Healthy Work Environments, Nurse-Physician Communication, and Patients’ Outcomes

Abstract

Background Adverse events and serious errors are common in critical care. Although factors in the work environment are important predictors of adverse outcomes for patients, communication between nurses and physicians may be the most significant factor associated with excess hospital mortality in critical care settings. Objectives To examine the relationships between nurses’ perceptions of their practice environment, nurse-physician communication, and selected patients’ outcomes. Methods A nonexperimental, descriptive design was used, and all nurses (N=866) working in 25 intensive care units in southeastern Michigan were surveyed. The Conditions for Work Effectiveness Questionnaire-II and the Practice Environment Scale of the Nursing Work Index were used to measure characteristics of the work environment; the ICU Nurse-Physician Questionnaire was used to measure nurse-physician communication. Nurses self-rated the frequency of ventilator-associated pneumonia, catheter-related sepsis, and medication errors in patients under their care. Results A total of 462 nurses (53%) responded. According to multilevel modeling, both practice environment scales accounted for 47% of the variance in nurse-physician communication scores (P=.001). Nurse-physician communication was predictive of nurse-assessed medication errors only (R2=0.11). Neither environment scale was predictive of any of the patient outcomes. Conclusions Healthy work environments are important for nurse-physician communication. In intensive care units, characteristics of the work environment did not vary enough to be significantly predictive of outcomes, suggesting that even in various types of critical care units, characteristics of the work environment may be more similar than different.

Safety culture in health care teams: A narrative review of the literature

“…Breakdown in team working and communication has an impact on patient safety outcomes including: duration of patient stay, patient mortality and medication errors (Gilbert, Yan, & Hoffman, 2010;Manojlovich & DeCicco, 2007;Neily et al, 2010;Welp & Manser, 2016). Welp and Manser (2016) propose an integrative framework supporting the relationship between teamwork, clinician occupational well-being and patient safety.…”

The effect of structural empowerment of nurses on quality outcomes in hospitals: a scoping review

“…All studies scored at least a moderate methodological quality; 5/12 studies scored high quality (Laschinger et al 1999, 2014b, Manojlovich & DeCicco 2007, Armstrong et al 2009, Armellino et al 2010, Breau & R eaume 2014 (Table 3). The included studies all used a prospective design (12/12), and valid and reliable instruments to measure SE (12/12).…”

“…The included studies all used a prospective design (12/12), and valid and reliable instruments to measure SE (12/12). However, only 2/12 studies had a response rate above 60% (Laschinger et al 1999(Laschinger et al , 2014b, 5/12 justified their sample size (Laschinger et al 1999, 2014b, Armstrong et al 2009, Armellino et al 2010, Breau & R eaume 2014) and 3/16 described the protection of anonymity (Manojlovich & DeCicco 2007, Armellino et al 2010, Breau & R eaume 2014. None of the studies provided information on the management of outliers.…”

Structural empowerment and patient safety culture among registered nurses working in adult critical care units

“…Donchin et al (2003) reported 1.7 errors per patient per day by physicians and nurses in an Israeli hospital. Researchers, with 866 surveys from nurses in 25 critical care units within eight hospitals, suggested that a perceived lack of power within the work environment contributes to less desired patient outcomes (Manojlovich & DeCicco 2007). Yates et al (2004) linked the organizationÕs PSC to decreased infections.…”