Database of Nursing Quality Indicators as well as implementing a mentoring plan. ANCC approved Magnet Recognition Program® recognition for our hospital in May 2020, making ours the first Magnet-recognized hospital in Taiwan. The nursing staff shared their experiences on their Magnet journey. Magnet-recognition demonstrates that a hospital is adequately equipped and trained to provide patients with outstanding nursing care and to operate an excellent nursing practice environment.

Nurses' ehealth literacy and associations with the nursing practice environment.

To report on ehealth literacy levels in nurses and to explore its associations with the nursing practice environment. Nurses increasingly use the Internet and associated technologies to seek health-relevant information and manage their health. High ehealth literacy is a predictor of better health outcomes in diverse populations but its levels and work-related determinants have not been adequately explored in direct-care nurses. The sample for this cross-sectional study consisted of 200 staff nurses and nursing assistants in Greece. Participants reported during February-March 2019 their sociodemographic and work-related characteristics on a self-administered questionnaire which included the "electronic Health Literacy Scale"-eHEALS, and the "Practice Environment Scale of the Nursing Work Index"-PES-NWI. Crude and adjusted logistic regressions were performed. In adjusted models, participants that scored higher on the "Collegial nurse-physician relationships" and "Nurse participation in hospital affairs" dimensions of the clinical environment had higher odds of reporting better ehealth literacy. The lowest item score in eHEALS was related to not being able to make health decisions using Internet information. Nurses' ehealth literacy was positively associated with some dimensions of the hospital practice environment. Nurses reported higher ehealth literacy scores in comparison to other studies; however, they were not confident in distinguishing reliable health information from Internet sources. This is quite alarming because it can directly impair the ability of nurses to provide relevant and up-to-date evidence-based care. This is the first study to report internationally on the positive associations of a good working environment with nurses' ehealth literacy levels. Nursing policy should address the ehealth literary of nurses and integrate it into continuing professional education initiatives. Special focus should be put on nurses' ambiguity in distinguishing which ehealth information is reliable and can guide nursing practice. This should be combined with efforts to improve the nursing clinical environment and increase nurses' participation in hospital decisions.

Association of Nursing Practice Environment on reported adverse events in private management hospitals: A cross-sectional study.

To examine the relationships between nurses' perceptions of their practice environment, other working conditions and reported adverse events in two private management hospitals. Patient safety is influenced by knowledge, available resources and the context in which nursing care is provided. In this sense, it has been found that certain work environments (e.g., workload, nurse turnover level, patient-to-nurse ratio, nurse staffing, nurse manager ability) influence patient outcomes. The association between nursing practice environment and reported adverse events has not been explored in private management hospitals. A cross-sectional study. The STROBE was selected as the checklist in this study. A total of 219 nurses were included in the study. This study was conducted from June 2018-June 2019 in Spain. Data were collected through questionnaires focusing on work conditions, reported adverse events (falls, medication errors, catheter-related sepsis and pressure ulcer) and Practice Environment Scale of the Nursing Work Index. Binary logistic regression analysis was performed to determine the factors influencing the occurrence of errors. Nurses reported poor perception of the professional environment, and 62.1% reported having made at least one error in the previous year. Manager support and leadership and nurse-physician relations were the most favourable aspects of work environment. Medical-surgical units, rotating in the same shift and favourable work environment, were associated with more reporting of adverse events. The factors of nursing practice (hospital area workload, staff rotating and perception of work environment) associated with reporting adverse events can be worked upon from the organisation and provided an opportunity for safety culture improvement and safer healthcare services. Improving the nurse work environment may reduce adverse patient events in private management hospitals.

Relationships among Nursing Practice Environment and Turnover Intention of Hospital Nurses: The Mediating Effect of The Work-Life Balance

Relationships among Nursing Practice Environment and Turnover Intention of Hospital Nurses: The Mediating Effect of The Work-Life Balance

Work environment and quality of nursing care in primary health care: a scoping review

Introduction The nursing practice environment (NPE) has been analysed and is now recognised as a variable that influences the results of nursing care, since the promotion of favourable environments is fundamental to the quality of care optimisation [1]. The development and implementation of a positive NPE in primary health care (PHC) improve nurses’ well-being, influence nursing satisfaction, reduce nurses’ intention to leave, improve nursing care outcomes and patient care quality [2]. Investigating the characteristics of the NPE and the quality of care in PHC has become a priority. The aim was to map and analyse the scientific evidence on the NPE and the quality of nursing care (QNC) in PHC. Materials and Methods We conducted a scoping review, according to Joanna Briggs Institute’s approach [3]. A three‐step search was carried out: (a) keywords search within MEDLINE and CINAHL; (b) keywords search within COCHRANE, PSYCOLOGY AND BEHAVIOUR SCIENCES, and COLLECTION B-ON; (c) literature search of references lists to identify additional studies. From published literature in English and Portuguese, with no date restrictions, we selected articles considered eligible to study the NPE and QNC in the context of PHC. A qualitative content analysis was performed. Results We retrieved 289 records and selected 12 papers, including quantitative and qualitative studies. Our analysis revealed that positive NPE improves nurses’ satisfaction and, consequently, improves QNC. Additionally, some characteristics of the NPE should be improved, such as the participation of nurses in management decisions, leadership, education, guidance, support and recognition of the work developed by nurses. Autonomy, control over the environment and collaboration between health professionals and managers improve teamwork and QNC. Discussion and Conclusions A positive NPE culture in PHC is highlighted as one of the key factors for the satisfaction, retention and recruitment of nurses and is associated with the improvement of the QNC. Concurrently, the development of a teaching-learning culture between managers and the nursing team develops and improves professional skills, with the consequent improvement of nursing practices.

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

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

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

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

Investigation and analysis of the practice environment of clinical nurses in a grade-A tertiary hospital of integrated traditional Chinese and western medicine

Investigation and analysis of the practice environment of clinical nurses in a grade-A tertiary hospital of integrated traditional Chinese and western medicine

병원간호사의 공감만족, 공감피로, 간호근무환경이 직무착근도에 미치는 영향

병원간호사의 공감만족, 공감피로, 간호근무환경이 직무착근도에 미치는 영향

Leadership, adequate staffing and material resources, and collegial nurse-physician relationships promote better patients, professionals and institutions outcomes.

To test a theoretical model aiming to understand which characteristics of the professional nursing practice environment most affect patients, professionals and institution outcomes. A cross-sectional and correlational study, using a structural equation model. One thousand seven hundred and seventy-three staff nurses were recruited using convenience sampling in five Brazilian hospitals from November 2017 to July 2018. Structural equation modelling was used to assess the relationship between the characteristics of the nursing work environment and patients (climate of safety and quality of care), nursing professionals (job satisfaction and emotional exhaustion) and institutions (intention to leave the job) outcomes. The model was tested using the partial least squares method, considering the bootstrapping technique to estimate the results. The path coefficients and their respective 95% confidence intervals were calculated. The quality of fit of the structural model was assessed by calculating the coefficient of determination (R2 ), the predictive validity coefficient (Q2 ) and the effect size (f2 ). The characteristics that most affected the outcomes for patients were Nurse manager ability, leadership and support of nurses (λ=0.27), and Staffing and resource adequacy (λ=0.26); for nursing professionals, Staffing and resource adequacy (λ=-0.19), and Collegial nurse-physician relations (λ=0.19); and for institutions, Nurse manager ability, leadership and support of nurses (λ=-0.10), and Collegial nurse-physician relations (λ=-0.10). The characteristics of the professional nursing practice environment that most contribute to achieving better outcomes include nurse manager ability, leadership and support of nurses, staffing and resource adequacy, and collegial nurse-physician relations. This study allowed us to assess which strategies should be prioritized in the professional nursing practice environment to achieve better results. Thus, investment in the training of leadership, in the adequacy of resources, and in physician-nurse relations will bring better results for patients, nursing professionals, and institutions.

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

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

Predictors of professional quality of life among nurses–A cross sectional study

A good practice environment is a vital aspect of the staffing and retention of health care workers, especially of nurses affecting patient care. This study investigates the predictors of nurses’ Professional Quality of Life working in public hospitals and private hospitals. A cross-sectional design was utilized, including 374 nurses conveniently sampling selected in two public hospitals and two private hospitals in the Philippines using a Practice Environment Scale of the Nursing Work Index and Professional Quality of Life scale having a good psychometric property, respectively. The overall mean score for practice environment for Nurses is at a low level, whereas the mean Professional Quality of Life score was at a moderate level. Age is significantly associated with the burnout subscale (r=-0.119, p<0.021) and with secondary traumatic stress (r=-0.193, p<0.001). Monthly salary is significantly associated with the compassion satisfaction subscale (r=-0.140, p=0.007) and STS (r=0.107, p=0.038). Meanwhile, the working hours' figure is significantly associated with compassion satisfaction subscale (r=-0.133, p=0.010). Finally, the practice environment of nurses shown is significantly associated with compassion satisfaction subscale (r=-0.426, p=0.007) and secondary traumatic stress (r=0.524, p<0.001). Filipino nurses have a lower practice environment and moderate professional quality of life. The predictors of the professional quality of life of nurses were age, monthly salary, working hours, and their practice environment. Specifically, the higher the salary and the shorter the working hours, the better their professional quality of life. Additionally, the poorer the practice environment, the lower the professional quality of life.

Investigation and analysis of the practice environment of clinical nurses in a grade-A tertiary hospital of integrated traditional Chinese and western medicine

Investigation and analysis of the practice environment of clinical nurses in a grade-A tertiary hospital of integrated traditional Chinese and western medicine

Diversity, Equity, and Inclusion: A Call to Action.

The year 2020 has been one of challenges and change. Nursing professional development practitioners are being called to action to purposefully address diversity, equity, and inclusion (DE&I). This article provides insight into how practitioners and administrators can work to create an environment of DE&I that starts with awareness and culminates in creating a nursing workforce and practice environment that reflects the values and beliefs of our profession. [J Contin Educ Nurs. 2021;52(2):57-60.].

Rationing of Nursing Care and its Relationship to Nurse Practice Environment in a Tertiary Public Hospital

Objectives. The purpose of the study is to determine the level of rationing of nursing care and its relationship to nurses’ perception of their practice environment. Methods. The study employed a descriptive, cross-sectional study design. The Basel Extent of Rationing of Nursing Care (BERNCA) was administered to assess the level of care rationing while the Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to describe nurses’ practice environment. A total of 147 nurses participated in the study. Multiple regression analysis was conducted to determine the effect of various respondent characteristics and nurse practice environment on care rationing. Results. Only practice environment total score was significantly associated with rationing of care total scores (B = -0.20, p < 0.05). Results of the regression show that for every unit increase in nurse practice environment total score, indicating a better work environment, there is a 0.20 unit decrease in rationing of nursing care total score, which indicated less rationing of care. Respondent characteristics are not significantly related. Conclusion. Nurses most frequently rationed tasks in the areas of caring/support and monitoring. The less frequently rationed tasks involved medical, technical, and therapeutic aspects of care. The identification of rationing predictors can aid in determining starting points for hospital policy reforms. Prevalence levels can indicate when care rationing exceeds identified thresholds, if any. Nursing administrators can use implicit rationing of nursing care as a crucial indicator of the impact of strategies and changes in the nurse practice environment (e.g., changes in staffing levels, skill mix, and other resources).

Nursing Practice Environment and the Nurse Manager Intervention: Critical Review

The Nursing Practice Environment (NPE) influences the quality of nursing care. Studies show far better outcomes for clients, with positive results on nursing teams’ satisfaction and patients with improvements in the outcomes of patients and healthcare organizations. The Practice Environment Scale-Nursing Work Index (PES-NWI) is an instrument that measures the nursing practice environment and is currently the most used at a global scale. The analyzed article proves the instrumentsreliability in the assessment of the NPE, despite needing further investigation at a psychometric level; and its applicability in different care settings – Other countries besides the US. However, it is emphasized the need to carry out further experimental and longitudinal studies to potentially identify the mechanisms that influence the NPE.