Quality Of Work Environment Research Articles

Hospital nursing, care quality, and patient satisfaction: Cross-sectional surveys of nurses and patients in hospitals in China and Europe

BackgroundThis study provides a comprehensive evaluation of nurse resources in Chinese hospitals and the link between nurse resources and nurse and patient outcomes. MethodsSurvey data were used from 9688 nurses and 5786 patients in 181 Chinese hospitals to estimate associations between nurse workforce characteristics and nurse and patient outcomes in China. Nurse and patient assessments in China were compared with a similar study in Europe. ResultsThirty-eight percent of nurses in China had high burnout and 45% were dissatisfied with their jobs. Substantial percentages of nurses described their work environment and the quality of care on their unit as poor or fair (61% and 29%, respectively) and graded their hospital low on patient safety (36%). These outcomes tend to be somewhat poorer in China than in Europe, though fewer nurses in China gave their hospitals poor safety grades.Nurses in Chinese hospitals with better work environments and higher nurse-assessed safety grades had lower odds of high burnout and job dissatisfaction (ORs ranged from 0.56 to 0.75) and of reporting poor or fair quality patient care (ORs ranged from 0.54 to 0.74), and patients in such hospitals were more likely to rate their hospital highly, to be satisfied with nursing communications, and to recommend their hospitals (significant ORs ranged from 1.24 to 1.40). Higher patient-to-nurse ratios were associated with poorer nurse outcomes (each additional patient per nurse increases both burnout and dissatisfaction by a factor of 1.04) and higher likelihoods of nurses reporting poor or fair quality of care (OR=1.05), but were unrelated to patient outcomes. Higher percentages of baccalaureate nurses were strongly related to better patient outcomes, with each 10% increase in the percent of baccalaureate nurses increasing patient satisfaction, high ratings, and willingness to recommend their hospital by factors ranging from 1.11 to 1.13. InterpretationNursing is important in quality and safety of hospital care and in patients’ perceptions of their care. Improving quality of hospital work environments and expanding the number of baccalaureate-prepared nurses hold promise for improving hospital outcomes in China.

Team Reflexivity and Innovation

Team reflexivity, the extent to which teams collectively reflect upon and adapt their working methods and functioning, has been shown to be an important predictor of team outcomes, notably innovation. As described in the current article, the authors developed and tested a team-level contingency model of team reflexivity, work demands, and innovation. They argue that highly reflexive teams will be more innovative than teams low in reflexivity when facing a demanding work environment. A field study of 98 primary health care teams in the United Kingdom corroborated their predictions: Team reflexivity was positively related to team innovation, and team reflexivity and work demands interacted such that high levels of both predicted higher levels of team innovation. Furthermore, an interaction between team reflexivity, quality of physical work environment (PWE), and team innovation showed that poor PWE coupled with high team reflexivity was associated with higher levels of team innovation. These results are discussed in the context of the need for team reflexivity and team innovation among teams at work facing high levels of work demands.

Associations between rationing of nursing care and inpatient mortality in Swiss hospitals

To explore the relationship between inpatient mortality and implicit rationing of nursing care, the quality of nurse work environments and the patient-to-nurse staffing ratio in Swiss acute care hospitals. Cross-sectional correlational design. Eight Swiss acute care hospitals examined in a survey-based study and 71 comparison institutions. A total of 165 862 discharge abstracts from patients treated in the 8 RICH Nursing Study (the Rationing of Nursing Care in Switzerland Study) hospitals and 760 608 discharge abstracts from patients treated in 71 Swiss acute care hospitals offering similar services and maintaining comparable patient volumes to the RICH Nursing hospitals. The dependent variable was inpatient mortality. Logistic regression models were used to estimate the effects of the independent hospital-level measures. Patients treated in the hospital with the highest rationing level were 51% more likely to die than those in peer institutions (adjusted OR: 1.51, 95% CI: 1.34-1.70). Patients treated in the study hospitals with higher nurse work environment quality ratings had a significantly lower likelihood of death (adjusted OR: 0.80, 95% CI: 0.67-0.97) and those treated in the hospital with the highest measured patient-to-nurse ratio (10:1) had a 37% higher risk of death (adjusted OR: 1.37, 95% CI: 1.24-1.52) than those in comparison institutions. Measures of rationing may reflect care conditions that place hospital patients at risk of negative outcomes and thus deserve attention in future hospital outcomes research studies.

Impact of Healthy Work Environments and Multistage Nurse Residency Programs on Retention of Newly Licensed RNs

The objective of the study was to examine effects of nurse-confirmed healthy unit work environments and multistage nurse residency programs (NRPs) on retention rates of newly licensed RNs (NLRNs). Establishing a culture of retention and healthy clinical nurse practice environments are two major challenges confronting nurse leaders today. Nurse residency programs are a major component of NLRN work environments and have been shown to be effective in abating nurse turnover. Sample for this study consisted of 5,316 new graduates in initial RN roles in 28 Magnet® hospitals. There were no differences in retention rates by education or patient population on clinical unit. NLRN retention rate was higher in community than in academic hospitals. More than half of NLRNs were placed on units with very healthy work environments. Newly licensed RNs on units with work environments needing improvement resigned at a significantly higher rate than did other NLRNs. The quality of clinical unit work environments is the most important factor in NLRN retention.

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children’s hospital1

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.

Job and career satisfaction and turnover intentions of newly graduated nurses

To describe new graduate nurses' worklife experiences in Ontario hospital settings in the first 2 years of practice and to examine predictors of job and career satisfaction and turnover intentions. With a large cohort of nurses approaching retirement, every effort must be made to ensure that the work environments of new graduate nurses are positive, promoting job satisfaction and commitment to the profession to address the nursing workforce shortage. A cross-sectional analysis of data from a mail survey of new graduate nurses (n=342) in their first and second year of experience was used to address the research objectives. Overall, new graduate nurses were positive about their working conditions and there were few differences between nurses in their first and second years of practice. Structural and personal factors explained significant amounts of variance (31-68%) in both job and career satisfaction and turnover intentions. Empowerment, work engagement and burnout were important significant predictors. Modifiable workplace factors play an important role in influencing new graduates' job and career satisfaction and turnover intentions. Managers can employ strategies to enhance quality work environments that promote retention of new graduates and lessen the nursing workforce shortage.

The influence of personal dispositional factors and organizational resources on workplace violence, burnout, and health outcomes in new graduate nurses: A cross-sectional study

BackgroundThe alarmingly high rate of illness-related absenteeism among nurses and recent reports of workplace violence and burnout are problematic for both the current workforce shortage and the recruitment and retention of new nurses. ObjectivesTo test a model derived from Leiter and Maslach's (2004) Six Areas of Worklife Model linking workplace factors (six areas of worklife, experiences of bullying and burnout) and a personal dispositional factor (psychological capital) to new graduates mental and physical health in their first year of practice. MethodsA cross-sectional survey design was utilized to survey 165 Ontario nurses with one year or less experience in nursing. Participants completed measures of nurses’ work environment quality, psychological capital, bullying exposure, burnout, and physical and mental health. Structural equation modelling was used to test the hypothesized model. ResultsThe fit indices suggested a reasonably adequate fit of the data to the hypothesized model (χ2=27.75, df=12, CFI=.97, IFI=.97, RMSEA=.09), however an additional direct path from psychological capital to emotional exhaustion substantially improved the model fit (χ2=17.94, df=11, CFI=.99, IFI=.99, RMSEA=.06). Increased psychological capital positively influenced nurses’ perceived person-job fit, which in turn was negatively related to bullying exposure and emotional exhaustion, and ultimately influenced their physical and mental health. ConclusionsThe findings suggest that psychological capital and perceived person-job fit are key variables in new graduate nurses’ worklife, which may contribute to decreased nurses’ burnout and increased physical and mental well-being. The results support an expanded conceptualization of the Areas of Worklife Model.

Work environment quality: the role of workplace participation and democracy

The article explores how employee participation influences the quality of the work environment and workers’ well-being at 11 Danish workplaces from within six different industries. Both direct participation and representative forms of participation at the workplace level were studied. Statistical as well as qualitative comparative analyses reveal that work environment quality and high levels of participation go hand in hand. Within a typology of participation models the highest level of participation, including strong elements of collective participation, and also the best work environment, measured as ‘psychosocial well-being’, were found at workplaces managed in accordance with democratic principles.

Leading Change for Sustainability

Nurse leaders are key drivers for the creation of quality work environments and quality patient care outcomes at the frontline of healthcare delivery. Their charge has been to provide leadership to assure quality nursing care, and ensure the satisfaction of their patients, families, staff, physicians, and hospital executives at each and every clinical care site. In this era of transparency and with the onset of accountable care organizations, the charge is now broader—outcomes must be sustained.

The Impact of Hospital Nursing Characteristics on 30-Day Mortality

Evidence indicates that hospital nursing characteristics such as staffing contribute to patient outcomes. Less attention has been given to other hospital nursing characteristics central to optimal professional practice, namely nurse education and skill mix, continuity of care, and quality of the work environment. To assess the relative effects and importance of nurse education and skill mix, continuity of care, and quality of work environment in predicting 30-day mortality after adjusting for institutional factors and individual patients characteristics. A cross-sectional analysis of outcome data for 18,142 patients discharged from 49 acute care hospitals in Alberta, Canada, for diagnoses of acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or stroke between April 1, 1998, and March 31, 1999, was done. Mortality data were linked to patient demographic and comorbidity factors, institutional characteristics, and hospital nursing characteristics derived from a survey of all registered nurses working in acute care hospitals. Using multilevel analysis, it was determined that the log-odds for 30-day mortality varied significantly across hospitals (variance .044, p < .001). Patient comorbidities and age explained 44.2% of the variance in 30-day mortality. After adjustment for patient comorbidities and demographic factors, and the size, teaching, and urban status of the study hospitals in a fixed-effects model, the odds ratios (95% confidence interval) of the significant hospital nursing characteristics that predict 30-day mortality were as follows: 0.81 (0.68-0.96) for higher nurse education level, 0.83 (0.73-0.96) for richer nurse skill mix, 1.26 (1.09-1.47) for higher proportion of casual or temporary positions, and 0.74 (0.6-00.91) for greater nurse-physician relationships. The institutional and hospital nursing characteristics explained an additional 36.9%. Hospital nursing characteristics are an important consideration in efforts to reduce the risk of 30-day mortality of patients.

Tarefas de investigação na sala de aula de Matemática: práticas de uma professora de Matemática

The present article reports on a teaching experience developed in the context of a Mathematics inservice teacher education program aiming at knowing how teachers integrate mathematics investigations in curricular development and think about their teaching practices. The study follows both qualitative and interpretative approach and focuses on the work of a 5th grade Mathematics teacher, developed along a whole teaching cycle (preparation, classroom conducting, and reflection), exploring an investigation task about the Pascal triangle. It is concluded that a teaching dynamic, that enhanced sharing and discussion about experiences and teaching materials, helped the teacher to include investigations in the classroom and to understand that this approach brings new challenges and requires changes to her own and her students work practices. After the reported experience, the teacher gave a higher curricular value to mathematics investigations and to communication and discussion skills as well as classroom interaction and overall working environment quality.

Serving two (or more) masters: accomplishing autonomous nursing practice in chronic disease management

The concept of professional autonomy has figured prominently in literature that addresses nursing's project of professionalization. Nursing's capacity to determine the nature and scope of its practice is related in important ways to the location of practice. Within highly structured environments such as acute-care hospitals, nurses' professional autonomy has frequently been contested yet is often implicated by nursing's elite as a necessary condition in the construction of quality work environments. Professional concerns and management practices related to retaining experienced nurses to support sustainability in healthcare delivery systems' impact on the ability of nurses to practice autonomously. Our paper focuses on the emerging field of practice of chronic disease management. We describe the complex relationships negotiated by a nurse in a theoretically autonomous practice setting as she seeks to fulfil both the requirements of a research protocol designed by physician experts representing the specialty of renal medicine, and her professional obligations to respond to the expressed needs of patients with early-stage renal disease. We utilize a case study approach to explore particular contemporary concerns that nurses in practice confront as they attempt to accomplish professional relationships with patients central to achieving prescribed medical outcomes where nursing practice, as an element of the achievement of those outcomes, is constituted as absent or unacknowledged by the medical researchers leading the project. Implications for nursing's discourses on the professional project of autonomy will be discussed.

Impact of Healthy Work Environments on New Graduate Nurses’ Environmental Reality Shock

Do healthy work environments (HWEs) facilitate new graduate transition into professional practice in hospitals? Are such environments related to a decrease in Environmental Reality Shock? Experienced nurses in 17 Magnet hospitals completed the Essentials of Magnetism II(©) (EOMII(©)) instrument that measures health of unit work environments. New graduates (N = 468) were then tracked with modified versions of the EOMII(©) from immediate post hire to 4, 8, and 12 months post hire to ascertain degree of Environmental Reality Shock. New graduate nurses have extremely high anticipations of unit work environments that would enable delivery of quality patient care. HWE is the most-significant variable in Environmental Reality Shock, number of related Issues and Concerns, and perceptions of quality of patient care. Suggestions of how to improve quality of unit work environments are offered.

Hospital nurses' work environment, quality of care provided and career plans

In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. A cross-sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse-assessed quality of care also increased and intentions to leave current job decreased linearly. Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals.

Qualidade e Ergonomia do local de trabalho contribuindo para o rendimento do grupo criativo no ambiente empresarial

This article aims to clarify some aspects of the quality of work environment and creativity collaboration with the ergonomics , and also aims to verify how the creative group can best be inserted in the business environment, where daily life is extremely formal and bureaucratic and the group in question needs constant renewal ideas renewal and external stimulation for proper development of their work. There is a growth in the study of creativity in post-industrial society because of its importance in replacement of manual laborers; some aspects have been addressed here: psychological, social and cultural rights of the creative process. You can check the results achieved by the importance of actions in the workplace team.

Proposition of Framework for Quality Working Environment Based on Sustainable Design in Small Manufacturing Enterprises

Quality improvements are implemented through various systems, techniques and tools in a company. The implementation of quality initiatives are commonplace in large companies rather than the smaller ones. Small and medium-sized enterprises (SMEs) are usually constrained by their size, expertise and financial resources. Nevertheless, it is important for them to improve their quality of physical work setting and working environment to sustain a competitive advantage. 5S is one of the most widely adopted techniques for industrial housekeeping and, in improving the quality of workplace environment. Since the cost of the development and implementation is one of the main constraints for 5S program at workplace in SMEs, the sustainable design concept shall be adopted. As the main part of the research work, a conceptual model of continuous improvement initiative for quality working environment within small and medium-sized manufacturing companies was developed and proposed. The focus of this research study is on the aspect of how to implement the 5S practices by incorporating sustainable design for improving a quality workplace environment and reducing the environmental impacts through a comprehensive approach. Finally, conclusions are drawn and suggestions made for further research in SME companies.

The Anatomy of Health Care Team Training and the State of Practice: A Critical Review

As the U.S. health care system enters a new era, the importance of team-based care approaches grows. How is the health care community ensuring that providers and administrators are equipped with the knowledge, skills, and attitudes (KSAs) foundational for effective teamwork? Are these KSAs transferring into daily practice? This review summarizes the present state of practice for health care team training described in published literature. Drawing from empirical investigations of training effectiveness, the authors explore training design, implementation, and evaluation to provide insight into the shape, structure, and anatomy of team training in health care. A 2009 literature search yielded 40 peer-reviewed articles detailing health care team training evaluations. Guided by 11 focal questions, two trained raters extracted details regarding training design, implementation, evaluation metrics, and outcomes. Findings indicate that team training is being implemented across a wide spectrum of providers and is primarily targeting communication, situational awareness, leadership, and role clarity. Relatively few details indicate how training needs were established. Most studies collected data immediately posttraining; however, less than 30% collected data six months or more posttraining. Content analyses highlight the need for enhanced detail in published training evaluation reports. In many respects, health care team training implementation and evaluation align with best practices suggested from the science of training, adult learning, and human performance; however, opportunities for improvement exist. The authors suggest several mechanisms for furthering the health care team training evidence base to enhance patient safety and work environment quality for clinicians.

TEAM REFLEXIVITY AND INNOVATION: THE MODERATING ROLE OF TEAM CONTEXT.

In a field study among 98 primary health care teams, we examined the moderating role of work demands. Results showed that when team level workload is high, combined with a high level of team reflexivity, team innovation is higher. A similar interaction was found for low quality of work environment.

Using Common Work Environment Metrics to Improve Performance in Healthcare Organizations

This article proposes a comprehensive framework for assessing, reporting and improving the quality of work environments in healthcare organizations across Canada. Healthy work environments (HWEs) contribute to positive outcomes for healthcare employees and physicians. The same HWE ingredients also can reduce operating costs, improve human resources utilization and ultimately lead to higher-quality patient care. We show how health system employers, governments, quality agencies and other stakeholders can implement effective HWE metrics. The common reporting framework and metrics we propose enable managers and policy makers to use HWE ingredients as levers to improve organizational performance. Progress requires the active involvement of stakeholders in developing common metrics, the integration of these metrics into existing measurement and reporting systems, the building in of managerial accountability for work environment quality and support for ongoing improvements at the front lines of care and service delivery.

A Comparison of Quality of Life Outcomes for People with Intellectual Disabilities in Supported Employment, Day Services and Employment Enterprises

Background Policy objectives for people with intellectual disabilities include day service modernization and the promotion of paid employment and quality of life. Quality of life is under represented as an outcome measure in vocational research. This research compares subjective and objective quality of life, and quality of work environment for adults with intellectual disabilities in supported employment, employment enterprises and day services with non‐disabled workers in community employment.Methods Comprehensive Quality of Life Scale, and Work Environment Scale were collected for people with intellectual disabilities: 17 supported employees; 10 employment enterprise workers; 10 day service attendees; and 17 non‐disabled work colleagues of supported employees.Results Supported employees reported higher objective quality of life than employment enterprise workers and day service attendees. Non‐disabled co‐workers reported higher objective quality of life and autonomy at work than the three groups of people with intellectual disabilities. Supported employees reported higher subjective quality of life than non‐disabled co‐workers.Conclusions The findings support the utility of supported employment as a means to provide constructive occupation and enhanced quality of life to people with intellectual disabilities. However, closing the gap with respect to non‐disabled co‐workers on objective quality of life measures represents a challenge and will require improving the quality of job finding and workplace support and the training provided.