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Background: The Patient CaringTouch System (PCTS) is an innovative, strategic and patient-centric framework developed by the Army Nurse Corps for nursing care delivery that is designed to reduce nursing care variation and improve patient and nurse outcomes., Purpose: This manuscript describes a program evaluation of the PCTS., Methods: A pre and post design was used to describe changes in patient and nursing measures following PCTS implementation., Discussion: Overall there was a good uptake of the PCTS; however, concurrent with initiation of the PCTS, declines in staffing levels and increases in patient acuity were noted. Medication administration error rates declined, but fall with injury rates increased. Pain reassessment following pain medication administration improved, as did several aspects of the nursing practice environment. Nurses' job dissatisfaction and intent to leave increased; however, potentially preventable losses decreased., Conclusions: The program evaluation results will be used to target areas for improvement so that the PCTS may be sustained., (Published by Elsevier Inc.)

Aim: The aim of this study was to confirm the psychometric properties of Practice Environment Scale of the Nursing Work Index in a military population. This study also demonstrates association rule analysis, a contemporary exploratory technique., Background: One of the instruments most commonly used to evaluate the nursing practice environment is the Practice Environment Scale of the Nursing Work Index. Although the instrument has been widely used, the reliability, validity and individual item function are not commonly evaluated. Gaps exist with regard to confirmatory evaluation of the subscale factors, individual item analysis and evaluation in the outpatient setting and with non-registered nursing staff., Design: This was a secondary data analysis of existing survey data., Methods: Multiple psychometric methods were used for this analysis using survey data collected in 2014. First, descriptive analyses were conducted, including exploration using association rules. Next, internal consistency was tested and confirmatory factor analysis was performed to test the factor structure. The specified factor structure did not hold; therefore, exploratory factor analysis was performed. Finally, item analysis was executed using item response theory. The differential item functioning technique allowed the comparison of responses by care setting and nurse type., Results: The results of this study indicate that responses differ between groups and that several individual items could be removed without altering the psychometric properties of the instrument., Conclusion: The instrument functions moderately well in a military population; however, researchers may want to consider nurse type and care setting during analysis to identify any meaningful variation in responses., (© 2017 John Wiley & Sons Ltd.)

Aim: The aim of the study was to develop recommendations for creating a healthy work environment based on current literature for nurses working within the US Military Health System (MHS). However, our findings would likely benefit other nursing populations and environments as well. Design: Systematic literature review. Data Sources: We conducted a systematic literature search for articles published between January 2010 until January 2024 from five databases: PubMed, Joanna Briggs, Embase, CINAHL and Scopus. Methods: Articles were screened, selected and extracted using Covidence software. Article findings were synthesized to create recommendations for the development, implementation and measurement of healthy work environments. Results: Ultimately, a total of 110 articles met the criteria for inclusion in this review. The articles informed 13 recommendations for creating a healthy work environment. The recommendations included ensuring teamwork, mentorship, job satisfaction, supportive leadership, nurse recognition and adequate staffing and resources. Additionally, we identified strategies for implementing and measuring these recommendations. Conclusions: This thorough systematic review created actionable recommendations for the creation of a healthy work environment. Based on available evidence, implementation of these recommendations could improve nursing work environments. Impact: This study identifies methods for implementing and measuring aspects of a healthy work environment. Nurse leaders or others can implement the recommendations provided here to develop healthy work environments in their hospitals, clinics or other facilities where nurses practice. Reporting Method: PRISMA 2020 guidelines. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. OBJECTIVE: The aim of this study was to describe the relationships between intent to leave, reasons nurses intend to leave, and the nursing work environment in military hospitals. BACKGROUND: Intention to leave is a precursor of nurse turnover. The reasons nurses intend to leave may be influenced by leader interventions and potentially preventable. METHODS: This descriptive, correlational secondary analysis included 724 nurse survey responses from 23 US Army hospitals. Bivariate correlations and predictive modeling techniques were used. RESULTS: Forty-nine percent of nurses indicated they intended to leave, 44% for potentially preventable reasons. Dissatisfaction with management and the nursing work environment were the top potentially preventable reasons to leave. Nurses who intended to leave for potentially preventable reasons scored aspects of the nursing work environment significantly lower than those intending to leave for nonpreventable reasons. CONCLUSIONS: Identifying potentially preventable reasons in conjunction with intent to leave can provide leaders opportunities to intervene and influence turnover intention. [ABSTRACT FROM AUTHOR]

Managerial coaching may be an effective strategy to reduce role ambiguity among nurses. Although the benefits of coaching relationships have been demonstrated outside of nursing, there is a lack of evidence about this career development relationship in nursing. A cross-sectional design was used to determine the relationship between managerial coaching and role ambiguity among military and civilian nurses who work in the Military Health System (MHS). Nurses who worked at a large academic medical center in San Antonio, Texas were asked to participate by completing a survey to examine the variables of interest. Among the 382 nurses that responded, perceived role ambiguity was low and managerial coaching was seldom perceived from first-line supervisors. However, there was a significant negative relationship between managerial coaching and role ambiguity. This study provides foundational knowledge about the relationship between managerial coaching and role ambiguity for nurses working in the MHS. • There is a lack of nursing literature on whether managerial coaching reduces role ambiguity. • Nurses seldom received coaching from their first-line supervisors in this study. • Despite low levels of role ambiguity reported by nurses, any experience could be important. • Perceptions of managerial coaching correlate with decreased role ambiguity perceptions. • Managerial coaching should be an expected part of performance management to reduce role ambiguity. [ABSTRACT FROM AUTHOR]

ABSTRACT: Favorable nursing practice environments have been associated with lower patient mortality, failure to rescue, nurse‐administered medication errors, infections, patient complaints, and patient falls. Favorable environments have also been associated with higher nurse‐reported care quality and patient satisfaction in civilian hospitals. However, limited information exists on the relationship between favorable nursing practice environments and positive outcomes in military facilities. Using 4 years of secondary data collected from 45 units in 10 Army hospitals, generalized estimating equations were used to test the associations between nurses’ scores on the Practice Environment Scale of the Nursing Work Index (PES‐NWI) and patient outcomes of falls with and without injury, medication administration errors with and without harm, and patient experience. Four significant associations were found between the PES‐NWI subscales and the patient outcomes under study. The Staffing and Resource Adequacy subscale was significantly associated with patient falls, the Collegial Nurse Physician Relations subscale was significantly associated with the rate of nurse‐administered medication errors, and the Nursing Foundations for Quality Care and Collegial Nurse Physician Relations subscales were both significantly associated with patient experience with nursing care. As in civilian hospitals, favorable nursing practice environment was associated with improved patient outcomes within these military nursing units. [ABSTRACT FROM AUTHOR]

To more precisely evaluate the effects of nurse staffing on hospital‐acquired pressure injury (HAPI) development, data on nursing care hours per patient day (NCHPPD), nursing skill mix, patient turnover (i.e., admissions, transfers, and discharges), and patient acuity were merged with patient information from pressure injury prevalence surveys that were collected annually for the Military Nursing Outcomes Database (MilNOD) project. The MilNOD included staffing and adverse events from 56 medical‐surgical, stepdown, and critical care units in 13 military hospitals over a 4‐year‐period. Data on 1,643 patients were analyzed with Cox proportional hazards models and generalized estimating equations. Staffing was not associated with pressure injuries in stepdown or critical care patients. However, among the 1,104 medical‐surgical patients, higher licensed practical nurse (LPN) nursing care hours per patient day (NCHPPD) 3 days and 1 week prior to the HAPI discovery date were associated with fewer HAPI (HR 0.27, p < .001), after controlling for patient age, Braden mobility score, and albumin level. Neither total staff number, nor RN NCHPPD, nor the proportion of staff who were RNs (RN skill mix) were associated with HAPI. These findings suggest that on military medical‐surgical units, LPNs play a major role in HAPI prevention. Although the national trend in acute care is to staff hospital units with more RNs and patient care technicians, and fewer LPNs, hospitals should reconsider LPNs as valuable members of the nursing care team. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]