Davis Kate, White Sarahlouise, Stephenson Matthew
Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia.
JBI Database System Rev Implement Rep. 2016 Jun;14(6):274-346. doi: 10.11124/JBISRIR-2016-002219.
A healthy workplace culture enables nurses to experience valuable learning in the workplace. Learning in the workplace enables the provision of evidence-based and continuously improving safe patient care, which is central to achieving good patient outcomes. Therefore, nurses need to learn within a workplace that supports the implementation of evidence-based, professional practice and enables the best patient outcomes; the influence of workplace culture may play a role in this.
The purpose of this review was to critically appraise and synthesize the best available qualitative evidence to understand both the nurses' learning experiences within the workplace and the factors within the workplace culture that influence those learning experiences.
Registered and enrolled nurses regulated by a nursing and midwifery board and/or recognized health practitioner regulation agency (or their international equivalent).
This review considered studies that described two phenomena of interest: the nurses' learning experience, either within an acute healthcare workplace or a workplace-related learning environment and the influence of workplace culture on the nurses' learning experience (within the workplace or workplace-related learning environment).
This review considered studies that included nurses working in an acute healthcare organization within a Western culture.
This review considered studies that focused on qualitative evidence and included the following research designs: phenomenological, grounded theory and critical theory.
Published and unpublished studies in English from 1980 to 2013 were identified using a three-step search strategy, searching various databases, and included hand searching of the reference lists within articles selected for appraisal.
For studies meeting the inclusion criteria, methodological quality was assessed using a standardized checklist from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).
Qualitative data were extracted from articles included in the review using the standardized data extraction tool from the JBI-QARI.
Qualitative research findings were pooled using the Joanna Briggs Institute Qualitative Appraisal and Review Instrument (JBI-QARI). This involved the aggregation and synthesis of findings to generate a set of categories, which were then subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings that could be used as a basis for evidence-based practice.
Fourteen articles were identified following appraisal and a total of 105 findings (85 unequivocal and 20 credible) were extracted from included studies and grouped into eight categories based on similarity of meaning. Subsequently, categories were grouped into two synthesized findings. The two synthesized findings were as follows: ORGANIZATIONAL INFLUENCES: Enabling nurses to demonstrate accountability for their own learning, along with clear organizational systems that provide resources, time, adequate staffing and support, demonstrates encouragement for and the value of nurses' learning and education.
Nurses value their peers, expert nurses, preceptors, mentors and educators facilitating and encouraging their learning and professional development.
An optimal workplace culture is central for nurses to experience valuable and relevant learning in the workplace. To emphasize the importance of nurses' learning in the workplace, working and learning is understood as an integrated experience. Consequently, a dual system that enables nurses to demonstrate accountability for their own learning, along with clear organizational and educational systems, is required to demonstrate the value in nurses' learning and education.
健康的工作场所文化能使护士在工作场所获得宝贵的学习机会。在工作场所学习有助于提供基于证据且不断改进的安全患者护理，这对于实现良好的患者治疗效果至关重要。因此，护士需要在一个支持实施基于证据的专业实践并能实现最佳患者治疗效果的工作场所中学习；工作场所文化的影响可能在其中发挥作用。
本综述的目的是批判性地评估和综合现有的最佳定性证据，以了解护士在工作场所的学习经历以及工作场所文化中影响这些学习经历的因素。
纳入标准 参与者类型：由护理和助产委员会及/或认可的健康从业者监管机构（或其国际同等机构）监管的注册护士和登记护士。
本综述考虑了描述两种感兴趣现象的研究：护士在急性医疗工作场所或与工作场所相关的学习环境中的学习经历，以及工作场所文化对护士学习经历（在工作场所或与工作场所相关的学习环境中）的影响。
本综述考虑了包括在西方文化背景下急性医疗组织中工作的护士的研究。
本综述考虑了侧重于定性证据且包括以下研究设计的研究：现象学、扎根理论和批判理论。
使用三步检索策略识别1980年至2013年以英文发表和未发表的研究，检索各种数据库，并包括对选定用于评估的文章的参考文献列表进行手工检索。
对于符合纳入标准的研究，使用乔安娜·布里格斯研究所定性评估和审查工具（JBI-QARI）的标准化清单评估方法学质量。
使用JBI-QARI的标准化数据提取工具从综述中纳入的文章中提取定性数据。
使用乔安娜·布里格斯研究所定性评估和审查工具（JBI-QARI）汇总定性研究结果。这涉及对研究结果的汇总和综合，以生成一组类别，然后对其进行元综合，以产生一组单一的全面综合研究结果，可作为循证实践的基础。
评估后确定了14篇文章，从纳入研究中总共提取了105项研究结果（85项明确的和20项可信的），并根据意义相似性分为八类。随后，将这些类别归为两个综合研究结果。两个综合研究结果如下：组织影响：使护士对自己的学习负责，同时具备提供资源、时间、充足人员配备和支持的明确组织系统，体现了对护士学习和教育的鼓励及其价值。
护士重视同行、专家护士、带教老师、导师和教育工作者促进和鼓励他们的学习及专业发展。
最佳的工作场所文化对于护士在工作场所获得有价值且相关的学习至关重要。为强调护士在工作场所学习的重要性，工作和学习被视为一种综合体验。因此，需要一个双重系统，使护士对自己的学习负责，同时具备明确的组织和教育系统，以体现护士学习和教育的价值。
