Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes and job satisfaction among nurses

A systematic review of the determinants of job satisfaction in healthcare workers in health facilities in Gulf Cooperation Council countries

Job satisfaction among healthcare workers is essential for maintaining high-quality care. Previous research has shown different levels of job satisfaction, but there is no comprehensive list of determinants of job satisfaction among healthcare workers. This study aims to provide a comprehensive list of determinants of job satisfaction in Gulf Cooperation Council (GCC) countries (Saudi Arabia, UAE, Bahrain, Kuwait, Oman, and Qatar). A systematic review was conducted following PRISMA guidelines across five databases: PubMed, CINAHL, Web of Science, Cochrane, and Scopus. Two independent reviewers performed data extraction and review using the Critical Appraisal Skills Programme (CASP) quality assessment checklist. The review was undertaken between 1 January 2012 and 4 November 2022. Five hundred titles and abstracts were screened, yielding 73 eligible studies for inclusion in this review. Of the included studies, 60 were carried out in Saudi Arabia (82.2%), six in Oman (8.2%), three in Qatar (4.1%), two in the United Arab Emirates (2.7%), one in Kuwait (1.4%), and one in the Kingdom of Saudi Arabia and the United Arab Emirates (1.4%). The analysis identified 14 key determinants of job satisfaction among healthcare workers in GCC: pay, promotion, co-workers, supervision, fringe benefits, contingent rewards, operating conditions, nature of work, communication, workload, leadership style, relation with patients, demographic variables, and others, such as hospital type. Thus, our study expands on Spector's nine determinants model of job satisfaction, hence providing a wider and more detail insight into job satisfaction in workplace.

Managing adverse events in nursing homes: A qualitative study

The incidence of adverse events (AEs) among older adults in nursing homes increases annually. This study explored the real experience of managing AEs among nursing-home staff. Six semistructured focus group discussions were held in two nursing homes with a diverse sample of 35 nursing-home staff, including 11 managers, 12 nurses, and 12 nursing assistants. The thematic analysis approach was used to analyze the data, revealing three principal themes: (1) AE awareness: definition, attribution, and avoidance; (2) AE reporting: benefits vs. barriers; and (3) improvement measures for AE management. The management of AEs in nursing homes was a multidimensional issue requiring a comprehensive consideration of individual, organizational, and systematic factors. By enhancing staff's understanding of AEs, optimizing the reporting mechanism, and implementing effective management improvement measures, the safety management of nursing homes can be significantly improved. Our research emphasized as well the importance of establishing a positive safety culture.

Challenges and best practices for moving forward in interprofessional collaboration in critical care units: nurses' perspectives

BACKGROUND

The positive outcomes for critically ill patients rely on effective interprofessional collaboration (IPC), which depends on the collective expertise and skill of the critical care team (CCT) working cohesively and collaboratively to provide patients with high-quality, safe care.

AIMS

(1) To determine the challenges to interprofessional collaboration in critical care units as perceived by the diploma versus. baccalaureate nurses (2) To explore best practices suggested by nurses for improving IPC.

METHODS

A descriptive design using a four-point scale survey and two open-ended questions was employed to collect the data from 125 nurses in three critical care medicine units at a university hospital. Quantitative data were analyzed using t-tests, one-way ANOVA, and Pearson correlations, with 𝑝 < 0.05 considered statistically significant. Open-ended questions were analyzed by content analysis.

RESULTS

The results demonstrated a substantial difference between nurses who graduated from nursing faculties and hold baccalaureate degrees and nurses who graduated from nursing institutions and hold diploma degrees in agreement and satisfaction with the relations and collaboration with the physicians. Additionally, a significant correlation was seen between the level of nurses' education and the limited time caused by heavy workloads and the nurses' perspectives toward their relations with physicians. A content analysis of the nurses' texts revealed that five categories have emerged as nurses' suggestions to keep up the best practices for moving forward in the nurse-physician collaboration: changing the physician's attitude toward the nurses, improving communication skills, role clarification, interprofessional conflict resolution, and support and motivation.

CONCLUSIONS

On the one hand, nurses with baccalaureate degrees expressed lower satisfaction with IPC. On the other hand, five categories were suggested by the nurses as best practices for moving forward in their collaboration with the physicians, these include physician attitudes toward the nurses, communication tools and skills, nurses' roles clarification, interprofessional conflict resolution, and support and motivation. Implementation of the results of the current study will improve patient outcomes by preventing oversights, medication errors, and redundant interventions. In addition to creating relaxed working conditions, improving the morale of the healthcare team, job satisfaction, and decreased staff turnover.

The Role of Structural Empowerment in Mediating the Relationship Between Practice Environment and Quality of Care Among Emergency Nurses: A Multilevel Modeling Approach

INTRODUCTION

Strong evidence demonstrated that working in a healthy environment has been associated with high-quality patient care. However, the mechanism underlying this relationship requires further investigation. This study aimed to examine the role of structural empowerment in mediating the relationship between nursing practice environment and quality of care among emergency nurses.

METHODS

A proportional stratified clustered sampling technique was used to recruit staff nurses working in acute care hospitals in Oman. Four standardized instruments were used to assess nurses' sociodemographic characteristics, perception of the practice environment, structural empowerment, and perceived quality of care. Hayes' process for mediation analysis was used to examine whether empowerment mediates the relationship between the practice environment and quality of care.

RESULTS

A total of 160 emergency nurses participated. The majority (78.8%) perceived the quality of care as good/excellent. Having an adequate foundation for quality of care, sufficient staffing, and managerial support were significant predictors of perceived quality of care. Practice environment was directly and indirectly related to the perceived quality of care through structural empowerment.

DISCUSSION

Nurse leaders can enhance care quality in emergency departments by improving the work environment through engaging nurses in quality activities, ensuring adequate staffing and resources, and providing robust leadership support, which collectively empower nurses and improve patient outcomes.

Enhancing the understanding of safety and the quality of patient care among medical and health sciences students in interprofessional climate: an interventional study

BACKGROUND

Interprofessional education (IPE) plays an essential role in improving healthcare outcomes through achieving shared understanding. Unfortunately, most healthcare professionals have not received training for patient safety (PS) in an interprofessional setting, which can meet the societal medical needs. This study aimed to foster the understanding of senior medical, dental, pharmacy and health sciences students about PS and quality of care at the University of Sharjah (UoS) in UAE.

METHODS

Using a convenience sampling technique, we recruited students from the College of Medicine (CoM), College of Pharmacy (CoP), College of Dental Medicine (CDM), and College of Health Sciences (CHS) of UoS. The study was conducted in spring 2023, and an ethical approval was obtained from the UoS Research Ethics Committee (REC-21-12-12). After a thorough literature search, a bespoke English language questionnaire was developed covering three domains-medical professionalism, leadership in healthcare, and precision medicine. To ensure its validity across different settings, cultural adaptation was ensured with reiterative revision among the panel of experts. The online synchronous real-time workshop included interactive resource sessions, breakout room discussions using real clinical cases, and pre-post surveys using the questionnaire.

RESULTS

A total of 248 students and 20 facilitators participated in the workshop. CoM had the highest representation (47.5%), followed by CoP (36.5%), CHS (13.3%), and CDM (2.7%). There was a statistically improved understanding of the participants, as reflected by significantly high scores of post-test survey in all domains of PS across all colleges (p < 0.001). Notably, students in years four and five from CoM and CoP showed significant improvement in their perceptions than other colleges (p < 0.001). The participants encountered challenges of weak internet connections, software issues, technical failures, and power outages during the workshop.

CONCLUSION

This study highlights the positive impact of an IPE-based interventional workshop on students' attitudes, perceptions, and insights about PS and quality of care. Students' understanding and insights of PS and quality of care underscore the paramount role of IPE in improving perceptions and approaches towards PS in the context of healthcare education.

Planned Changes to Nurse Leadership, Staffing and Skill-Mix: Impact on the Working Environment, Job Satisfaction and Intention to Leave

INTRODUCTION

Job satisfaction and intention to leave have been consistently linked to the working environment. However, there are few studies of interventions for improving the environment or staff outcomes.

AIM

To determine the impact of implementing a framework for safe nurse staffing on the environment and staff outcomes. This involved an assessment of required nursing hours per patient day, supernumerary nurse in charge and minimum 80:20 skill-mix, with intentional changes in staffing if required.

DESIGN

A pre-post observational design.

METHODS

This was a prospective observational study in six medical and/or surgical wards across three acute hospitals in Ireland. The outcomes were measured pre- and post-implementation, and included the environment, using the Practice Environment Scale of the Nursing Work Index; and job satisfaction and intention to leave using a dichotomised 4-point scale.

OUTCOMES

Changes in staffing levels, adjustments to skill-mix and the supervisory role of the ward leader were seen following the implementation. A multilevel model found significant increases over time on three of the five Nursing Work Index subscales: Staffing and Resource Adequacy, Collegial Nurse-Physician Relations, and Nurse Participation in Hospital Affairs. Job satisfaction increased and intention to leave decreased, although the differences were not statistically significant. Increased job satisfaction was significantly associated with Staffing and Resource Adequacy, Collegial Nurse Physician Relations and Nurse Manager, Leadership and Support. A decreased odds of intention to leave was associated with increased job satisfaction.

CONCLUSION

There were significant improvements in the environment following the implementation of the Framework. Three of the practice environment subscales were significantly associated with job satisfaction, while job satisfaction is a predictor of intention to stay. This study indicates that intentional changes to staffing can result in improvements to working environments which may in turn have an impact on job satisfaction and furthermore, on intention to stay.

IMPACT

This study investigated intentional changes to nurse staffing in medical and surgical wards, examining the impact pre- and post-implementation. This study underlined that when staffing is based on a systematic approach, based on a Framework for Safe Nurse Staffing, a subsequent improvement can be seen in staff's perceptions of the work environment, along with improvements in staff outcomes. This research will impact on staff working in acute settings as a means of determining staffing and improving outcomes using a Framework for Safe Nurse Staffing.

REPORTING METHOD

STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Health professionals' willingness to share responsibility and strengthen interprofessional collaboration: a cross-sectional survey

BACKGROUND

Doctors' unwillingness to share responsibility acts as a major barrier to interprofessional collaboration (IPC). Educating both doctors and allied health professionals in taking on or relinquishing responsibility could enhance IPC. Yet there is no evidence that these educational efforts increase IPC willingness. This study aims to (1) compare the willingness to take on or relinquish responsibility for decision-making in patient care and their willingness to strengthen IPC between members of five main health professions, and (2) investigate associations between the willingness to take on or relinquish responsibility and the willingness to strengthen IPC.

METHODS

We conducted a cross-sectional survey targeting pharmacists, doctors, medical practice assistants, nurses, and physiotherapists in Switzerland. Group differences were assessed, and associations were examined using multivariable logistic regression analyses.

RESULTS

Overall, 3670 health professionals participated. Members of all allied health professions were highly willing to take on more responsibility for decision-making for patient care (ranging from 74.3% to 86.5%). Medical practice assistants (52.3%) and nurses (46.8%) were highly willing to relinquish responsibility, less so pharmacists (34.2%) and physiotherapists (37.8%); doctors were torn between high (49.2%) and neither high nor low willingness (38%). Members of all professions were highly willing to strengthen IPC (ranging from 76.4 to 91.2%). We found a strong, statistically significant relationship between willingness to take on more responsibility and willingness to strengthen IPC (OR = 5.30, p < .001). The relationship between willingness to relinquish responsibility and willingness to strengthen IPC was smaller (OR = 3.30, p < .001).

CONCLUSION

Increasing the health professionals' willingness to take on responsibility is crucial to strengthen IPC. Increasing the willingness to relinquish responsibility would likely be less effective. Actions required include educational and political efforts to transfer responsibility to allied health professionals and to enable health professionals to decide when it is appropriate to take on or relinquish responsibility. Given the willingness of many health professionals to strengthen IPC, substantial potential in practice is evident.

"Eat Enough"-A nurse-led intervention to enhance hospitalized older adults' protein and energy nutrition

PURPOSE

To develop an intervention enhancing hospitalized older adults' nutrition.

METHODS

For the first time, a mixed-methods design with data triangulation was applied according to the six-step model of Corry et al. to elaborate on a complex nursing intervention in the form of a logic model. Patients who were aged ≥80 years and hospitalized for at least 5 days were included. Sample size for quantitative practice analysis was 135 older adults, whereas 22 older inpatients participated in interviews and observations for needs analysis and generated data for key principles.

FINDINGS

The intervention "Eat Enough" encompasses nursing team culture and comprises six actionable targets to deliver needs-based support and reach required protein and energy intake for hospitalized older adults by sensitizing nurses and the interprofessional team. Facilitating nutritional intake would be supported by an advanced practice nurse who considers the medical and nursing care plan and therapy.

CONCLUSIONS

The intervention "Eat Enough" demonstrates that nurses play a key role in interprofessional teams to enhance older adults' nutrition in hospital. The pipeline model displays how the actionable targets can be achieved, and how awareness raising can influence the context-leading to raised calories and protein requirement coverages and shorter length of stay.

IMPLICATIONS FOR CLINICAL PRACTICE

By identifying risk factors of malnutrition and strengthening nurses' responsibilities, the intervention "Eat Enough" could significantly enhance nutrition among hospitalized older adults. However, the logic model should be tested and implemented in future research.

The impact of the nurse practice environment, workload, and professional support on job outcomes and standards of care at primary health care clinics in South Africa: A structural equation model approach

Background

There is substantial evidence on the associations between a positive nurse practice environment and improved nurse and patient outcomes, as well as the factors that mediate these associations, in high-income countries and in hospital settings. The knowledge gaps in African and primary health care settings motivated this empirical study.

Objective

The objective of this study was to examine the impact of the dimensions of the nurse practice environment, specifically human resource management, foundations for nursing care, and participation in clinic affairs, on job outcomes and standards of care.

Design

A cross-sectional study was conducted between November 2021 and June 2022.

Setting

180 primary health care clinics in two South African provinces of Gauteng and North West.

Participants

665 nurses of all categories.

Methods

A causal model was developed with pathways between the nurse practice environment dimensions and the outcomes of job satisfaction, intention to leave, and standards of care. A set of standardised instruments was used to measure the study variables. Using structural equation modelling, workload and professional support were tested as potential mediators between the nurse practice environment and the outcome variables.

Results

The nurses scored the domain of foundations for nursing care 71.2 out of 100 on average, indicating high agreement, while the mean scores for nurses' participation in clinic affairs and human resources management were lower at 68.0 and 61.7 respectively. Although nurses expressed moderate satisfaction with professional support (67.7), they were less satisfied with their workload (52.2). The mean score of overall job satisfaction was moderate (58.9), with 53.8 % of the nurses reporting that they intended leaving the clinic where they were working. Thirty-six percent intended leaving the nursing profession, indicating low intention to stay. The final mediation model was judged to fit the data adequately based on goodness-of-fit indices, confirming that workload and professional support had a mediating role between the nurse practice environment dimensions of interest and both nurses' job outcomes and standards of care.

Conclusions

We have highlighted the value of supportive practice environments, effective workload management, and enhanced professional support in improving nurses' job outcomes and satisfaction with standards of care. Improving nurses' practice environments at primary health care level may have a wide-ranging impact on the performance of the health system. Therefore, primary health care facility managers should ensure that workload is distributed equitably, professional support for nurses is enhanced, and the overall work environment is improved.

Nurses' attitudes towards patient safety and their relationship to adverse patient events in Oman

Background

Adverse events (AEs) are major causes of mortality. Identification of nurses' attitudes towards patient safety and their impact on AEs is critical in enhancing safe practices.

Aim

To assess the relationship between attitudes towards patient safety and AEs as perceived by nurses working in Sultanate of Oman.

Methods

A descriptive, cross-sectional study was conducted. Data to evaluate nurses' attitudes towards patient safety was collected using the Safety Attitude Questionnaire. The relationship between attitudes towards patient safety and the perceived incidence of adverse patient events was examined using logistic regression analysis.

Results

A total of 184 questionnaires were administered from February to April 2022, with a response rate of 96.8%. The results revealed that nurses had a negative attitude towards patient safety. The highest reported adverse event was patient and family complaints. Findings showed a significant relationship between working conditions and patient and family verbal abuse (OR = 0.505, CI (0.283-0.901), p = 0.021). Job satisfaction was a significant predictor of patient fall (OR = 0.57, CI (0.353-0.932), p = 0.025) and medication error (OR = 0.58, CI (0.354-0.949), p = 0.030).

Conclusion

Nurses' attitudes towards patient safety are a significant predictor contributing to the occurrence of AEs. This finding provides key insights about patient safety status that key stakeholders could use to improve safety culture, including raising patient safety awareness.

The work of palliative care from the perspectives of district nurses: A qualitative study

AIM

To explore the work of palliative care from the perspectives of district nurses with a focus on the strategies they use to achieve positive outcomes for patients.

DESIGN

An exploratory descriptive qualitative study.

METHODS

A combination of group and individual interviews using semi-structured interviewing were used to explore district nurses' views of providing palliative care across two large urban community nursing services.

RESULTS

Sixteen district nurse participants were interviewed. Three key themes were identified: "Getting what was needed" involved finding solutions, selling a story and establishing relationships. District nurses sought ways to "Stay involved" recognizing the benefit of delaying discharge for some patients. "Completing a nursing task" was a way of managing time constraints and a form of self-protection from having difficult conversations.

CONCLUSION

This study highlights the importance of understanding the contextual nature of the practice setting in relation to the provision of palliative care. In doing so, it has revealed the strategies district nurses use to overcome the challenges associated with providing palliative care within a generalist workload.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

District nurses experience a tension between managing high patient workloads and remaining patient centred in palliative care. Being task focused is a way of remaining safe while managing a high volume of work and is not always a negative factor in the care they provide. However, focusing on a task while at the same time addressing other unmet needs requires a set of skills that less experienced nurses may not have.

IMPACT

Palliative care education alone will not improve the quality of palliative care provided by generalist community district nurses. The practice context is an important factor to take into consideration when supporting the integration of palliative care in district nursing.

NO PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was made to this study.

REPORTING METHOD

We have adhered to the relevant EQUATOR guidelines and used the COREQ reporting method.

Development of the FAce-to-face Cooperation Evaluation scale Short-version (FACES) to enhance collaboration among health and long-term care providers

This study aimed to develop the FAce-to-face Cooperation Evaluation scale Short-version (FACES) to create a simple low-burden rating scale for promoting collaboration between health and long-term care providers. A survey was conducted with 151 care providers, obtaining valid responses from 147 (30 nurses, 67 care managers, and 50 care workers; response rate 97.4 %). Through confirmatory factor analysis, we developed a short-version scale consisting of 7 items by selecting one item with the highest regression coefficient from each of the 7 factors in the original 21-item version. The reliability was verified by confirming internal consistency. Regarding construct validity, the goodness-of-fit indices confirmed acceptable fit, and the correlation between the original and the shortened version was 0.98. Convergent validity was found as significant using the collaborative behavior evaluation scale and job satisfaction measure. FACES is considered a useful scale for easily measuring the level of collaboration among various professions in the community.

Sequential Mediation Effects of Organizational Support and Collaboration on Missed Nursing Care

BACKGROUND

It is necessary to find ways to mediate the relationship between role overload and missed nursing care in settings where nursing staffing is inadequate. This study aimed to identify the single and multiple sequential mediation effects of organizational support, nurse-physician collaboration, and nurse-nurse collaboration on the relationship between role overload and missed nursing care.

METHODS

Data were collected from 237 registered Korean nurses working in general wards in October 2022. The measures used were the modified role overload scale, nurse-physician collaboration scale, nurse-nurse collaboration scale, a short version of the Perceived Organizational Support Scale, and the modified Missed Nursing Care Scale. Data were analyzed using PROCESS macro in SPSS. A hypothesis test was performed using Model 81, proposed by Hayes, which includes serial multiple mediators.

RESULTS

Organizational support, nurse-physician collaboration, and nurse-nurse collaboration showed a mediation effect on missed nursing care. Organizational support, nurse-physician collaboration, and nurse-nurse collaboration showed significant multiple sequential mediation effects on the relationship between role overload and missed nursing care. When the indirect effect sizes of nurse-physician collaboration were compared with those of nurse-nurse collaboration in both single and multiple sequential mediation paths, the indirect effect of nurse-physician collaboration was greater than that of nurse-nurse collaboration on the relationship between role overload and missed nursing care.

CONCLUSIONS

As an alternative strategy to reduce missed nursing care in situations with insufficient nursing staffing, organizational support should precede nurse-physician and nurse-nurse collaboration. In particular, improving nurse-physician collaboration shows promise in mitigating missed nursing care.

Relationship between interprofessional collaboration and psychological distress experienced by healthcare professionals during COVID-19: a monocentric cross-sectional study

Background

Since the onset of the COVID-19 pandemic, global healthcare systems have faced unprecedented challenges, leading to significant psychological distress among healthcare professionals. Recognizing the importance of enhanced interprofessional collaboration in alleviating this burden, as emphasized by the World Health Organization in 2020, we investigated whether such collaboration could mitigate staff psychological distress during crises. To our knowledge, no study has yet explored the role of interprofessional collaboration as a resilience factor in crises.

Methods

For this monocentric cross-sectional study at a German university hospital, we examined the relationship between the quality of interprofessional collaboration and the psychological distress of healthcare professionals during the initial pandemic wave. We employed validated mental health instruments, such as the GAD-7 and PHQ-2, to assess anxiety and depressive symptoms. Additionally, custom-designed questionnaires evaluated "Pandemic-Associated Burden and Anxiety (PAB; PAA)" and interprofessional crisis management experiences. A novel "Interprofessional collaboration and communication (IPC)" assessment tool was developed based on international competency frameworks, demonstrating strong reliability.

Results

The study involved 299 healthcare professionals (78.6% in direct contact with COVID-19 patients). Moderate levels of PAB/PAA were reported. However, a significant proportion experienced clinically relevant anxiety, as indicated by GAD-7. Negative IPC perceptions correlated with higher levels of psychological distress. Linear regression analysis showed associations between interprofessional collaboration and anxious and depressive symptoms, and pandemic-related burden.

Conclusion

Our findings highlight the vital role of enhanced interprofessional collaboration in strengthening the psychological well-being of healthcare professionals during crises. The study underscores the need to foster a collaborative environment and integrate interprofessional education for resilience.

The effectiveness of a training program on perceptions of caring culture among Turkish nurses: A quasi-experimental trial

AIM

To assess the effectiveness of a training program on perceptions of caring culture among Turkish nurses and investigate the relationships among caring culture, job satisfaction, and intention to leave.

BACKGROUND

Every organisation has its on culture with its vairous components including values, symbols, practices and policies. Healthcare organizations need a favorable caring culture to support nurses and other professional working in the organisation.

METHODS

This was a quasi-experimental trial of an educational intervention conducted between October and December 2020 at a university hospital in Turkey. The sample of the study consisted of 86 nurses. A four-week training program based on caring culture was provided for the training group. The data were collected using a Personal Information Form, the Turkish version of the Caring Culture Survey, and the Job Satisfaction Scale. Intention to leave was measured with a single question.

FINDINGS

The mean total caring culture and personal caring scores of the training group were significantly higher after the training than before (p < 0.05). There were significant positive correlations between the mean caring culture total and subscale scores of the participants and their total job satisfaction scores. Besides, there were significant negative correlations between the caring culture total and subscale scores of the participants and their intentions to leave, but these relationships were weak or moderate (p < 0.05).

CONCLUSION

This training program based on caring culture can contribute to improving the caring culture perceptions of nurses. Caring culture is positively related to job satisfaction and negatively related to intentions to leave.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Healthcare organizations should prioritize creating a caring culture and designing initiatives that focus on caring culture. The perceptions of nurses about caring culture should be measured and identified regularly.

Relationship between transformational leadership, adverse patient events, and nurse-assessed quality of care in emergency units: The mediating role of work satisfaction

BACKGROUND

Effective leadership plays a pivotal role in healthcare settings, particularly in the fast-paced and high-pressure environment of the emergency room, as it is closely linked to patient safety and the overall quality of care. This study assessed the mediating role of work satisfaction in the relationship between nurses' perceptions of their nurse managers' transformational leadership, reported adverse patient events, and the nurse-assessed quality of care in the emergency units.

METHODS

A cross-sectional survey design was carried out involving 283 emergency room nurses from the Philippines, utilizing standardized scales. Mediation testing was performed using Hayes' PROCESS macro in SPSS (Model 4).

RESULTS

Emergency room nurses perceived their nurse managers as highly transformational. Nurses' perceptions of transformational leadership in their nurse managers were associated with a reduction in reported adverse patient events and an increase in nurse-assessed nursing care quality. Work satisfaction partially mediated the relationship between transformational leadership and nurse-assessed nursing care quality, but it did not serve as a mediator between transformational leadership and reported adverse patient events.

CONCLUSION

The results suggested that enhancing transformational leadership behaviors among nurse leaders can foster work satisfaction in ER nurses, which, in effect, contributes to enhanced nursing quality of care provision in emergency settings.

Psychometric evaluation of the Persian version of Emergency Medical Services- Safety Attitudes Questionnaire (EMS-SAQ)

AIM

This study aimed to conduct a psychometric evaluation of the Persian adaptation of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ).

METHODS

In this cross-sectional study, the validity and reliability of the EMS-SAQ were assessed among 484 Iranian pre-hospital emergency department employees between February and June 2023.

RESULTS

Five factors were extracted namely safety climate, teamwork, job satisfaction, stress management, and working conditions with explained 38.75% of the total variance. The goodness of fit indexes confirmed the model (χ2 = 409.031, DF = 196, χ2 /df = 2.087, CFI = 0.900, IFI = 0.901, PCFI = 0.763 and PNFI = 0.701, and RMSEA = 0.069 [CI90% 0.059-0.078]).

CONCLUSION

The Persian version of the SAQ-EMS, comprising 22 items across five factors, demonstrated good validity and reliability. It is recommended to undertake qualitative studies focusing on the concept of patient safety in pre-hospital settings, considering diverse contexts and cultural nuances to develop more robust assessment tools.

Emergency room nurses' caring ability and its relationship with patient safety outcomes: A cross-sectional study

INTRODUCTION

Nurse caring ability plays a crucial role in providing quality care and ensuring patient safety. However, further research is warranted to understand the specific impact of caring ability on patient safety in the emergency department.

AIM

This study has two-fold purposes: (a) to examine the association between nurses' demographic characteristics and their perceptions of their caring ability, and (b) to explore the relationship between nurses' caring ability and nursing care quality, as well as its impact on adverse patient events and missed care.

METHODS

This cross-sectional study included a convenience sample of emergency room nurses working in select hospitals in the Philippines. Descriptive statistics and regression analyses were performed to analyze the data.

RESULTS

A total of 164 out of the 200 emergency nurses invited responded to the survey. The mean score for the caring ability inventory was 67.89 out of 80. Nurses' demographic characteristics, including job status (working part-time) and hospital size (working in small and medium-sized hospitals), were associated with higher levels of caring ability. Higher levels of nurses' caring ability were associated with better nursing care quality (β = 0.259, p <.001), a reduction in adverse events (β = -0.169, p <.05), and a decrease in instances of missed care (β = -0.158, p <.01).

CONCLUSION

This study emphasizes the significance of nurses' characteristics in influencing nurse caring abilities. Additionally, the results underscore the importance of nurse caring ability in the emergency department and its association with nursing care quality and patient safety outcomes. Organizational strategies directed toward promoting and enhancing nurse caring ability in the emergency department can have positive implications for nursing practice, including improved nursing care quality, reduced adverse events, and decreased instances of missed care.

How nursing practice environments limit implicit rationing of care and nurse-assessed adverse events: the role of flow at work

BACKGROUND

The nursing practice environment is beneficial in curbing implicit rationing of nursing care and adverse patient events. However, the underlying mechanisms of these relationships remain unexplored.

AIM

To test whether flow at work mediates the relationship between the nursing practice environment, implicit rationing of nursing care, and nurse-assessed adverse patient events.

METHODS

This cross-sectional study involved 231 nurses from five hospitals in Port Said, Egypt. The participants completed Arabic-translated versions of the Practice Environment Scale of the Nursing Work Index, the Work-Related Flow Inventory, the Perceived Implicit Rationing of Nursing Care instrument, and the Adverse Patient Events scale. Structural equation modeling was used to test the hypothetical model.

RESULTS

The favorable nursing practice environment positively predicted nurses' flow at work (β = 0.64, p < 0.001), while inversely predicting implicit rationing of nursing care (β = -0.23, p = 0.014) and adverse patient events (β = -0.35, p < 0.001). Nurses' flow at work inversely predicted implicit rationing of nursing care (β = -0.30, p = 0.002) and adverse patient events (β = -0.29, p = 0.002). Moreover, nurses' flow at work acted as a mediator, linking the nursing practice environment to the rationing of nursing care and adverse patient events, with 500 bootstrap results for the indirect effects (β = -0.24, p = 0.001, 95% CI: -0.43 to -0.09; and β = -0.44, p = 0.003, 95% CI: -0.79 to -0.16, respectively).

CONCLUSION

Nurses working in a favorable nursing practice environment are more likely to experience flow at work, limiting implicit rationing of nursing care and adverse patient events.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing administrators should strive to create a healthy nursing practice environment to foster nurses' flow and thereby reduce the frequency of implicit rationing of nursing care and adverse patient events.

Nursing Professional Commitment as a Mediator of the Relationship Between Work Environment and Missed Nursing Care Among Nurses: A Cross-Sectional Analysis

Introduction

Nursing care plays a pivotal role in promoting patient well-being and optimizing health outcomes. The nursing profession is characterized by its commitment to delivering high-quality care to patients.

Objective

The purpose of the study was to explore the role of nursing professional commitment as a mediator between the work environment and missed nursing care.

Methods

A cross-sectional analysis study "STROBE guideline" used an online structured questionnaire to collect data. It was conducted on a sample of 813 nurses who worked at seven governmental hospitals in Egypt, in the hospital wards, operating rooms, intensive care unit (ICU) or outpatient clinics, during a 4-month period from April to August 2022. Researchers used Characteristics of nurses, Nursing Work Index-Revised, Nursing Professional Commitment Scale, and MISSCARE Questionnaire to collect the data. Structural equation modeling by AMOS was used for testing nursing professional commitment as a mediator between the work environment and missed nursing care. Nurses' professional commitment was used as a mediator between work environment and missing nursing care.

Results

The working environment has a direct impact of -0.175, an indirect impact of -0.139, and a total impact of -0.314. Furthermore, professional commitment has a direct impact of -0.421. Additionally, when the working environment increases by 1, professional commitment increases by 0.33. Similarly, when the working environment increases by 1, missed care decreases by 0.175. Moreover, when professional commitment, as a mediating factor, increases by 1, missed care decreases by 0.421.

Conclusion

In conclusion, the findings of this study highlight the significant role of professional commitment as an intermediary factor between the working environment and missed nursing care. According to these results, it is necessary to formulate and implement intervention strategies to improve nurses' professional commitment and working environment, which is the key to reducing their missed nursing care.

Embedding patient safety in a scaffold of interprofessional education; a qualitative study with thematic analysis

BACKGROUND

Regardless of a proliferation of interest in reducing unsafe practices in healthcare, threats to patient safety (PS) remain high. Moreover, little attention has been paid towards the role of interprofessional education (IPE) in enhancing PS. This qualitative study was conducted to unfold the insights of the senior medical, dental and health sciences students at the University of Sharjah (UoS) in the United Arab Emirates (UAE) about PS in an online IPE-based workshop.

METHODS

This inductive thematic analysis study was conducted on senior medical and health students at the Colleges of Medicine, Dental Medicine, Health Sciences, and Pharmacy of UoS. During an online workshop, students discussed plausible solutions for four real practice-based clinical scenarios with elements of unsafe healthcare practices. During the breakout rooms, the students exhibited high level of articulation and proactively participated in discussions. The data from the online workshop were transcribed and then coding, categorizing, and labelling of recurrent themes were carried out. Multiple individual deliberations, consolidation, incorporation of the identified preliminary themes, and merging and reorganizing sub-themes led to a final thematic framework.

RESULTS

This work delved into the perspectives of 248 students regarding teamwork, communication, problem-solving, and other aspects concerning PS in interprofessional settings in an online workshop. The iterative process of data transcription, curating and qualitative analysis surfaced 32 codes. Later, the inductive themaric analysis yielded five themes with distinct yet interconnected nested subthemes in the context of PS in IPE settings. These themes of information sharing and grounding (problem-solving, social skills), maintaining communication (clinical reasoning, shared mental model), executing interprofessional activities (collaborative practice, collaboration scripts), professional cognitive abilities (cognitive maturity, metacognition), and negotiating professional identities (systematic change, socio-economic scaffolding) emerged as fundamental pillars for enhancing PS in healthcare.

CONCLUSION

Our study demonstrated the outcome of an innovative and team-based workshop which embedded PS within a scaffold of IPE environment. This research calls for incorporation of the emerging areas of clinical reasoning, problem solving, collaborative practice, and shared mental model into medical curricula for structured IPE in improving PS domains in medical education. These findings underscore the need for multifaceted dimensions of IPE imperatives for cultivating collaborative competence.

'Development and psychometric evaluation of the safety feeling scale in adult patients at hospital: Exploratory sequential mixed method'

AIM AND OBJECTIVES

This study aimed to develop and examine psychometric properties of the safety feeling scale (SFS) in adult patients to assess their sense of safety during a hospital stay.

DESIGN

Mixed methods design. A SQUIRE checklist was used.

METHODS

This is a study with two phases of scale development and evaluation of the psychometric properties of the scale. In the first phase, the concept of 'safety feeling' was analysed using a hybrid model. Thus, a systematic review and then a qualitative study with hospitalized patients (n = 31) were conducted by conventional content analysis. In the psychometric phase, factorial validity, reliability, feasibility, and responsiveness of the scale were evaluated by different tests in various samples.

RESULTS

After integrating the results of the systematic review and qualitative study, a scale item pool with 84 items was developed. In the psychometric phase, 12 items with four factors were specified; 'effective care,' 'confidence in the healthcare team,' 'emotional enrichment' and 'hygienic facilities,' explaining 51% of the total variance of the scale. They were confirmed by confirmatory factor analysis. Internal consistency and stability of the scale were satisfactory. Feasibility and responsiveness were also acceptable.

Association between the Nursing Practice Environment and Safety Perception with Patient Safety Culture during COVID-19

AIMS

In this study, we aimed to identify the relationship between nursing practice environments (NPEs) and safety perceptions with patient safety culture (PSC) during COVID-19.

DESIGN

We conducted a quantitative, non-experimental, correlational, and cross-sectional study. We interviewed 211 nurses from Peru using two scales: PES-NWI and HSOPSC. We used the Shapiro-Wilk test and Spearman's coefficient and estimated two regression models.

RESULTS

NPE was reported as favorable by 45.5% of the participants, and PSC was reported as neutral by 61.1%. Safety perception, the workplace, and NPE predict PSC. All NPE factors were correlated with PSC. However, safety perception, support of nurses subscale, the nurse manager's ability, and leadership were predictors of PSC.

CONCLUSION

To promote a safe work culture, health institutions should foster leadership that prioritizes safety, strengthens managers' abilities, encourages interprofessional collaboration, and considers nurses' feedback for constant improvement.

Nurses' perspective on team learning in interprofessional teams

AIM

The aim of this study is to find out what learning activities in interprofessional teams and what influencing factors for team learning activities in interprofessional teams can be described by nurses working in interprofessional teams.

DESIGN

We conducted a descriptive interview study.

METHODS

We used a semi-structured interview guideline and interviewed 10 nurses (N = 10) working in interprofessional teams. We analyzed our data using a qualitative content analysis.

RESULTS

Nurses describe team learning activities of knowledge sharing, team reflection, and storing and retrieving. Furthermore, our results show that team stability is important for interprofessional teams.

PATIENT OR PUBLIC CONTRIBUTION

Our results can be helpful for hospitals to improve organizational structures that help interprofessional teams to work together. Furthermore, vocational education and training for nurses should offer possibilities for nursing students to learn together with students of other fields.

Nurses' perceptions of career growth: A qualitative descriptive study

AIMS

To explore nurses' experiences and perceptions of career growth and its influencing factors, as career growth is more closely associated with individual attitudes and behaviours in the new career era.

DESIGN

A qualitative descriptive design was used.

METHODS

Thirty-one nurses from 10 secondary and 8 tertiary hospitals in Sichuan Province of China were purposively selected to participate in this study. The data were collected using individual semi-structured face-to-face interviews. Two researchers independently reviewed the transcripts and emergent coding. The data were analysed using qualitative content analysis.

FINDINGS

The nurses' perceptions of career growth fully described the nurses' experience and occurred in five dimensions: career promotion, career goal progress, professional ability and quality improvement, professional identity development and increase in personal prestige. The factors influencing career growth were identified at the organizational, individual and social levels. Career growth in nursing was complex, changed over time and showed several specific characteristics compared with other careers. The nurse-specific symbol of career growth was professional identity development, which reflected career progression characteristics.

CONCLUSIONS

Career growth is a multi-dimensional concept with varying influencing factors. The meaning of career growth for nurses is distinct from that for employees in other careers.

IMPACT

Nursing managers should guide nurses to comprehensively assess their career growth from multiple perspectives, and professional identity development deserves more attention. Both organizations and individuals should take responsibility for career management to pursue career growth.

Relationship between interprofessional teamwork and nurses' intent to leave work: The mediating role of job satisfaction and burnout

BACKGROUND

Reducing nurse turnover is a top priority for nursing management globally. While evidence has demonstrated that working in a favorable environment with greater interprofessional teamwork is essential in increasing nurse retention, few studies have explored the mechanism underlying this relationship.

AIM

To examine the direct and indirect effects of interprofessional teamwork on nurses' intentions to leave their jobs via the intermediary roles of job satisfaction and burnout.

METHODS

A cross-sectional study was conducted to collect data from 2113 nurses working in 21 hospitals in Oman. Data were collected using a survey questionnaire measuring teamwork, job satisfaction, burnout, and intention to leave. Logistic regression was used to investigate the direct effect of teamwork on intent to leave. A sequential mediation model was conducted to examine the mediating role of job satisfaction and burnout.

RESULTS

Interprofessional teamwork was directly associated with nurses' intentions to leave. The influence of teamwork on intention to leave was indirectly mediated by both job satisfaction and job burnout.

CONCLUSION

Findings illustrate the potential benefits of enhancing interprofessional teamwork in reducing nurses' intentions to leave. Interventions intended to foster teamwork could create satisfying workplaces, reduce perceived burnout, and ultimately contribute to organizational strategy for reducing nursing shortages.

Work environment and mental health in nurse assistants, nurses and health executives: results from the AMADEUS study

AIM

To explore work environment and mental health in nurse assistants, nurses and health executives in a national large-scale study.

BACKGROUND

We have data for physicians but not for other healthcare workers categories.

METHODS

6935 participants were recruited between 2021 May and June by professional mailings and professional networks.

RESULTS

All professional categories reported high rates of high psychological demand (>90%), low social support (>60%) burnout (50 to 60%), exposure to potentially morally injurious events (>40%) depression (approximately 30%). Surgery nurses reported the highest exposure to potentially morally injurious events. Major depression was identified in approximately 30% of participants in all categories but less than 10% reported consuming antidepressants. 31 to 49% of participants reported sleep disorders and 16 to 21% reported consuming regularly hypnotics. Physicians reported high hazardous drinking behavior and nurse assistant high smoking rates.

CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT

Our results suggest that preventing burnout and depression in healthcare workers is a priority. To reach this goal, nursing managers could develop some interventions to reduce psychological demand and increase personal accomplishment and social support between colleagues, prevent sustained bullying at the workplace and health risk behaviors. These interventions should be further developed and evaluated.