Improving the nursing practice environment in long-term care: an integrative review to inform clinical governance and nursing management

An integrative review found that favourable organisational conditions in long-term care were consistently associated with improvements in care processes and nursing-sensitive outcomes. The synthesis identified four interrelated domains: workforce structure, care processes, nursing-sensitive outcomes and organisational value. It also found relatively few studies that evaluated organisational value longitudinally or examined integrated governance approaches capable of linking these domains.

The review aimed to synthesise evidence on organisational interventions that promote the quality of the nursing practice environment in long-term care settings. The authors stated that long-term care is characterised by organisational complexity and prolonged care trajectories, making nursing clinical governance highly dependent on integrated organisational information systems that support evidence-informed decision-making. Although the nursing practice environment is widely recognised as a determinant of care quality and safety, evidence about organisational interventions in this setting had been fragmented.

Researchers followed Whittemore and Knafl’s integrative review framework, searching MEDLINE, CINAHL Complete and grey literature for studies published from January 2020 through January 2025. Ten studies met the eligibility criteria. The researchers synthesised the included studies using inductive thematic analysis. The four resulting domains covered workforce structure; care processes, including person-centred care, safety culture, digital integration and missed nursing care; nursing-sensitive outcomes; and organisational value.

Based on the review abstract, the authors propose that improving the nursing practice environment in long-term care requires integrated organisational interventions addressing workforce conditions, care processes, nursing-sensitive outcomes and organisational value simultaneously. They derived a conceptual framework intended to inform clinical governance, nursing leadership and evidence-informed management. The review does not establish that a specific integrated governance model has already been shown to improve outcomes, and the reported findings describe associations between favourable organisational conditions and improvements rather than the results of a new intervention trial.

The review’s conclusions are bounded by limited longitudinal evidence and the small number of studies examining integrated governance approaches. The authors called for future research to validate integrated governance models and evaluate their effects on organisational performance and quality of care. The available evidence therefore supports the proposed framework as a basis for further study and governance development, but its direct effects remain to be evaluated.

Subject of Research: Integrative review of organisational interventions improving the nursing practice environment in long-term care

Article Title: Improving the nursing practice environment in long-term care: an integrative review to inform clinical governance and nursing management

Article References: Braga, V., Ramos, A., Braga, R., & José, H. (2026). Improving the nursing practice environment in long-term care: an integrative review to inform clinical governance and nursing management. BMC Nursing. https://doi.org/10.1186/s12912-026-05298-0

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DOI: 10.1186/s12912-026-05298-0

Keywords: long-term care, nursing practice environment, clinical governance, nursing management, integrative review, organisational interventions, care processes, nursing-sensitive outcomes, organisational value, Improving, nursing, practice