The impact of the work environment of nurses on patient safety outcomes: A multi-level modelling approach
The impact of the work environment of nurses on patient safety outcomes: A multi-level modelling approach
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DOI：
10.1016/j.ijnurstu.2012.08.020
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发表时间：
2013-02-01
影响因子：
8.1
通讯作者：
Scott, P. Anne
中科院分区：
文献类型：
--
作者：
Kirwan, Marcia;Matthews, Anne;Scott, P. Anne
背景：患者安全是所有国家卫生服务的首要任务。护士在患者安全中的作用的重要性已经确定。有效的护士人员配置水平、护士教育水平和积极的护士工作环境是影响患者安全结果的因素。 目的：本研究旨在利用病房级别变量和护士级别变量，探讨护士执业的病房环境与特定患者安全结果之间的关系。结果是护士报告的其工作病房的患者安全水平，以及去年护士提交的正式不良事件报告的数量。设计：这项横断面定量研究是在欧洲 FP7 项目中进行的：护士预测：护理人力资源规划 (RN4CAST) 项目。设置：爱尔兰 30 家医院的 108 个普通内科和外科病房。参与者：所有 研究病房直接护理病人的护士被邀请参加。本分析使用了 1397 名护士的数据。方法：使用包含护理工作指数实践环境量表 (PES-NWI) 的问卷调查进行护士调查。获得了作者所在机构和代表 30 家研究医院的所有伦理委员会的伦理批准。进行多级建模来检查病房级别因素对患者安全的影响。其中包括病房受过学位教育的护士比例，以及 PES-NWI 分数的病房级别汇总平均值。 结果：研究结果支持其他研究结果，表明积极的实践环境可以提高患者安全结果。特别是在病房层面，病房执业环境和拥有学位的护士比例等因素被发现对安全结果有显着影响。本研究开发的模型预测了这些结果的 76% 和 51% 的病区间方差。研究结果可用于通过展示病房级别的因素来提高医院内的患者安全，这些因素使护士能够有效地履行这方面的职责。结论：应认识到病房级别护士因素的重要性，例如护士教育水平和工作环境，并将其视为对患者安全的重要影响因素。 (C) 2012 Elsevier Ltd. 保留所有权利。
Background: Patient safety is a priority for health services in all countries. The importance of the nurse's role in patient safety has been established. Effective nurse staffing levels, nurse education levels, and a positive work environment for nurses are factors which are known to impact on patient safety outcomes.Objectives: This study sought to explore the relationship between the ward environment in which nurses practice and specific patient safety outcomes, using ward level variables as well as nurse level variables. The outcomes were nurse-reported patient safety levels in the wards in which they work, and numbers of formal adverse events reports submitted by nurses in the last year.Design: This cross-sectional quantitative study was carried out within a European FP7 project: Nurse Forecasting: Human Resources Planning in Nursing (RN4CAST) project.Settings: 108 general medical and surgical wards in 30 hospitals throughout Ireland.Participants: All nurses in direct patient care in the study wards were invited to participate. Data from 1397 of these nurses were used in this analysis.Methods: A nurse survey was carried out using a questionnaire incorporating the Practice Environment Scale of the Nursing Work Index (PES-NWI). Ethical approval was obtained from the authors' institution and all ethics committees representing the 30 study hospitals. Multilevel modelling was carried out to examine the impact of ward level factors on patient safety. These included proportions of nurses on the ward educated to degree level, and aggregated ward-level mean for PES-NWI scores.Results: The study results support other research findings indicating that a positive practice environment enhances patient safety outcomes. Specifically at ward level, factors such as the ward practice environment and the proportion of nurses with degrees were found to significantly impact safety outcomes. The models developed for this study predicted 76% and 51% of the between-ward variance of these outcomes. The results can be used to enhance patient safety within hospitals by demonstrating factors at ward-level which enable nurses to effectively carry out this aspect of their role.Conclusions: The importance of ward-level nurse factors such as nurse education level and the work environment should be recognised and manipulated as important influences on patient safety. (C) 2012 Elsevier Ltd. All rights reserved.