An integrative literature review : the relationship between healthy work environment and nursing-sensitive patient outcomes

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Montana State University - Bozeman, College of Nursing


The impact of the nursing work environment on patient safety has received national attention, and has led to efforts to reduce morbidity and mortality in the health care environment (American Hospital Association, 2004). According to the American Association of Critical-Care Nurses, (2005) there is mounting evidence that unhealthy work environments contribute to medical errors, ineffective care delivery, and stress among health care professionals. There are few studies that examine a healthy work environment and the effect on patient outcomes. The purpose of this integrative literature review was to analyze the research that has been completed on healthy work environments and the effect they have on nursing-sensitive patient outcomes. An extensive literature search was performed using the following databases: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature On-Line (MEDLINE), The Agency for Health care Research and Quality Patient Safety Network (AHRQ PSN), and The Robert Wood Johnson Foundation publications on-line database. The studies were evaluated using the following strategies: overall quality, data reduction, and identification of patterns, themes, variations and relationships. They were then further analyzed and synthesized using; data display, data comparison, conclusion drawing and verification. Twelve studies met the inclusion criteria and were compiled, organized by theme and analyzed based on similarities and differences. The data was examined, discrepancies and gaps in literature were discussed and conclusions were drawn based on the patterns found in the literature. The majority (n= 9; 75%) of the articles that met inclusion criteria suggested that a healthy work environment effects nursing sensitive patient outcomes by showing a decrease in the number of negative outcomes. However researchers used multiple healthy work environment factors and different patient outcomes in each study making it difficult to compare results. The findings of this research suggests the need for better identification of a healthy work environment, the use of consistent nursing-sensitive patient outcomes by researchers, and suggests the importance of a healthy work environment on all aspects of patient care. Findings strengthen the principle that the work environment at the unit level mediates the effects of nursing interventions.




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