Related Experiment Video
Updated: Mar 17, 2026
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Promoting Positive Nursing Practice Environments: Outcomes of a Randomized Trial in Primary Care
Soraia Cristina de Abreu Pereira1,2,3, Eduardo José Ferreira Dos Santos3,4,5,6, Rosilene Alves Ferreira7
1School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal, up.pt.
Background:
The nursing practice environment is widely recognized as a key factor in promoting care quality and safety. It is associated with greater professional satisfaction, improved nurse retention, and reduced adverse events. Despite its importance being broadly acknowledged in the literature, there are few structured interventions aimed at promoting the nursing practice environment.
Objective:
To evaluate the effectiveness of the Positive Nursing Practice Environment Promotion Program (PPAPEP) in improving primary care nurses' perceptions of their work environment and attitudes toward patient safety.
Methods:
A randomized, controlled, parallel-group, double-blind clinical trial was conducted in primary healthcare units in Northern Portugal between September 2024 and April 2025. A total of 48 nurses participated, allocated by stratified randomization into intervention and control groups. The instruments Scale for the Environments Evaluation of Professional Nursing Practice-Shortened Version and the Safety Attitudes Questionnaire-Short Form were applied at three time points: preintervention, postintervention, and three-month follow-up. Statistical analysis included paired and independent t-tests, repeated-measures ANOVA, and correlation analysis.
Results:
The PPAPEP produced modest improvements in overall perceptions of the nursing practice environment in the intervention group, with small significative changes in the structure and process subscales. No statistically significant changes were observed in the safety climate. Follow-up analyses showed an inverted U-shaped pattern, indicating that the immediate positive effects slightly decreased over time. Perceptions of the practice environment and safety climate were strongly correlated at all time points.
Conclusions:
The PPAPEP has demonstrated effectiveness in improving the nursing practice environment. Effects on the safety climate were limited, suggesting that sustained changes require continuous interventions, periodic reinforcement, and institutional involvement. The strong association between nurses' perceptions of the work environment and the safety climate highlights the need for integrated strategies that simultaneously promote good working conditions and patient safety.
Trial Registration:
ClinicalTrials.gov.identifier: NCT06762015.
Related Concept Videos
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:11Guidelines for Writing Outcome
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care...
01:13Patient-centered Care
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:15Nursing Evaluation
01:30Current Trends in Nursing II