How nurses and their work environment affect patient experiences of the quality of care: a qualitative study

Abstract

BackgroundHealthcare organisations monitor patient experiences in order to evaluate and improve the quality of care. Because nurses spend a lot of time with patients, they have a major impact on patient experiences. To improve patient experiences of the quality of care, nurses need to know what factors within the nursing work environment are of influence. The main focus of this research was to comprehend the views of Dutch nurses on how their work and their work environment contribute to positive patient experiences.MethodsA descriptive qualitative research design was used to collect data. Four focus groups were conducted, one each with 6 or 7 registered nurses in mental health care, hospital care, home care and nursing home care. A total of 26 nurses were recruited through purposeful sampling. The interviews were audiotaped, transcribed and subjected to thematic analysis.ResultsThe nurses mentioned essential elements that they believe would improve patient experiences of the quality of nursing care: clinically competent nurses, collaborative working relationships, autonomous nursing practice, adequate staffing, control over nursing practice, managerial support and patient-centred culture. They also mentioned several inhibiting factors, such as cost-effectiveness policy and transparency goals for external accountability. Nurses feel pressured to increase productivity and report a high administrative workload. They stated that these factors will not improve patient experiences of the quality of nursing care.ConclusionsAccording to participants, a diverse range of elements affect patient experiences of the quality of nursing care. They believe that incorporating these elements into daily nursing practice would result in more positive patient experiences. However, nurses work in a healthcare context in which they have to reconcile cost-efficiency and accountability with their desire to provide nursing care that is based on patient needs and preferences, and they experience a conflict between these two approaches. Nurses must gain autonomy over their own practice in order to improve patient experiences.

Experiences of Clinic Nurses Regarding Diabetes Education in Turkey’ Health System

“…Accordingly, the education of patients with diabetes has gained more importance for the control of the disease [2,3]. The health education given on the chronic diseases increases the patient autonomy and feeling of confidence, while it decreases the complications and cost [16,17].…”

“…Nurses participating in this study prefer individual diabetes education. Individual patient education has several advantages such as having more time for the patient, but the group education is frequently assessed in the literature in terms of improving the diabetes results and developing the problem-solving skills in patients [17,20].…”

“My hands are tied”: Nurses’ perception of organizational culture in Kenyan private hospitals

“…[6,22,23] The current study findings concur with other studies which found that lack of career development opportunities, especially opportunities for further education was one of the causes of relatively high nursing staff turnover in Japan and other high resource countries. [9,22] Some participants spoke of "being ordered" to do, having to adopt an unquestioning attitude, and having to learn unwritten rules, one of which was "understanding their place" in a hospital hierarchy. This meant that there were predictable ways of behaving and anticipated outcomes if the rules were not followed.…”

“…[4] Satisfaction and commitment directly influence the RN's choices to stay or leave the institution. [3,9] Direct predictors of dissatisfaction and turnover include work overload and work stress, [1,5] whereas a supportive nursing management and favourable work group climate are predictive of staff retention. [4,9,10] In Africa, advancement opportunities and organizational characteristics associated with empowerment and autonomy have been found to decrease the likelihood of staff attrition.…”

“…[3,9] Direct predictors of dissatisfaction and turnover include work overload and work stress, [1,5] whereas a supportive nursing management and favourable work group climate are predictive of staff retention. [4,9,10] In Africa, advancement opportunities and organizational characteristics associated with empowerment and autonomy have been found to decrease the likelihood of staff attrition. [5] The nature of the work environment and ensuing organizational culture have been shown to determine RNs' job satisfaction and turnover rates.…”