White Mark, Wells John S G, Butterworth Tony
Nursing & Midwifery Planning & Development Unit, HSE-South, Kilcreene Hospital, Kilkenny, Ireland.
School of Health Science, Waterford Institute of Technology, Waterford, Ireland.
Int J Nurs Stud. 2014 Dec;51(12):1634-43. doi: 10.1016/j.ijnurstu.2014.05.002. Epub 2014 May 14.
Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to 'engage' and 'empower' ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the 'engagement' of the clinical teams who participate and vice-versa.
This paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the 'work engagement' of the nurses and ward teams involved.
DESIGN/METHODS: Using the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national 'Productive Ward' initiative in Ireland and compared them to a control group of similar size and matched (as far as is possible) on variables such as ward size, employment grade and clinical specialty area.
338 individual datasets were recorded, n=180 (53.6%) from the Productive Ward group, and n=158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (±standard deviation) in the Productive group was 4.33(±0.88), and 4.07(±1.06) in the control group, representing a modest but statistically significant between-group difference (p=0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (p<0.001, general linear model) and (for the most part), to its components, with both clerical and nurse manager grades, and the elderly specialist areas, exhibiting substantially higher scores.
The findings demonstrate how QI activities, like those integral to the Productive Ward programme, appear to positively impact on the work engagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of 'engagement' in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement.
质量改进（QI）项目，如“高效病房：释放护理时间”倡议，旨在“促使”和“赋能”病房团队积极参与、创新并引领一线的质量改进工作。然而，对于质量改进工作与参与其中的临床团队“参与度”之间的关系及影响，以及反之亦然的情况，我们知之甚少。
本文探讨并检验一项大规模质量改进项目——“高效病房”对所涉及的护士和病房团队“工作投入度”的影响。
设计/方法：我们使用乌得勒支工作投入量表（UWES），对爱尔兰近期开始参与全国“高效病房”倡议最新阶段的具有代表性的医院病房团队测试组进行了调查、测量和分析，并将其与规模相似且在病房规模、就业等级和临床专科领域等变量上尽可能匹配的对照组进行比较。
记录了338个个体数据集，其中来自“高效病房”组的有n = 180（53.6%），来自对照组的有n = 158（46.4%）；总体回复率为67%，“高效病房”组和对照组之间无显著差异。“高效病房”组的工作投入平均得分（±标准差）为4.33（±0.88），对照组为4.07（±1.06），组间差异虽小但具有统计学意义（p = 0.013，独立样本t检验）。在工作投入结构的所有三个维度上也观察到了类似的微小差异。就业等级和临床专科领域也与工作投入得分显著相关（p < 0.001，一般线性模型），并且（在大多数情况下）与工作投入得分的组成部分相关，文书和护士长等级以及老年专科领域的得分显著更高。
研究结果表明，像“高效病房”项目中不可或缺的那些质量改进活动，似乎对病房团队的工作投入（活力、专注度和奉献精神）产生了积极影响。证实了UWES作为质量改进干预中“参与度”的适当衡量标准的适用性。护士和一线临床团队的参与是创建、发展和维持改进文化的一个主要组成部分。
