Xu Liu1, Jing Zheng2, Ke Liu3, Judith Gedney Baggs4, Jiali Liu5, Yan Wu6, Liming You7. 1. School of Nursing, Sun Yat-sen University, Guangzhou, China. Electronic address: liuxu8@mail2.sysu.edu.cn. 2. School of Nursing, Sun Yat-sen University, Guangzhou, China. Electronic address: zhengj38@mail.sysu.edu.cn. 3. School of Nursing, Sun Yat-sen University, Guangzhou, China. Electronic address: liuke@mail.sysu.edu.cn. 4. School of Nursing, Oregon Health & Science University, Portland, Oregon, United States. Electronic address: baggsj@ohsu.edu. 5. School of Nursing, Sun Yat-sen University, Guangzhou, China. Electronic address: liujiali@mail2.sysu.edu.cn. 6. School of Nursing, Sun Yat-sen University, Guangzhou, China. Electronic address: wuyan3@mail3.sysu.edu.cn. 7. School of Nursing, Sun Yat-sen University, Guangzhou, China. Electronic address: youlm@mail.sysu.edu.cn.
Abstract
BACKGROUND: Promotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian's Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice. OBJECTIVE: The objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety. DESIGN: This was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed. METHODS: Work environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses' perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout. RESULTS: The findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety. CONCLUSIONS: Improving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.
BACKGROUND: Promotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian's Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice. OBJECTIVE: The objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety. DESIGN: This was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed. METHODS: Work environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses' perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout. RESULTS: The findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety. CONCLUSIONS: Improving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.
Authors: Daniel S Tawfik; Annette Scheid; Jochen Profit; Tait Shanafelt; Mickey Trockel; Kathryn C Adair; J Bryan Sexton; John P A Ioannidis Journal: Ann Intern Med Date: 2019-10-08 Impact factor: 25.391
Authors: Elisabete Maria das Neves Borges; Cristina Maria Leite Queirós; Margarida da Silva Neves de Abreu; Maria Pilar Mosteiro-Diaz; Maria Baldonedo-Mosteiro; Patrícia Campos Pavan Baptista; Vanda Elisa Andres Felli; Miriam Cristina Dos Santos Almeida; Silmar Maria Silva Journal: Rev Lat Am Enfermagem Date: 2021-06-28