The examination of practice environment, burnout, and missed care on pressure ulcer prevalence rates using a complexity science framework

Abstract

Abstract Introduction: Health-care literature is diverse in studying and addressing the health-care work environment related to safety and nursing. Evidence found in the literature demonstrates that the health-care work environment and patient safety are being studied for the purposes of reducing errors and improving care delivery. Burnout also is a widespread issue among health-care workers. What is not evident in the literature is empirical research related to nurse burnout and missed care and their impact on patient care outcomes. Purpose: The purpose of the study was to determine what influenced the nurse at the bedside to avoid or address burnout and to improve patient care quality and safety. A secondary analysis of data from the National Database of Nurse Quality Indicators® (NDNQI®) 2011 and 2012 RN Surveys and quarterly clinical data collection was conducted. The study used a sequential regression analysis to examine the relationships among nurse worklife environment, nurse burnout levels, the practice patterns of missed care, and a patient outcome, hospital-acquired pressure ulcers. Results: The linear weighted combination of the variables in the model explained only 1% to 3% of the variance in prevalence rate of pressure ulcers for 2011 and 2012, respectively. Findings revealed that only academic teaching status was significantly related to pressure ulcer prevalence rates in 2011. In 2012, academic teaching status, RN hours per patient day (RNHPPD), and the practice environment subscales (PES) of hospital affairs and quality of care were significantly related to pressure ulcer prevalence rates. Neither burnout nor missed care had direct relationships with pressure ulcer prevalence; however, other environmental factors were related to burnout and missed care. Conclusions: Relationships between environmental factors, nurse burnout, missed care, and pressure ulcer prevalence rates were described in this study, appreciating the influence of hospital level (teaching status, region, size, and Magnet® status) and unit level (RNHPPD, skill mix [RNHPPD/THPPD], BS or higher degrees, specialty certification, and total years on unit) parameters. With only a small amount of variance in the prevalence rate of pressure ulcers explained, other relationships among the variables within the model were noted and described. All five domains of the Practice Environment Scale (PES) had significant relationships with the variables (i.e., burnout and missed care) within the model. Most importantly, this was an introduction to proposed future studies that could use complexity science as a framework to appreciate the ever-changing health-care environment and interactions of relationships emerging that potentially impact patient safety and quality.