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

Long-term care (LTC) settings are 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 (NPE) is widely recognised as a determinant of care quality and safety, evidence regarding organisational interventions to improve the NPE and inform clinical governance in LTC remains fragmented. To synthesise the available evidence on organisational interventions that promote the quality of the nursing practice environment in long-term care settings. An integrative review was conducted following Whittemore and Knafl’s methodological framework. MEDLINE, CINAHL Complete, and grey literature were searched for studies published between January 2020 and January 2025. Ten studies met the eligibility criteria and were synthesised using an inductive thematic analysis. Four interrelated domains emerged: workforce structure , care processes (including person-centred care, safety culture, digital integration, and missed nursing care), nursing-sensitive outcomes , and organisational value . The evidence consistently suggested that favourable organisational conditions were associated with improvements in care processes and nursing-sensitive outcomes. However, relatively few studies evaluated organisational value longitudinally or examined integrated governance approaches capable of linking these domains. The findings suggest that improving the quality of the NPE in LTC requires integrated organisational interventions that simultaneously address workforce conditions, care processes, nursing-sensitive outcomes, and organisational value. The proposed conceptual framework, derived from the synthesis of the available evidence, may inform clinical governance, nursing leadership, and evidence-informed management. Nevertheless, the limited longitudinal evidence highlights the need for future research to validate integrated governance models and evaluate their impact on organisational performance and quality of care. Not applicable.