护士及其工作环境如何影响患者对护理质量的体验：一项定性研究。
How nurses and their work environment affect patient experiences of the quality of care: a qualitative study.
作者信息
Kieft Renate Amm, de Brouwer Brigitte B J M, Francke Anneke L, Delnoij Diana M J
机构信息
Dutch Nurses' Association, PO Box 8212, 3503, RE Utrecht, The Netherlands.
出版信息
BMC Health Serv Res. 2014 Jun 13;14:249. doi: 10.1186/1472-6963-14-249.
BACKGROUND
Healthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences.
METHODS
A descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis.
RESULTS
The nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care.
CONCLUSIONS
According to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and they experience a conflict between these two approaches. Nurses must gain autonomy over their own practice in order to improve patient experiences.
背景
医疗保健机构监测患者体验，以评估和提高护理质量。由于护士与患者相处的时间很长，他们对患者体验有重大影响。为了改善患者对护理质量的体验，护士需要了解护理工作环境中的哪些因素具有影响力。本研究的主要重点是了解荷兰护士对其工作及工作环境如何促成积极患者体验的看法。
方法
采用描述性定性研究设计来收集数据。进行了四个焦点小组讨论，分别在精神卫生保健、医院护理、家庭护理和养老院护理领域各有6或7名注册护士参与。通过目的抽样共招募了26名护士。访谈进行了录音、转录并进行了主题分析。
结果
护士们提到了他们认为会改善患者对护理质量体验的关键要素：临床能力强的护士、协作的工作关系、自主的护理实践、充足的人员配备、对护理实践的掌控、管理支持以及以患者为中心的文化。他们还提到了一些抑制因素，如成本效益政策和外部问责的透明度目标。护士们感到有提高生产力的压力，并表示行政工作量很大。他们指出这些因素不会改善患者对护理质量的体验。
结论
根据参与者的说法，多种因素会影响患者对护理质量的体验。他们认为将这些要素纳入日常护理实践会带来更积极的患者体验。然而，护士工作的医疗环境要求他们在追求基于患者需求和偏好提供护理的愿望与成本效益及问责制之间进行协调，并且他们在这两种方式之间经历着冲突。护士必须在自身实践中获得自主权，以改善患者体验。
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