The association between nursing work environment and quality of care: a cross-sectional study

Abstract

Background Due to societal and financial developments quality of care (QoC) is under pressure. QoC can be determined by patient outcomes and is, according to multiple studies, influenced majorly by nursing work environment. However, evidence is inconclusive. Also, variables to measure QoC vary widely, making it difficult to compare findings.

Aims To explore the association between nursing work environment and QoC, by (1) determining the association between nursing work environment and pain, malnutrition and readmissions, and (2) determining the association between pain, malnutrition and readmissions, and nurse-perceived quality of care (NPQoC).

Methods A quantitative cross-sectional study was conducted between January and March 2018 in a 400-bed Dutch tertiary teaching hospital. A hospital database and a survey containing the Practice Environment Scale of the Nursing Work Index instrument (PES-NWI), the 1-item indicator NPQoC, and nurse characteristics were used to collect data. Three multivariable logistic regression models were made with pain, malnutrition and readmission as dependent variables. Also, correlations were calculated between these variables and NPQoC.

Results Significant effects were found of nursing work environment on patient outcomes pain and malnutrition; units with better nursing work environment had 81% increase in the risk of moderate to severe pain, and 44% increase in the risk of moderate to severe malnutrition. Positive significant correlations were found between NPQoC and patient outcomes malnutrition and pain.

Conclusion and implication of key findings Due to wide variability of quality indicators measured in previous studies, it is difficult to compare current and previous findings. The 1-item indicator NPQoC could be appropriate to assess QoC. However, more comprehensive studies should be conducted to validate our results. Our study highlights the need for a joint international set of patient outcomes that are feasible to collect data and compare QoC.