Systematic review of interventions to improve nurses' work environments. (8th August 2020)

• Record Type: Journal Article
• Authors: Paguio, Jenniffer Torralba; Yu, Doris Sau Fung; Su, Jing Jing
• Is Part Of: Journal of advanced nursing. Volume 76:Number 10(2020)
• Page Start: 2471
• Page End: 2493
• Publication Date: 2020-08-08
• Subjects: hospital nurses -- nurses -- nursing -- organizational improvement -- practice environment -- quality improvement -- systematic review -- work environment; Nursing -- Periodicals; 610.7305
• DOI: 10.1111/jan.14462
• Languages: English
• ISSNs: 0309-2402

Abstract

Abstract: Aims: To evaluate the current evidence that examined the effects of nurses' work environment interventions on nurse, patient, and hospital outcomes; and the key intervention characteristics. Design: Quantitative systematic review without meta‐analysis. Data Sources: Nine databases (British Nursing Index, CINAHL, EMBASE, Global Health, Global Health Archives, MEDLINE, Ovid Nursing, PubMed, and Web of Science) were searched following Systematic review Without Meta‐analysis guideline to elicit studies that examined effects of interventions aimed at improving nurses' work environments among peer‐reviewed publications from inception to April 2019. Methods: Database search used the following keywords: nurs*, patient, hospital, healthcare intervention, organizational improvement, nurs*adj4 outcome, patient adj4 outcome*, hospital adj4 outcome*, and their MeSH terms. The Cochrane's Risk of Bias in Non‐Randomized Studies of Intervention (ROBINS‐I) was used for quality appraisal. Donabedian model of Quality of Care was used as the framework to categorize interventions components focusing on structure and process aspects of the nurse work environments. Results: The interventions included the use of accreditation process, educational strategies, and participatory approach. By defining the interventions which demonstrated positive effects on the nurse, patient, and hospital outcomes as effective, it appears that they are more consistently characterized as focusing on process improvement, adopting participatory approach, with greater involvement of frontline and nurse executives and at unit‐level implementation. Conclusion: Although the heterogeneity in the design of the review studies precludes making conclusive insights on the best evidence to improve nurses' work environments, the review informs the major research gaps in the topic area and the ways to design better interventions to enhance the outcomes. Impact: The study provides insights on intervention components and strategies that can contribute to healthy nurse work environments. By adapting unit‐level process improvements that actively involve frontline and nurse executives, nurse leaders may provide a more directed approach towards achieving favourable outcomes. Abstract : 目的: 评估护士工作环境干预措施影响护士、患者和医院结果的现有证据；以及主要的干预特征。 设计: 无荟萃分析的定量系统评估。 数据源: 根据无荟萃分析的系统评估指南，检索了九个数据库，即英国护理索引（British Nursing Index）、CINAHL、EMBASE、全球健康（Global Health）、全球健康档案（Global Health Archieves）、MEDLINE、奥维德护理（Ovid Nursing），PubMed和科学网（Web of Science），旨在从一开始到2019年4月在同行评审的出版物中研究旨在改善护士工作环境的干预措施的效果。 方法: 数据库搜索使用以下关键字：护理（nurs*）、患者（patient）、医院（hospital）、医疗保健干预（healthcare intervention）、组织改善（organization improvement），护理结果（nurs * adj4 outcome）、患者结果（patient adj4 outcome*）、医院结果（hospital adj4 outcome*）及其MeSH术语。科克伦（Cochrane）的非随机干预研究偏倚风险评估工具（ROBINS‐I）用于质量评估。以多纳贝德"护理质量"模型为框架，对关注护士工作环境的结构和过程方面的干预因素进行分类。 结果: 干预措施包括使用认证程序、教育策略和参与式方法。通过将对护士、患者和医院结果产生积极影响的干预措施定义为有效的干预措施，这些干预措施的特点似乎更加一致：注重流程改进、采用参与式方法、一线护士和护士主管以及单位级别的更多参与。 结论: 尽管回顾性研究设计的异质性使得无法对改善护士工作环境的最佳证据做出结论性的见解，但该综述揭示了主题领域的主要研究差距以及设计更好的干预措施以提高结果的方法。 影响: 该研究提供了有关改善护士工作环境的干预措施和策略的见解。通过调整单位级流程改进，让一线护士和护士主管积极参与，护士领导可以提供更有针对性的方法来实现理想的结果。