Introduction
The Agency for Health Care Research and Quality has explored different issues in the health care practice, such as health care quality, disparities in health care services, quality improvement processes, and patient safety (among other factors) (AACN, 2016).
This paper borrows from its analyses and explores a familiar topic in this subject area – patient safety and the nursing work environment. To emphasize the importance of this subject area, this paper articulates the methods, tools, and performance measures that characterize this topic. Similarly, it explores the culture of safety, principles that characterize the work environment, and quality standards in nursing care.
Through this assessment, this paper demonstrates knowledge about continuous quality improvement in the nursing environment by exploring practical issues in the discipline, which include safety culture, interdisciplinary communication, accountability issues, quality initiatives, and patient-centered care (among others). Starting this analysis is an exploration of the role of nurses and administrators in addressing some of these practical issues of concern in patient safety and in promoting a safe working environment for nurses.
Role of Nurses
Nurses have a pivotal role to play in improving the safety and culture of the nursing environment. Although most countries have systems and laws to ensure that health workers act appropriately and care for patients correctly, nurses also have a personal duty to make sure they perform as expected. For example, fatigue and distractions are personal factors that no nurse should allow to affect his/her work (Montgomery, 2007).
In other words, nurses should exercise personal discipline to provide quality care. Failing to do so may compromise their output and possibly increase cases of medical error, which may ultimately compromise patient safety (AACN, 2016). However, some of these derailing factors are products of the nature of the working environment. For example, a heavy workload may cause fatigue to the nurses. In this regard, administrators should pay close attention to the effects of extreme workloads on work performance.
This concern stems from studies that have shown that fatigue and sleep deprivation could impair medical and surgical performance (Kirwan, Matthews, & Scott, 2013). Here, the rule of thumb is that all nurses should be fit for work. According to the AACN (2016), this is the best way to improve the care environment and safeguard patient safety.
Role of Administrators
Health administrators have an active duty of ensuring that all nurses provide patient-centered care. From a policy perspective, administrators must enforce rules, policies, and laws that safeguard patient safety and promote a safe working environment for all (AACN, 2016). Such enforceable rules and policies should cover different processes and procedures in health provision, such as reporting medical errors and respecting the need for accountability in health practices.
Through recruitment and selection processes, administrators also have the privilege of enlisting health workers who understand patient needs and the need to provide patient-centric and culturally sensitive care. According to Kirwan et al. (2013), such strategies could increase the efficiency and effectiveness of nurses. Ballard (2003) adds to this discussion by saying it is the best way for administrators to make sure that health workers provide timely, safe, and equitable nursing care. Based on these assertions, we see that health administrators play a pivotal role in improving the nursing environment and in promoting patient safety. The latter is most effective if health administrators enforce existing rules and policies surrounding the same.
Quality Initiatives
Many researchers have defined quality care as a prerequisite for the realization of patient safety (Kirwan et al., 2013). For example, the Institute of Medicine considers patient safety as an offshoot of quality care (Weston & Roberts, 2013). According to Mitchel (2008), quality initiatives in the work environment should promote a safe working environment for nurses because they advocate for the prevention of harm to patients.
Here, the emphasis is on the nursing care system, which should strive to prevent the occurrence of errors and encourage nurses to learn from past mistakes, while promoting a safety culture that should involve all stakeholders, including nurses, organizations, and patients (Weston & Roberts, 2013). This is one way of recognizing the contribution of individuals and inter-professional health care teams in promoting patient safety and healthy working environments for nurses and patients alike.
The concepts of teamwork and interdisciplinary communication suffice here because, without them, it would be difficult to create the organizational synergy needed in safe and healthy work environments.
Ballard (2003) says communication could occur through the information engineering approach or the social construction approach. The social construction approach is more relevant to the nursing context because it explains how primary social processes create a meaningful social world. The social world, in the context of this analysis, is a safe working environment for nurses and patients. The quantifying attribute in this analysis is the quality of care offered to patients and their levels of satisfaction with the services they receive. In this regard, nurses should be accountable for their actions because they are instruments for change in the nursing care environment.
Integrating Care in the Nursing Practice
Researchers have often used Jean Watson’s theory of human caring in different contexts of nursing to improve the practice (Ryan, 2015). Some of its core principles include love, kindness, authentic presence (an enabling deep belief in others), cultivation of one’s spiritual practice to promote the wholeness of mind, promoting the caring/healing environment, and being open to unexpected and inexplicable life events (Ryan, 2015).
It is possible to integrate these concepts of Watson’s theory to different levels of nursing care practice. Some of the earliest scholars to do so understood that nursing theories, such as Watson’s theory of human caring, strengthened the clinical practice (Committee on the Work Environment for Nurses and Patient Safety, 2004). For example, Kirwan et al. (2013) say integrating theory and practice not only provides structure to nursing but also provides language to the discipline.
In this regard, many observers hope to see an improvement in interpersonal communication through the integration of nursing theories in clinical practice. Relative to this assertion, Ryan (2015) says, doing so “would openly proclaim the beliefs and values that underpin the nursing practice, and thus it would express essences of professional nursing that had formerly been unspoken. It would make explicit what was previously merely implied” (p. 5).
In another frame of analysis, experts have proposed that one way to integrate Watson’s theory to clinical practice is inviting nurses to discussion groups that would allow them to discuss how theories would strengthen the practice (Committee on the Work Environment for Nurses and Patient Safety, 2004). However, the first point of integrating the nursing theory and the clinical practice is through the concept of caring, which is central to both points of analysis.
Indeed, caring is at the center of the nursing practice and as Mitchel (2008) affirms, it is universal, in the sense that it influences how people think, feel, and, act. Different theorists and scholars in the nursing practice have tried to define the concept of caring and emphasize its centrality in the discipline (Kirwan et al., 2013). Nightingale was among the first such scholars. Through her work, easily, we can see how Watson’s theory integrates with the clinical practice because the theory espouses that human life is precious.
Nonetheless, some variables are bound to moderate the integration of the nursing theory to clinical practice. Ballard (2003) has investigated this issue in detail and found out that nursing beliefs emerge as the greatest moderating factor in the integration of nursing theory to clinical practice.
Conclusion
This paper has explored key issues in the management of the nursing working environment. It has demonstrated the role of theory in providing structure and language to the discipline and emphasized the importance of integrating theory and practice to promote safe and healthy work environments. In this paper, we have singled out nurses and health care administrators as having the greatest responsibility of promoting patient safety and creating safe working conditions for health workers and patients alike.
However, health care administrators have the greatest responsibility in promoting continuous improvement because the nurses are only agents of change. Nonetheless, all stakeholders in the health sector have a duty to promote patient safety and to participate in continuous improvement to create safe and healthy work environments for all.
References
AACN. (2016). AACN Standards for Establishing and Sustaining Healthy Work Environments. Web.
Ballard, K. (2003). Patient Safety: A Shared Responsibility. Online Journal of Issues in Nursing, 8(3), 1-7.
Committee on the Work Environment for Nurses and Patient Safety. (2004). Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: National Academies Press.
Kirwan, M., Matthews, A., & Scott, A. (2013). The impact of the work environment of nurses on patient safety outcomes: A multi-level modelling approach. Journal of Nursing Studies, 50(2), 253–263.
Mitchel, P. l. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Bethesda, ML: National Center for Biotechnology Information.
Montgomery, V. L. (2007). Effect of fatigue, workload, and environment on patient safety in the pediatric intensive care unit. Pediatr Crit Care Med, 8(2), 11-6.
Ryan, L. (2015). The Journey to Integrate Watson’s Caring Theory with Clinical Practice. Web.
Weston, M., & Roberts, D. (2013). The Influence of Quality Improvement Efforts on Patient Outcomes and Nursing Work: A Perspective from Chief Nursing Officers at Three Large Health Systems. Online Journal of Issues in Nursing, 8(3), 1-10.