Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA.
University of Vermont Medical Center, Burlington, VT.
Med Care. 2019 May;57(5):353-361. doi: 10.1097/MLR.0000000000001109.
The nurse work environment is theorized to influence the quality of nursing care, nurse job outcomes, and patient outcomes.
The aim of this meta-analysis was to evaluate quantitatively the association of the work environment with job and health outcomes.
Relevant studies published through September 2018 were identified. Inclusion criteria were use of a nationally endorsed work environment measure and reporting of odds ratios (ORs) and 95% confidence intervals from regression models of 4 outcome classes: nurse job outcomes, safety and quality ratings, patient outcomes, and patient satisfaction. Pooled ORs and confidence intervals were estimated for each outcome using fixed or random effects models.
Of 308 articles reviewed, 40 met inclusion criteria. After excluding 23 due to sample overlap or too few observations to meta-analyze, a set of 17 articles, comprising 21 independent samples, was analyzed. Cumulatively, these articles reported data from 2677 hospitals, 141 nursing units, 165,024 nurses, and 1,368,420 patients, in 22 countries.
Practice Environment Scale of the Nursing Work Index, a National Quality Forum nursing care performance standard.
Consistent, significant associations between the work environment and all outcome classes were identified. Better work environments were associated with lower odds of negative nurse outcomes (average OR of 0.71), poor safety or quality ratings (average OR of 0.65), and negative patient outcomes (average OR of 0.93), but higher odds of patient satisfaction (OR of 1.16).
The nurse work environment warrants attention to promote health care quality, safety, and patient and clinician well-being.
护士工作环境被认为会影响护理质量、护士工作结果和患者结果。
本项荟萃分析旨在定量评估工作环境与工作和健康结果之间的关联。
检索截至 2018 年 9 月发表的相关研究。纳入标准为使用全国认可的工作环境测量工具和报告 4 类结果的回归模型的比值比（OR）和 95%置信区间：护士工作结果、安全性和质量评分、患者结果和患者满意度。使用固定或随机效应模型估计每个结果的汇总 OR 和置信区间。
在审查的 308 篇文章中，有 40 篇符合纳入标准。在排除了因样本重叠或可用于元分析的观察值太少而排除了 23 篇后，对一组 17 篇文章（包括 21 个独立样本）进行了分析。这组文章累计报告了来自 22 个国家的 2677 家医院、141 个护理单元、165024 名护士和 1368420 名患者的数据。
护理工作指数实践环境量表，这是一个全国质量论坛护理服务绩效标准。
工作环境与所有结果类别之间存在一致且显著的关联。更好的工作环境与较低的负面护士结果（平均 OR 为 0.71）、较差的安全性或质量评分（平均 OR 为 0.65）和负面患者结果（平均 OR 为 0.93）相关，但与患者满意度（OR 为 1.16）更高。
需要关注护士工作环境，以促进医疗质量、安全性以及患者和临床医生的健康。
