"Percepción del entorno laboral de las enfermeras del área III de salud de Lorca tras la implantación del programa de guías de práctica clínica ""centros comprometidos con la excelencia en cuidados"

Resum

BACKGROUND: The health organizations hope to achieve better health outcomes for the population they serve. Among other aspects, it is required that nurses intend to achieve excellence in the care they provide. This involves constant updating of knowledge and skills and application of best practices. It requires an adequate working environment that favors an adequate working climate, that supports practices based on the best scientific evidence, that enables the mechanisms to provide quality and safe care and, thus, improve the satisfaction of professionals with their work. AIM: To know if there are changes in the perception of the work environment that nurses in the Health Area III of Lorca of the Community of Murcia after applying the Program of Implementation of Guidelines of Clinical Practice "Best Practices Spotlight Organizations (BPSO¿)". METHOD: Cross-sectional, observational study comparing data on quality and safety of nursing care and perception of the working environment of nursing professionals in Health Area III of Lorca in 2012 (M0) and 2016 (M1). The Program for the Implementation of Guidelines for Clinical Practice "Best Practices Spotlight Organizations (BPSO¿)" was establish. The population initially formed by 390 participants in 2012 and 395 in 2016, 100% of nurses and midwives ascribed to the Division of Nursing. Nursing professionals in hospital and community care who had some kind of working relationship with the Murciano Health Service, Area III at the time of the study and who were in active service. Socio-demographic, labor variables, attitude to the EBP, about the perception of the environment and job satisfaction, as well as the perception of the professionals of the quality of the care they provide and patient safety. Data collection instruments consisted of 5 blocks containing the questionnaires: Evidence-Based Nursing Attitude (CAPEBE). Ruzafa-Martínez (2011); Organizational climate, Koys & Decottis (1991) and Satisfaction of Nursing Professionals and Perception of Quality of Care and Patient Safety. Statistically significant results for p <0.05. The data was entered into a database and the analysis was performed with the SSPS statistical package for Windows version 21.0. RESULTS: A total of 451 professionals participated, 219 in the first measure (M0) of a total of 363 nursing professionals, a response rate of 60.33% and 232 in M1, out of a total of 368 professionals, response rate 63.04%. 75% (159) of female professionals and in the second, 74.2% (170), (Chi square 0.034, p = 0.854). The perception of nursing professionals about the percentage of application of EBP in their clinical environment is 55.11% (CI 95% 51.2 - 58.9) on average in 2012 and 55.41% (IC 95 % 52.2-58.5) in 2016 (U of Mann-Withney 24810.0, p = 0.723). The lowest scores in the organizational climate are observed in the dimensions "Recognition" and "Pressure". The highest scores are seen in the "Confidence" and "Support" dimensions. They are very satisfied with the choice of nursing as a profession and highly satisfied nurses are somewhat higher in M1 (Chi square 4.71, p = 0.194). 76% of M0 professionals and 82% of M1 indicate that they are moderately or very satisfied with the current work (Chi square 4,24, p = 0,237). Working in primary care, perceiving that human resources are adequate, and having opportunities for professional development is positively associated with the perception of quality of care. CONCLUSIONS: The results of the present study allow us to know the local situation, in terms of professional profiles and work characteristics of nurses, compared to regional, national and international contexts. Thus, we can manage the human resources of nurses with the best available information. The Clinical Practice Guidelines Implementation Program "Best Practices Spotlight Organizations (BPSO¿)" has meant a revulsive in the organization that has forced us to evaluate the organization in general and in particular. The impact of their results on professionals and patients requires time. But it has allowed us to know in what situation we are and what we may need to improve professional practice and results in the health of patients and ensure a high quality care based on personal experience and in the context of daily practice. This is the first research carried out in the Spanish context, which evaluates nurses&apos; work environment after the implementation of the Clinical Practices Program "Best Practices of Outstanding Organizations (BPSO¿)" and provides data on the characteristics of the environment In which the nurses of Area III of Lorca implement the evidence offered by the best practice guideline of RNAO¿