Peter Van Bogaert

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey

AIM To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. BACKGROUND Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. DESIGN A cross-sectional design with a survey. METHOD In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. RESULTS Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. CONCLUSION Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development.

Practice environments and their associations with nurse-reported outcomes in Belgian hospitals: Development and preliminary validation of a Dutch adaptation of the Revised Nursing Work Index

AIM To study the relationship between nurse work environment, job outcomes and nurse-assessed quality of care in the Belgian context. BACKGROUND Work environment characteristics are important for attracting and retaining professional nurses in hospitals. The Revised Nursing Work Index (NWI-R) was originally designed to describe the professional nurse work environment in U.S. Magnet Hospitals and subsequently has been extensively used in research internationally. METHOD The NWI-R was translated into Dutch to measure the nurse work environment in 155 nurses across 13 units in three Belgian hospitals. Factor analysis was used to identify a set of coherent subscales. The relationship between work environments and job outcomes and nurse-assessed quality of care was investigated using logistic and linear regression analyses. RESULTS Three reliable, consistent and meaningful subscales of the NWI-R were identified: nurse-physician relations, nurse management at the unit level and hospital management and organizational support. All three subscales had significant associations with several outcome variables. Nurse-physician relations had a significant positive association with nurse job satisfaction, intention to stay the hospital, the nurse-assessed unit level quality of care and personal accomplishment. Nurse management at the unit level had a significant positive association with the nurse job satisfaction, nurse-assessed quality of care on the unit and in the hospital, and personal accomplishment. Hospital management and organizational support had a significant positive association with the nurse-assessed quality of care in the hospital and personal accomplishment. Higher ratings of nurse-physician relations and nurse management at the unit level had significant negative associations with both the Maslach Burnout Inventory emotional exhaustion and depersonalization dimensions, whereas hospital management and organizational support was inversely associated only with depersonalization scores. CONCLUSION A Dutch version of the NWI-R questionnaire produced comparable subscales to those found by many other researchers internationally. The resulting measures of the professional practice environment in Belgian hospitals showed expected relationships with nurse self-reports of job outcomes and perceptions of hospital quality.

Effects of SolCos Model-Based Individual Reminiscence on Older Adults With Mild to Moderate Dementia Due to Alzheimer Disease: A Pilot Study

OBJECTIVE To examine effects of individual thematically-based reminiscence sessions based on the SolCos model for older adults with dementia because of Alzheimer disease (AD) as a pilot study. BACKGROUND Reminiscence activities are popular within nursing homes and generally considered to be enjoyable and helpful, however, there is a paucity of robust data demonstrating therapeutic impact. Criticisms of existing reminiscence studies include the failure to explicate the reminiscence protocol and to standardize delivery and choice of outcome measures. METHODS In this study, 82 older adults with probable AD were recruited from psychiatric day care, inpatient, and long term care facilities. Of the study group, 41 participants were randomly selected for individual reminiscence sessions during 4 weeks performed by 1 facilitator. A control group of 41 older adults were randomly involved and had no planned reminiscence treatment of any kind in the study period. All study participants were tested pre- and postintervention period with validated assessment scales to evaluate cognition and behavior. Analyses were based on delta scores, the differences between assessment scales pre- and postintervention scores, compared between the intervention and the control group. RESULTS A structured reminiscence protocol was developed with user involvement, and intervention group participants received 6-8 reminiscence sessions (average 7.4). The primary outcomes of Mini- Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-30) delta scores of the intervention group were significantly better than those of the control group. Participants of the intervention group with both mild and moderate AD had significantly better GDS-30 delta scores compared with the control group. Significantly better MMSE delta scores were found only in the intervention sub-group with moderate AD. Logistic regression analyses with all study participants showed an impact of reminiscence sessions on depressive symptoms measured with GDS-30. CONCLUSIONS The pilot study results showed positive effects associated with individual thematically-based reminiscence on well-being such as depressive symptoms and cognition of participants. This is an encouraging finding after a relatively short period. Further study is necessary to confirm these results, determine sustainability and optimal delivery methods.

Impacts of unit-level nurse practice environment, workload and burnout on nurse-reported outcomes in psychiatric hospitals: A multilevel modelling approach

AIM To investigate impacts of practice environment factors, nurse perceptions of workload and self-reported burnout at the unit-level on job outcomes and nurse-assessed quality of care in psychiatric hospitals. BACKGROUND Associations between practice environments and nurse and patient outcomes have been widely described in acute care hospitals in nursing research examining variables primarily at the respondent level. Research on this topic in psychiatric hospitals is sparse. DESIGN A cross-sectional design with a survey. METHOD Samples of registered nurses, licenced practical nurses and non-registered caregivers from 32 clinical units in two psychiatric hospitals were surveyed. Validated instruments were used to measure work environment, workload, burnout, job outcomes and nurse-perceived quality of care. Unit-level associations were examined using multilevel modelling techniques. RESULTS Multiple multilevel models identified depersonalization and nurse-physician relations as predictors of turnover intentions and quality of care of the interdisciplinary team. Ratings of nursing management at the unit level were predictors of all of the quality of care variables. Emotional exhaustion was predictive of quality of care at the unit level. While workload was correlated with burnout, it was not predictive of any of the outcomes examined in multiple multilevel models. CONCLUSION While relatively low levels of burnout and fairly favourable job and quality of care outcomes were reported by the mental health personnel surveyed, differences across units in ratings of practice environment factors such as nurse-physician relations and nurse management as well as levels of depersonalization were predictive of outcomes. While most findings are consistent with those from other studies of acute care settings, some (slight) differences were also identified.

Staff engagement as a target for managing work environments in psychiatric hospitals : implications for workforce stability and quality of care

AIMS AND OBJECTIVES To examine relationships between practice environment ratings, workload, work engagement, job outcomes and assessments of quality of care in nursing personnel in psychiatric hospitals. DESIGN Cross-sectional survey. BACKGROUND A broad base of research studies in health care reveals important links between work environment factors, staff burnout and organisational outcomes that merit examination in inpatient mental healthcare settings. Work engagement, a positively framed parallel construct for burnout, may offer an additional insight into the impacts of work on staff. METHODS A sample of 357 registered nurses (65·5%), licensed practical nurses (23·5%) and non-registered caregiver (10·6%) of two Belgian psychiatric hospitals were surveyed. A causal model was tested using structural equation modelling, whereby it was proposed that work engagement would be influenced by work environment factors and itself impact perceived quality of care and staff job outcomes such as job satisfaction and turnover intentions. RESULTS An adjusted model was confirmed. Practice environment features influenced staff vigour and dedication and demonstrated positive effects on job satisfaction, turnover intentions and perceived quality of care through their effects on absorption. CONCLUSION The findings of this study suggest that work engagement is a likely direct consequence of practice environments that may ultimately have impacts on both staff and patient outcomes. RELEVANCE TO CLINICAL PRACTICE Leaders, nurse managers, clinicians as well as nurses themselves should be aware of the importance of work environments in mental healthcare facilities that favour engagement. Future efforts should focus on developing and sustaining practice environments that engage mental healthcare workers within interdisciplinary teams with the goal of creating a stable workforce possessing optimal possible knowledge, skills and abilities for delivering care.

Nurse work engagement impacts job outcome and nurse-assessed quality of care: model testing with nurse practice environment and nurse work characteristics as predictors

Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Design: Cross-sectional survey. Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services.

The Productive Ward program™: a longitudinal multilevel study of nurse perceived practice environment, burnout, and nurse-reported quality of care and job outcomes.

Objective: The objective of this study was to investigate the impact of The Productive Ward–Releasing Time to Care™ program implemented in a hospital transformation process on nurse perception related to practice environment, burnout, quality of care, and job outcomes. Background: To address the continuously evolving complex challenges of patient care, high-performance nursing care is necessary. Methods: A longitudinal survey design was used to conduct a study in a 600-bed acute care university hospital with 3 measurement periods: T0: base line in 2006, T1 in 2011, and T2 in 2013. As part of the hospital transformation process, the productive ward program was introduced between T1 and T2. Results: Relevant impact on nurse-physician relations, nurse management, hospital management-organizational support, nurse-reported quality of care, and job outcomes were identified. Conclusion: Hospital strategies and policies should be aligned with daily practices so that engaged and committed staff can promote excellent outcomes.

Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study

BackgroundHigh levels of work-related stress, burnout, job dissatisfaction, and poor health are common within the nursing profession. A comprehensive understanding of nurses’ psychosocial work environment is necessary to respond to complex patients’ needs. The aims of this study were threefold: (1) To retest and confirm two structural equation models exploring associations between practice environment and work characteristics as predictors of burnout (model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses’ and nurse managers’ perceptions and experiences of staff nurses’ workload; (3) To explain and interpret the two models by using the qualitative study findings.MethodThis mixed method study is based on an explanatory sequential study design. We first performed a cross-sectional survey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured interviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study data was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and interpreting the findings of the two models.ResultsThe two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data. Nurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the unit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and between 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job outcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (≤5%). The qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary collaboration, communication and teamwork; staff nurse personal characteristics and competencies; patient centeredness, quality and patient safety. Respondents’ statements corresponded closely to the models’ associations.ConclusionA deep understanding of various associations and impacts on studied outcome variables such as risk factors and protective factors was gained through the retested models and the interviews with the study participants. Besides the softer work characteristics — such as decision latitude, social capital and team cohesion — more insight and knowledge of the hard work characteristic workload is essential.

The Productive Ward Program™: A Two-Year Implementation Impact Review Using a Longitudinal Multilevel Study

Aim To investigate the impact of the quality improvement program “Productive Ward – Releasing Time to Care™” using nurses’ and midwives’ reports of practice environment, burnout, quality of care, job outcomes, as well as workload, decision latitude, social capital, and engagement. Background Despite the requirement for health systems to improve quality and the proliferation of quality improvement programs designed for healthcare, the empirical evidence supporting large-scale quality improvement programs impacting patient satisfaction, staff engagement, and quality care remains sparse. Method A longitudinal study was performed in a large 600-bed acute care university hospital at two measurement intervals for nurse practice environment, burnout, and quality of care and job outcomes and three measurement intervals for workload, decision latitude, social capital, and engagement between June 2011 and November 2014. Results Positive results were identified in practice environment, decision latitude, and social capital. Less favorable results were identified in relation to perceived workload, emotional exhaustion. and vigor. Moreover, measures of quality of care and job satisfaction were reported less favorably. Conclusion This study highlights the need to further understand how to implement large-scale quality improvement programs so that they integrate with daily practices and promote “quality improvement” as “business as usual.”

Staff Nurses’ Perceptions and Experiences about Structural Empowerment: A Qualitative Phenomenological Study

The aim of the study reported in this article was to investigate staff nurses’ perceptions and experiences about structural empowerment and perceptions regarding the extent to which structural empowerment supports safe quality patient care. To address the complex needs of patients, staff nurse involvement in clinical and organizational decision-making processes within interdisciplinary care settings is crucial. A qualitative study was conducted using individual semi-structured interviews of 11 staff nurses assigned to medical or surgical units in a 600-bed university hospital in Belgium. During the study period, the hospital was going through an organizational transformation process to move from a classic hierarchical and departmental organizational structure to one that was flat and interdisciplinary. Staff nurses reported experiencing structural empowerment and they were willing to be involved in decision-making processes primarily about patient care within the context of their practice unit. However, participants were not always fully aware of the challenges and the effect of empowerment on their daily practice, the quality of care and patient safety. Ongoing hospital change initiatives supported staff nurses’ involvement in decision-making processes for certain matters but for some decisions, a classic hierarchical and departmental process still remained. Nurses perceived relatively high work demands and at times viewed empowerment as presenting additional. Staff nurses recognized the opportunities structural empowerment provided within their daily practice. Nurse managers and unit climate were seen as crucial for success while lack of time and perceived work demands were viewed as barriers to empowerment.