Practice Environments of Nurses in Ambulatory Oncology Settings A Thematic Analysis
Practice Environments of Nurses in Ambulatory Oncology Settings A Thematic Analysis
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DOI：
10.1097/ncc.0b013e31820b6efa
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发表时间：
2012-01-01
期刊：
影响因子：
2.6
通讯作者：
Friese, Christopher R.
中科院分区：
文献类型：
--
作者：
Kamimura, Akiko;Schneider, Karin;Friese, Christopher R.
背景：护士的执业环境已在住院环境中得到广泛研究，但很少在门诊环境中进行研究。由于大多数癌症护理是在门诊提供的，更好地了解护理实践环境可能有助于提高质量的努力。目的：我们试图研究有助于高质量的病人护理和护理工作满意度的护理实践环境的特点。方法：在2009-2010年，我们进行了焦点小组与护士谁照顾成人癌症住院部外。一个半结构化的主持人指南探讨了实践环境的功能，促进安全，高质量的护理和高工作满意度。我们还要求护士识别妨碍高质量护理和降低工作满意度的实践环境特征。我们进行了主题分析，报告主题，并构建一个概念框架。结果如下：从2个焦点小组，由13名参与者组成，护士报告说，工作量的变化，管理人员和医疗助理的支持，以及实践的物理资源，可以促进或阻碍高质量的护理和工作满意度。团队成员之间的高质量沟通提高了患者的安全性和满意度。结论：从住院设置的研究结果相一致，护士确定的人员配备和资源充足，管理支持和合议制的重要投入，以高质量的护理。实践的意义：这些发现可以告知门诊肿瘤学实践的质量改进措施。加强护士与医疗助理的关系，平滑病人的工作量变化，并实施战略，以加强沟通，可能有助于高质量的癌症护理。测试我们提出的概念框架的研究将弥合现有的知识差距，在流动设置。
Background: The practice environments of nurses have been studied extensively in inpatient settings, but rarely in the ambulatory context. As the majority of cancer care is delivered in ambulatory settings, a better understanding of the nursing practice environment may contribute to quality improvement efforts. Objective: We sought to examine the features of nursing practice environments that contribute to quality patient care and nursing job satisfaction. Methods: In 2009-2010, we conducted focus groups with nurses who cared for adults with cancer outside inpatient units. A semistructured moderator guide explored practice environment features that promoted safe, high-quality care and high job satisfaction. We also asked nurses to identify practice environment features that hindered quality care and reduced job satisfaction. We conducted thematic analysis to report themes and to construct a conceptual framework. Results: From 2 focus groups, composed of 13 participants, nurses reported that variability in workloads, support from managers and medical assistants, and the practice's physical resources could facilitate or hinder high-quality care and job satisfaction. High-quality communication across team members improved patient safety and satisfaction. Conclusions: Consistent with research findings from inpatient settings, nurses identified staffing and resource adequacy, management support, and collegiality as important inputs to high-quality care. Implications for Practice: These findings can inform quality improvement initiatives in ambulatory oncology practices. Strengthening nurse-medical assistant relationships, smoothing patient workload variability, and implementing strategies to strengthen communication may contribute to quality cancer care. Studies to test our proposed conceptual framework would bridge existing knowledge gaps in ambulatory settings.