Journal of advanced nursing · 2026
Dimensions and Meanings of the Work Environment of Nurses in Primary Care: A Mixed-Methods Study.
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de Andrade Lucas Lorran Costa, Brehmer Laura Cavalcanti de Farias, Lorenzini Elisiane, Lima Kássia Janara Veras, Faust Sabrina Blasius, Monteiro Wagner Ferreira, Sicsú Amélia Nunes, Ramos Flávia Regina Souza
Аннотация
AIM: To examine the dimensions and meanings of the work environment of Primary Health Care nurses in relation to organizational conditions and professional practice.
DESIGN: Sequential explanatory mixed-methods study.
METHODS: This study was conducted with Primary Health Care nurses in Manaus, Brazil. The quantitative phase included 243 participants using a validated work environment scale, analysed descriptively and compared across health districts. The qualitative phase involved 16 interviews analysed through thematic analysis. The phases were integrated using joint displays and meta-inferences to connect, compare and interpret the findings.
RESULTS: Work motivation was classified as healthy, particularly regarding meaning, recognition and autonomy, whereas safety and strategic management fell within the attention range, without differences across the districts. The qualitative findings confirmed and expanded these results and, for motivation, reframed them: motivation rested on the meaning nurses attribute to care rather than on favourable conditions, compensating for weaknesses in safety and management, the most fragile dimension.
CONCLUSION: The work environment is sustained from within, through professional commitment, whereas the structures that should protect and organize the work remain fragile, especially in a territorially complex, resource-constrained Amazonian setting.
IMPLICATIONS FOR THE PROFESSION: The findings support continuous, institutionalized strategies for worker protection, violence prevention, psychological support and participatory management.
IMPACT: This study shows that professional engagement coexists with organizational challenges, informing policy and workforce interventions.
REPORTING METHOD: STROBE and COREQ guidelines.
NO PATIENT OR PUBLIC INVOLVEMENT: No patient or public involvement.
DESIGN: Sequential explanatory mixed-methods study.
METHODS: This study was conducted with Primary Health Care nurses in Manaus, Brazil. The quantitative phase included 243 participants using a validated work environment scale, analysed descriptively and compared across health districts. The qualitative phase involved 16 interviews analysed through thematic analysis. The phases were integrated using joint displays and meta-inferences to connect, compare and interpret the findings.
RESULTS: Work motivation was classified as healthy, particularly regarding meaning, recognition and autonomy, whereas safety and strategic management fell within the attention range, without differences across the districts. The qualitative findings confirmed and expanded these results and, for motivation, reframed them: motivation rested on the meaning nurses attribute to care rather than on favourable conditions, compensating for weaknesses in safety and management, the most fragile dimension.
CONCLUSION: The work environment is sustained from within, through professional commitment, whereas the structures that should protect and organize the work remain fragile, especially in a territorially complex, resource-constrained Amazonian setting.
IMPLICATIONS FOR THE PROFESSION: The findings support continuous, institutionalized strategies for worker protection, violence prevention, psychological support and participatory management.
IMPACT: This study shows that professional engagement coexists with organizational challenges, informing policy and workforce interventions.
REPORTING METHOD: STROBE and COREQ guidelines.
NO PATIENT OR PUBLIC INVOLVEMENT: No patient or public involvement.