NURSING PRACTICE ENVIRONMENT AND PATIENT OUTCOMES: THE EXPERIENCE OF NURSES WORKING AT THREE TEACHING HOSPITALS, MALAYSIA

Abstract

Lately, increasing cases of adverse events are a patient safety issue in hospitals worldwide and require serious attention by the administrators in the healthcare sector. This study was carried out to assess the category of nursing practice environments (NPEs) and to assess the level of patient outcomes (POs) as perceived by nurses in teaching hospitals, Malaysia. It aimed to examine- the relationship between NPEs and POs in hospital settings. This was a descriptive correlational study conducted in a two month period on 395 nurses (94.3%) who participated voluntarily in this study. Data were collected using a self-rated 45-item questionnaire that comprised of demographic data, the Practice Environment Scale of the Nursing Work Index and the Adverse Events Instrument to assess NPEs and negative outcomes respectively. The reliability and validity with Cronbach's alpha was 0.89 and 0.81. The study showed that the NPEs in teaching hospitals were mean score of 2.44, which describes nurses' perception as highly disagreeable and dissatisfaction with the characteristics of NPEs in their daily duty and suggested as a stressful environment. This study indicated that the level of POs was low with patient falls (X 1.55) and medication errors ( X 1.59), whereas nosocomial infections (X 2.04) and patient complaints (X 2.15) were moderate. This indicates that POs in teaching hospitals need to be improved to gain more positive POs mainly on nosocomial infections and patient complaints. The finding also showed the nurse manager ability, leadership and support of nurses were associated with patient falls (r = -0.123, p = .015), nurse-physician relations were associated complaints with patient -0.116, p complaints (r In = other -0.105, p words, = the .038) more and overall satisfaction NPEs towards was their associated with patient (r = = .021). NPEs as well as the more agreeable for each domain contributed to decrease adverse events and this translated to better POs. These results suggest that stressful environment for nurses is a serious problem which should be addressed in order to create a healthy NPEs for nurses as the key to improve Pos and encourage nurses to be more satisfied and joyful in their practice environment.