Causal Modelling of Factors Influencing Quality of Nursing Care in China
DOI:
https://doi.org/10.60099/prijnr.2023.261537Keywords:
Causal model, High-performance work systems, Nursing practice environment, Perceived organizational support, Psychological empowerment, Quality nursing care, Work engagementAbstract
The quality of nursing care is essential and contributes to restoring people’s health and well-being, especially when people are hospitalized. Various factors relating to the quality of nursing care have been identified, including nursing shortages. However, in China, there has been little research undertaken on factors influencing nursing care quality. This cross-sectional study aimed to develop and test the Chinese Model of Quality Nursing Care. A multi-stage, proportional stratified random sampling was used to recruit 784 registered nurses in three affiliated hospitals of a medical university in the People’s Republic of China. Eight Instruments were used for data collection: a demographic data form, the Good Nursing Care Scale, the Nurse Staffing Item, the Practice Environment Scale of the Nursing Work Index, the 3-item Utrecht Work Engagement Scale, the Psychological Empowerment Scale, the High-performance Work Systems Scale, the 8-item Survey of Perceived Organizational Support. In addition, the Analysis of Moment Structure software program was used to test the hypothesized model.
Results indicated that the modified model fitted the empirical data and explained 31% of the variance in the quality of nursing care. Nursing practice environment, psychological empowerment and work engagement had positive direct effects on the quality of nursing care, with the nursing practice environment having the strongest total effect. Nursing practice environment, high-performance work systems, and perceived organizational support indirectly positively affected the quality of nursing care through psychological empowerment and work engagement. Unexpectedly, the patient-to-nurse ratio had no significant influence on the quality of nursing care. The results support the need for hospital managers to take action to improve the organizational support and work environment and create high-performance work systems to retain more nurses and midwives to enhance the quality of nursing care. The model requires further testing in practice and possible refinement.
References
Gishu T, Weldetsadik AY, Tekleab AM. Patients’ perception of quality of nursing care; atertiary center experience from Ethiopia. BMC Nurs. 2019; 18:37. https://doi.org/10. 1186/s12912-019-0361-z
Gaalan K, Kunaviktikul W, Akkadechanunt T, Wichaikhum O-A, Turale S. Factors predicting quality of nursing care among nurses in tertiary care hospitals in Mongolia. Int Nurs Rev. 2019;66(2):176-82. https://doi.org/10.1111/inr.12502
Zhang HY, Wu ZJ, Huo YM, Jian WY, Me L. Nursing quality and safety environment in tertiary general hospitals in China: a cross-sectional study. China Health QManage. 2019;26(3):9-13. doi: 10.13912/j.cnki.chqm.2019.26.3.03.
Yao Y, Yin PB, Liu XY. Falls prevention in China: time for action. Lancet Public Health. 2021;6(12):e875-6. https://doi.org/10.1016/S2468-2667(21)00251-6
Yao L, Ma XD, An L, Shang WH, LI W, Feng JJ, Zhan LL. Development process and prospect on nursing quality management and control in China in past decade. Chinese Nurs Manage. 2022;22(12):1761-6. https://doi.org/10.3969/j.issn.1672-1756.2022.12.001 (In Chinese)
Clarke SP, Donaldson NE. Nurse staffing and patient care quality and safety. In: Hughes RG, editor. Patient safety and quality: an evidence-based handbook for nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 25. pp. 111-35.
National Health and Family Planning Commission. National Nursing Career Development Plan (2021-2025). 2020 Mar 14[cited 2023 Jan 18]; Available from: http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=441f75ad347b4ed68a7d2f2972f78e67
National Health Commission of the People’s Republic of China. Nursing Professional Quality Control Indicators (2020 edition). 2020 Jan 24 [cited 2023 Mar 11]; Available from: http://www.nhc.gov.cn/yzygj/s7657/202008/c39639a79f7d4a6b935f33f87c57e2dc.shtml
Cao J. Toward a health silk road: China’s proposal for global health cooperation. China Q Int Strateg Stud. 2020;6(1):19-35. https://doi.org/10.1142/S2377740020500013.
Shinouyo M. “Health Silk Road” will strengthen world public health by spreading traditional Chinese medicine. 2022 Oct 20 [cited 2023 Mar 17]. Available from: http://za.china-embassy.gov.cn/chn/dshdxwfb/202210/t20221020_10788883.htm (In Chinese)
He AJ, Bali AS, Ramesh M. Active stewardship in healthcare: lessons from China's health policy reforms. Soc Policy Adm. 2022;56(6):925-40. doi: 10.1111/spol.12832.
World Health Organization. Global health observatory: explore a world of health data. 2023 Jan 12 [cited 2023 Apr 28]. Available from: https://www.who.int/data/gho/data/themes/health-workforce
Lake ET. Development of the practice environment scale of the nursing work index. Res Nurs Health. 2002;25(3): 176–88. https://doi.org/10.1002/nur.10032
Stolt M, Katajisto J, Kottorp A, Leino-Kilpi H. Measuring quality of care: A Rasch validity analysis of the good nursing care scale. J Nurs Care Qual. 2019;34(4):E1-E6. doi:10.1097/NCQ.0000000000000391.
Leggat SG, Karimi L, Bartram T. A path analysis study of factors influencing hospital staff perceptions of quality of care factors associated with patient satisfaction and patient experience. BMC Health Serv Res. 2017;17(1):739. doi: 10.1186/s12913-017-2718-x.
Bonias D, Bartram T, Leggat SG, Stanton P. Does psychological empowerment mediate the relationship between high performance work systems and patient care quality in hospitals? Asia Pac J Hum Resour. 2010;48(3):319-37. https://doi.org/10.1177/1038411110381667
Parr JM, Teo S, Koziol-McLain J. A quest for quality care: exploration of a model of leadership relationships, work engagement, and patient outcomes. J Adv Nurs. 2021;77: 207–20. https://doi.org/10.1111/jan.14583
Zacharatos A, Barling J, Iverson R. High-performance work systems and occupational safety. J Appl Psychol. 2005; 90(1):77–93. https://doi.apa.org/doi/10.1037/0021-9010.90.1.77
Liu X, Jing Z, Ke L, Judith GB, Liu JL,Yan Wu, et al. Associations of nurse education level and nurse staffing with patient experiences of hospital care: a cross sectional study in China. Res Nurs Health. 2020;43(1):103-13. https://doi.org/10.1002/nur.22003
Rockstuhl T, Eisenberger R, Shore LM, Kurtessis JN, Ford MT, Buffardi LC. et.al. Perceived organizational support (POS) across 54 nations: a cross-cultural meta-analysis of POS effects. J Int Bus Stud. 2020; 51:933-62. https://doi.org/10.1057/s41267-020-00311-3
Rani R, Rahman N, Yusak N. The relationship between high performance work system (HPWS), psychological empowerment (PE) and service employees’ performance (SEP): evidence from automotive retail industry. Manag Sci Lett. 2021;11(2021):1913-8. http://dx.doi.org/10.5267/j.msl.2021.1.011
Spreitzer GM. Psychological empowerment in the workplace: dimensions, measurement, and validation. Acad Manage J. 1995;38(5):1442-65. https://doi.org/10.2307/256865
Gong Y, Wu Y, Huang P, Yan X, Luo Z. Psychological empowerment and work engagement as mediating roles between trait emotional intelligence and job satisfaction. Front Psychol. 2020; 11:232. https://doi.org/10.3389/fpsyg.2020.00232
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 977;84(2):191–215. https://doi.org/10.1037/0033-295X.84.2.191
Bakker AB, Demerouti E. 2018. Multiple levels in job demands-resources theory: implications for employee well-being and performance. In: Diener E, Oishi S, Tay L, editors. Handbook of well-being. Salt Lake City: DEF Publishers; 2018, pp. 1-13.
Pfeffer J. The human equation. Boston: Harvard Business School Press; 1998.
Sheehan C, Tham TL, Holland P, Cooper B. Psychological contract fulfilment, engagement and nurse professional turnover intention. Int J Manpow. 2019;40(1):2-16. doi: 10.1108/IJM-08-2017-0211.
Chinese Government. The “Healthy China 2030” planning outline. 2020 Mar 14 [cited 2023 Feb 6]. Available from: http://www.gov.cn/zhengce/2016-10/25/content_ 5124174.htm
National Health Commission of the People’s Republic of China. The new recruited nurse training syllabus (for trial implementation) 2020 Apr 26 [cited 2023 Feb 18]. Available from: http://www.dffyw.com/faguixiazai/xzf/202009/48170.html
Juanamasta IG, Aungsuroch Y, Gunawan J. A concept analysis of quality nursing care. J Korean Acad Nurs. 2021; 51(4):430-41. https://doi.org/10.4040/jkan.21075
Schaufeli WB, Salanova M, Gonzalez-roma V, Bakker AB. The measurement of engagement and burnout: a two sample confirmatory factor analytic approach. J Happiness Stud. 2001; 3(1):71-92. https://doi.org/10.1023/A:1015630930326
Kline RB. Principles and practices of structural equation modeling. 3rd ed. New York: The Guilford; 2011.
Schaufeli WB, Shimazu A, Hakanen J, Salanova M, Witte HD. An ultra-short measure for work engagement: the UWES-3 validation across five countries. Eur J Psychol Assess. 2019;35(4):577–91. https://doi.org/10.1027/1015-5759/a000430
Meng Q, Sun F. The impact of psychological empowerment on work engagement among university faculty members in China.Psychol Res Behav Manag. 2019;12:983-90. doi: 10.2147/PRBM.S215912.
Wang L, Li LZ. Reliability and validity of Chinese Nursing Work Environment Scale. Chinese J Nurs. 2011;2: 121-3. doi: 10.3761/j.issn.0254-1769.2011.02.002 (in Chinese)
Brislin RW. Back-translation for cross-cultural research. J Cross Cult Psychol. 1970;1(3):185-216. https://doi.org/10.1177%2F135910457000100301
Hair, J.F., Black, W.C., Babin, B.J. and Anderson, R.E. (2010) Multivariate Data Analysis. 7th Edition, Pearson, New York. Pearson Prentice Hall; 2010.
Zhuang LJ, Liang GX, Li RF, Xu YJ. Research progress of ‘magnet hospital’ program in human resource management in nursing. Chinese Gen Pract Nurs. 2016;14(26):2722-3. doi: 10.3969/j.issn.1674-4748.2016.26.008 (in Chinese).
Li RF, Liang GX, Xu YJ, Zhuang LJ. Research progress on nursing human resource allocation in China. Chinese Nurs Res. 2016;30(15):1799-802. doi: 10.3969/j. issn.1009-6493.2016.15.003 (in Chinese).
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