Quality improvement programs and the professional nursing practice environment: an integrative review

Danno, Camila Hidemi; Esteves, Larissa Sapucaia Ferreira; Bohomol, Elena

doi:10.1590/0034-7167-2020-0108

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (1) • 2021 • https://doi.org/10.1590/0034-7167-2020-0108 copy

Quality improvement programs and the professional nursing practice environment: an integrative review

Programas de mejoría de calidad y el ambiente de práctica profesional de enfermería: revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze the knowledge produced regarding the practice environment in hospitals with quality improvement programs.

Methods:

integrative literature review performed in the Latin American and Caribbean Literature in Health Sciences databases, US National Library of Medicine/National Institutes of Health, Web of Science, Scopus and CINAHL, consisting in 10 articles.

Results:

data were presented and discussed using categories: Measures for the professional nursing practice environment; Hospital accreditation as an improvement program; Nursing autonomy, interpersonal relationship between nurse and doctor and the nurse as a manager and leader.

Final Considerations:

it was possible to analyze that the influence of quality improvement programs can be considered as favorable in the professional nursing practice environment. The survey also brings contributions to administration in implementing strategies aiming at continuous improvement in the environment characteristics.

Descriptors:
Nursing; Quality of Health Care; Accreditation; Workplace; Quality Improvement

Definition	Proposal	Descriptors DeCs / MeSH	Keywords
P - Patient/population	Nursing working in hospitals	Nursing staff; Hospital / Nursing, Team; Team Nursing; Hospitals	Nursing; Nursing professionals; Hospital
I - Intervention or issue of interest	Hospital quality improvement programs	Accreditation; Hospital accreditation; Quality of health care; Quality management / Accreditation; Quality of Health Care; Total Quality Management; Management, Total Quality	Accreditation Program; Quality of Health Care
O - Outcomes	Favourable or unfavourable nursing practice environment	Ambiente de trabalho / Workplace	Nursing work environment

Article	Title of Journal/ Journal Impact factor or Citescore 2018	Country of survey/ Year of publication	Research Outline/ Level of evidence
A1⁽¹⁴14 Oliveira PB, Spiri WC, Dell´Acqua MCQ, Mondini CCSD. Comparison between the accredited and non-accredited public hospital working environments. Acta Paul Enferm. 2016; 29(1):53-9. doi: 10.1590/1982-0194201600008 https://doi.org/10.1590/1982-01942016000... ⁾	Acta Paulista de Enfermagem/ 0,5814	Brazil/ 2016	Transversal, quantitative / VI
A2⁽¹⁵15 Alves DFS, Guirardello EB. Nursing work environment, patient safety and quality of care in pediatric hospital. Rev Gaúcha Enferm. 2016;37(2):e58817. doi: 10.1590/1983-1447.2016.02.58817 https://doi.org/10.1590/1983-1447.2016.0... ⁾	Revista Gaúcha de Enfermagem/ 0,5493	Brazil/ 2016	Transversal, descriptive, quantitative/ VI
A3⁽¹⁶16 Walker K, Fitzgeral K, Duff J. Supporting a healthy culture: results of the Practice Environment Scale, Australia in a Magnet Designated Hospital. J Nurs Adm. 2014; 44(12):653-8. doi: 10.1097/NNA.0000000000000143 https://doi.org/10.1097/NNA.000000000000... ⁾	The Journal of Nursing Administration/ 0,49	Australia/ 2014	Quantitative/ VI
A4⁽¹⁷17 McCsker J, Dendukuri N, Cardinal L, Laplante J, Bambonye L. Nursing work environment and quality of care: diferences between units at the same hospital. Int J health Care Qual Assur Inc Leadersh Health Serv. 2004;17(6):313-22. doi: 10.1108/09526860410557561 https://doi.org/10.1108/0952686041055756... ⁾	International Journal of Health Care Quality Assurance Incorporating Leadership Health Services/ 0,72	Canada/ 2004	Quantitative/ VI
A5⁽¹⁸18 Liu J, Zhou H, Yang X. Evaluation and improvement of the nurse satisfactory status in a tertiary hospital using the professional practice environment scale. Med Sci Monit. 2017;23:874-80. doi: 10.12659/msm.902249. https://doi.org/10.12659/msm.902249... ⁾	Medical Science Monitor/ 1,98	China/ 2017	Historical control study, quantitative / VI
A6⁽¹⁹19 Kelly L, Todd M. Compassion Fatigue and the Healthy Work Environment. AACN Adv Crit Care. 2017;26(4):351-8. doi: 10.4037/aacnacc2017283 https://doi.org/10.4037/aacnacc2017283... ⁾	AACN Advanced Critical Care/ 1,04	United States/ 2017	Transversal, quantitative/ VI
A7⁽²⁰20 Anzai E, Douglas C, Bonner A. Nursing practice environment, quality of care, and morale of hospital nurses in Japan. Nurs Health Sci. 2014;16(2):171-8. doi: 10.1111/nhs.12081 https://doi.org/10.1111/nhs.12081... ⁾	Nursing and Health Sciences/ 1,321	Japan/ 2014	Quantitative/ VI
A8⁽²¹21 Kagan I, farkash-Fink N, Fish M. Effect of Joint Commission International Accreditation on the Nursing Work Environment in a Tertiary Medical Center. J Nurs Care Qual. 2016;00(00):1-8. doi: 10.1097/NCQ.0000000000000180 https://doi.org/10.1097/NCQ.000000000000... ⁾	Journal of Nurse Nursing Care Quality/ 1,191	Israel/ 2016	Quantitative/ VI
A9⁽²²22 Oliveira JLC, Souza VS, Pereira ACS, Fernandez MC, Haddad L, Marcon SS, et al. Work environment and accreditation: analysis by mixed explanatory sequential method. Esc Anna Nery. 2018; 22(4):e20170379. doi: 10.1590/2177-9465-ean-2017-0379 https://doi.org/10.1590/2177-9465-ean-20... ⁾	Escola Anna Nery Revista de Enfermagem/ 1,0249	Brazil/ 2018	Combined explanatory sequential method / VI
A10⁽²³23 Pires BSM, Oliveira LZF, Siqueira CL, Feldman LB, Oliveira RA, Gasparino RC. Nurse work environment: comparison between private and public hospitals. Einstein. 2018;16(4):1-6. doi: 10.31744/einstein_journal/2018AO4322 https://doi.org/10.31744/einstein_journa... ⁾	Einstein/ 0,1040	Brazil/ 2018	Quantitative/ VI

Article	Improvement program	Environmental assessment tool / Population	Results and Outcome on the Practice Environment
A1⁽¹⁴14 Oliveira PB, Spiri WC, Dell´Acqua MCQ, Mondini CCSD. Comparison between the accredited and non-accredited public hospital working environments. Acta Paul Enferm. 2016; 29(1):53-9. doi: 10.1590/1982-0194201600008 https://doi.org/10.1590/1982-01942016000... ⁾	ONA^* * ONA - National Accreditation Organization;	NWI-R^† † NWI-R - Nursing Work Index - Revised; / 106 IU^‡ ‡ IU - Inpatient Unit; nurses, two public hospitals	Favorable environments. Autonomy averaged 2.0 in both. Accreditation did not interfere with the result.
A2⁽¹⁵15 Alves DFS, Guirardello EB. Nursing work environment, patient safety and quality of care in pediatric hospital. Rev Gaúcha Enferm. 2016;37(2):e58817. doi: 10.1590/1983-1447.2016.02.58817 https://doi.org/10.1590/1983-1447.2016.0... ⁾	JCI ^§ § JCI - Joint CommissionInternational;	NWI-R^† † NWI-R - Nursing Work Index - Revised; / 136 IU^‡ ‡ IU - Inpatient Unit; and ICU^\|\| nursing staff	Favorable environment. Relationship between doctors and nursing with 1.93 and Autonomy with 1.99.
A3⁽¹⁶16 Walker K, Fitzgeral K, Duff J. Supporting a healthy culture: results of the Practice Environment Scale, Australia in a Magnet Designated Hospital. J Nurs Adm. 2014; 44(12):653-8. doi: 10.1097/NNA.0000000000000143 https://doi.org/10.1097/NNA.000000000000... ⁾	Magnet Certificate ^®	PES ^¶ ¶ PES - Practice Environment Scale; Australia/ 492 nursing staff	Favorable environment. Quality nursing fundamentals of care with 3.18, Unit manager capacity, leadership and support of nurses with 3.09.
A4⁽¹⁷17 McCsker J, Dendukuri N, Cardinal L, Laplante J, Bambonye L. Nursing work environment and quality of care: diferences between units at the same hospital. Int J health Care Qual Assur Inc Leadersh Health Serv. 2004;17(6):313-22. doi: 10.1108/09526860410557561 https://doi.org/10.1108/0952686041055756... ⁾	Canadian Accreditation	NWI-R^† † NWI-R - Nursing Work Index - Revised; / 246 nurses	Favorable environment. Adequacy of personnel and resources with 2.03, but the relationship between nurse and doctor showed weakness, with 2.79.
A5⁽¹⁸18 Liu J, Zhou H, Yang X. Evaluation and improvement of the nurse satisfactory status in a tertiary hospital using the professional practice environment scale. Med Sci Monit. 2017;23:874-80. doi: 10.12659/msm.902249. https://doi.org/10.12659/msm.902249... ⁾	JCI ^§ § JCI - Joint CommissionInternational;	PES ^¶ ¶ PES - Practice Environment Scale; China/ 1.085 nurses	Favorable environment. Item Internal relationship and autonomy, best evaluated, with 3.27, followed by Motivation with 3.22.
A6⁽¹⁹19 Kelly L, Todd M. Compassion Fatigue and the Healthy Work Environment. AACN Adv Crit Care. 2017;26(4):351-8. doi: 10.4037/aacnacc2017283 https://doi.org/10.4037/aacnacc2017283... ⁾	Magnet Certificate ^®	HWEA^ HWEA - Healthy Work Environment Assessment. / 105 ICU nurses^\|\| \|\| ICU - Intensive Care Unit;	Good atmosphere. Effective decision making was best evaluated with 3.72, followed by Authentic Leadership with 3.71.
A7⁽²⁰20 Anzai E, Douglas C, Bonner A. Nursing practice environment, quality of care, and morale of hospital nurses in Japan. Nurs Health Sci. 2014;16(2):171-8. doi: 10.1111/nhs.12081 https://doi.org/10.1111/nhs.12081... ⁾	Japanese Certification	PES ^¶ ¶ PES - Practice Environment Scale; Japan/ 223 ICU nurses^\|\| \|\| ICU - Intensive Care Unit;	Favorable environment. Relationship between doctor and nurse with 2.84; Capacity of nursing manager, leadership, and support of nurses with 2.82.
A8⁽²¹21 Kagan I, farkash-Fink N, Fish M. Effect of Joint Commission International Accreditation on the Nursing Work Environment in a Tertiary Medical Center. J Nurs Care Qual. 2016;00(00):1-8. doi: 10.1097/NCQ.0000000000000180 https://doi.org/10.1097/NCQ.000000000000... ⁾	JCI ^§ § JCI - Joint CommissionInternational;	NWI-R^† † NWI-R - Nursing Work Index - Revised; / 363 nurses	Unfavorable environment. After accreditation, averages increased in all variables, with Control over Practice being the best evaluated with 3.64.
A9⁽²²22 Oliveira JLC, Souza VS, Pereira ACS, Fernandez MC, Haddad L, Marcon SS, et al. Work environment and accreditation: analysis by mixed explanatory sequential method. Esc Anna Nery. 2018; 22(4):e20170379. doi: 10.1590/2177-9465-ean-2017-0379 https://doi.org/10.1590/2177-9465-ean-20... ⁾	ONA^* * ONA - National Accreditation Organization;	NWI-R^† † NWI-R - Nursing Work Index - Revised; / 226 ICU^\|\| \|\| ICU - Intensive Care Unit; nursing staff, three hospitals	Favorable environments. Even with the 1.88 medical-nurse relationship at the accredited hospital, accreditation did not interfere with the result.
A10⁽²³23 Pires BSM, Oliveira LZF, Siqueira CL, Feldman LB, Oliveira RA, Gasparino RC. Nurse work environment: comparison between private and public hospitals. Einstein. 2018;16(4):1-6. doi: 10.31744/einstein_journal/2018AO4322 https://doi.org/10.31744/einstein_journa... ⁾	ONA^* * ONA - National Accreditation Organization;	NWI-R^† † NWI-R - Nursing Work Index - Revised; / 188 nurses, four hospitals	The accreditation favored the environment. Averages close to 2.0 in the domains. However, 62.2% of the total indicated a lack of staff and overload as detractors.

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[1] Corresponding author: Camila Hidemi Danno. E-mail: milahidemi@hotmail.com