Van Bogaert Peter, Peremans Lieve, Van Heusden Danny, Verspuy Martijn, Kureckova Veronika, Van de Cruys Zoë, Franck Erik
Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium.
Department of Nursing, Antwerp University Hospital, Wilrijkstraat 10, B- 2650 Edegem, Belgium.
BMC Nurs. 2017 Jan 18;16:5. doi: 10.1186/s12912-016-0200-4. eCollection 2017.
High levels of work-related stress, burnout, job dissatisfaction, and poor health are common within the nursing profession. A comprehensive understanding of nurses' psychosocial work environment is necessary to respond to complex patients' needs. The aims of this study were threefold: (1) To retest and confirm two structural equation models exploring associations between practice environment and work characteristics as predictors of burnout (model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses' and nurse managers' perceptions and experiences of staff nurses' workload; (3) To explain and interpret the two models by using the qualitative study findings.
This mixed method study is based on an explanatory sequential study design. We first performed a cross-sectional survey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured interviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study data was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and interpreting the findings of the two models.
The two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data. Nurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the unit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and between 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job outcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (≤5%). The qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary collaboration, communication and teamwork; staff nurse personal characteristics and competencies; patient centeredness, quality and patient safety. Respondents' statements corresponded closely to the models' associations.
A deep understanding of various associations and impacts on studied outcome variables such as risk factors and protective factors was gained through the retested models and the interviews with the study participants. Besides the work characteristics - such as decision latitude, social capital and team cohesion - more insight and knowledge of the work characteristic workload is essential.
在护理行业中，高水平的工作压力、职业倦怠、工作不满和健康状况不佳很常见。全面了解护士的社会心理工作环境对于满足复杂的患者需求至关重要。本研究的目的有三个：（1）重新测试并确认两个结构方程模型，探索实践环境与工作特征之间的关联，这些关联作为职业倦怠（模型1）和工作投入（模型2）的预测因素，以及护士报告的工作成果和护理质量；（2）研究注册护士和护士长对注册护士工作量的看法和体验；（3）通过定性研究结果解释和阐释这两个模型。
这项混合方法研究基于解释性序列研究设计。我们首先在两家大型急性护理大学医院进行了横断面调查设计。其次，我们对研究医院之一的内科或外科病房的注册护士和护士长进行了个人半结构化访谈。研究数据于2014年9月至2015年6月收集。最后，定性研究结果有助于解释和阐释这两个模型的结果。
以职业倦怠和工作投入作为中介结果变量的两个模型与数据拟合良好。护士报告的工作成果和护理质量解释了52%至62%的方差。科室层面的护士管理和工作量对结果变量有直接影响，解释的方差分别为23%至36%和12%至17%。个人成就感和去个性化对工作成果的解释方差为23%，对活力的解释方差为20%。职业倦怠和工作投入对护理质量的直接影响较小（≤5%）。定性研究揭示了各种主题，如日常实践的组织和工作条件；跨学科协作、沟通和团队合作；注册护士的个人特征和能力；以患者为中心、质量和患者安全。受访者的陈述与模型的关联密切对应。
通过重新测试的模型以及与研究参与者的访谈，深入了解了对所研究的结果变量（如风险因素和保护因素）的各种关联和影响。除了决策自由度、社会资本和团队凝聚力等工作特征外，深入了解工作特征工作量也至关重要。
