Background: Nursing practice environment has impact on the quality of nursing care and on patients’ and nurses’ outcomes, namely better performances of these healthcare workers. Improving the nursing practice environment is a low-cost organizational strategy to achieve better patients’ outcomes and retain qualified nurses, thus improving nursing care of units, healthcare organizations and healthcare system. This study aims to analyse the relationship between nursing practice environment and the nurses` perception of quality of care, patient safety, and safety culture in Primary Health Care in Portugal. Methods: We conducted a descriptive, analytical, and cross-sectional study using data from RN4CAST Portugal. The sample was composed of 1059 nurses from 55 Health Center Groups of the mainland Portugal, 15 Health Centers of the Autonomous Region of Madeira and 6 Health Centers of the Autonomous Region of the Azores. Multivariate analysis and correlation analysis methods were used for data processing. Results: Nurses consider that, in the Portuguese Primary Health Care, there is a mixed and unfavourable nursing practice environment, with a perception of a good quality of care, and both acceptable patients’ safety and safety culture. The Collegial Nurse-Physician Relations and Nursing Foundations for Quality of Care dimensions to have the best ratings. The perception of Primary Health Care nurses on the dimension Nurse Participation in Organization Affairs was the one that showed the lowest score, followed by Staffing and Resource Adequacy and Nurse Manager Ability, Leadership, and Support of Nurses. Based on perception of nurses, the relationship between the nursing practice environment and the safety culture is higher, followed by the quality of care and patients’ safety. Conclusions: The perception of Primary Health Care nurses is that there is an unfavourable and mixed nursing practice environment, with good quality of care, and acceptable patient safety and safety culture. The quality of the nursing practice environments is associated to better quality and safety of care. Thus, improving the nursing practice environments in healthcare organizations is a low-cost organizational strategy to achieve greater patients and nurses’ outcomes, improving the quality of nursing care to patients in the Primary Health Care units.

Background: The delivery of quality, safe, and patient-centered care is foundational for professional practice. The primary nursing model allows nurses to have excellent knowledge about patients and families and to plan and coordinate care from admission to discharge, with better management of health situations. Nurses play a crucial role in improving patients’ outcomes, namely those sensitive to nursing care. The knowledge of the relationship between the primary nursing model and the nursing-sensitive outcomes provides new scientific evidence that strengthens the relevance of this nursing care organization model in the inpatients’ health outcomes. This systematic review describes the relationship between nurse-sensitive inpatients’ outcomes and the primary nursing care model. Methods: A systematic review was conducted with a narrative synthesis, and the following databases were searched: MEDLINE, CINAHL, Web of Science, Nursing & Allied Health Collection, SciELO Collections, and Cochrane. Results: A total of 22 full texts were assessed, of which five were included in the study according to the selection criteria. The analysis results indicated that the primary nursing care model was related to nursing-sensitive patient safety outcomes. Patients’ experience was also considered a nursing-sensitive outcome, namely in the satisfaction with nursing care. Conclusion: The negative outcomes are clearly related to the primary nursing care model. There is scarce research that relates primary nursing to positive outcomes, such as patients’ functional status and self-care abilities, and more studies are needed.

Objective: This study aims to validate the Portuguese version of the Practice Environment Scale of the Nursing Work Index (PES-NWI) and assess construct validity through exploratory and confirmatory factor analyses. Materials and Methods: This cross-sectional study validates the psychometric properties of the PES-NWI in Portugal. Exploratory factorial analysis is used to analyze the psychometric properties of the PES-NWI in a sample of 5,075 Portuguese nurses; the data sample covers all geographic regions in the country. Confirmatory factor analysis is performed to confirm the model’s data adequacy. Results: Factorial analysis explained 54.6 % of the variance and a five-dimension structure. The five factors identified were Nurse Participation in Hospital Affairs, Nurse Manager Ability, Leadership and Support of Nurses, Nursing Foundations for Quality of Care, Staffing and Resource Adequacy, and Nurse-Physician Relations. The confirmatory analysis showed that the five-factor model fit well with the data in the Portuguese context. Conclusion: In a Portuguese health context, the PES-NWI is a valid scale to access the nursing environment and improve working conditions.

Background: The nursing practice environment significantly influences nurses’ job satisfaction, turnover, and burnout; therefore, it is essential to promote favorable environments to ensure the retention of qualified professionals. Improving the nursing practice environment is a low-cost organizational strategy associated with satisfaction, retaining professionals, and reducing burnout. The aim of this study was to assess the relationship between the nursing practice environment and job satisfaction, turnover, and burnout among primary healthcare nurses in Portugal. Methods: A descriptive, cross-sectional, and correlational study was carried out based on data from the RN4CAST Portugal Project. The Nurse Survey Instrument (Core Nurse Survey) of the RN4Cast Project (2018) was used for data collection. The sample consisted of 1059 nurses from fifty-five health center groups in mainland Portugal, fifteen health centers in the Autonomous Region of Madeira, and six health centers in the Autonomous Region of the Azores. Results: Primary healthcare nurses in Portugal rated the nursing practice environment as unfavorable or mixed, with an average ($\overline{\mathrm{x}}$) of 2.5 (standard deviation (SD) = 0.4), which is associated with lower job satisfaction, with an average of 2.0 (SD = 0.4), moderate intention to leave, with 40.3%, and low levels of burnout, with an average of 1.6 (SD = 0.8). There was also a negative correlation between the nursing practice environment and burnout (r = −0.28) and its dimensions. Emotional exhaustion (r = −0.35) represents the individual dimension of stress and physical exhaustion, corresponding to feelings regarding the depletion of emotional and physical resources, depersonalization (r = −0.18) represents the interpersonal context dimension of burnout, and a lack of personal accomplishment (r = −0.15) represents the self-assessment dimension of burnout and refers to feelings of incompetence and a lack of confidence and self-efficacy at work. Conclusions: The quality of the work environment is associated with greater job satisfaction and a reduction in burnout. For this reason, improving the work environment has therefore been associated with increased job satisfaction and reduced burnout among primary healthcare nurses, promoting nurse retention and the well-being of healthcare teams.