All ETDs from UAB

Advisory Committee Chair

Patricia A Patrician

Advisory Committee Members

Sara Breckenridge-Sproat

Lori Loan

Rebecca S Miltner

Dheeraj Raju

Document Type

Dissertation

Date of Award

2017

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

In the United States, preventable medical errors account for many avoidable patient deaths per year. A favorable nursing practice environment, characterized by factors that improve or enhance a nurse’s ability to practice professional nursing, is a potential mechanism for promoting a culture of safety and enhancing the quality of care in hospitals. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is the national standard for measuring the nursing practice environment, and its importance has been validated repeatedly in civilian nurse populations around the world. For the last several years, the scores on the PES-NWI in military facilities have met or exceeded those found in Magnet® hospitals, facilities known for having exemplary support of nurses and for providing high quality care. However, we do not know to what extent the associations between PES-NWI scores and patient outcomes observed in Magnet® hospitals, such as fewer patient falls and improved patient experiences, also exist within the military system. The purpose of this dissertation was three-fold. First, a comprehensive review of the literature surrounding the PES-NWI was conducted to fully understand the instrument’s current use. Next, the psychometric properties of the instrument were evaluated using a military nurse sample to confirm satisfactory function in this population and identify implications for future use. Finally, the associations between the subscale scores on the PES-NWI and patient falls with and without injury, medication errors with and without harm, and patient experience were tested. The resulting body of work confirmed that use of the PES-NWI remains high and that this instrument functions well in a military setting. This research adds to a large body of evidence demonstrating associations between a favorable nursing practice environment and fewer adverse events. In addition, this analysis augments past research by identifying the specific aspects of the nursing practice environment that matter most for particular outcomes in the military setting. By identifying these relationships, we increase the actionable nature of the PES-NWI survey results, particularly with respect to nurse-administered medication errors and patient fall rate data.

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