Ambiente de prática de enfermagem nos cuidados de saúde primários em Portugal

Abstract

The nursing practice environment (NPE) has consequences on the quality of nursing care, patient and nurse outcomes, namely better performances by these professionals. Improving NPE in health care organizations is a low-cost organizational strategy to achieve higher patient outcomes and retain qualified nurses, thus improving the nursing care of units, organizations, and the health system. Studies on NPE in primary health care (PHC) are much scarcer than in hospital settings. Our research question was defined: What is the relationship and impact of the NPE on quality of care, patient safety, safety culture, job satisfaction, intention to leave, and burnout of PHC nurses in Portugal? and a quantitative, observational, analytical, and cross-sectional study was designed. We explored the relationships between the variables: NPE; quality of care; patient safety; safety culture; job satisfaction; intention to leave; and burnout of PHC nurses in Portugal. The aim of this study was defined: To assess relationship and impact of the NPE on quality of care, patient safety, safety culture, job satisfaction, intention to leave, and burnout of PHC nurses in Portugal. The psychometric properties of the Practice Environment Scale - Nursing Work Index (PES-NWI) were analysed in PHC and the impact of the NPE on the quality of care, patient safety, safety culture, job satisfaction, intention to leave, and burnout of PHC nurses was assessed. The assessment of the psychometric properties of the PES-NWI in PHC in Portugal was the first study on this level of care in Portugal and the second worldwide, after Spain. The PES-NWI in PHC in Portugal, composed of 28 itens, revealed an adequate structure with good psychometric performance distributed by five factors: Participation of Nurses in the Governance of the Organization; Fundamentals of Nursing for Quality Care; Competences of Nurse Manager, Leadership and Support to Nurses; Adequacy of Human and Material Resources; and Nurse-Physician Relationship. It was concluded that nurses consider that there is an unfavourable and mixed NPE in PHC in Portugal, associated with a perception of good quality of care, acceptable patient safety, acceptable safety culture, low job satisfaction, moderate intention to leave and low burnout. The association of NPE was higher with safety culture, followed by quality of care, job satisfaction and patient safety. NPE was negatively correlated with burnout and its dimensions emotional exhaustion, depersonalization, and loss of professional fulfilment. Our results confirmed the hypotheses of the positive impact of NPE on the nurses` quality of care, patient safety, safety culture, job satisfaction and burnout.

Date of Award	6 Mar 2023
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Élvio Jesus (Supervisor) & Sofia Almeida (Co-Supervisor)