Centre for Aging Research and Education, School of Nursing, York University, Toronto, ON, Canada.
Institute for Social Research, York University, Toronto, ON, Canada.
J Nurs Scholarsh. 2018 Sep;50(5):513-521. doi: 10.1111/jnu.12414. Epub 2018 Jul 26.
To test the relationships between the geriatric practice environment, geriatric nursing practice, and overall quality of care for older adults and their families as reported by nurses working in hospitals, while controlling for nurse and hospital characteristics.
A cross-sectional tailored survey design was employed. A questionnaire was mailed to a randomly selected sample of nurses whose primary practice area was medicine, surgery, geriatrics, emergency, or critical care in acute care hospitals in Ontario, Canada.
Participants (N = 2,005) working in 148 hospitals responded to validated measures of the geriatric practice environment, geriatric nursing practice, overall quality of care for older adults and their families, and nurse and hospital characteristics. The relationships were tested using structural equation modeling.
Controlling for nurse and hospital characteristics, the geriatric practice environment had a statistically significant positive relationship of large magnitude with both geriatric nursing practice (β = 0.52) and overall quality of care (β = 0.92); however, the indirect relationship between the geriatric practice environment and overall quality of care, mediated by geriatric nursing practice, was not significant (β = -0.02). Final model fit was acceptable, with the root mean square error of approximation = 0.07, comparative fit index = 0.93, and Tucker-Lewis Index = 0.87.
A strong geriatric practice environment positively and directly influences geriatric nursing practice and overall quality of care for older adults and their families but does not appear to influence overall quality of care indirectly through geriatric nursing practice.
The results can be used as the basis for promoting practice environments that support overall quality of care and geriatric nursing practice in acute care hospitals.
在控制护士和医院特征的情况下，检验老年病实践环境、老年护理实践与老年及其家庭整体护理质量之间的关系，这些关系是由在加拿大安大略省医院工作的护士报告的，其主要实践领域为内科、外科、老年病学、急诊或重症监护。
采用跨截面定制调查设计。问卷邮寄给随机选择的、在加拿大安大略省医院工作的护士，他们的主要实践领域为内科、外科、老年病学、急诊或重症监护。
在 148 家医院工作的参与者（n=2005）回答了老年病实践环境、老年护理实践、老年及其家庭整体护理质量以及护士和医院特征的有效测量方法。使用结构方程模型检验了这些关系。
在控制护士和医院特征的情况下，老年病实践环境与老年护理实践（β=0.52）和整体护理质量（β=0.92）呈显著正相关，且相关程度较大；然而，老年病实践环境与整体护理质量之间的间接关系，由老年护理实践介导，并不显著（β=-0.02）。最终模型拟合度可接受，近似均方根误差为 0.07，比较拟合指数为 0.93，塔克-刘易斯指数为 0.87。
强有力的老年病实践环境积极且直接影响老年护理实践和老年及其家庭的整体护理质量，但似乎并没有通过老年护理实践对整体护理质量产生间接影响。
研究结果可作为在急性护理医院中促进支持整体护理质量和老年护理实践的实践环境的基础。
