BACKGROUND:The nurse work environment is theorized to influence the quality of nursing care, nurse job outcomes, and patient outcomes.
OBJECTIVE:The aim of this meta-analysis was to evaluate ...quantitatively the association of the work environment with job and health outcomes.
RESEARCH DESIGN:Relevant studies published through September 2018 were identified. Inclusion criteria were use of a nationally endorsed work environment measure and reporting of odds ratios (ORs) and 95% confidence intervals from regression models of 4 outcome classesnurse job outcomes, safety and quality ratings, patient outcomes, and patient satisfaction. Pooled ORs and confidence intervals were estimated for each outcome using fixed or random effects models.
SUBJECTS:Of 308 articles reviewed, 40 met inclusion criteria. After excluding 23 due to sample overlap or too few observations to meta-analyze, a set of 17 articles, comprising 21 independent samples, was analyzed. Cumulatively, these articles reported data from 2677 hospitals, 141 nursing units, 165,024 nurses, and 1,368,420 patients, in 22 countries.
MEASURES:Practice Environment Scale of the Nursing Work Index, a National Quality Forum nursing care performance standard.
RESULTS:Consistent, significant associations between the work environment and all outcome classes were identified. Better work environments were associated with lower odds of negative nurse outcomes (average OR of 0.71), poor safety or quality ratings (average OR of 0.65), and negative patient outcomes (average OR of 0.93), but higher odds of patient satisfaction (OR of 1.16).
CONCLUSIONS:The nurse work environment warrants attention to promote health care quality, safety, and patient and clinician well-being.
BackgroundAs nurses are the principal care provider in the hospital setting, the completion or omission of nursing care is likely to have a sizable impact on the patient care experience. However, ...this relationship has not been explored empirically.AimTo describe the prevalence and patterns of missed nursing care and explore their relationship to the patient care experience.MethodsThis cross-sectional study used secondary nurse and patient survey data from 409 adult non-federal acute care US hospitals in four states. Descriptive statistics were calculated and linear regression models were conducted at the hospital level. Regression models included controls for hospital structural characteristics.ResultsIn an average hospital, nurses missed 2.7 of 12 required care activities per shift. Three-fourths (73.4%) of nurses reported missing at least one activity on their last shift. This percentage ranged from 25 to 100 across hospitals. Nurses most commonly reported not being able to comfort or talk with patients (47.6%) and plan care (38.5%). 6 out of 10 patients rated hospitals highly. This proportion ranged from 33% to 90% across hospitals. At hospitals where nurses missed more care (1 SD higher=0.74 items), 2.2% fewer patients rated the hospital highly (p<0.001); a coefficient equivalent to a one-quarter SD change.ConclusionsMissed nursing care is common in US hospitals and varies widely. Most patients rate their hospital care experience highly, but this also varies widely across hospitals. Patients have poorer care experiences in hospitals where more nurses miss required nursing care. Supporting nurses’ ability to complete required care may optimise the patient care experience. As hospitals face changing reimbursement landscapes, ensuring adequate nursing resources should be a top priority.
Aim
To document how changes in the hospital work environment and nurse staffing over time are associated with changes in missed nursing care.
Background
Missed nursing care is considered an indicator ...of poorer care quality and has been associated with worse patient care experiences and health outcomes. Several systematic reviews of cross‐sectional studies report that nurses in hospitals with supportive work environments and higher staffing miss less care. Causal evidence demonstrating these relationships is needed.
Methods
This panel study utilized secondary data from 23,650 nurses surveyed in 2006 and 14,935 surveyed in 2016 in 458 hospitals from a four‐state survey of random samples of licensed nurses.
Results
Over the 10‐year period, most hospitals exhibited improved work environments, better nurse staffing and more missed care. In hospitals with improved work environments or nurse staffing, the prevalence and frequency of missed care decreased significantly. The effect on missed care of changes in the work environment was greater than that of nurse staffing.
Conclusions
Changes in the hospital work environment and staffing influence missed care.
Implications for Nursing Management
Modifications in the work environment and staffing are strategies to mitigate care compromise. Nurse managers should investigate work settings in order to identify weaknesses.
Improvements in nurses' practice environments are essential to retain nurses and keep patients safe. The pace of improvements can accelerate if evidence is translated clearly for researchers, ...managers, and policymakers. This article evaluates the utility of published multidimensional instruments to measure the nursing practice environment. The assessment criteria are theoretical relevance, ease of use, and dissemination. This article also synthesizes the research that has used these instruments. Seven instruments and 54 studies are evaluated. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is proposed as the most useful instrument. Its content, length, and dissemination best satisfy the set of criteria. Researchers should use the PES-NWI to generate consistent and comparable evidence; expand the content to reflect all conceptual domains; develop a short form; test the instrument in different care settings; expand the evidence of the practice environment's influence on patient outcomes; and test interventions for practice environment improvements.
Why and how to avoid a desk‐rejection Lake, Eileen T.
Research in nursing & health,
April 2020, 2020-04-00, 20200401, Letnik:
43, Številka:
2
Journal Article
AimsTo explore factors associated with nurses' moral distress during the first COVID‐19 surge and their longer‐term mental health.DesignCross‐sectional, correlational survey study.MethodsRegistered ...nurses were surveyed in September 2020 about their experiences during the first peak month of COVID‐19 using the new, validated, COVID‐19 Moral Distress Scale for Nurses. Nurses' mental health was measured by recently experienced symptoms. Analyses included descriptive statistics and regression analysis. Outcome variables were moral distress and mental health. Explanatory variables were frequency of COVID‐19 patients, leadership communication and personal protective equipment/cleaning supplies access. The sample comprised 307 nurses (43% response rate) from two academic medical centres. ResultsMany respondents had difficulty accessing personal protective equipment. Most nurses reported that hospital leadership communication was transparent, effective and timely. The most distressing situations were the transmission risk to nurses' family members, caring for patients without family members present, and caring for patients dying without family or clergy present. These occurred occasionally with moderate distress. Nurses reported 2.5 days each in the past week of feeling anxiety, withdrawn and having difficulty sleeping. Moral distress decreased with effective communication and access to personal protective equipment. Moral distress was associated with longer‐term mental health.ConclusionPandemic patient care situations are the greatest sources of nurses' moral distress. Effective leadership communication, fewer COVID‐19 patients, and access to protective equipment decrease moral distress, which influences longer‐term mental health.ImpactLittle was known about the impact of COVID‐19 on nurses' moral distress. We found that nurses' moral distress was associated with the volume of care for infected patients, access to personal protective equipment, and communication from leaders. We found that moral distress was associated with longer‐term mental health. Leaders should communicate transparently to decrease nurses' moral distress and the negative effects of global crises on nurses' longer‐term mental health.
Objective: The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. Background: ...Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited. Methods: Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients. Results: Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments. Conclusion: Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.
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