Apiradee Nantsupawat

Impact of Nurse Work Environment and Staffing on Hospital Nurse and Quality of Care in Thailand

PURPOSE To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. DESIGN Secondary data analysis of the 2007 Thai Nurse Survey. METHODS The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. FINDINGS Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurses workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p < .05). Nurses who reported favorable work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p < .05) compared with nurses who reported unfavorable work environments. The addition of each patient to a nurses workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p < .001). CONCLUSIONS Improving nurse work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. CLINICAL RELEVANCE Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world.

Nurse Burnout, Nurse-Reported Quality of Care, and Patient Outcomes in Thai Hospitals.

PURPOSE The purpose of this study was to investigate the effect of nurse burnout on nurse-reported quality of care and patient adverse events and outcomes in Thai hospitals. METHODS Cross-sectional analysis of data from 2,084 registered nurses working in 94 community hospitals across Thailand. Data were collected through survey questionnaire, including the Maslach Burnout Inventory (MBI), which measures of nurse perceived quality of care and patient outcomes. Multiple logistic regression modeling was performed to explore associations between nurse burnout on quality of care and patient outcomes. FINDINGS Thirty-two percent of nurses reported high emotional exhaustion, 18% high depersonalization, and 35% low personal accomplishment. In addition, 16% of nurses rated quality of care on their work unit as fair or poor, 5% reported patient falls, 11% reported medication errors, and 14% reported infections. All three subscales of the MBI were associated with increased reporting of fair or poor quality of care, patient falls, medication errors, and infections. Every unit of increasing emotional exhaustion score was associated with a 2.63 times rise in reporting fair or poor quality of care, a 30% increase in patient falls, a 47% increase in medication errors, and a 32% increase in infection. CONCLUSIONS Findings clearly indicate that nurse burnout is associated with increased odds of reporting negative patient outcomes. Implementing interventions to reduce nurse burnout is critical to improving patient care in Thai hospitals. CLINICAL RELEVANCE Hospital administrators, nurse managers, and health leaders urgently need to create favorable work environments supporting nursing practice in order to reduce burnout and improve quality of care.

Effects of nurse work environment on job dissatisfaction, burnout, intention to leave

BACKGROUND The nursing shortage is a critical issue in many countries. High turnover rates among nurses is contributing to the shortage, and job dissatisfaction, intention to leave, and burnout have been identified as some of the predictors of nurse turnover. A well-established body of evidence demonstrates that the work environment for nurses influences nurse job dissatisfaction, intention to leave, and burnout, but there never has been a study undertaken in Thailand to investigate this relationship. OBJECTIVES To investigate how work environment affects job dissatisfaction, burnout, and intention to leave among nurses in Thailand. METHODS The study used a cross-sectional survey to collect data from 1351 nurses working in 43 inpatient units in five university hospitals across Thailand. The participants completed the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and measures of job dissatisfaction and intention to leave. Logistical regression models assessed the association between work environment and nurse-reported job dissatisfaction, burnout, and intent to leave. RESULTS Nurses working in university hospitals with better work environments had significantly less job dissatisfaction, intention to leave, and burnout. CONCLUSION The nurse work environment is a significant feature contributing to nurse retention in Thai university hospitals. IMPLICATIONS FOR NURSING AND HEALTH POLICY Improving the work environment for nurses may lead to lower levels of job dissatisfaction, intention to leave, and burnout. Focusing on these nurse outcomes can be used as a strategy to retain nurses in the healthcare system. Addressing the challenges of poor work environments requires coordinated action from policymakers and health managers.

Relationship between nurse staffing levels and nurse outcomes in community hospitals, Thailand

A growing body of research has shown an association between nurse staffing levels and a range of nurse outcomes. There is little empirical research evaluating this relationship in Thailand. This study evaluated the influence of nurse staffing levels on outcomes among nurses. A cross-sectional survey design was conducted at 92 community hospitals using a stratified random sampling design across Thailand during May and July 2012. Questionnaires included items focusing on nurse staffing levels; job dissatisfaction and emotional exhaustion, both related to nurse retention; and needlestick and sharps injuries. The study sample comprised 1412 registered nurses who provided direct patient care. The findings showed that each additional patient per nurse was associated with an additional 5% of nurses reporting dissatisfaction in their job; 8% of nurses reporting high emotional exhaustion, and 4% of nurses reporting needlestick and sharps injuries. This study provides evidence of how nurse staffing levels result in nurse outcomes. Nurses are significant healthcare providers that directly affect quality of care and patient safety in hospitals. Improvement of nurse staffing levels holds promise for improving nurse outcomes in Thailand.

Developing an Electronic Logbook to Monitor the Progress for International Doctoral Students in Thailand: A Pilot Study

This was a descriptive research aiming at investigating the quality of life of the Royal Thai Navy College of Nursing’s (RTNCN) personnel. There were 325 samples which were from the executives, nursing instructors, supporting staff and nursing students in the academic year 2014. The research tool was the World Health Organization Quality of Life assessment (WHOQOL - BRIEF - THAI) and the reliability of which was tested using the Cronbach’s Alpha with the result at 0.91. The statistics applied in this study were descriptive statistic. The results were as follows: 1) The Quality of Life in the aspects of physical health, psychological state, environment and overview of Quality of Life were mainly at moderate level (66.77, 54.77, 45.54, 75.38 and 57.85 percent respectively); and 2) Analyzing the Mean, it was found that QOL in all aspects of the personnel was at moderate level.

Occupancy rate and adverse patient outcomes in general hospitals in Thailand: A predictive study

Patient outcomes are important indicators of the quality of care. Occupancy rate is one factor that significantly affects adverse patient outcomes. The aim of the present study was to determine factors associated with adverse patient outcomes in Thailand. A retrospective study was conducted with 146 inpatient units from 16 general hospitals. Hospital characteristics and adverse patient outcomes were recorded, and data were analyzed by using frequency, percentage, and binomial logistic regression. The results revealed that the average number of beds per hospital was 430.5 (standard deviation [SD] = 108.6), the average number of beds per unit was 27.9 (SD = 8.9), and the average occupancy rate was 81.1% (SD = 20.6, range = 28.8-133.1%). Data were adjusted for hospital size, unit type, and number of beds in each unit; a 1% increase in occupancy rate increased the likelihood of pressure ulcers by 4.3% (P = 0.001), of hospital-acquired pneumonia by 2.4% (P = 0.032), and of hospital-acquired urinary tract infections by 2.1% (P = 0.033). The findings suggest that a higher level of occupancy rates predicted a greater likelihood of adverse patient outcomes.