Perceived nursing work environment of critical care nurses

BACKGROUND: Different concepts and measures have been used to evaluate the work environment of nurses in hospital settings. There is increasing need for updated measurement tools that reflect the evolving nature of the work environment. OBJECTIVES: To report the psychometric properties of the Perceived Nursing Work Environment (PNWE) instrument, and to compare these results with those of other scales derived from the same background instrument: the Nursing Work Index-Revised. METHODS: The Nursing Work Index-Revised was used in a national survey of critical care nurses. Exploratory principal component analysis with orthogonal rotation was conducted. Psychometric properties were examined. Construct validity was evaluated by comparing the scores for a subsample of nurses in magnet and nonmagnet hospitals. RESULTS: Surveys obtained from 68 hospitals across the nation had a mean response rate of 41%, resulting in a sample of 2,324 participants. The PNWE, with its seven subscales and 42 items, explained 53% of the total variance of the Nursing Work Index-Revised. The subscales exhibited moderate to high reliabilities ranging from .70 to .91, except for one subscale (.56), and generally low intercorrelation. A similar version of the nurse-physician collaboration subscale was found in three of the other four scales compared. The positive scheduling climate subscale was a unique finding. Nurses employed at magnet hospitals had more positive perceived work environments than those employed at nonmagnet hospitals, and showed higher mean scores in four of the seven subscales (p < .05). CONCLUSIONS: The PNWE, a measure of the work environment as perceived by nurses, represents the latest version of the Nursing Work Index-Revised based on current practice. In this study, it exhibited sound psychometric properties. Further application and testing of the PNWE in various patient care settings is recommended.     

Understanding the complexity of registered nurse work in acute care settings

Nursing shortages and patient safety mandates require nursing managers and administrators to consider new ways of understanding the complexity of healthcare provider work in actual situations. The authors report findings from a study guided by an innovative research approach to explore factors affecting registered nurse performance during real work on acute care medical-surgical units. Our findings suggest beginning targets for interventions to improve patient safety, as well as recruitment and retention, through support for registered nurse work.     

Prison health care: work environment and the nursing role

This article, the first in a new series on prison nursing, gives an overview of the world of prison nursing and the environmental factors that make it so different from other types of nursing. It welcomes the recommendation in the report 'Patient or Prisoner: A New Strategy for Health Care in Prisons' (HM Chief Inspector of Prisons for England and Wales, 1996) that the NHS should be responsible for providing health care for prisoners and the recent publication of the report of the Joint Prison Service/NHS Executive Working Group 'Future Organization of Prison health Care' (Department of Health, 1999), which endorses a formal partnership between the NHS and prison service. The article highlights the benefits that this will have for prison nurses who often feel professionally isolated. The role of the nurse working in the prison healthcare environment is outlined. The work of prison nurses differs from the role of nurses working in other healthcare situations as it is controlled by environmental factors associated with regimes, security and the prison culture. However, changes are taking place and a closer link with local services is envisaged. These changes are an excellent opportunity for nurses and nursing to establish a clear role in prisons and to develop further healthcare standards in the prison service.     

Patient-centered care,nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study

BackgroundPatient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care.ObjectiveThe aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care.DesignThis is a sub-study of the cross-sectional multi-center “Matching Registered Nurse Services with Changing Care Demands” study.SettingWe included 123 units in 23 acute care hospitals from all three of Switzerland’s language regions.ParticipantsThe sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included.MethodsPatients‘ perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level.ResultsPatients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30–0.98]). Higher leadership ratings were associated with sufficient information (β 0.403 [95%-CI: 0.03–0.77) and adapted treatment and care (β 0.462 [95%-CI: 0.04–0.88]). Furthermore, higher levels of implicit rationing of nursing care were associated with lower levels of patient-centered care, e.g., adapted treatment and care (β −0.912 [95%-CI: −1.50–0.33]).ConclusionOur study shows a negative association between implicit rationing of nursing care and patient-centered care: i.e.the lower the level of implicit rationing of nursing care, the better patients understood nurses, felt sufficiently informed and recognized that they were receiving highly individualized treatment. To improve patient-centered care, the nurse work environment and the level of implicit rationing of nursing care should be taken into consideration.     

An exploratory study about meaningful work in acute care nursing

OBJECTIVE. To develop deeper understandings about nurses' perceptions of meaningful work and the contextual factors that impact finding meaning in work. BACKGROUND. Much has been written about nurses' job satisfaction and the impact on quality of health care. However, scant qualitative evidence exists regarding nurses' perceptions of meaningful work and how factors in the work environment influence their perceptions. The literature reveals links among work satisfaction, retention, quality of care, and meaningfulness in work. METHODS. Using a narrative design, researchers interviewed 13 public health nurses and 13 acute care nurses. Categorical‐content analysis with Atlas.ti data management software was conducted separately for each group of nurses. This article reports results for acute care nurses. RESULTS. Twenty‐four stories of meaningful moments were analyzed and categorized. Three primary themes of meaningful work emerged: connections, contributions, and recognition. Participants described learning‐focused environment, teamwork, constructive management, and time with patients as facilitators of meaningfulness and task‐focused environment, stressful relationships, and divisive management as barriers. Meaningful nursing roles were advocate, catalyst and guide, and caring presence. CONCLUSIONS. Nurse administrators are the key to improving quality of care by nurturing opportunities for nurses to find meaning and satisfaction in their work. Study findings provide nurse leaders with new avenues for improving work environments and job satisfaction to potentially enhance healthcare outcomes.     

Understanding palliative nursing care

Palliative care is care that is given to patients and their significant others who are experiencing life-threatening or life-altering illnesses by providing emotional, spiritual, and physical support. Patients can continue to receive aggressive medical treatment while receiving palliative care and recovery is possible. Pain control is a top priority in palliative care. Non-pharmacological interventions have also been shown to be effective in palliative care as well. Palliative care is truly a holistic, collaborative practice engaging many disciplines in the care of the patient and their love ones.     

护理工作环境相关研究进展

本文从护理工作环境的含义、护理工作环境的测量、护理工作环境的相关理论以及与护理工作环境有关的研究进展等方面进行综述,旨在帮助医院及护理管理者了解国内外护理工作环境的相关进展,为进一步的研究和决策提供参考。     

Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment

Agreement was reached with 12 acute medical and surgical wards/units at Sydney's Prince of Wales Hospital to participate in a trial of team nursing (TN). Six units employed action research principles to undertake a change to a team nursing model and six remained with the pre-existing individual patient allocation (IPA) model. Task-based teaming was widely discarded by the team nursing units in favour of allocating patients within the team and introducing more supportive and communicative processes aimed at fostering responsibility sharing. Localised team-based models of care arose in the change wards and were outlined, implemented and refined using social action research principles. A 12-month prospective experimental comparison of job satisfaction and staff retention between the TN and IPA groups indicated statistically significant job satisfaction benefits and practically important staff retention benefits associated with moving away from an IPA model of nursing care delivery towards a team-based model of care delivery. Perhaps not surprisingly, job satisfaction gains were most marked among new graduate nurses, who reported real benefits from a teaming inspired shift in model of care in the acute inpatient environment.     

The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK

In England best practice guidance in cancer recommends that all patients have access to a specialist nurse such as the tumour specific clinical nurse specialist. The role has become pivotal providing aspects of care e.g. meeting information needs, holistic nurse led follow up including symptom control, managing care and providing psychological and social interventions including referral to others in the role of keyworker. There are approximately 295 lung cancer nurse specialists in England and recent study to model optimum caseload used an on line survey to look at workload of lung cancer specialist nurses. A survey of 100 lung cancer nurses from across the UK (RR78%) examined the perception of the work left undone against best practice guidance, caseload size, workload and other factors. 67 of 78 respondents perceived they left work such as proactive management (52) undertaking holistic needs assessments (46) providing appropriate psychological care (26) and meeting information needs (16). The majority (70) worked unpaid overtime (mean 3.8 h range 1–10 h) per week. Although proactive management is thought to result in better outcomes for lung cancer patients in terms of survival, quality of life and decisions of end of life a substantial number of the specialist nurses felt that factors such as caseload and organisational factors inhibited this.     

护理工作环境评价量表的测评

[目的]对运用德尔菲法构建的护理工作环境评价指标体系进行信度和效度的验证. [方法]采用重测信度、内在一致性信度进行信度评价,结构效度进行效度考评.[结果]护理工作环境评价指标体系量表的重测信度为0.877,克朗巴赫α系数为0.915,分半系数为0.941.对条目进行因子分析,提取了特征值大于1的公因子7个,解释了总方差的55.92%,因子分析的结果与问卷结构基本吻合.[结论]初步验证了指标体系的合理性和可操作性,从整体看护理工作环境指标体系有较好的信度和效度.     

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers. This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work. Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate. Three major themes emerged from interview data: planning for ward allocation, communication and professionalism. In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff. Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses. For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration. A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles. The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled--with the aim of providing quality patient care.     

不同经济区域护理职业环境的对比研究

目的 从宏观层面调查不同经济区域的护理职业环境,并进行对比分析。旨在为政策制订者和护理管理者进行资源优化和统筹提供借鉴。 方法 采用中国版护理工作环境量表对我国八大经济区域31个省市的19 000名护士进行横断面调查,结合聚类分析与核密度估计法对不同经济区域的护理职业环境进行对比分析。 结果 护士对职业环境的感知处于“有点满意”状态,其中,护士对基本保障维度最不满意,其次为充足人力、职业发展、领导与管理维度。此外,根据不同经济区域间护理职业环境的差异,可分为3个类别,第1类由东北、北部沿海和黄河中游经济区组成;第2类由东部沿海经济区组成;第3类则由南部沿海、长江中游、西南以及大西北经济区组成。 结论 护理职业环境各要素发展不平衡,并且护理职业环境存在地域差异。     

Analysis of the moral habitability of the nursing work environment

BACKGROUND: Following health reform, nurses have experienced the tremendous stress of heavy workloads, long hours and difficult professional responsibilities. In recognition of these problems, a study was conducted that examined the impact of the working environment on the health of nurses. After conducting focus groups across Canada with nurses and others well acquainted with nursing issues, it became clear that the difficult work environments described had significant ethical implications. AIM: The aim of this paper is to report the findings of research that examined the moral habitability of the nursing working environment. METHODS: A secondary analysis was conducted using the theoretical work of Margaret Urban Walker. Moral practices and responsibilities from Walker's perspective cannot be extricated from other social roles, practices and divisions of labour. Moral-social orders, such as work environments in this research, must be made transparent to examine their moral habitability. Morally habitable environments are those in which differently situated people experience their responsibilities as intelligible and coherent. They also foster recognition, cooperation and shared benefits. FINDINGS: Four overarching categories were developed through the analysis of the data: (1) oppressive work environments; (2) incoherent moral understandings; (3) moral suffering and (4) moral influence and resistance. The findings clearly indicate that participants perceived the work environment to be morally uninhabitable. The social and spatial positioning of nurses left them vulnerable to being overburdened by and unsure of their responsibilities. Nevertheless, nurses found meaningful ways to resist and to influence the moral environment. CONCLUSIONS: We recommend that nurses develop strong moral identities, make visible the inseparability of their proximity to patients and moral accountability, and further identify what forms of collective action are most effective in improving the moral habitability of their work environments.     

健康护理工作环境构建策略思考

通过对国外护理工作环境优化现状的总结,提出构建健康工作环境的设想;并从外部机制和内部策略相结合的角度,探讨如何从行政管理、临床业务、专业发展三方面着手,构建健康护理工作环境,从而提高组织整体管理效能、提升护士工作满意度、促进专业发展和优化护理质量.