Department of Nursing, University Hospital Antwerp, Belgium.
J Adv Nurs. 2009 Oct;65(10):2175-85. doi: 10.1111/j.1365-2648.2009.05082.x.
The aim of the study was to investigate relationships between nurse practice environment, burnout, job outcomes and nurse-assessed quality of care.
A growing line of work confirms that, in countries with distinctly different healthcare systems, nurses report similar shortcomings in their work environments and the quality of care in hospitals. Neither the specific work environment factors most involved in dissatisfaction, burnout and other negative job outcomes, and patient outcomes, nor the mechanisms tying nurse job outcomes to quality of care are well understood.
A Nurse Practice Environment and Outcome causal structure involving pathways between practice environment dimensions and outcome variables with components of burnout in a mediating position was developed. Survey data from 401 staff nurses across 31 units in two hospitals (including the Revised Nursing Work Index, the Maslach Burnout Inventory, and job outcome and nurse-assessed quality of care variables) were used to test this model using structural equation modelling techniques. The data were collected from December 2006 to January 2007.
Goodness of fit statistics confirmed an improved model with burnout dimensions in mediating positions between nurse practice environment dimensions and both job outcomes and nurse-assessed quality of care, explaining 20% and 46% of variation in these two indicators, respectively.
These findings suggest that hospital organizational properties, including nurse-physician relations, are related to quality of care assessments, and to the outcomes of job satisfaction and turnover intentions, with burnout dimensions appearing to play mediating roles. Additionally, a direct relationship between assessments of care quality and management at the unit level was observed.
本研究旨在探讨护士执业环境、倦怠、工作结果与护士评估的护理质量之间的关系。
越来越多的研究证实，在具有明显不同医疗体系的国家中，护士报告称其工作环境和医院护理质量存在相似的缺陷。无论是与不满、倦怠和其他负面工作结果以及患者结果最相关的特定工作环境因素，还是将护士工作结果与护理质量联系起来的机制，都还没有得到很好的理解。
开发了一个护士执业环境和结果因果结构，其中包含实践环境维度与结果变量之间的路径，以及倦怠的组成部分处于中介位置。使用结构方程建模技术，对来自两家医院 31 个单元的 401 名在职护士的调查数据（包括修订后的护理工作指数、Maslach 倦怠量表、工作结果和护士评估的护理质量变量）进行了测试。数据收集于 2006 年 12 月至 2007 年 1 月。
拟合优度统计数据证实，在护士执业环境维度与工作结果和护士评估的护理质量之间的中介位置存在倦怠维度的模型得到了改进，分别解释了这两个指标 20%和 46%的变化。
这些发现表明，医院组织特性，包括护士与医生的关系，与护理质量评估以及工作满意度和离职意向的结果相关，倦怠维度似乎发挥了中介作用。此外，还观察到了护理质量评估与单元级别的管理之间的直接关系。
