| ObjectiveTo investigate the status and influencing factors of nurses’ perception of the nursing work environment,nurses’ health-promoting behaviors,and nurses’ evaluation of nursing quality.To analyze the correlation and mechanism of nurses’ evaluation of nursing quality with the nursing work environment and health-promoting behaviors.The aim is to provide reference for nursing managers to develop targeted measures to improve the nursing work environment,enhance nurses’ health-promoting behaviors,and improve nursing quality.MethodsConvenience sampling was conducted in January-February 2022,selecting one tertiary Grade A comprehensive hospital each in Beijing and Xi’an.A total of 824 clinical nurses were surveyed using the General Information Questionnaire for Nurses,the Chinese version of the Nursing Work Environment Scale,the Chinese revised version of the Health-Promoting Lifestyle Profile II,and the Chinese version of the Nurse Assessed Quality Nursing Care Scale.Data entry and statistical analysis were performed using SPSS 26.0 and R 4.1.3software.Descriptive statistics were used to analyze the status of the nursing work environment,nurses’ health-promoting behaviors,and nurses’ evaluation of nursing quality.Single-factor analysis and multiple-factor analysis were used to analyze the influencing factors of the nursing work environment,nurses’ health-promoting behaviors,and nurses’ evaluation of nursing quality.Pearson correlation analysis was used to analyze the correlation between the nursing work environment,health-promoting behaviors,and nurses’ evaluation of nursing quality.Structural equation modeling was used to test the path relationship between the nursing work environment,health-promoting behaviors,and nurses’ evaluation of nursing quality,and the mediating effect model was used to test the mediating effect of health-promoting behaviors between the nursing work environment and nurses’ evaluation of nursing quality.Results(1)The total score of the Nursing Work Environment Scale was 94.89±14.01,with an average score of 3.39±0.50.The average scores of the five dimensions from high to low were: foundation of high-quality service,collaboration between nurse and physician,nurse manager leadership style,sufficient human and material resources,and nurse involvement in hospital affairs.The results of single-factor analysis showed that there were statistically significant differences in nursing work environment scores among the study subjects with different gender,age,education level,job title,department,weekly working hours,average sleep duration on workdays,and average daily overtime hours(all P<0.05).The results of multiple-factor analysis showed that job satisfaction,intention to stay,age,family support,gender,and job title were influencing factors of the nursing work environment(all P<0.05).(2)The total score of the Health-Promoting Lifestyle Profile was 120.30±22.26,with an average score of 3.01±0.56.The average scores of the six dimensions from high to low were: interpersonal relationships,spiritual growth,reasonable nutrition,stress management,health responsibility,and physical activity.The results of single-factor analysis showed that there were statistically significant differences in health-promoting behaviors scores among the study subjects with different gender,age,job title,department,average sleep duration on workdays,and average daily overtime hours(all P<0.05).The results of multiple-factor analysis showed that job satisfaction,intention to stay,gender,age,and average sleep duration on workdays were influencing factors of nurses’ health-promoting behaviors(all P<0.05).(3)The total score of the Nurse Assessed Quality Nursing Care Scale was176.94±19.04,with an average score of 4.66±0.50.The average scores of the six dimensions from high to low were: employee characteristics,task-oriented nursing,person-oriented nursing,patient outcomes,physical environment,and precondition.The results of single-factor analysis showed that there were statistically significant differences in the evaluation of nursing quality scores among the study subjects with different education levels,job titles,and average daily overtime hours(all P<0.05).The results of multiple-factor analysis showed that intention to stay,job title,and family support were influencing factors of nurses’ evaluation of nursing quality(all P<0.05).(4)Pearson correlation analysis results showed that the nursing work environment had a positive correlation with nurses’ evaluation of nursing quality(r=0.565,P<0.01),the nursing work environment had a positive correlation with health-promoting behaviors(r=0.642,P<0.01),and health-promoting behaviors had a positive correlation with nurses’ evaluation of nursing quality(r=0.426,P<0.01).(5)The results of structural equation modeling and mediating effect model showed that the nursing work environment had a direct positive impact on nurses’ evaluation of nursing quality(β=0.507,P<0.001),the nursing work environment had a direct positive impact on health-promoting behaviors(β=0.753,P<0.001),and health-promoting behaviors partially mediated the relationship between the nursing work environment and nurses’ evaluation of nursing quality(β=0.096,P=0.033),with a mediation effect of15.9%.Conclusions(1)Nurses’ perception of the nursing work environment is at a relatively high level,with high scores in the foundation of high-quality service,collaboration between nurse and physician,nurse manager leadership style and ability,and low scores in sufficient human and material resources and nurse involvement in hospital affairs.The results indicate that the insufficient involvement of nurses in hospital affairs is an issue that needs to be addressed.Job satisfaction,intention to stay,age,family support,gender,and job title are influencing factors of the nursing work environment.(2)Nurses’ health-promoting behaviors are at a relatively high level,with interpersonal relationships,spiritual growth,and reasonable nutrition as promoting factors,while stress management,health responsibility,and physical activity need to be enhanced.Job satisfaction,intention to stay,gender,age,and average sleep duration on workdays are influencing factors of nurses’ health-promoting behaviors.(3)Nurses’ evaluation of nursing quality is generally high,with high scores in employee characteristics,task-oriented nursing,and person-oriented nursing,and lower scores in patient outcomes,physical environment,and precondition,which need improvement.Intention to stay,job title,and family support are influencing factors of nurses’ evaluation of nursing quality.(4)Nurses’ perception of the nursing work environment,nurses’ health-promoting behaviors,and nurses’ evaluation of nursing quality are positively correlated with each other.The nursing work environment has a direct positive impact on nurses’ evaluation of nursing quality and health-promoting behaviors,and health-promoting behaviors partially mediate the relationship between the nursing work environment and nurses’ evaluation of nursing quality.Therefore,nursing managers should not only focus on factors influencing nurses’ evaluation of nursing quality but also pay attention to the impact of the nursing work environment and nurses’ health-promoting behaviors on nurses’ evaluation of nursing quality.Efforts should be made to improve the nursing work environment and enhance nurses’ health-promoting behaviors,especially in increasing physical activity levels.Attention should be given to factors influencing nurses’ perception of the nursing work environment,creating a supportive nursing work environment,and increasing nurses’ participation in hospital affairs.By improving the nursing work environment and enhancing nurses’ health-promoting behaviors,conditions can be created for nurses to provide high-quality nursing services to patients and improve nursing quality and patient satisfaction. |
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