The impact of nurse practice environment on patient outcomes and mediation effects of registered nurse outcomes in Middle Eastern acute care hospitals: A cross-sectional study

Elsevier

Available online 25 June 2022, 151605

Applied Nursing ResearchHighlights

What is already known about the topic?

Reports from leading institutes, such as Institute of Medicine (2004), highlight the role of supportive and healthy nurse practice environment in optimizing patient outcomes.

There is no evidence from Middle East hospitals that examines the potential impact of nurse practice environment on patient outcomes.

What this paper adds.

This study empirically examined the impact of nurse practice environment on patient outcomes directly as well as indirectly through nurse outcomes.

Findings of this study establish a baseline for further exploration of the impact of nurse practice environment on patient safety outcomes in the Middle East context.

AbstractAims

Examining associations between unit nurse practice environment and four patient outcomes (catheter-associated urinary tract infections [CAUTIs], central line-associated bloodstream infections [CLABSIs], falls, and pressure injuries) and mediation effects of three RN unit workgroup outcomes (job enjoyment, psychological safety, and intent to stay at 1 and 3 years) on these relationships.

Methods

A cross-sectional correlational design, using the National Database of Nursing Quality Indicators® (NDNQI®) unit-level data from 2018 on inpatient units from seven Middle Eastern hospitals. Ninety units were included, where the sample of units for each patient outcome varied (n = 73–90) based on outcome data availability.

Results

Higher unit nurse practice environment scores were significantly associated with higher CLABSIs (exp(b) = 8.181, 95 % CI = [2.204, 30.371], p = .002) and lower pressure injuries (exp(b) = 0.153, 95 % CI = [0.032, 0.730], p = .018). However, mediation analysis showed no significant direct effects of unit nurse practice environment on patient outcomes. Mediation analysis showed that nurses' psychological safety-respect significantly mediated the relationship between unit nurse practice environment and CAUTIs (β = 2.620, p = .013, 95 % bcb CI = [0.837, 5.070]). Nurses' intent to stay at 1-year and psychological safety-respect had significant direct effects (β = −4.784, p = .017 and β = 3.073, p = .012, respectively) on CAUTIs.

Conclusions

Nurse practice environment was significantly associated with two patient outcomes and a mediation role of RN outcomes was supported when examining one patient outcome. Future research should examine these relationships in a larger sample for replication.

Tweetable abstract

Although nurse practice environment can impact patient outcomes directly, nurse outcomes play a crucial role in mediating this relationship.

Keywords

Nurse practice environment

CAUTI

CLABSI

Falls

Pressure injuries

Job enjoyment

Psychological safety

Intent to stay

© 2022 Elsevier Inc. All rights reserved.

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