Temkin-Greener Helena, Zheng Nan, Katz Paul, Zhao Hongwei, Mukamel Dana B
Department of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, New York 14642, USA.
Med Care. 2009 Apr;47(4):482-91. doi: 10.1097/mlr.0b013e318190cfd3.
Qualitative studies of the nursing home work environment have long suggested that attributes such as leadership and communication may be related to nursing home performance, including residents' outcomes. However, empirical studies examining these relationships have been scant.
This study is designed to develop an instrument for measuring nursing home work environment and perceived work effectiveness; test the reliability and validity of the instrument; and identify individual and facility-level factors associated with better facility performance.
The analysis was based on survey responses provided by managers (N = 308) and direct care workers (N = 7418) employed in 162 facilities throughout New York State. Exploratory factor analysis, Cronbach's alphas, analysis of variance, and regression models were used to assess instrument reliability and validity. Multivariate regression models, with fixed facility effects, were used to examine factors associated with work effectiveness.
The reliability and the validity of the survey instrument for measuring work environment and perceived work effectiveness have been demonstrated. Several individual (eg, occupation, race) and facility characteristics (eg, management style, workplace conditions, staffing) that are significant predictors of perceived work effectiveness were identified.
The organizational performance model used in this study recognizes the multidimensionality of the work environment in nursing homes. Our findings suggest that efforts at improving work effectiveness must also be multifaceted. Empirical findings from such a line of research may provide insights for improving the quality of the work environment and ultimately the quality of residents' care.
长期以来，对疗养院工作环境的定性研究表明，领导能力和沟通能力等特质可能与疗养院的绩效相关，包括居民的治疗结果。然而，检验这些关系的实证研究却很少。
本研究旨在开发一种测量疗养院工作环境和感知工作效能的工具；测试该工具的信度和效度；并确定与疗养院更好绩效相关的个体和机构层面因素。
分析基于纽约州162家机构中管理人员（N = 308）和直接护理人员（N = 7418）提供的调查回复。探索性因素分析、克朗巴哈系数、方差分析和回归模型用于评估工具的信度和效度。具有固定机构效应的多元回归模型用于检验与工作效能相关的因素。
已证明测量工作环境和感知工作效能的调查工具的信度和效度。确定了几个作为感知工作效能重要预测因素的个体（如职业、种族）和机构特征（如管理风格、工作场所条件、人员配备）。
本研究中使用的组织绩效模型认识到疗养院工作环境的多维性。我们的研究结果表明，提高工作效能的努力也必须是多方面的。这一系列研究的实证结果可能为改善工作环境质量以及最终改善居民护理质量提供见解。
