领导者影响力、专业实践环境与护士对基本护理实践的参与度

Leader Influence, the Professional Practice Environment, and Nurse Engagement in Essential Nursing Practice.

作者信息

Ducharme Maria P, Bernhardt Jean M, Padula Cynthia A, Adams Jeffrey M

机构信息

Author Affiliations: Senior Vice President, Patient Care Services, and Chief Nursing Officer, The Miriam Hospital, Providence, Rhode Island (Dr Ducharme); Assistant Professor, Massachusetts General Hospital, Boston (Dr Bernhardt); Per-Diem Nurse Researcher, The Miriam Hospital, Providence, Rhode Island (Dr Padula); and Executive Director, Workforce Outcomes Research and Leadership Development Institute; Professor of Practice, Arizona State University College of Nursing and Health Innovation, Phoenix; and Senior Scientist, Brigham and Women's Hospital and Dana-Farber Cancer Institute, and Executive Nurse Fellow, Robert Wood Johnson Foundation, Boston, Massachusetts (Dr Adams).

出版信息

J Nurs Adm. 2017 Jul/Aug;47(7-8):367-375. doi: 10.1097/NNA.0000000000000497.

DOI:10.1097/NNA.0000000000000497

PMID:28678050

Abstract

OBJECTIVE

The purpose of this study was to examine relationships between leaders' perceived influence over professional practice environments (PPEs) and clinical nurses' reported engagement in essential professional nursing practice.

BACKGROUND

There is little empirical evidence identifying impact of nurse leader influence or why nursing leaders are not perceived, nor do they perceive themselves, as influential in healthcare decision making.

METHODS

A nonexperimental method of prediction was used to examine relationships between engagement in professional practice, measured by Essentials of Magnetism II (EOMII) tool, and nurse leaders' perceived influence, measured by Leadership Influence over Professional Practice Environment Scale (LIPPES). A convenience sample of 30 nurse leaders and 169 clinical nurses, employed in a 247-bed acute care Magnet® hospital, participated.

RESULTS

Findings indicated that leaders perceived their influence presence from "often" to "always," with mean scores of 3.02 to 3.70 on a 4-point Likert scale, with the lowest subscale as "access to resources" for which a significant relationship was found with clinical nurses' reported presence of adequate staffing (P < .004). Clinical nurses reported more positive perceptions in adequacy of staffing on the EOMII when nurse leaders perceived themselves to be more influential, as measured by the LIPPES, in collegial administrative approach (P = .014), authority (P = .001), access to resources (P = .004), and leadership expectations of staff (P = .039). Relationships were seen in the outcome measure of the EOMII scale, nurse-assessed quality of patient care (NAQC), where nurse leaders' perception of their authority (P = .003) and access to resources (P = .022) positively impacted and was predictive of NAQC.

CONCLUSIONS

Findings support assertion that nurse leaders are integral in enhancing PPEs and their influence links structures necessary for an environment that supports outcomes.

摘要

目的

本研究旨在探讨领导者所感知的对专业实践环境（PPE）的影响与临床护士报告的参与基本专业护理实践之间的关系。

背景

几乎没有实证证据表明护士领导者的影响有何作用，也不清楚为何护理领导者在医疗保健决策中未被视为有影响力，他们自己也不这样认为。

方法

采用非实验性预测方法，以《磁性医院标准II》（EOMII）工具衡量的专业实践参与度与以《专业实践环境中的领导影响力量表》（LIPPES）衡量的护士领导者感知影响力之间的关系。来自一家拥有247张床位的急性护理磁性认证医院的30名护士领导者和169名临床护士组成的便利样本参与了研究。

结果

研究结果表明，领导者认为他们的影响力“经常”到“总是”存在，在4点李克特量表上的平均得分为3.02至3.70，得分最低的子量表是“资源获取”，该子量表与临床护士报告的充足人员配备情况存在显著关系（P < 0.004）。当护士领导者认为自己在 collegial administrative approach（P = 0.014）、权威（P = 0.001）、资源获取（P = 0.004）以及对员工的领导期望（P = 0.039）方面更具影响力时，临床护士在EOMII上对人员配备充足性的看法更为积极。在EOMII量表的结果指标，即护士评估的患者护理质量（NAQC）中也发现了这种关系，护士领导者对其权威（P = 0.003）和资源获取（P = 0.022）的感知对NAQC有积极影响并可预测NAQC。