van Kraaij Julia, Spruit-Bentvelzen Lotte, van Lieshout Famke, Vermeulen Hester, van Oostveen Catharina
Radboud University Medical Center, IQ Health Science Department, Nijmegen, the Netherlands.
Erasmus MC, University Medical Center, Department of Quality and Patient Care, Rotterdam, the Netherlands.
Int J Nurs Stud Adv. 2024 Nov 12;7:100265. doi: 10.1016/j.ijnsa.2024.100265. eCollection 2024 Dec.
The nursing work environment is crucial for nurses' well-being and patients' quality of care. Despite effective interventions to improve the nursing work environment, understanding the most effective types and integration mechanisms for nurses remain challenging. As nursing practices evolve amid complex care demands and staff shortages, understanding nurses' challenges, support systems, and adoption mechanisms is vital to optimize the work environment and to enhance quality of care, job satisfaction, and staff retention.
To explore strategies for promoting and supporting nurse-led changes to improving their work environment.
The study employed a participatory action research design on three nursing wards in a Dutch academic hospital. Action research teams with diverse ward nurses were established on each ward. The research took place between September 2022 and October 2023. Data were collected during observations, PhotoVoice workshops, and individual interviews. Data were analyzed using the rigorous and accelerated data reduction technique.
Nurses and managers showed patterns of behavior that either hindered or facilitated changes, leading to the emergence of three themes: strengthening relationships, taking the lead, and being up to the task. These themes highlight the importance of fostering collaboration, encouraging proactive attitudes, and building capabilities to address challenges and drive positive changes in their work environment. Feelings of uncertainty emerged in all themes, and this uncertainty hindered nurses from taking responsibility for facilitating change.
This study demonstrated different mechanisms that either facilitate or hinder nurse-led changes and how feelings of uncertainty play a role. Nurses emphasized the importance of collaboration and proactive attitudes but faced challenges in recognizing responsibility and their perceived competencies. Strengthening nurses' resilience to and management of uncertainty is essential. Healthcare organizations should help nurses navigate uncertainty to foster positive changes.
Collaboration, proactivity, and competency are key in nurse-led changes. Strengthening nurses' resilience and uncertainty management is crucial.
护理工作环境对护士的幸福感和患者的护理质量至关重要。尽管有有效的干预措施来改善护理工作环境，但了解对护士最有效的类型和整合机制仍然具有挑战性。随着护理实践在复杂的护理需求和人员短缺中不断发展，了解护士面临的挑战、支持系统和采用机制对于优化工作环境、提高护理质量、工作满意度和员工留用率至关重要。
探索促进和支持护士主导的变革以改善其工作环境的策略。
该研究在一家荷兰学术医院的三个护理病房采用了参与式行动研究设计。每个病房都成立了由不同病房护士组成的行动研究团队。研究于2022年9月至2023年10月进行。通过观察、摄影发声工作坊和个人访谈收集数据。使用严格且加速的数据简化技术对数据进行分析。
护士和管理人员表现出阻碍或促进变革的行为模式，从而出现了三个主题：加强关系、带头引领和胜任任务。这些主题强调了促进协作、鼓励积极态度以及培养应对挑战和推动工作环境积极变化的能力的重要性。所有主题中都出现了不确定感，这种不确定感阻碍了护士承担促进变革的责任。
本研究展示了促进或阻碍护士主导变革的不同机制以及不确定感如何发挥作用。护士强调了协作和积极态度的重要性，但在认识责任和自身感知的能力方面面临挑战。增强护士对不确定性的适应力和管理能力至关重要。医疗保健组织应帮助护士应对不确定性，以促进积极变革。
协作、积极性和能力是护士主导变革的关键。增强护士的适应力和不确定性管理能力至关重要。
