HOW NURSES AND THEIR WORK ENVIRONMENT AFFECT PATIENT EXPERIENCES OF THE QUALITY OF CARE: A QUALITATIVE STUDY

HOW NURSES AND THEIR WORK ENVIRONMENT AFFECT PATIENT EXPERIENCES OF THE QUALITY OF CARE: A QUALITATIVE STUDY

Introduction

Scholars and researchers in the nursing care practice have long known about a relationship between the professional environment in which nurses operate and the quality of patient experiences during care. The relationship continues to be the subject of intensive research as these stakeholders in the care industry seek for the best optimizations for both nursing work environments and patient experiences.

Research among Dutch nurses done in 2014 pointed to the existence of distinct relationships between positive nursing environments and good patient experiences. The literature provided after research complemented already existing literature from other parts of the world and by other scholars along the same lines. The Dutch study, which was carried out by Kieft, de Brouwer, Francke, and Delnoij, stipulated that nurses whose professional environments was positive contributed positively to the creation of good patient experiences during care (Kieft et al., 2014, np). This essay critically analyzes a specific academic article with the intention of using its respondents’ views to establish the extent of relativity between nursing environment and patient experiences.

Literature Review

Nurses have long known that having a good work environment also translated into better patient experiences. Scholarly research into this relationship also points to the existence of secondary factors such as nurses’ attitude and administrative effort in ensuring patient experiences are positive (Boev, 2012, pg. 369). Therefore, nursing environments that facilitate nurses through attitude and compassion lead to better patient experiences.

The primary scholarly article on which this study is based focused on a Dutch study. This study was carried out by Kieft, de Brouwer, Francke, and Delnoij who intended to establish the extent to which nursing environments affected nursing performance and patient experience outcomes (Kieft et al., 2014, np). Certain elements were brought up in the course of the study that affected the nursing performance and quality of service. These factors also demonstrated a direct relationship with patient experience, whereby they optimized the nature of care leading to better outcomes (Hinno, Partanen and Vehviläinen-Julkunen, 2011, pg. 257). Some of these catalyzing factors include nursing competency, working conditions, collaborations with other care departments, adequate staffing, and a caring culture biased towards the patients’ welfare.

Another school of thought in the matter states that processes in their care environment that improved collaboration, competency, and practice autonomy all catalyzed the creation of positive patient experiences (Namdari et al., 2018, in press). In essence, when all stakeholders in the care environment facilitated the nursing environment in a non-materialistic manner, the nurses themselves got motivated enough to serve patients better.

Managerial input cannot be ignored in studies aimed at understanding the relationship between nursing environments and patient experiences. There is a direct correlation between administrative input in care environments and the level nursing environment conduciveness that nurses enjoy (Boev, 2012, pg. 370). Such association emanates from factors such as equipment, training, institutional support, and labor relations. Studies show that care environments with good managerial input enhance the care dynamics that nurses and other care professionals enjoy. Concurrently, the improvement of these environmental dynamics enables nurses to operate better thus optimizing the quality of care patients enjoy and their general experience (Pich, Kable and Hazelton, 2011, pg.S13). Such relationships demonstrated the diversity of collaborative relationships and partnerships involved in ensuring nurses provide the best care experiences to their patients.

While the relationship between nursing environments and patient experiences is known to exist, little is known about how it forms and grows from a critical perspective. Some scholars underpin the importance of a nurse-oriented strategy in enabling these professionals to provide better services thus improving patient experiences (Namdari et al., 2018, in press). Others underline the need for the entire care institution to focus on patient-centered care strategies in which the nursing professionals are mere participants. The Dutch study is one such review where the researchers failed to understand the real source of input resulting in improved patient experiences (Saeed, 2015, pg. 2) Part of the research investment suggested that nursing environment-oriented input was responsible, while the majority centered on patient-focused care strategies in which the nurses participate at their respective capacity.

While investigating the relationship dynamics between care environments and patient experience, one cannot ignore the presence of modern models of healthcare. The Dutch study used in this essay suffered from an entrepreneurial model introduced by the government in 2006 (Kieft et al., 2014, np). Herein, the care centers focused on improving the quality of care to their patients in a bid to reduce the length of stay while concentrating as well on readmission requirements (Namdari et al., 2018, in press). Such strategies also influence the care environment in a manner that could alter studies aimed at understanding the relationship between nursing care environment and patient experiences during their care regime.

Critical Analysis of the Article

The primary scholarly article from which this essay benefit is titled ‘How nurses and their work environment affect patient experiences of the quality of care: a qualitative study’ (Kieft et al., 2014, np). This article, authored by Kieft, de Brouwer, Francke, and Delnoij in 2014 sought to understand the relationship between nursing environments in which care professionals operate and the quality of patient experiences from the perspective of Dutch study.

Research Question

The article’s research questions centered on finding out the feelings of Dutch nurses about how the operational conditions influenced the patient’s experiences during care.

Study Design

Due to the behavioral aspect of the Dutch nursing study, it would benefit more from a qualitative approach. Such a design is applicable in all research environments where there are phenomenological and behavioral aspects that cannot be quantified and analyzed statistically. Inherently, the study sought to understand how certain environmental aspects and changed influenced complex human behavior and decision-making meaning qualitative methods were better than any other alternative.

Research Methodology

In the course of the Dutch nursing research process, a specific research methodology was applied. It entailed the use of descriptive qualitative methods of data collection. Additionally, four focus groups each with about seven RNs operating in diverse care environments such as mental healthcare, general nursing, and hospital care, were organized. Through purposeful sampling, the total number of nurses that participated was 26, and their data were recorded, transcribed and subjected to thematic analytical processes.

Such qualitative methods applied to the Dutch nursing study based on the fact that the primary objective was to establish links between care environments and patient experiences. The complexities of human behavior and decision-making, coupled with the fact that there were many factors involved in patient experience outcomes made such thematic analytical processes better than all other alternatives.

Data Collection Tools

A combination of two methods was used in the Dutch nursing research process for purposes of data collection. First, purposeful sampling was used in determining the respondents of an interview-based data collection process. All nursing respondents have to fulfill specific criterion to qualify to participate. The first criteria were that they had to be registered nurses or certified nursing professionals operating in the Dutch society. Second, these professionals had to have worked in the Dutch care environment for at least two years (Kieft et al., 2014, np). Finally, they had to be operational in any of the main care-oriented nursing environments present in Dutch society. These environments include mental health care, hospital care, home-based nursing care, and nursing home care.

The second segment of data collection used was a strategically designed interview. All questions were aimed at collecting information related to the quality of care environment and how it influenced the ability of these nurses to function. The questionnaire also sought to establish the nurses’ feelings about their care environment dynamics concerning the patients’ experiences. All these data collection methods and tools were handled by the team of researchers with adequate monitoring input to prevent ethical and bias issues.

Data Analysis

After collection, the data captured was encoded and grouped. Certain thematic factors emerged in the course of data coding and categorization, which served to establish certain thematic boundaries that would benefit analysis. Using MaxQDA, the researching team encoded the data further along these thematic boundaries while involving the respondents. Such strategies ensure that no aspects of the data collection and analysis process were overlooked. Eventually, the data re-arranged itself along the respondents’ feelings with regards to their care environment and its influence on patient experiences. Finally, all conclusions arrived at were recorded and compared to the literature review and theoretical standpoint for alignment or disparity to complete the research process.

Analyzing the data captured would enable the researchers to answer the research questions that formed the theoretical standpoint perfectly. One advantage of thematic qualitative methods of research is that the patterns of response from respondent data usually align or diverge from the research questioning framework (Pich, Kable and Hazelton, 2011, pg.S13). In this case, all answers would align themselves in a manner that would inform researchers what nurses in the Netherlands felt about the relationship between the care environment and their patients’ experiences during care.

Participant Recruitment

Four focus groups each with about seven RNs operating in diverse care environments such as mental healthcare, general nursing, and hospital care, were organized. Through purposeful sampling, the total number of nurses that participated was 26, and their data were recorded, transcribed and subjected to thematic analytical processes. All nursing respondents have to fulfill specific criterion to qualify to participate. The first criteria were that they had to be registered nurses or certified nursing professionals operating in the Dutch society. Second, these professionals had to have worked in the Dutch care environment for at least two years. Finally, they had to be operational in any of the main care-oriented nursing environments present in the Netherlands.

The nurse respondents recruited for the research process were participants of a Dutch healthcare program called Excellent Care which focused on creating dynamic care environments based on eight significant factors (Kieft et al., 2014, np). These nurses were placed under the supervision of two research personnel throughout their participation. The first one undertook actual research processes, while the second one oversaw research monitoring responsibilities.

All respondents were identified based on specific criteria associated with their nursing career and care environment characteristics. Four criteria were applied in this process. The first criteria were that they had to be registered nurses or certified nursing professionals operating in the Dutch society. Second, these professionals had to have worked in the Dutch care environment for at least two years. Finally, they had to be operational in any of the main care-oriented nursing environments present in the Netherlands.

All participants were chosen because of several reasons. First, as registered or certified nursing professionals, they were in constant contact with patients at various levels of the Dutch care system. Second, their operations in the Netherlands made them viable candidates for the study, whose operational boundaries limited it to the country. Lastly, their diverse areas of specialization in mental, hospital, and home-based care diluted any notion of bias in the research process making the study generally about nursing in the Netherlands.

Purposeful sampling was applied in the course of data collection. Consent was obtained from the respondents. Based on the nature of the research process, no further approval was required as the research endeavor did not invade any privacy or institutional rights and privileges.

Key Findings and Recommendations

The research process came up with several findings related to certain factors that either facilitated positive patient experiences or inhibited them. The facilitative factors included nurse competency, collaborative practices, nurse autonomy, adequate staffing, patient-oriented care practices, and managerial support. Inhibitors identified involved cost-effectiveness policies adopted, and transparency or accountability goals.

These findings would impact the provision of clinically sufficient and cost-effective care in various ways. First, all care strategies would aspire to offer patient-centered care. Additionally, the same approach would reduce the costs of care through patient satisfaction centered on the need to reduce readmission rates and patient length of stay in the care institution (Kieft et al., 2014, np). All findings and recommendations could be traced back to the data used in the research process.

Reflection

As a nurse working in a different location other than the Netherlands, the article’s research process and key finding would impact me in a somewhat similar manner. The degree of similarity would be high but never 100% due to the difference in care strategies, care environment, and care staff in different parts of the world. However, the relationship between the nursing environment and patient experiences is a worldwide phenomenon.

My government understands the relationship between care environment and patient experiences well and has set in place strategies to optimize the same. Such strategies include continuous nurse education and training to allow skills development, increased empowerment of nurse leaders to promote nurse autonomy, and employment of more nurses to ensure adequate staffing.

After reading the article, I would go about certain aspects of my nursing practice differently. First, I would aspire to acquire more training and apprenticeship opportunities to improve my skill set. The research findings point to better patient experiences when nurses are adequately trained. The assumption of cost-effectiveness and accountancy mindsets in nursing environments seems to undermine the relationship between nursing environments and patient experiences. Therefore, I would encourage management to adopt more patient-centered strategies in their care regimes as a priority over cost-effectiveness.

Specific changes would go a long way in augmenting the quality of care in the organization. Such changes would compose of a set of strategies that were aimed at improving the nursing environment with the long-term objective of positive patient experiences. The strategies include continuous nurse education and training to enable skills development, increased empowerment of nurse leaders to facilitate nurse autonomy, and employment of more nurses to ensure adequate staffing. Additionally, the healthcare institution would improve its managerial input in favor of nursing welfare as that too was identified as a facilitative factor in enhancing the patient experiences.

Conclusion

The relationship between care environments and patient experiences has long been the subject of scholarly and industrial research. One such research endeavor that focused on Dutch nurses was authored as an academic article in 2014. The study sought to establish the feelings of Dutch nurses about their care environment concerning the patients’ experiences. The research determined that certain factors in the Dutch healthcare system would be useful in improving the care environment and patient experiences by extension. They included nurse competency, collaborative practices, nurse autonomy, adequate staffing, patient-oriented care practices, and managerial support.

Furthermore, the application of the findings in the Dutch study would also benefit from the consideration of certain factors that undermined the primary objective. The first of the two was the adoption of cost-effectiveness and accountability measures in the care environment at the behest of patient-centered practices. Such loss of the critical focus point not only resulted in higher readmission rates and increased care costs but reduced the quality of patient experiences as well. Another factor to be considered was the adoption of accountability measured that ignored patient experiences while focusing on care institution performance. Although the accountability factor is similar to that of cost-effectiveness, it points again to the loss of vision in care environments that are too fixated on their performance metrics at the behest of patient experiences. Such care environment may appear healthy on paper, but patients are not happy thus deteriorating the actual performance of care in the society.

References

Boev, C. (2012). The Relationship Between Nurses’ Perception of Work Environment and Patient Satisfaction in Adult Critical Care. Journal of Nursing Scholarship, 44(4), pp.368-375.

Hinno, S., Partanen, P. and Vehviläinen-Julkunen, K. (2011). Hospital nurses’ work environment, quality of care provided and career plans. International Nursing Review, 58(2), pp.255-262.

Kieft, R., de Brouwer, B., Francke, A. and Delnoij, D. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Services Research, 14(1).

Namdari, S., Nasiri, A., Nakhaee, S. and Taheri, F. (2018). Exploring the Effects of Nurses’ Family-Work Conflict on Patient Care Quality: A Qualitative Study. Modern Care Journal, In Press(In Press).

Pich, J., Kable, A. and Hazelton, M. (2011). Emergency Department nurses experiences with patient-related violence at work; Preliminary qualitative results from the Australian VENT Study. Australasian Emergency Nursing Journal, 14, p.S13.

Saeed, N. (2015). Relatives’ Involvement in Nursing Care : A Qualitative Study Describing Critical Care Nurses’ Experiences : Qualitative Research Critique. The Journal of Middle East and North Africa Sciences, 1(2), pp.1-5.