Galuska Lee, Hahn Judith, Polifroni E Carol, Crow Gregory
Center for Nursing Excellence, University of California Los Angeles Health, Los Angeles (Dr Galuska); Center for Professional Practice Excellence, Yale-New Haven Hospital, Connecticut (Dr Hahn); School of Nursing, University of Connecticut, Storrs (Dr Polifroni); and School of Nursing and Health Professions, University of San Francisco, California, and Tim Porter-O'Grady Associates, Atlanta, Georgia (Dr Crow).
Nurs Adm Q. 2018 Apr/Jun;42(2):154-163. doi: 10.1097/NAQ.0000000000000280.
Health care transformation is guided by the triple aim of improving health, enhancing the patient experience, and reducing costs. Experts have recommended the addition of a fourth aim, improving the experience of providing care. They advise that achievement of the triple aim will only be possible if we create the conditions where health care workers can find meaning and joy in their work. Nurses' experiences with meaning and joy in their practice have not been well described. In an effort to fill this knowledge gap, nurses across the nation recently participated in a qualitative study to share their experiences with meaning and joy in their nursing practice. The study utilized a narrative inquiry approach with a lens of appreciation to elicit and interpret nurses' stories. The stories, recorded and archived in StoryCorps, provided rich insight into meaning and joy in nursing practice. The study captured contemporary themes that crossed practice settings and generations across the United States. Four themes emerged from the analysis, including: fulfilling purpose-"I am a nurse"; meaningful connection; impact-the wow factor; and the practice environment. The practice environment theme included 3 subthemes: teams work, leaders model the way, and opportunities to learn and grow. The themes are described and illustrated with participant quotes. The study findings build on published evidence related to meaning in nursing practice and our conceptual understanding of joy. Results align with recommendations for defining and focusing on the fourth aim: To improve the practice experiences of nurses so they can more fully contribute to achieving both the triple aim in health care and their own well-being. Specific implications for leaders and supportive practice environments are discussed.
医疗保健转型以改善健康、提升患者体验和降低成本这三大目标为导向。专家建议增加第四个目标，即改善护理体验。他们认为，只有当我们创造条件让医护人员能在工作中找到意义和乐趣时，实现这三大目标才有可能。护士在实践中体验到的意义和乐趣尚未得到充分描述。为了填补这一知识空白，全国各地的护士最近参与了一项定性研究，分享他们在护理实践中体验到的意义和乐趣。该研究采用叙事探究方法，以欣赏的视角来引出和解读护士的故事。这些故事记录并存档于StoryCorps，为护理实践中的意义和乐趣提供了丰富的见解。该研究捕捉到了跨越美国不同实践环境和代际的当代主题。分析得出了四个主题，包括：实现目标——“我是一名护士”；有意义的联系；影响——惊人之处；以及实践环境。实践环境主题包括三个子主题：团队协作、领导者以身作则以及学习和成长的机会。文中用参与者的引语对这些主题进行了描述和阐释。该研究结果建立在已发表的与护理实践中的意义以及我们对乐趣的概念理解相关的证据之上。结果与关于定义和关注第四个目标的建议一致：改善护士的实践体验，以便他们能更充分地为实现医疗保健的三大目标以及自身幸福做出贡献。文中还讨论了对领导者和支持性实践环境的具体影响。
