Do mood and the receipt of work-based support influence nurse perceived quality of care delivery? A behavioural diary study

AIMS AND OBJECTIVES: To examine the effect of nurse mood in the worst event of shift (negative affect, positive affect), receipt of work-based support from managers and colleagues, colleague and patient involvement on perceived quality of care delivery. BACKGROUND: While the effect of the work environment on nurse mood is well documented, little is known about the effects of the worst event of shift on the quality of care delivered by nurses. DESIGN: This behavioural diary study employed a within-subject and between-subject designs incorporating both cross-sectional and longitudinal elements. METHODS: One hundred and seventy-one nurses in four large district general hospitals in England completed end-of-shift computerised behavioural diaries over three shifts to explore the effects of the worst clinical incident of shift. Diaries measured negative affect, positive affect, colleague involvement, receipt of work-based support and perceived quality of care delivery. Analysis used multilevel modelling (mlwin 2.19; Centre for Multi-level Modelling, University of Bristol, Bristol, UK). RESULTS: High levels of negative affect and low levels of positive affect reported in the worst clinical incident of shift were associated with reduced perceived quality of care delivery. Receipt of managerial support and its interaction with negative affect had no relationship with perceived quality of care delivery. Perceived quality of care delivery deteriorated the most when the nurse reported a combination of high negative affect and no receipt of colleague support in the worst clinical incident of shift. Perceived quality of care delivery was also particularly influenced when the nurse reported low positive affect and colleague actions contributed to the problem. CONCLUSIONS: Receipt of colleague support is particularly salient in protecting perceived quality of care delivery, especially if the nurse also reports high levels of negative affect in the worst event of shift. RELEVANCE TO CLINICAL PRACTICE: The effect of work-based support on care delivery is complex and requires further investigation.