Papastavrou Evridiki, Acaroglu Rengin, Sendir Merdiye, Berg Agneta, Efstathiou Georgios, Idvall Ewa, Kalafati Maria, Katajisto Jouko, Leino-Kilpi Helena, Lemonidou Chryssoula, da Luz Maria Deolinda Antunes, Suhonen Riitta
Cyprus University of Technology, Department of Nursing, School of Health Studies, Limassol, Cyprus.
Istanbul University, Florence Nightingale School Faculty of Nursing, Istanbul, Turkey.
Int J Nurs Stud. 2015 Jan;52(1):121-33. doi: 10.1016/j.ijnurstu.2014.05.008. Epub 2014 May 29.
Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies.
The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries.
This study had an international, multisite, prospective, cross-sectional, exploratory survey design.
The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey.
Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study.
Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model.
Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care.
The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.
以往的研究发现，医院的实践环境质量越高，护士和患者的结局就越好。实践环境可能会影响护士提供个性化护理的能力，但个性化护理与专业实践环境之间的详细关系尚未得到广泛研究。关于实践环境与护理个体化程度之间的关联存在一些证据，但这些证据基于单一国家的研究。
本研究的目的是确定七个国家的护士对其专业实践环境的看法是否与其对护理个体化程度的看法相关。
本研究采用国际多地点前瞻性横断面探索性调查设计。
该研究涉及塞浦路斯、芬兰、希腊、美国堪萨斯州、葡萄牙、瑞典和土耳其七个国家的急症护理医院中的急性骨科和创伤外科住院病房（n = 91）以及急症护理医院（n = 34）。
七个国家急症护理医院的骨科和创伤住院病房中从事直接患者护理工作的护士（n = 1163），包括注册护士或执业护士，参与了本研究。
使用自填式问卷进行数据收集，问卷包括两种工具，即修订后的专业实践环境问卷和护士个体化护理量表（护士个体化护理量表A和B）。使用描述性统计、同时多元回归分析和广义线性模型对数据进行统计分析。
应用两个回归模型来评估修订后的专业实践环境问卷对护士个体化护理量表A和B的预测效度。结果表明，专业实践环境的要素与护理个体化相关。内部工作动机、文化敏感性、对实践的控制、团队合作以及与医生的人员关系是个体化护理支持（护士个体化护理量表A）和提供（护士个体化护理量表B）的预测因素。
本研究结果提供了证据表明环境因素可以解释护理个体化的差异。这些发现支持这样的观点，即需要在比直接的护患关系更广泛的背景下理解个体化护理，并且精心营造护理环境可能是提高护理质量和结局的有效途径。
