title: The relationship between individualized care and the practice environment: an international study.
abstract: BACKGROUND
  Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies.
  
  
  OBJECTIVE
  The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries.
  
  
  METHODS
  This study had an international, multisite, prospective, cross-sectional, exploratory survey design.
  
  
  METHODS
  The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey.
  
  
  METHODS
  Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study.
  
  
  METHODS
  Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model.
  
  
  RESULTS
  Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care.
  
  
  CONCLUSIONS
  The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.
authors.affiliation: Cyprus University of Technology, Department of Nursing, School of Health Studies, Limassol, Cyprus. Electronic address: e.papastavrou@cut.ac.cy.
authors.forename: Evridiki
authors.initials: E
authors.lastname: Papastavrou
authors.affiliation: Istanbul University, Florence Nightingale School Faculty of Nursing, Istanbul, Turkey. Electronic address: rencar@istanbul.edu.tr.
authors.forename: Rengin
authors.initials: R
authors.lastname: Acaroglu
authors.affiliation: Istanbul University, Florence Nightingale School Faculty of Nursing, Istanbul, Turkey. Electronic address: msendir@istanbul.edu.tr.
authors.forename: Merdiye
authors.initials: M
authors.lastname: Sendir
authors.affiliation: Kristianstad University, Kristianstad, Sweden; University West, Sweden. Electronic address: Agneta.Berg@hkr.se.
authors.forename: Agneta
authors.initials: A
authors.lastname: Berg
authors.affiliation: Nursing Services - Education Sector, Ministry of Health, Cyprus. Electronic address: george.efstathiou@cytanet.com.cy.
authors.forename: Georgios
authors.initials: G
authors.lastname: Efstathiou
authors.affiliation: Malmö University, Department of Care Science, Malmö, Sweden; Skåne University Hospital, Department of Intensive Care and Perioperative Medicine, Malmö, Sweden. Electronic address: ewa.idvall@mah.se.
authors.forename: Ewa
authors.initials: E
authors.lastname: Idvall
authors.affiliation: National and Kapodistrian University of Athens, Faculty of Nursing, Athens, Greece. Electronic address: mkalafat@nurs.uoa.gr.
authors.forename: Maria
authors.initials: M
authors.lastname: Kalafati
authors.affiliation: University of Turku, Department of Mathematics and Statistics, Turku, Finland. Electronic address: jouko.katajisto@utu.fi.
authors.forename: Jouko
authors.initials: J
authors.lastname: Katajisto
authors.affiliation: University of Turku, Department of Nursing Science, Turku, Finland; Turku University Hospital, Turku, Finland. Electronic address: heleiki@utu.fi.
authors.forename: Helena
authors.initials: H
authors.lastname: Leino-Kilpi
authors.affiliation: National and Kapodistrian University of Athens, Faculty of Nursing, Athens, Greece. Electronic address: clemonid@nurs.uoa.gr.
authors.forename: Chryssoula
authors.initials: C
authors.lastname: Lemonidou
authors.affiliation: Unidade de Investigacão e Desenvolvimento em Enfermagem (UI&DE), Escola Superior de Enfermagem de Lisboa (Nursing Research and Development Unit UI&DE), Portugal. Electronic address: dluz@esel.pt.
authors.forename: Maria Deolinda Antunes
authors.initials: MD
authors.lastname: da Luz
authors.affiliation: University of Turku, Department of Nursing Science, Turku, Finland. Electronic address: suhonen.riitta@kolumbus.fi.
authors.forename: Riitta
authors.initials: R
authors.lastname: Suhonen
mesh_terms: D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D057285:Precision Medicine
keywords: Individualized care; International study; Nurses; Professional practice environment; Questionnaires; Regression analysis