'Point Break' ... The Nursing Practice Environment in Acute Hospitals

Background In recent decades, the Irish health care system has undergone immense restructuring and reconfiguration; consequently, the organisational context in which nursing and health care is delivered has become a powerful... [ view full abstract ]

Background
In recent decades, the Irish health care system has undergone immense restructuring and reconfiguration; consequently, the organisational context in which nursing and health care is delivered has become a powerful factor affecting clinical practice and health care outcomes. Understanding the integral practice environment components has inherent difficulties, however, because of it being an obscure construct to conceptualize and measure.

Aim
To identify and quantify the factors within the nurse practice environment, in Irish acute hospital services, which are critical to ensure the delivery of quality nursing care as measured by nursing care-metrics, and nursing sensitive patient outcomes.


Method
The hypothesis that the practice environment can impact upon the quality of nursing care provided, and on subsequent patient outcomes, was examined using an Exploratory Sequential Mixed Methods Design. In the first study phase, data was collected from 16 focus groups, which consisted of a stratified sample of 70 staff nurses, clinical nurse managers and senior nurse managers across three large acute hospitals to identify the key nursing practice environment factors which may be significant predictors of quality nursing care processes and patient outcomes. Data was analysed using framework thematic analysis. Ethical approval was obtained from each of the research sites and the associated academic institution.

Findings
Data from the first study phase, provides a more current contextualised representation of the challenges of delivering quality nursing care and provide clarity on the practice environment factors, which can enhance or impede upon a nurse’s ability to deliver quality care. Themes identified included nursing workforce, increasing workloads, stress/burnout and a target driven culture.

Conclusions & Implications
Factors within the practice environment are amenable to change by individual nurses, nursing management and the organisations so that improving the workplace becomes a universal responsibility. The study contributes to the growing body of international knowledge regarding effective work environments in acute hospital settings, in particular, the linkages with objective measures of quality nursing care and nursing-sensitive patient outcomes. The results of this research will support the development of empirically informed strategies to enhance nursing practice environments to facilitate nurses in their delivery of quality patient care.