Impact du climat organisationnel sur le façonnement des pratiques relationnelles de soin et la satisfaction professionnelle d’infirmières soignantes en milieu hospitalier

Relational caring practices (RCP) are at the heart of the professional standards and values defining the quality of the nursing profession; however, these practices are often compromised in unfavourable work environments. Difficulties experienced by nurses in implementing RCP’s (“caring” behaviours that make up a form of nurse-patient interaction) jeopardize healthcare quality and cause much frustration among nurses. By emphasizing relational aspects of the nursing process, this project, taking a “caring” framework, has implications for an innovative vision of healthcare quality and service organization through its attempts to explain how organizational climate influences RCP’s and professional job satisfaction among hospital staff nurses.  This study is based on an adaptation of Duffy and Hoskins’ (2003) Quality-Caring Model©, which combines Donabedian’s quality evaluation model (1980, 1992) and Watson’s Human Caring theory (1979, 1988). A sequential explanatory mixed design, combining a predictive correlational quantitative method and a single case study with overlapping analysis levels, was selected. In the quantitative portion of the study  involving 292 staff nurses, various validated Likert rating scales were used to measure the following variables: organizational climate (general climate and 5 composite dimensions); preferred RCP’s; current RCP’s; gaps between preferred and current RCP’s; and, professional job satisfaction. Hierarchical linear regression analyses were used to address 6 hypotheses in the quantitative portion. For the qualitative portion, data drawn from source documents, comments gathered through questionnaires and interviews conducted with 15 informants were systematically handled using content analysis strategies, to explain the relationships between the key concepts. Inferences from the quantitative and qualitative portions of the study were integrated using a complementarity approach.   Quantitative analyses revealed that after considering control variables were considered, a single organizational climate dimension (task specifications) accounted for 5 % of the variation in preferred RCP scores. Overall organizational climate and specific organizational climate dimensions (addressing characteristics of the job, organization, superior and team) played a major role in explaining current RCP levels (explaining from 5 % to 11% of variation), gaps between preferred and current RCP’s (4 % to 9 % of variation) and [staff nurse] professional job satisfaction (13 % to 30 % of variation). Furthermore, above and beyond the significant impact of overall organizational climate and control variables, RCP frequency was related to increased professional job satisfaction (ß = 0.31, p < 0.001), while the gap between preferred and current RCP’s were associated with lower professional job satisfaction (ß = - 0.30, p < 0.001) and accounted for similar portions of variability in this professional job satisfaction (7 % and 8 % respectively). The qualitative component revealed 4 factor orders that explain how the organizational climate shapes RCP’s and professional job satisfaction among nurses. These factors were: 1) workload intensity; 2) team approach and perceptions of the nurse’s role; 3) perceptions of the superior and organization; 4) specific patient/family and nurse characteristics. The analysis of these factors revealed interesting dynamic interactions between four of the five of the environment’s composite dimensions, thus suggesting that each dimension can be influenced by actions taken in relation to others. The integration of the quantitative and qualitative findings explained the significant impact of role characteristics on actual RCP’s, as well as professional job satisfaction, and support adoption of a systemic management approach improving multiple aspects of the work environment of hospital staff nurses.

Keyphrases: caring, administration, Organizational climate, relational caring practices, professional job satisfaction, healthcare organization, quality, administration, mixed methods, nursing process