Li Junlong, Xiang Lijia, Li Qin, Liu Jie, Pan Jay
HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Department of Human Resources, Sichuan Vocational College of Health and Rehabilitation, Zigong, China.
Int Nurs Rev. 2025 Mar;72(1):e12981. doi: 10.1111/inr.12981. Epub 2024 Apr 29.
This study aimed to investigate how clinical pathway implementation satisfaction, work engagement, and hospital-patient relationship impact the quality of care that is provided by nurses in public hospitals.
Clinical pathways are recommended as a form of quality improvement by broader healthcare systems and are widely used in the world. Nurses are the most involved group of healthcare professionals in the implementation of clinical pathways in public hospitals. So, it is important to investigate how their satisfaction with the process affects the quality of care they provide and influencing factors.
This descriptive cross-sectional study surveyed nurses practicing across seven tertiary public hospitals in Sichuan Province, China, online. The survey consisted of a questionnaire for the general characteristics of the participants and four Chinese maturity scales validated by previous studies: clinical pathway implementation satisfaction scale, work engagement scale, hospital-patient relationship perception scale, and quality of care scale. The bootstrap method was used to test a moderated mediation model using Hayes' PROCESS macro models 4 and 8. We followed STROBE guidelines to prepare the study report.
A total of 880 nurses filled out the questionnaires, 821 of which were regarded as valid. Clinical pathway implementation satisfaction had a positive effect on quality of care (B = 0.873, P < 0.001). Work engagement played a mediation role between nurses' clinical pathway implementation satisfaction and the quality of care (effect = 0.080, Boot 95% CI = [0.023, 0.142]). This mediation model was moderated by the hospital-patient relationship (P < 0.01).
Clinical pathway implementation satisfaction may enhance the quality of care by work engagement of nurses. Moreover, a good hospital-patient relationship can enhance the positive impact of nurses' satisfaction on work engagement and health service quality.
Public hospital managers need to pay attention to nurses' evaluation of and perceptions toward clinical pathway implementation and then take corresponding measures to improve their satisfaction to enhance the quality of care. At the same time, the government, society, and hospitals also need to foster good hospital-patient relationships to ensure that nurses have a high level of work engagement that aids in providing high-quality care services.
本研究旨在探讨临床路径实施满意度、工作投入度及医患关系如何影响公立医院护士提供的护理质量。
临床路径被更广泛的医疗系统推荐为一种质量改进形式，并在全球广泛应用。护士是公立医院临床路径实施中参与度最高的医疗专业人员群体。因此，调查他们对该过程的满意度如何影响其提供的护理质量及影响因素很重要。
本描述性横断面研究对中国四川省七家三级公立医院的执业护士进行了在线调查。该调查包括一份关于参与者一般特征的问卷，以及四个经先前研究验证的中国成熟量表：临床路径实施满意度量表、工作投入度量表、医患关系感知量表和护理质量量表。采用Bootstrap方法，使用Hayes的PROCESS宏模型4和8检验一个有调节的中介模型。我们遵循STROBE指南编写研究报告。
共有880名护士填写了问卷，其中821份被视为有效。临床路径实施满意度对护理质量有积极影响（B = 0.873，P < 0.001）。工作投入度在护士临床路径实施满意度和护理质量之间起中介作用（效应 = 0.080，Boot 95% CI = [0.023, 0.142]）。该中介模型受医患关系调节（P < 0.01）。
临床路径实施满意度可能通过护士的工作投入度提高护理质量。此外，良好的医患关系可增强护士满意度对工作投入度和医疗服务质量的积极影响。
公立医院管理者需关注护士对临床路径实施的评价和看法，然后采取相应措施提高其满意度以提升护理质量。同时，政府、社会和医院也需营造良好的医患关系，以确保护士有高水平的工作投入度，有助于提供高质量的护理服务。
