Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.
J Nurs Manag. 2010 Nov;18(8):901-13. doi: 10.1111/j.1365-2834.2010.01172.x.
To determine the relationship between nurses' perceptions of their work environment and quality/risk outcomes for patients and nurses in acute care settings.
Nurses are leaving the profession as a result of high levels of job dissatisfaction arising from current working conditions. To gain organizational support for workplace improvements, evidence is needed to demonstrate the impact of the work environment on patient care.
A multi-level design was used to collect data from nurses (n=679) and patients (n=1005) within 61 medical and surgical units in 21 hospitals in Canada.
Using multilevel structural equation modelling, the hypothesized model fitted well with the data [χ(2)=21.074, d.f.=10, Comparative Fit Index (CFI)=0.985, Tucker-Lewis Index (TLI)=0.921, Root Mean Square Error of Approximation (RMSEA)=0.041, Standardized Root Mean Square Residual (SRMR) 0.002 (within) and 0.054 (between)]. Empowering workplaces had positive effects on nurse-assessed quality of care and predicted fewer falls and nurse-assessed risks as mediated through group processes. These conditions positively impacted individual psychological empowerment which, in turn, had significant direct effects on empowered behaviour, job satisfaction and care quality.
Empowered workplaces support positive outcomes for both nurses and patients.
Managers employing strategies to create more empowered workplaces have the potential to improve nursing teamwork that supports higher quality care, less patient risk and more satisfied nurses.
确定急性护理环境中护士对工作环境的看法与患者和护士的质量/风险结果之间的关系。
由于当前工作条件导致工作满意度高，护士离开该行业。为了获得组织对工作场所改进的支持，需要有证据表明工作环境对患者护理的影响。
使用多水平设计从加拿大 21 家医院的 61 个医疗和外科病房中的 679 名护士和 1005 名患者中收集数据。
使用多层次结构方程模型，假设模型与数据拟合良好[χ²（2）= 21.074，df = 10，比较拟合指数（CFI）= 0.985，Tucker-Lewis 指数（TLI）= 0.921，近似均方根误差（RMSEA）= 0.041，标准化均方根残差（SRMR）0.002（内部）和 0.054（之间）]。赋权工作场所对护士评估的护理质量有积极影响，并通过群体过程预测跌倒和护士评估的风险减少。这些条件对个体心理赋权产生积极影响，进而对赋权行为、工作满意度和护理质量产生重大直接影响。
赋权的工作场所为护士和患者都带来积极的结果。
采用创造更赋权工作场所策略的管理人员有可能改善护理团队合作，从而支持更高质量的护理、降低患者风险和提高护士满意度。
