Impact of primary care nursing workforce characteristics on the control of high-blood pressure: a multilevel analysis

Abstract

ObjectiveTo determine the impact of Primary Health Care (PHC) nursing workforce characteristics and of the clinical practice environment (CPE) perceived by nurses on the control of high-blood pressure (HBP).DesignCross-sectional analytical study.SettingAdministrative and clinical registries of hypertensive patients from PHC information systems and questionnaire from PHC nurses.Participants76 797 hypertensive patients in two health zones within the Community of Madrid, North-West Zone (NWZ) with a higher socioeconomic situation and South-West Zone (SWZ) with a lower socioeconomic situation, and 442 reference nurses. Segmented analyses by area were made due to their different socioeconomic characteristics. Primary outcome measure: Poor HBP control (adequate figures below the value 140/90 mm Hg) associated with the characteristics of the nursing workforce and self-perceived CPE.ResultsThe prevalence of poor HBP control, estimated by an empty multilevel model, was 33.5% (95% CI 31.5% to 35.6%). In the multilevel multivariate regression models, the perception of a more favourable CPE was associated with a reduction in poor control in NWZ men and SWZ women (OR=0.99 (95% CI 0.98 to 0.99)); the economic immigration conditions increased poor control in NWZ women (OR=1.53 (95% CI 1.24 to 1.89)) and in SWZ, both men (OR=1.89 (95% CI 1.43 to 2.51)) and women (OR=1.39 (95% CI 1.09 to 1.76)). In all four models, increasing the annual number of patient consultations was associated with a reduction in poor control (NWZ women: OR=0.98 (95% CI0.98 to 0.99); NWZ men: OR=0.98 (95% CI 0.97 to 0.99); SWZ women: OR=0.98 (95% CI 0.97 to 0.99); SWZ men: OR=0.99 (95% CI 0.97 to 0.99).ConclusionsA CPE, perceived by PHC nurses as more favourable, and more patient–nurse consultations, contribute to better HBP control. Economic immigration condition is a risk factor for poor HBP control. Health policies oriented towards promoting positive environments for nursing practice are needed.

Nursing practice environment in Primary Health Care: a scoping review

“…Studying NPEs in PHC provides evidence on how to increase the quality of nursing care (19,(39)(40) and customer safety, how to improve obtaining results (35,39) and decrease customer complications (20,31) , namely improving disease control and preventing associated risks (36) .…”

“…Job satisfaction is affected by the NPE, more than any other factor (32,36) . The NPE consists of the fundamental organizational factor (36) , which has a strong impact on the organization's exit intention decisions (32,34) .…”

“…Job satisfaction is affected by the NPE, more than any other factor (32,36) . The NPE consists of the fundamental organizational factor (36) , which has a strong impact on the organization's exit intention decisions (32,34) . If nurses have support and management support (19,36) and greater visibility of their interventions, they are more likely to be more satisfied (36) .…”

“…The NPE consists of the fundamental organizational factor (36) , which has a strong impact on the organization's exit intention decisions (32,34) . If nurses have support and management support (19,36) and greater visibility of their interventions, they are more likely to be more satisfied (36) . It is through an NPE favorable to the practice in PHC that there is greater professional satisfaction (34)(35)(37)(38)(39)(40) .…”

“…There is little knowledge and scientific evidence about NPEs in the context of PHC (1,39) , which can affect the expansion of the profession (1,19,40,41) . NPE is one of the variables with the greatest impact on the quality of care (36) . If NPEs are not improved, high levels of stress will continue, burnout e turnover (31,40) .…”