Qualitative Analysis by Experts of the Essential Elements of the Nursing Practice Environments Proposed by the TOP10 Questionnaire of Assessment of Environments in Primary Health Care
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Sample
2.3. Process
2.4. Data Analysis
2.5. Ethical Considerations
3. Results
3.1. Phase 1
3.2. Phase 2
- Do you think this item or others may not be relevant in reaching excellent nursing care in your professional work environment?
- Do you think this item is fundamental in guaranteeing excellent nursing care in your professional work environment?
- Do you think this item is strongly related to another/other item(s) that we have already discussed or those we will discuss subsequently?
Content Analysis
3.2.1. Dimension 1: Nurse Participation in Center Affairs
3.2.2. Dimension 2: Nursing Foundation for Quality of Care
3.2.3. Dimension 3: Nurse Manager Ability, Leadership, and Support of Nurses
3.2.4. Dimension 4: Staffing and Resource Adequacy
3.2.5. Dimension 5: Nurse–Physician Relationships
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- McClure, M.L.; Poulin, M.J.; Sovie, M.; Wandelt, M. Magnet hospitals. Attraction and retention of professional nurses. Task Force on Nursing Practice in Hospitals. American Academy of Nursing. ANA Publ, 1983; 18, G-160. pp. 1–135. Available online: http://citeseerx.ist.psu.edu/viewdoc/download;jsessionid=1C7787038D1F9066F62B5E1146FEF479?doi=10.1.1.487.3161&rep=rep1&type=pdf (accessed on 15 July 2018). [CrossRef]
- Copanitsanou, P.; Fotos, N.; Brokalaki, H. Effects of work environment on patient and nurse outcomes. Br. J. Nurs. 2017, 26, 172–176. [Google Scholar] [CrossRef]
- Aiken, L.H.; Sloane, D.M.; Bruyneel, L.; van den Heede, K.; Griffiths, P.; Busse, R.; Diomidous, M.; Kinnunen, J.; Kózka, M.; Lesaffre, E.; et al. Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. Lancet 2014, 383, 1824–1830. [Google Scholar] [CrossRef]
- Hickson, J. New nurses’ perceptions of hostility and job satisfaction. J. Nurs. Admin 2013, 43, 293–301. [Google Scholar] [CrossRef]
- Kutney-Lee, A.; Stimpfel, A.W.; Sloane, D.M.; Cimiotti, J.P.; Quinn, L.W.; Aiken, L.H. Changes in patient and nurse outcomes associated with magnet hospital recognition. Med. Care 2015, 53, 550–557. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lake, E.T. Development of the practice environment scale of the Nursing Work Index. Res. Nurs. Health 2002, 25, 176–188. [Google Scholar] [CrossRef] [PubMed]
- de Pedro-Gómez, J.; Morales-Asencio, J.M.; Sesé-Abad, A.; Bennasar-Veny, M.; Pericas-Beltran, J.; Miguélez-Chamorro, A. Psychometric testing of the Spanish version of the Practice Environment Scale of the Nursing Work Index in a primary healthcare context. J. Adv. Nurs. 2012, 68, 212–221. [Google Scholar] [CrossRef] [PubMed]
- Mensik, J. The essentials of magnetism for home health. JONA J. Nurs. Adm. 2007, 37, 230–234. [Google Scholar] [CrossRef] [PubMed]
- Gea-Caballero, V.; Juárez-Vela, R.; Díaz-Herrera, M.A.; Mármol-López, M.I.; Alfaro Blazquez, R.; Martínez-Riera, J.R. Development of a short questionnaire based on the Practice Environment Scale-Nursing Work Index in primary health care. Peer J. 2019, 7, e7369. [Google Scholar] [CrossRef]
- Gea-Caballero, V.; Castro-Sánchez, E.; Júarez-Vela, R.; Díaz-Herrera, M.Á.; de Miguel-Montoya, I.; Martínez-Riera, J.R. Elementos esenciales de los entornos profesionales enfermeros en Atención Primaria y su influencia en la calidad del cuidado. Enfermería Clínica 2017, 28, 27–35. [Google Scholar] [CrossRef] [Green Version]
- Cortès-Franch, I.; López-Valcárcel, B.G. The economic-financial crisis and health in Spain. Evidence and viewpoints. SESPAS report 2014. Gac. Sanit. 2014, 28, 1–6. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- RNAO Registered Nurses Association Ontario. Developing and sustaining Nursing Leadership. RNAO: Toronto, ON, Canada, 2006. [Internet]. Available online: http://rnao.ca/bpg/guidelines/developing-and-sustaining-nursing-leadership (accessed on 30 October 2018).
- McMillan, S.S.; King, M.; Tully, M.P. How to use the nominal group and Delphi techniques. Int. J. Clin. Pharm. 2016, 38, 655–662. [Google Scholar] [CrossRef]
- Adamson, J.; Tashakkori, A. Handbook of Mixed Methods in Social and Behavioural Research; Tashakkori, A., Teddlie, C., Eds.; Sage: Thousand Oaks, CA, USA, 2003; ISBN 0-7619-2073-0. [Google Scholar]
- Schmidt, R.C. Managing Delphi surveys using non parametric statistical techniques. Int. Abstr. Oper. Res. 2008. [Google Scholar] [CrossRef]
- Fuentelsaz-Gallego, C.; Moreno-Casbas, M.T.; Gómez-García, T.; González-María, E. Entorno laboral, satisfacción y burnout de las enfermeras de unidades de cuidados críticos y unidades de hospitalización. Proyecto RN4CAST-España. Enfermería Intensiva 2013, 24, 104–112. [Google Scholar] [CrossRef] [PubMed]
- Moreno, A.P.; Gallardo, M.D.P.S.; Arnedo, C.F.; Molina, L.S.; Calatayud, M.L.D.L.P.; Barberá-Martín, A.; Morales-Asencio, J.M.; De Pedro-Gómez, J. Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care. Atención Primaria 2013, 45, 476–485. [Google Scholar] [CrossRef] [PubMed]
- Pérez-Campos, M.A.; Sánchez-García, I.; Pancorbo-Hidalgo, P.L. Assessment of the professional practice environment by Spanish nurses who participate in Internet forums. Enfermería clínica 2013, 23, 271. [Google Scholar] [CrossRef]
- Generalitat de Catalunya. Health Plan of Catalonia 2011–2015. [Internet]. 2012. Available online: http://www.google.es/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB8QFjAA&url=http%3A%2F%2Fsalutweb.gencat.cat%2Fweb%2F.content%2Fhome%2Fel_departament%2Fpla_de_salut%2Fdocuments%2Farxius%2Fplan_de_salud_catalunya_es.pdf&ei=tIyiVLe6J8rrUoyRgqgO&usg=AFQjCNEejdMc_24tAeIwpXf6LlLmEbYH-A&sig2=itAq-OEphsu-kCHc-5qHdw (accessed on 30 October 2018).
- Kramer, M.; Schmalenberg, C. Development and evaluation of essentials of magnetism tool. JONA J. Nurs. Admin 2004, 34, 365–378. [Google Scholar] [CrossRef]
- Heede, K.V.D.; Florquin, M.; Bruyneel, L.; Aiken, L.; Diya, L.; Lesaffre, E.; Sermeus, W. Effective strategies for nurse retention in acute hospitals: A mixed method study. Int. J. Nurs. Stud. 2013, 50, 185–194. [Google Scholar] [CrossRef]
- Lake, E.; Friese, C. Variations in nursing practice environments: Relation to staffing and hospital characteristics. Nurs. Res. 2006, 55, 1–9. [Google Scholar] [CrossRef] [Green Version]
- Fuentelsaz-Gallego, C.; Moreno-Casbas, M.T.; González-María, E. Validation of the Spanish version of the questionnaire Practice Environment Scale of the Nursing Work Index. Int. J. Nurs. Stud. 2013, 50, 274–280. [Google Scholar] [CrossRef]
- de Pedro-Gómez, J.; Morales-Asencio, J.M.; Sesé, A.; Bennasar, M.; Artigues, G.; Perelló, C. Nursing practice settings and competence to incorporate evidence into decisions: Analysis of the situation in the Balearic Islands (Spain). Gac. Sanit. 2011, 25, 191. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cruzado Álvarez, C.; Jiménez, F.J.; Sánchez Paule, Y. Principales problemas de los recursos humanos sanitarios en la Unión Europea y España. Enfermería Docente 2012, 97, 20–24. Available online: http://scielo.isciii.es/scielo.php?pid=S1132-12962017000200025&script=sci_arttext&tlng=en (accessed on 20 October 2018).
- Consejo General de Enfermería. Informe sobre recursos humanos sanitarios en España y la Unión Europea 2014. Análisis comparativo de la situación de médicos y enfermeras. 2014. Available online: https://www.consejogeneralenfermeria.org/docs_revista/InformeRRHHSanitarios2014.pdf (accessed on 20 October 2018).
- Miguélez-Chamorro, A.; Casado-Mora, M.I.; Company-Sancho, M.C.; Balboa-Blanco, E.; Font-Oliver, M.A.; Román-Medina, I. Enfermería de Práctica Avanzada y gestión de casos: Elementos imprescindibles en el nuevo modelo de atención a la cronicidad compleja en España. Enfermería Clínica 2019, 29, 99–106. [Google Scholar] [CrossRef] [PubMed]
- Segura-Benedict, A.; Gea-Caballero, V. La promoción colectiva de la salud comunitaria. A propósito del informe SESPAS 2018. Revista Iberoamericana de Enfermería Comunitaria 2018, 11, 4–5. Available online: http://enfermeriacomunitaria.org/web/attachments/article/2055/RIdEC-v11-n2-dic2018-may2019%20-%20Editorial.pdf (accessed on 18 January 2019).
Expert Identity | Education | Experience (years) | Current Post | Other PHC 1 Activities | Health Technician | Manager | Research | Scientific Association |
---|---|---|---|---|---|---|---|---|
E1 | RN 2 | 7 | FNP 1 | Yes | Yes | No | Yes | Yes |
E2 | RN 2 OD 3 | 7 | Deputy Charge Nurse | Yes | No | Yes | Yes | Yes |
E3 | RN 2 OD 3 PhD 4 | >10 | Associate Professor | Yes | Yes | Yes | Yes | Yes |
E4 | RN 2 OD 3 | 6 | FNP 1 | Yes | Yes | Yes | Yes | Yes |
E5 | RN 2 OD 3 | 9 | Associate Professor | Yes | Yes | Yes | Yes | No |
E6 | RN 2 MSc 5 | >10 | FNP 1 Lecturer | Yes | Yes | No | Yes | Yes |
E7 | RN 2 | >10 | Health Services Director | Yes | Yes | Yes | Yes | Yes |
E8 | RN 2 MSc 5 | >10 | FNP 1 Lecturer | Yes | Yes | No | Yes | Yes |
High Level of Consensus | Item Selected by 6 or More Experts (≥75%) |
---|---|
Acceptable level of consensus | Item selected by 4 or 5 experts (50–74%). |
Uncertain level of consensus | Item selected by 3 experts (at least 37.5%). In this case, we opted for assessing the qualitative analysis and avoid the recount technique. |
Very low level of consensus | Item selected by 1 or 2 experts (25% or less). These items were analysed using a transcription analysis. |
Null consensus | Items not selected as important by any expert. These items were removed from the group discussion straight away (7 of 31 items, 22.5% of the total). |
Item Heading | PRE 1 (N/%) | POST 2 (N/%) |
---|---|---|
2. Opportunity for staff nurses to participate in policy decisions. | 6 (75%) | 8 (100%) |
6. Career development/clinical ladder opportunity. | 4 (50%) | 4 (50%) |
11. There is an active quality assurance program. | 5 (62.5%) | 4 (50%) |
14. Patient care assignments that foster continuity of care (e.g., the same nurse looks after the patient for the whole time). | 4 (50%) | 5 (62.5%) |
15. A clear philosophy of nursing that pervades the patient care environment. | 5 (62.5%) | 8 (100%) |
18. Active staff development or continuing education programs for nurses. | 4 (50%) | 4 (50%) |
20. A nurse manager (supervisor/coordinator) is a good manager and leader. | 5 (62.5%) | 8 (100%) |
26. There are enough qualified nurses to provide quality patient care. | 3 (37.5%) | 4 (50%) |
31. Collaboration (joint practice) between nurses and physicians | 4 (50%) | 6 (75%) |
Dimension | N of Items by Importance | Items |
---|---|---|
1 Nurse participation in center affairs | 2 | 2 Opportunity for staff nurses to participate in policy decisions. 6 Career development/clinical ladder opportunity. |
2 Nursing foundation for quality of care | 5 | 11 An active quality assurance program. 14 Patient care assignments that foster continuity of care (e.g., the same nurse looks after the patient for the whole time). 15 A clear philosophy of nursing that pervades the patient care environment. 18 Active staff development or continuing education programs for nurses. 19 Working with nurses who are clinically competent. |
3 Nurse manager ability, leadership and support of nurses | 1 | 20 A nurse manager (supervisor/coordinator) is a good manager and leader. |
4 Staffing and resource adequacy | 1 | 26 There are enough qualified nurses to provide quality patient care. |
5 Nurse-physician relationships | 1 | 31 Collaboration (joint practice) between nurses and physicians |
Items Selected by Experts (Extracted of PES-NWI) | Items TOP10 (Extracted of PES-NWI) |
---|---|
2 Opportunity for staff nurses to participate in policy decisions. 6 Career development/clinical ladder opportunity. * 11 An active quality assurance program. 14 Patient care assignments that foster continuity of care (e.g., the same nurse looks after the patient for the whole time). 15 A clear philosophy of nursing that pervades the patient care environment. 18 Active staff development or continuing education programs for nurses. 19 Working with nurses who are clinically competent. 20 A nurse manager (supervisor/coordinator) is a good manager and leader. 26 There are enough qualified nurses to provide quality patient care. 31 Collaboration (joint practice) between nurses and physicians | 2 Opportunity for staff nurses to participate in policy decisions. 11 An active quality assurance program. 14 Patient care assignments that foster continuity of care (e.g., the same nurse looks after the patient for the whole time). 15 A clear philosophy of nursing that pervades the patient care environment. 18 Active staff development or continuing education programs for nurses. 19 Working with nurses who are clinically competent. 20 A nurse manager (supervisor/coordinator) is a good manager and leader. 25 There are enough health workers to provide quality patient care. * 26 There are enough qualified nurses to provide quality patient care. 31 Collaboration (joint practice) between nurses and physicians |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Martínez-Riera, J.R.; Juárez-Vela, R.; Díaz-Herrera, M.Á.; Montejano-Lozoya, R.; Doménech-Briz, V.; Benavent-Cervera, J.V.; Cabellos-García, A.C.; Melo, P.; Nguyen, T.H.; Gea-Caballero, V. Qualitative Analysis by Experts of the Essential Elements of the Nursing Practice Environments Proposed by the TOP10 Questionnaire of Assessment of Environments in Primary Health Care. Int. J. Environ. Res. Public Health 2020, 17, 7520. https://doi.org/10.3390/ijerph17207520
Martínez-Riera JR, Juárez-Vela R, Díaz-Herrera MÁ, Montejano-Lozoya R, Doménech-Briz V, Benavent-Cervera JV, Cabellos-García AC, Melo P, Nguyen TH, Gea-Caballero V. Qualitative Analysis by Experts of the Essential Elements of the Nursing Practice Environments Proposed by the TOP10 Questionnaire of Assessment of Environments in Primary Health Care. International Journal of Environmental Research and Public Health. 2020; 17(20):7520. https://doi.org/10.3390/ijerph17207520
Chicago/Turabian StyleMartínez-Riera, José Ramón, Raúl Juárez-Vela, Miguel Ángel Díaz-Herrera, Raimunda Montejano-Lozoya, Vicente Doménech-Briz, José Vicente Benavent-Cervera, Ana Cristina Cabellos-García, Pedro Melo, Tam H. Nguyen, and Vicente Gea-Caballero. 2020. "Qualitative Analysis by Experts of the Essential Elements of the Nursing Practice Environments Proposed by the TOP10 Questionnaire of Assessment of Environments in Primary Health Care" International Journal of Environmental Research and Public Health 17, no. 20: 7520. https://doi.org/10.3390/ijerph17207520