Positive Practice Environment Research Articles

Nurse perceptions of practice environment, quality of care and patient safety across four hospital levels within the public health sector of South Africa

Improving the practice environment, quality of care and patient safety are global health priorities. In South Africa, quality of care and patient safety are among the top goals of the National Department of Health; nevertheless, empirical data regarding the condition of the nursing practice environment, quality of care and patient safety in public hospitals is lacking.AimThis study examined nurses’ perceptions of the practice environment, quality of care and patient safety across four hospital levels (central, tertiary, provincial and district) within the public health sector of South Africa.MethodsThis was a cross-sectional survey design. We used multi-phase sampling to recruit all categories of nursing staff from central (n = 408), tertiary (n = 254), provincial (n = 401) and district (n = 244 [large n = 81; medium n = 83 and small n = 80]) public hospitals in all nine provinces of South Africa. After ethical approval, a self-reported questionnaire with subscales on the practice environment, quality of care and patient safety was administered. Data was collected from April 2021 to June 2022, with a response rate of 43.1%. ANOVA type Hierarchical Linear Modelling (HLM) was used to present the differences in nurses’ perceptions across four hospital levels.ResultsNurses rated the overall practice environment as poor (M = 2.46; SD = 0.65), especially with regard to the subscales of nurse participation in hospital affairs (M = 2.22; SD = 0.76), staffing and resource adequacy (M = 2.23; SD = 0.80), and nurse leadership, management, and support of nurses (M = 2.39; SD = 0.81). One-fifth (19.59%; n = 248) of nurses rated the overall grade of patient safety in their units as poor or failing, and more than one third (38.45%; n = 486) reported that the quality of care delivered to patient was fair or poor. Statistical and practical significant results indicated that central hospitals most often presented more positive perceptions of the practice environment, quality of care and patient safety, while small district hospitals often presented the most negative. The practice environment was most highly correlated with quality of care and patient safety outcomes.ConclusionThere is a need to strengthen compliance with existing policies that enhance quality of care and patient safety. This includes the need to create positive practice environments in all public hospitals, but with an increased focus on smaller hospital settings.

Strategies and Interventions to Support Quality Outcomes in the Home Care Setting: A Longitudinal Multilevel Study.

The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations. This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization. A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021). In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round. The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.

Personnel perceptions of a positive practice environment in public nursing education institutions in South Africa: A descriptive qualitative study

BackgroundWhile much is known about aspects of the practice environment and its influence on staff outcomes and quality of education, less is known about creating positive practice environments in public nursing education institutions, especially in developing countries. AimTo describe the perceptions of the personnel of a public nursing education institution identified as having the most positive practice environment and nurse educator outcomes. DesignA qualitative descriptive research design was used. MethodsAll-inclusive voluntary sampling was applied at one public nursing education institution in the Gauteng Province with the principal, vice-principal, heads of departments (N = 11; n = 6), nurse educators (N = 93; n = 17), and administrative staff (N = 42; n = 11). Semi-structured individual and focus group interviews were conducted and inductive thematic analysis was used. Data was collected from November 2019 until March 2020. ResultsPersonnel indicated interpersonal relationships, effective communication and enhancing team dynamics as the main theme of the study, with seven specific sub-themes as raised by managers, nurse educators and administrative staff. ConclusionInterpersonal relationships, communication and enhancing team dynamics is the main drive for a positive practice environment. The most significant responsibility in creating such an environment is the managers' ability to lead and support personnel. In addition to intentionally fostering collegial and collaborative relationships, managers need to be approachable. In addition to upholding fundamental human rights values and fostering active participation in decision-making, managers should exercise sensitive leadership. and encourage staff wellness support measures. Twitter abstractInterpersonal relationships, effective communication and enhancing team dynamics are the most crucial tactics for promoting positive practice environments at public nursing education institutions in a province of South Africa.

Transforming cultures from incivility and bullying to a positive practice environment: Narrowing the perception gap.

Transforming cultures from incivility and bullying to a positive practice environment: Narrowing the perception gap.

Factors impacting the selection of psychiatric hospitals for community service placement of nurses

Background. As a strategy to promote access to quality health services, including psychiatric nursing, compulsory community service for nurses wasintroduced in January 2008.Objective. To determine the factors impacting the KwaZulu-Natal College of Nursing (KZNCN) student nurses’ selection of psychiatric hospitals as theirplacement areas for community service.Methods. A quantitative, exploratory, descriptive research design was adopted. Convenience sampling was used to select 125 respondents from sixcampuses of KZNCN. An electronic 5-point Likert scale-based self-administered questionnaire was used to collect data. SPSS version 26 (IBM Corp.,USA) was used for data analysis.Results. The study found that the following factors impacted the selection of psychiatric hospitals for community service: insufficient time allocated forthe practice of psychiatry during training; fear of exposure to threat; poor infrastructure and scarce facilities; and insufficient danger allowance.Conclusion. A positive practice environment should be created in psychiatric hospitals to attract student nurses and retain them in the psychiatricenvironment after community service.

Compassion, collaboration, and community: Strategies for staff well-being.

Compassion, collaboration, and community: Strategies for staff well-being.

Experience of stigma and harassment among respondents to the 2019 Canadian abortion provider survey

ObjectiveWe conducted a national survey to assess the experiences of stigma and harassment among physicians and nurse practitioners providing abortions and abortion service administrators in Canada. Study designWe conducted an exploratory, cross-sectional, national, anonymized, online survey between July and December 2020. Subsections of the survey explored stigma and harassment experienced by respondents, including the 35-item Revised Abortion Providers Stigma Scale and open-ended responses. We analyzed the quantitative data to generate descriptive statistics and employed a reflexive thematic analysis to interpret open-ended responses. ResultsThree hundred fifty-four participants started the stigma and harassment section of the survey. Among low-volume clinicians (<30 abortions/year, 60%, n = 180) 8% reported harassment; 21% among higher volume clinicians (≥30 abortions/year, 40%, n = 119) and 47% among administrators (n = 39), most commonly picketing. The mean stigma score was 67.8 (standard deviation 17.2; maximum score 175). Our qualitative analysis identified five themes characterizing perceptions of stigma and harassment: concerns related to harassment from picketing, protestors, and the public; wanting protestor “bubble zones”; aiming to be anonymous to avoid being a target; not providing an abortion service; but also witnessing a safe and positive practice environment. ConclusionsBeing a low-volume clinician compared to higher volume clinician and administrator appears to be associated with less harassment. Clinicians providing abortion care in Canada reported mid-range abortion-related stigma scores, and expressed strong concerns that stigma interfered with their abortion provision. Our results indicate that further de-stigmatization and protection of abortion providers in Canada is needed through policy and practice interventions including bubble zones. ImplicationsWhile Canadian abortion care clinicians and administrators reported relatively low incidence of harassment, our results indicate that they are concerned about stigma and harassment. However, as this was an exploratory survey, these data may not be representative of all Canadian abortion providers. Our data identify a need to support abortion clinicians and to bolster protections for dedicated abortion services.

Blueprints for well-being: Modeling the way through Human-Centered Leadership and Pathway to Excellence.

Blueprints for well-being: Modeling the way through Human-Centered Leadership and Pathway to Excellence.

Establishing a Pathway to Excellence® Research Agenda: A Delphi Study to Identify Research Priorities for Evaluating Positive Practice Environments.

The aim of this study was to develop research priorities for positive practice environments identified by Pathway to Excellence® (Pathway) leaders and appraisers. Identifying research priorities achieves 2 goals: 1) advancing research agendas that impact improving practice environments, and nurse and patient outcomes; and 2) informing nursing leaders, researchers, and funders of potential research projects to conduct and support. Research topics related to the 6 Pathway standards were developed and then rated for importance through 3 rounds of a Delphi survey by leaders at Pathway-designated organizations and Pathway appraisers. Twenty research priorities were identified from the initial 54 research topics. The top 2 priorities were building and maintaining shared governance participation (91.9%) and nurse participation in performance improvement and evidence-based practice activities (90.7%). Establishing a Pathway research agenda will guide nursing leadership, researchers, and funders in selecting impactful research priorities to help bolster positive practice environments that engage and empower nurses.

Relationship among clinical practice environment, creative self-efficacy, achievement motivation, and innovative behavior in nursing students: A cross-sectional study

BackgroundInnovation is essential to advance nursing and health care. However, few studies have focused on innovative behavior of nursing students. ObjectivesThe purpose of this study was to explore the mediating effects of creative self-efficacy and achievement motivation on the relationship between clinical practice environment and innovative behavior in Bachelor of Science in Nursing (BSN) students. DesignA descriptive cross-sectional study using an online questionnaire. SettingParticipants were recruited online from five practice hospitals in Henan Province, China. ParticipantsA total of 588 BSN students enrolled in the study. MethodsThe participants completed the innovative behavior questionnaire, the clinical practice environment scale, the achievement motivation scale, and the creative self-efficacy scale online in 2022. SPSS PROCESS macro was used for data analysis. The reporting followed the STROBE checklist. ResultsA total of 499 valid questionnaires were collected. A positive clinical practice environment was associated with more innovative behavior, and this relation was partially mediated by creative self-efficacy and motive to avoid failure. ConclusionOur study complements the evidence on the mechanism of action between the clinical practice environment and innovative behavior. Our findings have important implications for nursing educators to develop education strategies to inspire nursing students to pursue innovations in school and clinical settings.

The Relationship Between Nursing Practice Environment and Innovative Behavior in the Al-Madinah Region, Saudi Arabia: A Descriptive Study.

Background and objective A positive and supportive practice environment is essential for inspiring innovation in nursing. Innovative behaviors (IBs) could motivate nurses to devise solutions in several domains, such as identifying and solving workplace problems, building new work methods, delivering their services efficiently and effectively, adopting new medical technology advancements, and leading the change process to face current challenges in healthcare. In this study, we aimed to investigate the relationship between the nursing practice environment (NPE) and IB in the Al-Madinah region of Saudi Arabia. Methods A quantitative, descriptive, cross-sectional correlational design was employed for the study. The convenience sample consisted of 330 bedside nurses working in five general hospitals in the Al-Madinah region who voluntarily completed a self-report questionnaire consisting of queries related to demographic and professional characteristics, the Practice Environment Scale of the Nursing Work Index (PES-NWI), and the Innovative Behavior Inventory (IBI). The collected data were analyzed using descriptive statistics and Pearson's correlation. Results Based on the study findings, the NPE was favorable. The overall PES-NWI mean score was 2.62 ± 0.50, and the mean scores of four of the five subscaleswere >2.50. The collegial nurse-physician relations subscale was perceived as the most favorable (2.87 ± 0.59), while staffing and resource adequacy was perceived as unfavorable (2.35 ± 0.65). The overallIBI mean score was 3.53 ± 0.56, indicating that nurses had a moderate level of agreement on IB. The highest mean score in IB was in the idea search domain (3.72 ± 0.77), while it was lowest in the implementation of starting activities domain (3.11 ± 0.86). Conclusions The correlation between the NPE and IB was positive and statistically significant. However, the correlation of the staffing and resources adequacy subscale in relation to subscales of idea search, overcoming obstacles, and innovation output did not reach statistical significance. Healthcare organizations should incorporate the principles of work innovation and healthy nursing work environments into their core values and enhance and nurture them through strategic management.

Enabling positive practice environments for women in science and education with FIPWiSE toolkit

Positive practice environments (PPEs) support the recruitment and retention of employees, enable the delivery of high-quality work outcomes, and benefit society as a whole. It is necessary to provide equal rights, obligations, equal treatment, and opportunities for all genders according to their needs to achieve gender equity and PPEs in workplaces. FIP developed the FIPWiSE (the FIP women in science and education initiative) toolkit for positive practice environments for women in science and education to support and enable them by building on the World Health Professional Alliances (WHPA) PPE campaign. FIP is a founding member of the WHPA and used the toolkit as a basis to describe and identify factors that enable PPEs from a pharmaceutical science and pharmacy education perspective. The toolkit provides a set of possible solutions related to women in science and education for individuals, employers, institutions, and policymakers, as well as real-life examples, perspectives, and good practice implementations and suggestions from women from all around the world.

Nurses suffering in silence: Addressing the stigma of mental health in nursing and healthcare.

Nurses suffering in silence: Addressing the stigma of mental health in nursing and healthcare.

The Organizational Climate for Nurse Practitioners Working in Primary Health Care in New Zealand: A National Survey

Little is known about the working conditions of nurse practitioners (NPs) in primary health care in New Zealand. Data were collected using an online organizational climate questionnaire from NPs and managers who employed NPs. Nearly two-thirds of all primary health care NPs in the country (n = 136) responded together with a purposive sample of 58 managers. More than 90% of respondents from both groups identified that organizations created an environment where NPs could practice independently and autonomously with collegial support. Other results signaled opportunities for improvement in local and national health policy. This study adds to international evidence on creating positive practice environments for NPs.

The influence of nurse manager competency on practice environment, missed nursing care, and patient care quality: A cross-sectional study of nurse managers in U.S. hospitals.

Identify and examine drivers of nurse manager competency and high-quality practice environments. Nurse managers are a key predictor of positive professional practice environments, which are, in turn, associated with nurse, patient, and organisational outcomes. However, little work has examined the factors that contribute to nurse manager competency. Nurse managers completed online surveys, which were matched to unit-level aggregate data of their subordinate direct care nurses' responses on the National Database of Nursing Quality Indicators. This resulted in a final sample of 541 nurse managers across 47 U.S. hospitals. Multilevel path analysis was utilized to assess a model of the antecedents and consequences of nurse manager competency. Nurse manager competency and practice environments were predictive of missed nursing care and nurse-reported quality of care. Nurse manager experience was found to have twice the effect on competency as advanced education. Nurse manager competency and its downstream effects are achieved through nurse manager experience and advanced education. Nurse manager competency yields better practice environments and nursing care. Considering the influence of experience, careful attention should be paid to the competency development process of more novice nurse managers.

Fostering a culture of nursing excellence during the COVID-19 crisis.

Medical center uses Pathway to Excellence® framework to sustain a positive practice environment

ANCC Pathway to Excellence® now included in the Leapfrog Hospital Survey

ANCC Pathway to Excellence® now included in the Leapfrog Hospital Survey

Strategic Planning for a Very Different Nursing Workforce

The COVID-19 pandemic amplified and intensified dramatic changes already emerging within the nursing workforce. This article examines and extrapolates from current trends to enable nurse leaders to prepare for the future nursing workforce and practice environment. Suggestions for strategic planning including imaging and prioritizing from a set of options for achieving a desired future state are offered. Strategic planning focusing on the wise use of nursing expertise and creating a positive professional practice environment can support the transition from the current crisis to a more resilient health care system supported by the full utilization of the knowledge and skills of registered nurses.

Engaging nurses to achieve a culture of excellence: a children's hospital journey towards Pathway to Excellence accreditation.

High-quality nursing care is linked to improved patient experience and patient outcomes, so having work environments that nurture a culture of nursing excellence is fundamental to delivering high-quality patient care. The American Nurses Credentialing Center (ANCC) runs the Pathway to Excellence programme, an international accreditation recognising healthcare organisations that provide nurses with a positive and safe practice environment in which they can excel. In 2020, Nottingham Children's Hospital became the first children's hospital in Europe to gain Pathway to Excellence accreditation, demonstrating that it has developed a culture of nursing excellence and a positive environment for nurses to work in. This article describes the hospital's journey towards accreditation. Crucial to its success were strategic planning, transformational leadership and using a change management approach, as well as effective staff engagement guided by the ADKAR model for change, an acronym representing five individual outcomes in terms of awareness, desire, knowledge, ability and reinforcement.

The association between the practice environment and selected nurse educator outcomes in public nursing education institutions: A cross-sectional study

AimThe purpose of this study is to describe the association between the practice environment and nurse educator outcomes (burnout, engagement, incivility, job satisfaction and intention to leave) in public nursing education institutions in the Gauteng province of South Africa. BackgroundThe practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse workforce; however, the association between the practice environment and nurse educator outcomes has been relatively unexplored. DesignCross-sectional design. MethodsThe Gauteng province was purposively selected, as it has the highest number of public nursing education institutions in South Africa. All-inclusive sampling was applied to public nursing educations institutions in Gauteng province (N = 6) and then to Heads of Department (N = 30; n = 17) and nurse educators (senior lecturers [N = 162; n = 45] and lecturers [N = 257; n = 80]). Data were collected during March to November 2018. The data were collected using the Practice Environment Scale of the Nursing Work Index; Maslach Burnout Inventory - Educators Survey; Utrecht Work Engagement Scale (UWES); Incivility in Nursing Education-Revised (INE-R); job satisfaction and Propensity to Leave Scale. ResultsThe results show that nurse educators are an aging population, with limited numbers having master’s and doctoral qualifications. The most job dissatisfaction is regarding wages (M=2.0; SD 1.07); appreciation, recognition and rewards for good work (M=2.1; SD 1.01); and opportunities for advancement (M=2.2; SD 1.01). The nurse educators do not experience their public nursing education institutions as having a positive practice environment. Nurse educators experienced high levels of work engagement, moderate levels of burnout and low levels of incivility, that were highly correlated with the subscale of foundations of quality outcomes. They experienced moderate levels of job satisfaction but did not intend to leave their places of employment, which was highly correlated with the subscale of manager’s ability, leadership and support. ConclusionsA positive practice environment improves nurse educator outcomes. The subscale of foundations of quality outcomes and manager’s ability, leadership and support had the most impact on nurse educator outcomes, thus quality teaching practices should be cultivated and recognised; and managers must have the necessary skill and knowledge to lead effectively, while also including nurse educators in decisions that impact them and involving them in the affairs of the nursing education institution. There is a shortage of qualified nurse educators globally and in South Africa and urgent attention must be given to factors that influence the recruitment and retention of nurse educators. Twitter abstractThe practice environment holds the most promise for recruiting and retaining a qualified and engaged nurse educator workforce, especially regarding foundations of quality outcomes and manager’s ability, leadership and support.