Nurse work environment and its impact on reasons for missed care, safety climate, and job satisfaction: A cross-sectional study.

AIM: To describe the nurse work environment and its relation to reasons for missed nursing care, safety climate, and job satisfaction. DESIGN: This was a cross-sectional study. METHODS: Two hundred and nineteen nursing professionals by a convenience sample from two teaching hospitals between April 2017 and October 2017. The variables nurse work environment, reasons for missed nursing care, safety climate, and job satisfaction were collected by measuring instruments, and a descriptive, correlation, and comparative analyses were performed. RESULTS: The nurse work environment was classified as mixed, with three subscales of the instrument resulting in scores that represented a better nurse work environment, namely: nursing foundations for quality care; collegial nurse-physician relations; and nurse manager ability, leadership, and support. The most frequent reasons for missed care were related to labour and material resources. A better work environment was associated with a high level of work satisfaction, better perception of the safety climate, and fewer reasons for missed care. CONCLUSION: Better nurse work environments can contribute to improving nurses' perception of job satisfaction and the safety climate, and to reducing reasons for missed care. IMPACT: Authentic leadership in the nurse work environment has implications in terms of reducing the reasons for missed nursing care, improving the perception of the safety climate, and job satisfaction. Nurse managers should evaluate the nurse work environment and missed nursing care as an important predictors of the quality of patient care.

Nursing work environment and accreditation: Is there a relationship?

BACKGROUND: The association between Magnet recognition and nursing work environment is well established; however, little is known about hospital accreditation and its relationship to the nursing work environment. OBJECTIVE: To describe the Brazilian nurses' perceptions of the work environment and their relationship with hospital accreditation. METHODS: A cross-sectional survey study was carried out in three Brazilian hospitals. Nurses who delivered direct patient care and worked for at least 6 months were invited to participate. Those who were on vacation or leave for any reason during data collection were excluded. The participants were asked to fill out the personal and professional characterization form and the Brazilian version of the Revised Nursing Work Index. RESULTS: The work environment was evaluated as favourable by Brazilian nurses. Linear regression analysis evidenced that hospital accreditation is associated with the nursing work environment, affecting the nurse-physician relationship (OR = 0.266, p < .001), organisational support (OR = 0.256, p < .001), control over the practice setting (OR = 0.229, p < .001) and autonomy (OR = 0.227, p < .001). CONCLUSION: The findings suggest that there is a positive influence of hospital accreditation on nurses' perceptions of the work environment concerning autonomy, nurse-physician relationship, control over the practice setting and organisational support. IMPLICATION FOR NURSING MANAGEMENT: Nurse managers can apply the recommendations of certification programmes in practice settings to improve the nursing work environment.

Nurse work environment and job-related outcomes in Brazilian hospitals.

BACKGROUND: It has been reported that a work environment that does not support nurses, and high levels of emotional exhaustion and job dissatisfaction are associated with nurses' intent to leave their job. The aim of this study was to determine if these work-related factors and job-related outcomes are common in Brazilian nurses. METHODS: This cross-sectional study included a 2015 survey of nursing professionals who worked in 48 units of three Brazilian, acute care hospitals. Descriptive statistics were used to examine the sample and a series of logistic regression models were fit to examine two job-related outcomes of interest: job dissatisfaction and intent to leave during the next 12 months. RESULTS: A total of 450 completed surveys were available, where nurses reported high emotional exhaustion (26%), job dissatisfaction (28%), and an intent to leave (12%). Poor control over the work environment (OR = 2.19) and high emotional exhaustion (OR = 4.47) were associated with an increase in the odds of job dissatisfaction. Inadequate staffing (OR = 2.43), high emotional exhaustion (OR = 2.24) and job dissatisfaction (OR = 5.74) were associated with an increase in the odds that nurses would leave their job in the next 12 months. CONCLUSION: Features of the nurse work environment and high emotional exhaustion were associated with job dissatisfaction. Job dissatisfaction and inadequate staffing are likely to result in nurses leaving their job. It is imperative that hospital administrators provide a work environment that supports nursing and improves nurse outcomes and the quality of patient care.

Nursing work environment, patient safety and quality of care in pediatric hospital. / Ambiente de trabalho da enfermagem, segurança do paciente e qualidade do cuidado em hospital pediátrico.

Objectives To describe the characteristics of the nursing work environment, safety attitudes, quality of care, measured by the nursing staff of the pediatric units, as well as to analyze the evolution of quality of care and hospital indicators. Methods Descriptive study with 136 nursing professionals at a paediatric hospital, conducted through personal and professional characterization form, Nursing Work Index - Revised, Safety Attitudes Questionnaire - Short Form 2006 and quality indicators. Results The professionals perceive the environment as favourable to professional practice, and consider good quality care that is also observed by reducing the incidence of adverse events and decreased length of stay. The domain job satisfaction was considered favourable to patient safety. Conclusions The work environment is favourable to nursing practice, the professionals nursing approve the quality of care and the indicators tended reducing adverse events and length of stay.

Validation of the Brazilian version of the Newcastle Satisfaction with Nursing Scales: a partial least squares path modeling approach.

BACKGROUND AND PURPOSE: Assessing patient satisfaction requires reliable and valid instruments. This study evaluated the reliability and validity of the Brazilian version of the Newcastle Satisfaction with Nursing Scales (B-NSNS). METHODS: This cross-sectional study enrolled 351 adult inpatients. Partial least squares path modeling (PLS-PM) approach was used to evaluate the reliability and validity of this instrument. RESULTS: After the adjustments of model, both constructs exhibited adequate convergent and discriminant validity, showing that experiences with nursing care have a significant effect on patient satisfaction (r = .70) and account for 49.1% of the variance in patient satisfaction with the nursing care (R2 = 0.49). CONCLUSIONS: The B-NSNS result in a valid and reliable measure for use in managing nursing care.

[Pediatric patient classification system: improvement of an instrument]. / Sistema de classificação de pacientes pediátricos: aperfeiçoamento de um instrumento.

OBJECTIVE: Improve the content validity of the instrument for classification of pediatric patients and evaluate its construct validity. METHOD: A descriptive exploratory study in the measurement of the content validity index, and correlational design for construct validation through exploratory factor analysis. RESULTS: The content validity index for indicators was 0.99 and it was 0.97 for graded situations. Three domains were extracted in the construct validation, namely: patient, family and therapeutic procedures, with 74.97% of explained variance. The instrument showed evidences of content and construct validity. CONCLUSION: The validation of the instrument occurred under the approach of family-centered care, and allowed incorporating some essential needs of childhood such as playing, interaction and affection in the content of the instrument.

Construction and validation of an instrument for evaluating Lean Healthcare in healthcare institutions.

OBJECTIVE: To build and validate an instrument to evaluate Lean Healthcare in healthcare institutions. METHOD: Methodological study conducted in three stages: 1) Instrument construction; 2) Content validity using the Delphi technique with 14 experts; and 3) Construct validation using Structural Equation Modeling with sample consisted of 113 professionals with experience in Lean Healthcare. Data collection carried out from October/2020 to January/2021 using a digital form. Data analysis performed with the SmartPLS2.0/M3 software. RESULTS: Items were developed after an integrative review and divided into the dimensions Structure, Process and Outcome, according to Donabedian's theoretical framework. Content validation in two rounds of the Delphi technique. Final instrument, after model adjustment, containing 16 items with Cronbach's alpha of 0.77 in Structure, 0.71 in Process and 0.83 in Outcome. CONCLUSION: The instrument presented evidence of validity and reliability, enabling its use in healthcare institutions to evaluate Lean Healthcare.

Nurses' perceptions about the patient safety climate in Primary Health Care.

OBJECTIVE: to evaluate the patient safety climate in Primary Health Care from the perspective of nurses working in the services. METHOD: a quantitative and cross-sectional study conducted with 148 nurses from a municipality in the state of São Paulo. The Brazilian version of the Primary Care Safety Questionnaire Survey and personal, professional, and organizational performance variables (intention to stay at work, job satisfaction, care quality, and frequency of incidents) were used. Parametric and non-parametric comparison tests and Spearman's correlation coefficient were performed, considering a 5% significance level. RESULTS: the safety climate was positive, varying from 4.52 to 5.33 and differing across districts for workload (p=0.0214) and leadership (p=0.0129). The safety climate professional variables and dimensions differed in relation to the frequency of incidents. Teamwork and safety and learning system were strongly correlated with job satisfaction and moderately with perceived care quality. CONCLUSION: teamwork and safety and learning system stood out for their positive correlations with job satisfaction and care quality. A positive safety climate favors the involvement of Primary Care nurses to develop improvement plans aligned with the National Patient Safety Program. BACKGROUND: (1) The safety climate is perceived differently across health districts. (2) There is a correlation between the climate dimensions and professional satisfaction. (3) Workload and leadership exert an influence on the safety climate perception. (4) There is a relationship between the safety climate and reporting of care-related incidents. (5) The safety climate is perceived differently among nurses regarding their role.

[Patient profile and nursing workload at the nephrology unit]. / Perfil dos pacientes e carga de trabalho de enfermagem na unidade de nefrologia.

Chronic kidney failure (CKF), which is frequently silent, can lead to considerable changes in the lives of patients. Depending on the stage, hospitalization and hours of nursing care are required to ensure medical and surgical treatment. The aim of this descriptive and quantitative study is to measure nursing workload at a nephrology unit based on daily application of the Nursing Activities Score (NAS) for 47 consecutive days. Patients were mostly young male adults in the chronic stage of the disease or admitted for kidney transplant. A total of 833 observations were obtained from 62 patients. The resulting NAS workload upon admission was 52%, corresponding to 12.5 hours of care per patient for 24 hours, which is similar to the workload found in intensive care units. This profile allows calculation of nursing work hours required for each patient and is a valuable tool for nursing managers when determining the number of staff members required to ensure assistance. Other studies should be conducted for clinical validation.

Patient Safety Climate, Quality of Care, and Intention of Nursing Professionals to Remain in Their Job During the COVID-19 Pandemic.

OBJECTIVE: This study aimed to examine the relationship between patient safety climate, quality of care, and intention of nursing professionals to remain in their job. METHODS: A cross-sectional study was carried out in a teaching hospital in Brazil wherein nursing professionals were surveyed. The Brazilian version of the Patient Safety Climate in Healthcare Organizations tool was applied to measure the patient safety climate. Spearman correlation coefficient and multiple linear regression models were applied for the analysis. RESULTS: A high percentage of problematic response was observed for most dimensions, except for fear of shame. Quality of care resulted in a strong correlation with organizational resources for safety and with overall emphasis on patient safety, and the nurse-perceived staffing adequacy was strongly correlated with organizational resources for safety. The multiple linear regression model showed higher scores in quality of care in dimensions related to organizational, work unit, and interpersonal aspects as well as in the adequacy of the number of professionals. A higher score in intention to stay in one's job was also found in the dimensions of fear of blame and punishment, provision of safe care, and adequacy of the number of professionals. CONCLUSIONS: The organizational and work unit aspects can lead to a better perception of the quality of care. Improving interpersonal relationships and increasing the number of professionals on staff were found to increase nurses' intention to remain in their jobs. Assessing a hospital's patient safety climate will enable improvement in the provision of safe and harm-free health care assistance.

Application of the Primary Care Safety Questionnaire to primary health care professionals: cross-sectional study.

OBJECTIVE: To evaluate the perception of the patient safety climate in primary health care associated with professional categories, health centers, and previous experience of participation in the National Program for the Improvement of Access and Quality of Primary Care. METHOD: Cross-sectional study with 119 health professionals in a city in the interior of the state of São Paulo, between August 2019 and February 2020, using the Brazilian version of the Primary Care Safety Questionnaire. RESULTS: The safety climate was favorable, with better evaluation for communication and leadership and worse evaluation for workload. There were differences among health centers regarding teamwork (p=0.0010), workload (p=0.0001) and total score (p=0.0185). Professionals with previous experience participating in the improvement program have a better perception of the climate. CONCLUSION: The perception of climate did not differ between professional categories but differed between health centers.

[The translation and adaptation of the Gaudenz-Fragebogen to the Brazilian culture]. / Tradução e adaptação para a cultura brasileira do Gaudenz-Fragebogen.

The article describes the translation and adaptation of the Gaudenz-Fragebogen, an instrument of German origin used to diagnose female urinary incontinence, to the Brazilian culture. The steps recommended by international literature were followed: translation, synthesis of translations, back translation, valuation of the synthetic version by a board of specialists and pre-test. The process of translation and adaptation was adequately accomplished, and the instrument was demonstrated to be easily understood.This instrument was used in other studies prior to the validation process, and using the instrument in other studies is crucial so that its measurement properties can be assessed.

Validation of the Brazilian version of the Nursing Work Index-Revised (B-NWI-R).

AIMS AND OBJECTIVE: The goal of this paper was to evaluate the reliability and validity of the Nursing Work Index-Revised-Brazilian version (B-NWI-R). BACKGROUND: Some instruments evaluate the presence of certain characteristics in the professional practice environment of nurses. Among them, the B-NWI-R, often cited in the literature and which is examined in the present study. This instrument is composed of 57 items and four subscales: autonomy, control over the work environment, nurse-physician relationships and organisational support. DESIGN: A cross-sectional research design was carried out in three public university hospitals in the State of São Paulo, Brazil. METHODS: The sample was composed of 278 nurses. The reliability of the instrument was evaluated through its homogeneity, using the Cronbach's alpha coefficient. The validity of the subscales of the B-NWI-R was evaluated through divergent construct validity and criterion-related validity. For the divergent construct validity, the Brazilian version of the Maslach Burnout Inventory (MBI) was employed, while for the criterion-related validity, variables such as 'satisfaction at work', 'perception of quality of care' and 'nurses' intention to leave work in the following year' were considered. RESULTS: The results showed satisfactory consistency for the total of the items (α=0·95) and for the subscales of the B-NWI-R: 'control over practice settings' (α=0·75); 'nurse-physician relationships' (α=0·75); 'organisational support' (α=0·75) and 'autonomy' (α=0·63). The divergent validity resulted in significant correlation between the adapted instrument subscales and those of the MBI. In addition, a significant correlation was obtained between the subscales of the B-NWI-R and the variables 'perception of quality of care', 'satisfaction at work' and 'intention to leave work in the following year'. CONCLUSION: The reliability and validity of the B-NWI-R have been established. RELEVANCE TO CLINICAL PRACTICE: The B-NWI-R subscales can be used to assess the nurses' perceptions of the work environment.

[Pediatric Patient Classification System: construction and validation of care categories]. / Sistema de Classificação de Pacientes Pediátricos: construção e validação de categorias de cuidados.

Patient classification is essential for managing a hospital unit. Literature, however, does not present conceptualizations of pediatric patient categories. The objectives of this study were to define and validate pediatric patient care categories, according to the level of dependency of the nursing team. The care categories were defined based on a literature review, and the content of the proposed categories was validated by a group of judges involved in managing and providing care in a pediatric unit, and by judges involved in pediatric education and research as well as in the construction of patient instruments. Five care categories were established and validated: Minimal, Intermediate, High dependency, Semi-intensive and Intensive. The validation of the care categories were the basis for constructing a system for the classification of pediatric patients, that may contribute with the decision making process of nurses working in management and health care.

Nursing knowledge patterns: nurses' image and role in society perceived by students.

OBJECTIVES: to understand high school students' perception about the nurse's image and role in society, from nursing knowledge patterns. METHODS: phenomenographic qualitative study, developed between October 2017 and January 2018, in a public university in the countryside of the state of São Paulo, with eight Interdisciplinary Higher Education Program (Programa de Formação Interdisciplinar Superior) students. The findings were collected through semi-structured interviews and analyzed by the phenomenography framework, supported by rereading nursing knowledge patterns. RESULTS: two categories emerged: Perception of nurses' image, which contemplates their positive and negative characteristics, attributes and place where they operate; and Nurses' role in society, in which their work is compared with physicians'. Final Considerations: despite their essential role in care, subordination to medical knowledge and lack of knowledge of nurses' functions still reflect their image.

Nursing safety attitudes: relationship with time of experience and intention to leave the job.

OBJECTIVE: To evaluate the safety attitudes of the nursing staff and their relationship with staff adequacy and material resources, time of experience and intention to leave the job. METHOD: A descriptive and cross-sectional study in a teaching hospital, sampled by convenience, with the application of the Safety Attitudes Questionnaire, collected from January to April 2016. RESULTS: 262 professionals participated, of whom 98 were nurses and 164 technicians. They reported a positive safety attitude for job satisfaction. The adequacy of staff and material resources positively influenced safety attitudes. There was a negative correlation between time of experience and perception of management, safety climate, working conditions and safe behaviors and, between the intention to leave the job and the teamwork climate, job satisfaction, and safe behaviors. CONCLUSION: The negative perception of safety attitudes was related to the time of experience and to the intention to leave the job.

Lean Healthcare in the institutional, professional, and patient perspective: an integrative review.

OBJECTIVE: To analyze the scientific evidences in the literature about the evaluation of Lean Healthcare after its implementation. METHOD: An integrative review conducted in the CINAHL, Scopus, WOS, and Embase databases, and in the PubMed portal, resulting in 18 articles published in English, Spanish and Portuguese, from 2008 to 2019. RESULTS: The findings were categorized into results for the institution, professional, and patient. The predominant category was institutional, with cost analysis and increased productivity, followed by the professional, with job satisfaction and leadership, and finally the patient, with satisfaction, attitudes, and behaviors. CONCLUSION: This study reinforces the need to establish, for management, a systematic method of monitoring the results achieved in the Lean Healthcare implementation phase. Since the value in this method is defined by the patient, further research in this aspect may lead to new evidence.

Nursing workload at a gastroenterology unit.

One of the biggest challenges nurses face is the need to justify the quantity and quality of staff for care delivery. For this, management instruments are available which help them to determine the staff needed in the nursing team. This descriptive study aims to evaluate the nursing workload at a specialized clinical and surgical gastroenterology unit. To collect data, the Nursing Activities Score (NAS) was used during 30 consecutive days, with 1080 comments, obtained from the records of 149 patients. The mean NAS score was 34.9% and, considering that each point of NAS corresponds to 0.24 hour, on the average, 8.4 hours of nursing care were required within 24 hours. This means that this profile is of patients who demand intermediate and semi-intensive care, which suggests that the NAS study can be used to evaluate the workload of nurses at that unit.

Bullying in the nursing work environment: integrative review.

OBJECTIVE: To evaluate the studies that approach bullying in the nursing practice environment. METHOD: Integrative review, conducted between April and December 2018, by combining the descriptors "bullying/bullying" AND "nursing/nursing/nurse" AND "workplace/workplace". We identified 224 studies of which 38 met the inclusion criteria. RESULTS: The studies on nursing bullying presented three main approaches related to the prevalence in nursing practice, the repercussions for health and professional development, and the construction of theoretical models for bullying and nursing work environment variables. CONCLUSION: Bullying is a negative behavior present in the nursing practice environment and has a direct impact on professional performance, impairing general health and professional performance. Despite being a behavior with recognized negative potential in the work environment, few studies propose effective actions to prevent or control this phenomenon in health institutions.

Job satisfaction of the nursing team in intensive care units.

OBJECTIVE: to evaluate job satisfaction and its relationship with the personal and professional characteristics of the nursing team. METHOD: a descriptive and cross-sectional study with 163 nursing workers from the intensive care units of a teaching hospital. For data collection, the Brazilian version of the Job Satisfaction Survey and a personal and professional characterization form were used. Data were analyzed using descriptive statistics, comparisons and correlations. RESULTS: the professionals demonstrated ambivalence for job satisfaction in a global way and concerning the communication domain. They were satisfied with the supervision, co-workers, and nature of work, while dissatisfied with other domains. There was a correlation between the intention to stay in the job and the majority of the Job Satisfaction Survey domains, except for co-workers and operating procedures, and a correlation between time working at the unit and at the institution with the domains pay, contingent rewards, and supervision. CONCLUSION: there was an ambivalence regarding job satisfaction and the variables intention of stay in the job and time working at the unit and at the institution were correlated with job satisfaction concerning the domains pay, contingent rewards, and supervision.