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El entorno laboral de los profesionales de enfermería es un área temática de gran interés para organizaciones internacionales en salud, organizaciones profesionales internacionales y locales, académicos, investigadores y directores o gerentes de enfermería, por la mediación o el impacto que estos entornos pueden tener en los resultados personales y profesionales de los enfermeros, en la calidad de la atención que se brinda a los pacientes y en los resultados de las organizaciones proveedoras de servicios de salud. Por lo anterior, existe el gran desafío de establecer entornos laborales saludables para mejorar la práctica de los enfermeros. Para promover la investigación empírica de los entornos laborales saludables de los enfermeros de práctica asistencial en el ámbito hospitalario, se desarrolló el instrumento ENLASA-Enfermería empleando un diseño de métodos mixtos secuencial exploratorio de tres fases. En la primera fase se adelantó la definición del concepto y la identificación de sus características, iniciando con una sub-fase de revisión teórica, continuando con una subfase de abordaje cualitativo con enfermeros y finalmente una sub-fase analítica para interconectar los hallazgos teóricos y cualitativos. En la segunda fase se generó un banco de ítems organizado en dos dimensiones (parte A: componentes estructurales organizacionales y parte B: dimensión de procesos organizacionales) que fue sometido a una revisión por expertos para estimar la validez facial y de contenido, y posteriormente se realizó una prueba piloto con una muestra de 22 enfermeros. Finalmente, en la tercera fase se aplicó el instrumento a una muestra de 307 enfermeros clínicos del ámbito hospitalario de diferentes municipios y ciudades de Colombia, con lo cual se realizó una evaluación de las propiedades métricas en términos de validez de constructo y confiabilidad. Los resultados obtenidos permitieron clasificar cada una de las partes de ENLASAEnfermería como satisfactorias en términos de validez facial y de contenido con índices globales superiores a 0,80 en las variables evaluadas por cada parte; con consistencia interna satisfactoria (Alfa de Cronbach parte A: 0,930 y parte B: 0,944) y con una estructura interna que permitió reconocer los elementos conceptuales de un entorno laboral saludable que respaldan su contenido. Se concluyó que ENLASA-Enfermería es un instrumento válido y confiable, prometedor para la investigación y la evaluación de los entornos laborales saludables de enfermeros clínicos en el ámbito hospitalario en Colombia.

The work environment of nursing professionals is a subject area of great interest to international health organizations, international and local professional organizations, academics, researchers and nursing directors or managers due to the mediation or the impact that these environments may have in the results of the professionals nursing, in the quality of care provided to patients and in the results of health service provider organizations. Therefore, there is the great challenge of establishing healthy work environments to improve the practice of professionals nursing. To promote empirical research on healthy work environments for nurses in care practice in the hospital setting, the ENLASA-Nursing instrument was developed using a three-phase exploratory sequential mixed methods design. In the first phase, the definition of the concept and the identification of its characteristics were advanced, starting with a sub-phase of theoretical review, continuing with a subphase of qualitative approach with nurses and finally an analytical sub-phase to interconnect the theoretical findings and qualitative. In the second phase, a bank of items organized in two dimensions (part A: organizational structural components and part B: organizational processes dimension) was generated, which was subjected to a review by experts to estimate facial and content validity and subsequently carried out a pilot test with a sample of 22 nurses. Finally, in the third phase, the instrument was applied to a sample of 307 clinical nurses from the hospital environment of different municipalities and cities in Colombia, with which an evaluation of the metric properties in terms of construct validity and reliability was carried out. The results obtained allowed classifying each of the parts of ENLASA-Nursing as satisfactory in terms of facial validity and content with indices global above 0.80 in the variables evaluated; with satisfactory internal consistency (Cronbach's Alpha part A: 0,930 and part B: 0,944) and with an internal structure that demonstrated relationships between items, subdimensions and dimensions, confirming the existence of the healthy work environment construct measured by the instrument. It was concluded that ENLASA-Nursing is a valid and reliable instrument, promising for the research, establishment and evaluation of healthy work environments of clinical nurses in the hospital setting in Colombia.

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Objective: to explore self-perception competence among Spanish nurses dealing with patient death and its relationship with work environment, evidence-based practice, and occupational stress. Method: a cross-sectional web-based survey collected information from a convenience sample of 534 nurses from professional Spanish Colleges who answered four validated questionnaires: Coping with Death Scale, Practice Environment Scale of the Nursing Work Index, Perception of Evidence-Based Practice (EBP) and Nursing Stress Scale. Results: a total of 79% of the participants were women, the average age was 40 years old, 38% had a postgraduate degree and 77% worked in public health settings. Many nurses evaluated their work environment as unfavorable (66%), reported high occupational stress (83.5±14.9), and had high scores on knowledge/skills in EBP (47.9±11.3). However, 61.2% of them perceived an optimal coping (>157 score). The multivariate logistic model indicated positive associations with work environment and EBP characteristics (OR: 1.30, p=0.054; OR: 1.04, p=0.007; OR: 1.13, p<0.001, respectively) but negative associations with occupational stress and short work experience (OR: 0.98, p=0.0043; OR: 0.74, p<0.002, respectively). These factors explained 23.1% of the coping variance (p<0.001). Conclusion: although most nurses perceived optimal coping, the situation could be enhanced by modifying several contextual factors. The identification of these factors would improve the quality of end-of-life care by facilitating nursing management.

Objetivo: explorar a capacidade de autopercepção entre enfermeiros espanhóis que lidam com a morte do paciente e sua relação com o ambiente de trabalho, a prática baseada em evidências e o estresse ocupacional. Método: pesquisa transversal pela internet coletou informações de uma amostra de conveniência de 534 enfermeiros das Faculdades Profissionais Espanholas que responderam a quatro questionários: Escala de Enfrentamento da Morte, Escala Ambiente de Trabalho da Prática de Enfermagem, Percepção da Prática Baseada em Evidências (EBP, acrônimo em inglês) e Escala de Estresse em Enfermagem. Resultados: 79% das participantes eram mulheres com média de 40 anos, 38% tinham pós-graduação e 77% trabalhavam em ambiente de saúde pública. Muitos enfermeiros avaliaram seu ambiente de trabalho como desfavorável (66%), relataram alto estresse ocupacional (83,5 ± 14,9) e altas pontuações em conhecimento/habilidades em EBP (47,9 ± 11,3). No entanto, 61,2% deles consideraram um enfrentamento ótimo (pontuação >157). O modelo logístico multivariado indicou associações positivas com o ambiente de trabalho e as características da EBP (OR: 1,30, p = 0,054; OR: 1,04, p = 0,007; OR: 1,13, p < 0,001, respectivamente), mas negativas com estresse ocupacional e curta experiência de trabalho (OR: 0,98, p = 0,0043; OR: 0,74, p < 0,002, respectivamente). Esses fatores explicaram 23,1% da variância de enfrentamento (p < 0,001). Conclusão: embora a maioria dos enfermeiros considerasse um enfrentamento ótimo, a situação poderia ser melhorada pela modificação de vários fatores contextuais. A identificação desses fatores melhoraria a qualidade da assistência no final da vida, facilitando a gestão da enfermagem.

Objetivo: explorar el afrontamiento autopercibido por los profesionales españoles de enfermería para trabajar con pacientes moribundos y su relación con el entorno laboral, la práctica clínica y el estrés ocupacional. Método: estudio observacional transversal vía internet de una muestra de conveniencia con 534 enfermeros reclutados a través de colegios profesionales españoles que respondieron a cuatro cuestionarios validados: Escala de Afrontamiento de la Muerte, Entorno de la Práctica Enfermera, Práctica Basada en la Evidencia en Enfermería (PBE) y Escala de Estrés para Enfermería. Resultados: la mayoría de los participantes fueron mujeres (79%), de 40 años de media, con estudios de posgrado (38%) y trabajando en el sistema público (77%). Gran parte evaluó su ambiente de trabajo como desfavorable (66%), mostrando estrés ocupacional (83,5 ± 14,9) y altas puntuaciones en conocimiento/habilidades-PBE (47,9 ± 11,3). Sin embargo, el 61,2% autopercibía un afrontamiento óptimo (> 157 puntos). El análisis de regresión logística multivariante mostró que el afrontamiento se asociaba positivamente con el entorno laboral y dos subescalas-PBE (OR: 1,30, p= 0,054; OR: 1,04, p= 0,007; OR: 1,13, p <0,001, respectivamente), pero negativamente con el estrés ocupacional y la poca experiencia laboral (OR: 0,98, p= 0,0043; OR: 0,74, p <0,002, respectivamente). Estos factores explicaban el 23,1% de la varianza (p <0.001). Conclusión: aunque la mayoría de los enfermeros percibían un afrontamiento óptimo, la situación podría mejorarse modificando algunos factores. La identificación de estos factores mejoraría la calidad de la atención de los pacientes al final de la vida, facilitando la gestión de enfermería.

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Job-related burnout has been reported by intensive care nurses worldwide; this study was performed to examine burnout in intensive care unit bedside nurses and nurse technicians in Brazil. A cross-sectional survey that included the Practice Environment Scale and the Maslach Burnout Inventory was completed by 209 nurses and nurse technicians working in 4 Brazilian intensive care units in 3 teaching hospitals. Compared with nurse technicians, nurses reported higher levels of emotional exhaustion and depersonalization, and a lower level of personal accomplishment. A 1-unit increase in the quality of nurse practice environment was associated with a decrease in high levels of emotional exhaustion and low levels of personal accomplishment. Each additional patient added to a nurse's workload was associated with an increase in high emotional exhaustion and low personal accomplishment. Approximately one-third of Brazilian nurses working in intensive care units report job-related burnout; the practice environment and staffing appear to be contributing factors.

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INTRODUCTION: The ongoing challenge for Chilean hospitals of meeting population health needs merits attention to the health care workforce. No studies have explored how nursing might contribute to addressing this challenge. International research shows that organizational characteristics of the nursing workforce and practice environment are associated with patient outcomes. Chile lacks actionable evidence that applies to its context of care. METHOD: First, a review of international literature was developed to synthesize evidence on the association between organizational characteristics of the nursing workforce and patient outcomes. Second, a review of literature and other nonacademic sources was performed to describe the context of care and data pertaining to nurses in Chilean hospitals. Third, a research agenda for efficient utilization of the hospital nursing workforce in Chile was proposed. RESULTS: International evidence shows that low patient-to-nurse ratios, high skill mix, and good practice environments are associated with better patient outcomes. Chilean hospitals have financial constraints that greatly influence the context of nursing practice and the scarce data about nursing organization call for greater attention. CONCLUSION: The establishment and implementation of a research agenda is needed to build local evidence regarding effective organization of nurses to inform policies and to improve patient outcomes in Chile.

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CONTEXT: Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. OBJECTIVES: To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. DESIGN AND SETTING: Cross sectional analysis combining nurse survey data with infant discharge data. PARTICIPANTS: A national sample of neonatal intensive care units (N=97), nurses (N=5614) and very low birth weight infants (N=6997). METHODS: Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on "any human milk") and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). RESULTS: The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p<0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p<0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p=.056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p<0.001). CONCLUSIONS: Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge.

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A pesar de los esfuerzos por medir los ambientes de práctica de Enfermería en Colombia, las mediciones no son reales debido a la falta de instrumentos específicos que permitan evidenciar las condiciones del entorno de la práctica. El objetivo de esta investigación es validar la versión en español del instrumento PES- NWI "Practice Environment Scale of the Nursing Work Index" de Eileen Lake , el cual ha sido aplicado en diferentes contextos internacionales, reconociendo los entornos o ambientes de trabajo en enfermería. Se usó un diseño de tipo metodológico, puesto que se evaluaron las propiedades psicométricas de la escala. Resultados: El instrumento reporta validez facial superior a 0.90 en las tres variables evaluadas, validez de contenido iguales o superiores a 0.90, validez de constructo que arroja como resultado la presencia de las cinco dimensiones del instrumento original y una confiabilidad medida a través de pruebas de consistencia interna mediante el coeficiente de alfa de cronbach de 0.89. Se considera la versión en español del instrumento PES-NWI como válida de manera global para la medición del entorno laboral de la práctica de enfermería y se exponen las recomendaciones para el uso de este instrumento en la academia, en las instituciones hospitalarias y como propuesta para intervenir las condiciones del entorno que promuevan ambientes óptimos para la práctica del profesional de enfermería.

Despite efforts to measure the nursing practice environments in Colombia, the actual measurements are not real due to lack of specific tools that reveal the practice environment. The objective of this research is to validate the Spanish version of the PES-NWI instrument "Practice Environment Scale of the Nursing Work Index" by Eileen Lake, which has been applied in different international contexts, acknowledging the nursing work environments. For achieving, a methodological design was used, as it assessed the psychometric properties of the scale. Results: The instrument reports facial validity above to 0.90 in the three variables assessed, content validity above to 0.90, construct validity that resulted in the presence of five dimensions as the original instrument and reliability measured using internal consistency by Cronbach's alpha coefficient of 0.89. It is considered the Spanish version of the PES-NWI instrument valid globally for the measurement of the nursing work environment and sets out recommendations for the use of this instrument in academia, in hospitals and as a proposal for intervene in the environmental conditions that promote optimal environment of nursing practice

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