Relationship of the nursing practice environment with the quality of care and patients' safety in primary health care.

BACKGROUND: Nursing practice environment has impact on the quality of nursing care and on patients' and nurses' outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients' outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal. METHODS: We conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing. RESULTS: Nurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients' safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients' safety. CONCLUSIONS: The perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses' outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

The Primary Nursing Care Model and Inpatients' Nursing-Sensitive Outcomes: A Systematic Review and Narrative Synthesis of Quantitative Studies.

BACKGROUND: The delivery of quality, safe, and patient-centered care is foundational for professional practice. The primary nursing model allows nurses to have excellent knowledge about patients and families and to plan and coordinate care from admission to discharge, with better management of health situations. Nurses play a crucial role in improving patients' outcomes, namely those sensitive to nursing care. The knowledge of the relationship between the primary nursing model and the nursing-sensitive outcomes provides new scientific evidence that strengthens the relevance of this nursing care organization model in the inpatients' health outcomes. This systematic review describes the relationship between nurse-sensitive inpatients' outcomes and the primary nursing care model. METHODS: A systematic review was conducted with a narrative synthesis, and the following databases were searched: MEDLINE, CINAHL, Web of Science, Nursing & Allied Health Collection, SciELO Collections, and Cochrane. RESULTS: A total of 22 full texts were assessed, of which five were included in the study according to the selection criteria. The analysis results indicated that the primary nursing care model was related to nursing-sensitive patient safety outcomes. Patients' experience was also considered a nursing-sensitive outcome, namely in the satisfaction with nursing care. CONCLUSION: The negative outcomes are clearly related to the primary nursing care model. There is scarce research that relates primary nursing to positive outcomes, such as patients' functional status and self-care abilities, and more studies are needed.

Nurse-led care management models for patients with multimorbidity in hospital settings: A scoping review.

AIM: The aim of this scoping review is to map the nurse-led care management models for patients with multimorbidity in hospital settings. BACKGROUND: Patients with multimorbidity in hospital, due their complexity, benefit a nurse-led care management model. This care management model allows for better identification of patients' needs and a person-centred approach. EVALUATION: This review followed the JBI methodology for scoping reviews. The search included the international databases Web of Science, CINAHL, MEDLINE, Nursing & Allied Health Collection and grey literature. A total of 21 articles were included in the final content analysis. KEY ISSUES: Three categories of nurse-led care management models emerged from the data, namely, nurse-led programs, case management and nurse facilitator models. The interventions focused on training, discharge support, follow-up, health promotion and patient-centred care. CONCLUSION: The centrality of the patient is a common characteristic of nurse-led care models, namely, the acquisition of disease self-management skills, preparation for hospital discharge and continuity of care in the community. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse-led care management models can empower patients to manage their chronic conditions more effectively. Adapting these care management models in hospital settings will be a challenge for nurse managers. SCOPING REVIEW PROTOCOL: The full protocol used can be accessed at doi:10.11124/jbies-20-00222.

Validation of the Psychometric Properties of the Practice Environment Scale of Nursing Work Index in Primary Health Care in Portugal.

Studies related to the work environment in primary health care are scarce in the literature. The present study aimed to validate the psychometric properties of the Practice Environment Scale of Nursing Work Index (PES-NWI) in primary health care (PHC) and to evaluate its construct validity through exploratory and confirmatory factor analyses in a sample of Portuguese nurses. A quantitative, cross-sectional, and validation study design was implemented. METHODS: The sample consisted of 1059 nurses from the PHC units of all 55 health center groups (HCGs) in mainland Portugal, 15 health centers in the Autonomous Region of Madeira, and 6 health centers in the Autonomous Region of the Azores. The study tested different structural models using exploratory and confirmatory factor analysis techniques. The reliability of the scale was tested by determining Cronbach's alpha coefficient. RESULTS: The internal consistency of the PES-NWI was 0.91. Exploratory and confirmatory factor analyses were performed on the PES-NWI model in PHC with five factors: NPOA, NFQC, NMALSN, SRA, and CNPR. The results show that the scale presents acceptable fit quality indexes in the final factorial solution and adequate convergent validity. CONCLUSION: The PES-NWI in PHC has an adequate, robust, and reliable five-factor structure. The scale is valid and can be used in clinical practice, nursing management, and PHC research.

Validation and Psychometric Assessment of the Practice Environment Scale of the Nursing Work Index in the Portuguese Hospital Context.

BACKGROUND: The nursing work environment has an impact on patient safety outcomes and its measurement should be a regular practice. PURPOSE: To assess the reliability and construct validity of the Practice Environment Scale of the Nursing Work Index in the Portuguese context. METHODS: An exploratory factor analysis followed by a confirmatory factor analysis to assess model adjustment quality was performed with a sample of 3,686 nurses. RESULTS: The final solution for the exploratory factor analysis comprised 26 items and five factors (56.6% of the total variance). The confirmatory factor analysis, after refinement, showed a stable factor structure. CONCLUSIONS: The final model showed good construct validity and high reliability, which supports the decision to exclude the items that are not essential to the construct being measured.

RN4CAST Study in Portugal: Validation of the Portuguese Version of the Practice Environment Scale of the Nursing Work Index / Estudio RN4CAST en Portugal: validación de la versión portuguesa de la escala del entorno de práctica del índice de trabajo de enfermería / Estudo RN4Cast em Portugal: validação da versão portuguesa da escala do ambiente de prática do índice de trabalho de enfermagem

ABSTRACT Objective: This study aims to validate the Portuguese version of the Practice Environment Scale of the Nursing Work Index (PES-NWI) and assess construct validity through exploratory and confirmatory factor analyses. Materials and Methods: This cross-sectional study validates the psychometric properties of the PES-NWI in Portugal. Exploratory factorial analysis is used to analyze the psychometric properties of the PES-NWI in a sample of 5,075 Portuguese nurses; the data sample covers all geographic regions in the country. Confirmatory factor analysis is performed to confirm the model's data adequacy. Results: Factorial analysis explained 54.6 % of the variance and a five-dimension structure. The five factors identified were Nurse Participation in Hospital Affairs, Nurse Manager Ability, Leadership and Support of Nurses, Nursing Foundations for Quality of Care, Staffing and Resource Adequacy, and Nurse-Physician Relations. The confirmatory analysis showed that the five-factor model fit well with the data in the Portuguese context. Conclusion: In a Portuguese health context, the PES-NWI is a valid scale to access the nursing environment and improve working conditions.

RESUMEN Objetivo: este estudio tiene como objetivo validar la versión portuguesa de la escala del entorno de práctica del índice de trabajo de enfermería (PES-NWI, por sus siglas en inglés) y evaluar la validez de los constructos mediante análisis factorial exploratorio y confirmatorio. Materiales y métodos: el presente estudio transversal valida las propiedades psicométricas de la PES-NWI en Portugal. El análisis factorial exploratorio se utilizó para analizar las propiedades psicométricas de la PES-NWI en una muestra de 5 075 enfermeras portuguesas; la muestra de datos abarcaba todas las regiones geográficas del país. Se realizó un análisis factorial confirmatorio para corroborar la adecuación de los datos del modelo. Resultados: un análisis factorial explicó el 54.6 % de la varianza y una estructura de cinco dimensiones. Los cinco factores identificados fueron la participación de la enfermera en los asuntos hospitalarios; la capacidad del gerente de enfermería, el liderazgo y el apoyo de las enfermeras; los fundamentos de la enfermería para la calidad de la atención; la adecuación del personal y de los recursos y las relaciones entre la enfermera y el médico. El análisis confirmatorio mostró que el modelo de cinco factores se ajustaba bien a los datos en el contexto portugués. Conclusión: en el contexto de salud portugués, la PES-NWI es una escala válida para acceder al entorno de enfermería y mejorar las condiciones de trabajo.

RESUMO Objetivo: o objetivo deste estudo é validar a versão portuguesa da escala do ambiente de prática do índice de trabalho de enfermagem (PES-NWI, por sua sigla em inglês) e avaliar a validade dos constructos mediante análise fatorial exploratória e confirmatória. Materiais e métodos: este estudo transversal valida as propriedades psicométricas da PES-NWI em Portugal. A análise fatorial exploratória foi utilizada para analisar as propriedades psicométricas da PES-NWI em uma amostra de 5 075 enfermeiras portuguesas; a amostra de dados abrangia todas as regiões geográficas do país. Foi realizada uma análise fatorial confirmatória para corroborar a adequação dos dados do modelo. Resultados: uma análise fatorial explicou 54,6 % da variância e uma estrutura de cinco dimensões. Os cinco fatores identificados foram a participação da enfermeira nos assuntos hospitalares; a capacidade do gerente de enfermagem, a liderança e o apoio das enfermeiras; os fundamentos da enfermagem para a qualidade da atenção; a adequação do pessoal e dos recursos e das relações entre a enfermeira e o médico. A análise confirmatória mostrou que o modelo de cinco fatores se ajustava bem aos dados no contexto português. Conclusões: no contexto de saúde português, a PES-NWI é uma escala válida para acessar o ambiente de enfermagem e melhorar as condições de trabalho.

Nursing Work Environment and Patient Outcomes in a Hospital Context: A Scoping Review.

OBJECTIVE: The aims of this study were to summarize the current state of knowledge regarding the relationship between nursing work environment (NWE) and patient outcomes and to identify gaps in the literature. BACKGROUND: There was an increased awareness of the impact of NWE on patient outcomes, in particular, related to safety and quality of care. METHOD: Scoping review was conducted. Studies published between 2002 and the 1st quarter of 2018 were included to provide an overview of the research on the associations between NWE and patient outcomes. RESULTS: Of 2238 titles and abstracts identified, 35 studies were included, and publication ranged from 2005 to 2018. All studies included were observational, 4 had a longitudinal design, and the remaining studies were cross-sectional. Evidence indicates that better NWE decreases the risk of patient adverse events and increases the quality of care. CONCLUSIONS: The associations between different dimensions of NWE and patient outcomes should be explored.

A enfermagem em Portugal aos 40 anos do Serviço Nacional de Saúde / Nursing in Portugal in the National Health Service at 40

Resumo Retratamos a evolução da enfermagem em Portugal desde a criação do Serviço Nacional de Saúde (SNS) em 1979, focando sobre os efetivos, a formação, as condições de trabalho, a carreira, e a organização profissional. Utilizamos a literatura sobre a evolução do sector da saúde em Portugal, e fontes de dados estatísticos da Ordem dos Enfermeiros e do SNS. Nos últimos 40 anos, o número de enfermeiros aumentou de 233%, mas o rácio enfermeiro/médico só passou de 1.15 para 1.4. A maioria exerce funções nos hospitais, apesar dos repetidos compromissos políticos a favor da expansão dos cuidados de saúde primários. No SNS, 55% são funcionários públicos com contrato por tempo indeterminado; os outros detêm um contrato individual de trabalho de direito privado. O curso de licenciatura em enfermagem é oferecido em 20 escolas do sector público e 16 do sector privado. Em 2019, a carreira de enfermagem foi revista em 3 categorias: enfermeiro, enfermeiro especialista e enfermeiro gestor. Apesar de queixas em relação as condições de trabalho, a remuneração e ao progresso na carreira, os enfermeiros continuam moderadamente satisfeitos. O papel do enfermeiro, mudou pouco ao longo dos anos e há resistência por parte da Ordem dos Médicos à sua expansão.

Abstract We describe the development of nursing in Portugal since the creation of the National Health Service (SNS) in 1979, focusing on staff numbers, education, work conditions, career, and professional organization. We used the literature on the evolution of the Portuguese health sector and statistical data from the Nursing Council and the SNS. The number of nurses grew by 233% in the last 40 years, but the nurse/physician ratio only increased from 1.15 to 1.4. Most work in hospitals, despite repeated political commitments to expand primary health care. In the SNS, 55% are public servants, and the others are employed through private law contracts. The basic nursing course is currently offered in 20 public and 16 private institutions. In 2019, the career structure was revised and now comprises three categories: nurse, specialist nurse, nurse manager. Nurses remain moderately satisfied despite complaints about working conditions, remuneration, and lack of career progress. Nurses' role barely changed over the years, and the Medical Association is resisting to its expansion.

Nursing in Portugal in the National Health Service at 40. / A enfermagem em Portugal aos 40 anos do Serviço Nacional de Saúde.

We describe the development of nursing in Portugal since the creation of the National Health Service (SNS) in 1979, focusing on staff numbers, education, work conditions, career, and professional organization. We used the literature on the evolution of the Portuguese health sector and statistical data from the Nursing Council and the SNS. The number of nurses grew by 233% in the last 40 years, but the nurse/physician ratio only increased from 1.15 to 1.4. Most work in hospitals, despite repeated political commitments to expand primary health care. In the SNS, 55% are public servants, and the others are employed through private law contracts. The basic nursing course is currently offered in 20 public and 16 private institutions. In 2019, the career structure was revised and now comprises three categories: nurse, specialist nurse, nurse manager. Nurses remain moderately satisfied despite complaints about working conditions, remuneration, and lack of career progress. Nurses' role barely changed over the years, and the Medical Association is resisting to its expansion.

Retratamos a evolução da enfermagem em Portugal desde a criação do Serviço Nacional de Saúde (SNS) em 1979, focando sobre os efetivos, a formação, as condições de trabalho, a carreira, e a organização profissional. Utilizamos a literatura sobre a evolução do sector da saúde em Portugal, e fontes de dados estatísticos da Ordem dos Enfermeiros e do SNS. Nos últimos 40 anos, o número de enfermeiros aumentou de 233%, mas o rácio enfermeiro/médico só passou de 1.15 para 1.4. A maioria exerce funções nos hospitais, apesar dos repetidos compromissos políticos a favor da expansão dos cuidados de saúde primários. No SNS, 55% são funcionários públicos com contrato por tempo indeterminado; os outros detêm um contrato individual de trabalho de direito privado. O curso de licenciatura em enfermagem é oferecido em 20 escolas do sector público e 16 do sector privado. Em 2019, a carreira de enfermagem foi revista em 3 categorias: enfermeiro, enfermeiro especialista e enfermeiro gestor. Apesar de queixas em relação as condições de trabalho, a remuneração e ao progresso na carreira, os enfermeiros continuam moderadamente satisfeitos. O papel do enfermeiro, mudou pouco ao longo dos anos e há resistência por parte da Ordem dos Médicos à sua expansão.

Nurses' Intention to Leave the Organization: A Mediation Study of Professional Burnout and Engagement.

The nature of the turnover process calls for the study of more complex relationships among variables beyond simple bivariate or multiple associations between predictors and turnover intentions. The present article aims to examine the predictive value of job demands and resources in the explanation of nurses' intention to leave the organization and to test the mediating roles of professional burnout and engagement in these relationships, within a Portuguese nursing population. The research models were tested within the scope of the Registered Nurse Forecasting project. Data included the self-report questionnaires of 2,235 Portuguese nurses from 31 hospitals, collected through stratified random sampling procedures. The statistical analyses of the structural models showed that nurses' participation in hospital affairs, a job resource at the work organization level, was the only significant predictor of nurses´ intention to leave the organization (ß = -.45, p < .001). Analyses of the mediation models revealed that the emotional exhaustion symptoms of burnout (ß = -.11, p < .001) and job engagement feelings (ß = -.15, p < .001) were both significant mediators between nurses' decisional involvement and their intentions to leave the organization. Results suggest that including nurses in decision-making processes regarding their professional practice policy and environment, and improving nurses' professional well-being are two crucial strategies to reduce nurses' turnover intentions.

Nurses' intention to leave the organization: a mediation study of professional burnout and engagement

The nature of the turnover process calls for the study of more complex relationships among variables beyond simple bivariate or multiple associations between predictors and turnover intentions. The present article aims to examine the predictive value of job demands and resources in the explanation of nurses' intention to leave the organization and to test the mediating roles of professional burnout and engagement in these relationships, within a Portuguese nursing population. The research models were tested within the scope of the Registered Nurse Forecasting project. Data included the self-report questionnaires of 2,235 Portuguese nurses from 31 hospitals, collected through stratified random sampling procedures. The statistical analyses of the structural models showed that nurses' participation in hospital affairs, a job resource at the work organization level, was the only significant predictor of nurses' intention to leave the organization (β = -.45, p < .001). Analyses of the mediation models revealed that the emotional exhaustion symptoms of burnout (β = -.11, p < .001) and job engagement feelings (β = -.15, p < .001) were both significant mediators between nurses' decisional involvement and their intentions to leave the organization. Results suggest that including nurses in decision-making processes regarding their professional practice policy and environment, and improving nurses' professional well-being are two crucial strategies to reduce nurses' turnover intentions

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Work environment issues and intention-to-leave in Portuguese nurses: A cross-sectional study.

This study extends the Registered Nurses Forecasting (RN4CAST) study evidence base with newly collected data from Portuguese nurses working in acute care hospitals, in which the measurement of the quality of work environment, workload and its association with intention-to-leave emerge as of key importance. Data included surveys of 2235 nurses in 144 nursing units in 31 hospitals via stratified random sampling. Multilevel multivariate regression analysis shows that intention-to-leave is higher among nurses with a specialty degree, nurses aged 35-39, and in nursing units where nurses are less satisfied with opportunities for career advancement, staffing levels and participation in hospital affairs. Analysis with moderation effects showed the observed effect of age and of having a specialty degree on intention-to-leave during the regression analysis is reduced in nursing units where nurses are more satisfied with opportunities for career advancement. The most important finding from the study suggests that promoting retention strategies that increase satisfaction with opportunities for career advancement among Portuguese nurses has the potential to override individual characteristics associated with increased turnover intentions.

Technology developments applied to healthcare/nursing.

Future technology developments as applied to healthcare and particularly nursing were discussed. Emerging technologies such as genetics, small unobtrusive monitoring devices, use of information and communication technologies are as tools to not only facilitate but also promote communication among all parties of the healthcare process. These emerging technologies can be used for ubiquitous healthcare (u-health). The role of nursing in the u-health is fundamental and required for success and growth. Nursing's role will evolve as nurses become 'information-mediators' in a broader-sense than current role. All technologies will ultimately focus on the consumer through 'behind-the-scenes' data collection, which in turn will also allow nurses to analyze these data to improve care. We need to acknowledge an increased presence and or pervasiveness of information technologies as key components of quality healthcare. This sort of acknowledgment will help propel nursing, and healthcare, to increase use of these tools. To develop nurses with these types of skills the nursing education process will require a fundamental change to integrate these technology-sorts of tools as necessary elements for success.

Cognitive ability patterns and nurses' clinical decision making.

The present study concerns the clinical decision-making process in a naturalistic context and its relationship to the nurses' abilities of critical thinking, creative thinking and emotional intelligence. Apart from describing a model of the clinical decision-making process in nursing, the results showed its continuous and interactive nature as well as that different patterns of decisions correspond to distinct patterns of those cognitive abilities. Despite some limitations, we consider that this study has implications in the caring, administration, education and nursing informatics areas.

Cognitive abilities and clinical decision making in nursing.

This investigation focused the clinical decision-making process in a naturalistic context and its relationship to the nurses' abilities of critical thinking, creative thinking and emotional intelligence. Apart from describing a model of the clinical decision-making process in nursing, the results showed its continuous and interactive nature as well as that different patterns of decisions correspond to distinct patterns of those cognitive abilities. Despite some limitations, we consider that this study has implications in the caring, administration, education and nursing informatics areas.