护理工作环境对患者安全结果的影响：职业倦怠/工作投入的中介作用。
The impact of nursing work environments on patient safety outcomes: the mediating role of burnout/engagement.
作者信息
Spence Laschinger Heather K, Leiter Michael P
机构信息
School of Nursing, University of Western Ontario, London, Ontario, Canada.
出版信息
J Nurs Adm. 2006 May;36(5):259-67. doi: 10.1097/00005110-200605000-00019.
OBJECTIVE
To test a theoretical model of professional nurse work environments linking conditions for professional nursing practice to burnout and, subsequently, patient safety outcomes.
BACKGROUND
The 2004 Institute of Medicine report raised serious concerns about the impact of hospital restructuring on nursing work environments and patient safety outcomes. Few studies have used a theoretical framework to study the nature of the relationships between nursing work environments and patient safety outcomes.
METHODS
Hospital-based nurses in Canada (N = 8,597) completed measures of worklife (Practice Environment Scale of the Nursing Work Index), burnout (Maslach Burnout Inventory-Human Service Scale), and their report of frequency of adverse patient events.
RESULTS
Structural equation modeling analysis supported an extension of Leiter and Laschinger's Nursing Worklife Model. Nursing leadership played a fundamental role in the quality of worklife regarding policy involvement, staffing levels, support for a nursing model of care (vs medical), and nurse/physician relationships. Staffing adequacy directly affected emotional exhaustion, and use of a nursing model of care had a direct effect on nurses' personal accomplishment. Both directly affected patient safety outcomes.
CONCLUSIONS
The results suggest that patient safety outcomes are related to the quality of the nursing practice work environment and nursing leadership's role in changing the work environment to decrease nurse burnout.
目的
检验一个专业护士工作环境的理论模型，该模型将专业护理实践条件与职业倦怠相联系，并进而与患者安全结果相关联。
背景
2004年医学研究所的报告引发了对医院重组对护理工作环境及患者安全结果影响的严重关切。很少有研究使用理论框架来研究护理工作环境与患者安全结果之间关系的本质。
方法
加拿大的医院护士（N = 8597）完成了工作生活（护理工作指数实践环境量表）、职业倦怠（马氏职业倦怠量表-人类服务版）的测量，以及他们对不良患者事件发生频率的报告。
结果
结构方程模型分析支持了莱特和拉辛金格的护理工作生活模型的扩展。护理领导力在工作生活质量方面发挥了根本性作用，涉及政策参与、人员配备水平、对护理护理模式（相对于医疗模式）的支持以及护士/医生关系。人员配备充足直接影响情绪衰竭，采用护理护理模式对护士的个人成就感有直接影响。两者都直接影响患者安全结果。
结论
结果表明，患者安全结果与护理实践工作环境的质量以及护理领导力在改变工作环境以减少护士职业倦怠方面的作用相关。
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