School of Nursing, Dalian Medical University, Dalian, China.
Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.
J Adv Nurs. 2018 Apr;74(4):935-945. doi: 10.1111/jan.13507. Epub 2017 Dec 21.
To propose a hypothesized theoretical model and apply it to examine the structural relationships among work environment, patient-to-nurse ratio, job satisfaction, burnout, intention to leave and quality nursing care.
Improving quality nursing care is a first consideration in nursing management globally. A better understanding of factors influencing quality nursing care can help hospital administrators implement effective programmes to improve quality of services. Although certain bivariate correlations have been found between selected factors and quality nursing care in different study models, no studies have examined the relationships among work environment, patient-to-nurse ratio, job satisfaction, burnout, intention to leave and quality nursing care in a more comprehensive theoretical model.
A cross-sectional survey.
The questionnaires were collected from 510 Chinese nurses in four Chinese tertiary hospitals in January 2015. The validity and internal consistency reliability of research instruments were evaluated. Structural equation modelling was used to test a theoretical model.
The findings revealed that the data supported the theoretical model. Work environment had a large total effect size on quality nursing care. Burnout largely and directly influenced quality nursing care, which was followed by work environment and patient-to-nurse ratio. Job satisfaction indirectly affected quality nursing care through burnout.
This study shows how work environment past burnout and job satisfaction influences quality nursing care. Apart from nurses' work conditions of work environment and patient-to-nurse ratio, hospital administrators should pay more attention to nurse outcomes of job satisfaction and burnout when designing intervention programmes to improve quality nursing care.
提出一个假设理论模型，并应用该模型检验工作环境、护患比、工作满意度、职业倦怠、离职意愿与护理质量之间的结构关系。
提高护理质量是全球护理管理的首要考虑因素。更好地了解影响护理质量的因素可以帮助医院管理人员实施有效的计划来提高服务质量。尽管在不同的研究模型中已经发现了某些选定因素与护理质量之间的某些双变量相关性，但没有研究在更全面的理论模型中检验工作环境、护患比、工作满意度、职业倦怠、离职意愿与护理质量之间的关系。
横断面调查。
2015 年 1 月，从中国 4 家三级医院的 510 名中国护士中收集了问卷。评估了研究工具的有效性和内部一致性信度。使用结构方程模型检验理论模型。
研究结果表明，数据支持该理论模型。工作环境对护理质量的总效应较大。职业倦怠对护理质量有较大的直接影响，其次是工作环境和护患比。工作满意度通过职业倦怠间接影响护理质量。
本研究表明工作环境、职业倦怠和工作满意度如何影响护理质量。除了护士的工作条件（工作环境和护患比）外，医院管理人员在设计提高护理质量的干预计划时，还应更加关注护士的工作满意度和职业倦怠等结果。
