Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden; Stockholm Health Care Services (SLSO), Region Stockholm, Sweden.
Eur J Oncol Nurs. 2020 Aug;47:101778. doi: 10.1016/j.ejon.2020.101778. Epub 2020 Jun 12.
Hospital organizational features related to registered nurses' (RNs') practice environment are often studied using quantitative measures. These are however unable to capture nuances of experiences of the practice environment from the perspective of individual RNs. The aim of this study is therefore to investigate individual RNs' experiences of their work situation in cancer care in Swedish acute care hospitals.
This study is based on a qualitative framework analysis of data derived from an open-ended question by 200 RNs working in specialized or general cancer care hospital units, who responded to the Swedish RN4CAST survey on nurse work environment. Antonovsky's salutogenic concepts "meaningfulness", "comprehensibility", and "manageability" were applied post-analysis to support interpretation of results.
RNs describe a tension between expectations to uphold safe, high quality care, and working in an environment where they are unable to influence conditions for care delivery. A lacking sense of agency, on individual and collective levels, points to organizational factors impeding RNs' use of their competence in clinical decision-making and in governing practice within their professional scope.
RNs in this study appear to experience work situations which, while often described as meaningful, generally appear neither comprehensible nor manageable. The lack of an individual and collective sense of agency found here could potentially erode RNs' sense of meaningfulness and readiness to invest in their work.
医院组织特征与注册护士（RNs）的实践环境相关，通常使用定量措施进行研究。然而，这些措施无法从单个 RN 的角度捕捉到实践环境的细微差别。因此，本研究旨在调查瑞典急性护理医院中癌症护理中个体 RN 对其工作情况的体验。
本研究基于对 200 名在专门或一般癌症护理医院工作的 RN 进行的开放式问题的定性框架分析，他们对瑞典 RN4CAST 护士工作环境调查做出了回应。在进行分析后，应用了 Antonovsky 的健康促进概念“意义”、“可理解性”和“可管理性”来支持对结果的解释。
RNs 描述了在期望维持安全、高质量的护理和在无法影响护理提供条件的环境中工作之间的紧张关系。在个体和集体层面上缺乏代理感，指向了阻碍 RNs 在临床决策和在其专业范围内管理实践中使用其能力的组织因素。
本研究中的 RNs 似乎经历了工作情况，这些情况虽然经常被描述为有意义，但通常既不可理解也不可管理。这里发现的缺乏个体和集体代理感可能会侵蚀 RNs 的意义感和对工作的投入意愿。
