The Effects of a Participatory Intervention in Mental Health Units on Nurses’ Perceptions of the Practice Environment: A Mixed Methods Study

BACKGROUND: The practice environment influences the quality of care and the nursing outcomes achieved in their workplaces. OBJECTIVE: To examine the perception of the clinical practice environment among nurses working in mental health units in the context of their participation in an action research study aimed at improving the nurse–patient relationship. METHOD: An explanatory sequential mixed methods study was designed. The data were collected in three phases in 18 mental health units ( n = 95 nurses). Quantitative data were collected through the Practice Environment Scale of the Nursing Work Index, and qualitative data were collected through reflective diaries and focus groups in the context of participatory action research. RESULTS: The nurses’ assessment of their practice environment shifted from positive to negative. Nurse manager leadership was the aspect that worsened the most. In addition, the perception of their participation in the affairs of the center and nursing foundations for quality of care decreased. The nurses considered it essential to be able to influence decision-making bodies and that the institution should promote a model of care that upholds the therapeutic relationship in actual clinical practice. CONCLUSIONS: Nurses perceived that they should be involved in organizational decisions and required more presence and understanding from managers. Furthermore, nurses stated that institutions should promote nursing foundations for quality of care. This study contributes to understanding how nurses in mental health units perceive their work environment and how it affects the improvement of the nurse–patient relationship in clinical practice.

The Association of Work Environments and Nurse-Nurse Collaboration: A Multicenter Cross-Sectional Study

Background: Along with the recent healthcare reform, intraprofessional collaboration in nursing is considered an essential factor for managing the challenges related to diverse roles and tasks of nurses in providing high quality care. There is lack of knowledge on how the nursing work environment could influence nurse-nurse collaboration. Purpose: The study aimed to assess the relationship between nursing work environment and nurses’ intraprofessional collaboration.Methods: A total of 300 nurses working in four teaching hospitals participated in this multicenter cross-sectional study. Data were collected using the Nurse-Nurse Collaboration Scale (NNCS) and the Practice Environment Scale of the Nursing Work Index (PES–NWI). The Pearson correlation test was used to analyze the data.Results: The results showed that the mean score of the PES–NWI was 2.65±0.32 out of 4. The highest and lowest scores belonged to the subscales of the nursing foundations for quality of care (2.86±0.31) and staffing and resource adequacy (2.24±0.49), respectively. The mean total score of nurse-nurse collaboration was 2.94±0.21 out of a score of 4. The results showed a significant positive relationship between nursing work environment and nurses’ intraprofessional collaboration (r=0.49, p<0.05).Conclusion: The nursing practice environment has a positive and significant relationship with nurse-nurse collaboration. Therefore, improving nurses’ practice environment and providing healthy workplaces could improve the intraprofessional nurse’s collaboration. Moreover, nurse managers should improve nurses’ skills in some areas of collaboration such as conflict management.

AMBIENTE DE PRÁTICA E A SEGURANÇA DO DOENTE NO BLOCO OPERATÓRIO: DIMENSÕES PREDITORAS

Objetivos: identificar o ambiente de prática percepcionado pelos enfermeiros perioperatórios e determinar as dimensões do ambiente de prática preditoras da segurança do doente. Método: estudo descritivo e explicativo, numa amostra de 1.001 enfermeiros de 24 hospitais portugueses (janeiro a outubro de 2018), utilizando o questionário Segurança do Doente no Bloco Operatório e a versão portuguesa do Practice Environment Scale - Work Nursing Index. Recurso à análise descritiva, alfa de Cronbach e método stepwise na análise do modelo de regressão linear. Resultados: a média global (M=2,49) do ambiente de prática indicia sua classificação como desfavorável. Os modelos de regressão revelam que todas as dimensões do ambiente são preditoras da segurança do doente no bloco operatório, destacando-se a dimensão “Fundamentos de enfermagem para qualidade dos cuidados”. Conclusão: este estudo permitiu evidenciar a influência do ambiente de prática na segurança do doente no contexto perioperatório e a necessidade de introdução de melhorias.

Effect of Practice Environment on Nurse Reported Quality and Patient Safety: The Mediation Role of Person-Centeredness

This study aims to explore the potential mediation role of person-centeredness between the effects of the work environment and nurse reported quality and patient safety. A quantitative cross-sectional survey collected data from 1055 nurses, working in medical and surgical units, in twelve Malaysian private hospitals. The data collection used structured questionnaires. The Hayes macro explored the mediation effect of person-centeredness between the associations of work environment dimensions and care outcomes, controlling nurses’ demographics and practice characteristics. A total of 652 nurses responded completely to the survey (61.8% response rate). About 47.7% of nurses worked 7-h shifts, and 37.0% were assigned more than 15 patients. Higher workload was associated with unfavorable outcomes. Nurses working in 12-h shifts reported a lower work environment rating (3.46 ± 0.41, p < 0.01) and person-centered care (3.55 ± 0.35, p < 0.01). Nurses assigned to more than 15 patients were less likely to report a favorable practice environment (3.53 ± 0.41, p < 0.05), perceived lower person-centered care (3.61 ± 0.36, p < 0.01), and rated lower patient safety (3.54 ± 0.62, p < 0.05). Person-centeredness mediates the effect of nurse work environment dimensions on quality and patient safety. Medical and surgical nurses, working in a healthy environment, had a high level of person-centeredness, which, in turn, positively affected the reported outcomes. The function of person-centeredness was to complement the effects of the nurse work environment on care outcomes. Improving the nurse work environment (task-oriented) with a high level of person-centeredness (patient-oriented) was a mechanism through which future initiatives could improve nursing care and prevent patient harm.