Introducing the 2020 Pathway to Excellence® manual

Strategies and Interventions to Support Quality Outcomes in the Home Care Setting: A Longitudinal Multilevel Study

BACKGROUND

The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations.

OBJECTIVE

This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization.

METHODS

A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021).

RESULTS

In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round.

CONCLUSION

The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.

Another Piece of the Practice Environment Puzzle: Development and Validation of a Team Virtuousness Instrument

The Practice Environment Scale of the Nursing Work Index, a widely used practice environment instrument, does not measure vital coworker interrelations. Team virtuousness measures coworker interrelations, yet the literature lacks a comprehensive instrument built from a theoretical foundation that captures the structure. This study sought to develop a comprehensive measure of team virtuousness built from Aquinas' Virtue Ethics Theory that captures the underlying structure. Subjects included nursing unit staff and master of business administration (MBA) students. A total of 114 items were generated and administered to MBA students. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were run on randomly split halves. Based on analyses, 33 items were subsequently administered to nursing unit staff. EFA and CFA were repeated on randomly split halves; CFA item loadings replicated EFA. Three components emerged from the MBA student data: integrity, α = .96; group benevolence, α = .70; and excellence, α = .91. Two components emerged from the nursing unit data: wisdom, α = .97; and excellence, α = .94. Team virtuousness varied significantly among units and correlated significantly with engagement. The two component instrument, named the Perceived Trustworthiness Indicator, is a comprehensive measure of team virtuousness built from a theoretical framework that captures the underlying structure, demonstrates adequate reliability and validity, and measures coworker interrelations on nursing units. Forgiveness and relational and inner harmony emerged as elements of team virtuousness, broadening understanding.