Ditlopo Prudence, Rispel Laetitia C, Van Bogaert Peter, Blaauw Duane
Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 27 St Andrew's Road, Parktown, 2193, South Africa.
Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 27 St Andrew's Road, Parktown, 2193, South Africa.
Int J Nurs Stud Adv. 2024 Sep 10;7:100241. doi: 10.1016/j.ijnsa.2024.100241. eCollection 2024 Dec.
There is substantial evidence on the associations between a positive nurse practice environment and improved nurse and patient outcomes, as well as the factors that mediate these associations, in high-income countries and in hospital settings. The knowledge gaps in African and primary health care settings motivated this empirical study.
The objective of this study was to examine the impact of the dimensions of the nurse practice environment, specifically human resource management, foundations for nursing care, and participation in clinic affairs, on job outcomes and standards of care.
A cross-sectional study was conducted between November 2021 and June 2022.
180 primary health care clinics in two South African provinces of Gauteng and North West.
665 nurses of all categories.
A causal model was developed with pathways between the nurse practice environment dimensions and the outcomes of job satisfaction, intention to leave, and standards of care. A set of standardised instruments was used to measure the study variables. Using structural equation modelling, workload and professional support were tested as potential mediators between the nurse practice environment and the outcome variables.
The nurses scored the domain of foundations for nursing care 71.2 out of 100 on average, indicating high agreement, while the mean scores for nurses' participation in clinic affairs and human resources management were lower at 68.0 and 61.7 respectively. Although nurses expressed moderate satisfaction with professional support (67.7), they were less satisfied with their workload (52.2). The mean score of overall job satisfaction was moderate (58.9), with 53.8 % of the nurses reporting that they intended leaving the clinic where they were working. Thirty-six percent intended leaving the nursing profession, indicating low intention to stay. The final mediation model was judged to fit the data adequately based on goodness-of-fit indices, confirming that workload and professional support had a mediating role between the nurse practice environment dimensions of interest and both nurses' job outcomes and standards of care.
We have highlighted the value of supportive practice environments, effective workload management, and enhanced professional support in improving nurses' job outcomes and satisfaction with standards of care. Improving nurses' practice environments at primary health care level may have a wide-ranging impact on the performance of the health system. Therefore, primary health care facility managers should ensure that workload is distributed equitably, professional support for nurses is enhanced, and the overall work environment is improved.
在高收入国家的医院环境中，有大量证据表明积极的护士执业环境与改善护士和患者的结局之间存在关联，以及调节这些关联的因素。非洲和初级卫生保健环境中的知识空白推动了这项实证研究。
本研究的目的是检验护士执业环境维度，特别是人力资源管理、护理基础以及参与诊所事务，对工作结局和护理标准的影响。
于2021年11月至2022年6月进行了一项横断面研究。
南非豪登省和西北省的180家初级卫生保健诊所。
665名各类护士。
构建了一个因果模型，该模型包含护士执业环境维度与工作满意度、离职意愿和护理标准结局之间的路径。使用一组标准化工具来测量研究变量。采用结构方程模型，检验工作量和专业支持作为护士执业环境与结局变量之间的潜在中介作用。
护士对护理基础领域的平均评分为71.2（满分100），表明高度认同，而护士参与诊所事务和人力资源管理的平均得分较低，分别为68.0和61.7。尽管护士对专业支持表示中等程度的满意（67.7），但他们对工作量的满意度较低（52.2）。总体工作满意度的平均得分为中等（58.9），53.8%的护士表示他们打算离开工作的诊所。36%的护士打算离开护理行业，表明留任意愿较低。根据拟合优度指标判断，最终的中介模型与数据拟合良好，证实工作量和专业支持在感兴趣的护士执业环境维度与护士的工作结局和护理标准之间具有中介作用。
我们强调了支持性执业环境、有效的工作量管理和加强专业支持在改善护士工作结局和对护理标准满意度方面的价值。改善初级卫生保健层面的护士执业环境可能会对卫生系统的绩效产生广泛影响。因此，初级卫生保健机构管理者应确保工作量公平分配，加强对护士的专业支持，并改善整体工作环境。
