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Open Access Highly Accessed Systematic Review

Interventions aimed at improving the nursing work environment: a systematic review

Donna MJ Schalk1, Marloes LP Bijl2, Ruud JG Halfens2, Louk Hollands2 and Greta G Cummings3*

Author Affiliations

1 Faculty of Health and Social Studies, Research Department Acute Care, Han University of Applied Sciences, Nijmegen, the Netherlands

2 Department of Healthcare and Nursing Science, Maastricht University, Maastricht, the Netherlands

3 Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada

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Implementation Science 2010, 5:34  doi:10.1186/1748-5908-5-34

Published: 27 April 2010

Abstract

Background

Nursing work environments (NWEs) in Canada and other Western countries have increasingly received attention following years of restructuring and reported high workloads, high absenteeism, and shortages of nursing staff. Despite numerous efforts to improve NWEs, little is known about the effectiveness of interventions to improve NWEs. The aim of this study was to review systematically the scientific literature on implemented interventions aimed at improving the NWE and their effectiveness.

Methods

An online search of the databases CINAHL, Medline, Scopus, ABI, Academic Search Complete, HEALTHstar, ERIC, Psychinfo, and Embase, and a manual search of Emerald and Longwoods was conducted. (Quasi-) experimental studies with pre/post measures of interventions aimed at improving the NWE, study populations of nurses, and quantitative outcome measures of the nursing work environment were required for inclusion. Each study was assessed for methodological strength using a quality assessment and validity tool for intervention studies. A taxonomy of NWE characteristics was developed that would allow us to identify on which part of the NWE an intervention targeted for improvement, after which the effects of the interventions were examined.

Results

Over 9,000 titles and abstracts were screened. Eleven controlled intervention studies met the inclusion criteria, of which eight used a quasi-experimental design and three an experimental design. In total, nine different interventions were reported in the included studies. The most effective interventions at improving the NWE were: primary nursing (two studies), the educational toolbox (one study), the individualized care and clinical supervision (one study), and the violence prevention intervention (one study).

Conclusions

Little is known about the effectiveness of interventions aimed at improving the NWE, and published studies on this topic show weaknesses in their design. To advance the field, we recommend that investigators use controlled studies with pre/post measures to evaluate interventions that are aimed at improving the NWE. Thereby, more evidence-based knowledge about the implementation of interventions will become available for healthcare leaders to use in rebuilding nursing work environments.