Grindel C G, Peterson K, Kinneman M, Turner T L
Northeastern University, Boston, MA, USA.
J Nurs Adm. 1996 May;26(5):43-51. doi: 10.1097/00005110-199605000-00009.
Evaluating the practice environment is essential to determine if the practice environment is conducive to the delivery of quality patient care. The Practice Environment Project (PEP) was created to provide a framework for current and ongoing evaluation of the practice environment.
Major changes in the delivery of patient care services have focused attention on the evaluation of the effectiveness of these changes. The extent and type of change may vary throughout an institution. The identification of core variables to assess the effectiveness of these changes sets the framework for ongoing evaluation of new unit-based models for delivery of services.
In part 1, quantitative data were collected from nursing staff members (job satisfaction, collaboration with physicians, autonomy), physicians (quality of nursing care, collaboration with nurses), and patients (satisfaction with nursing care). In part 2, focus groups were held with nursing personnel to discuss factors that affected the provision of services. Unit-based action plans were developed to manage barriers to the delivery of services.
Patients and physicians reported a high degree of satisfaction with patient care. Physicians reported a higher level of collaboration with nurses than that reported by nurses. Nurses reported a high degree of autonomy in practice, however, in other areas of job satisfaction (development and recognition), they suggested areas for improvement.
The PEP created a mechanism to evaluate the current state-of-the-practice environment by identifying core elements for evaluation of work redesign. It also provided a framework for managing barriers that disrupted the delivery of patient care services.
评估实践环境对于确定该环境是否有利于提供高质量的患者护理至关重要。实践环境项目（PEP）旨在为当前及持续评估实践环境提供一个框架。
患者护理服务提供方面的重大变革已将注意力集中在对这些变革有效性的评估上。变革的程度和类型在整个机构中可能有所不同。确定用于评估这些变革有效性的核心变量为持续评估基于新单元的服务提供模式奠定了框架。
在第一部分中，从护理人员（工作满意度、与医生的协作、自主性）、医生（护理质量、与护士的协作）以及患者（对护理的满意度）收集定量数据。在第二部分中，与护理人员举行焦点小组讨论影响服务提供的因素。制定基于单元的行动计划以管理服务提供中的障碍。
患者和医生对患者护理表示高度满意。医生报告与护士的协作程度高于护士报告的程度。护士报告在实践中有高度的自主性，然而，在工作满意度的其他方面（发展和认可），他们提出了改进的领域。
PEP创建了一种机制，通过确定工作重新设计评估的核心要素来评估实践环境的当前状态。它还为管理扰乱患者护理服务提供的障碍提供了一个框架。
