Group power through the lens of the 21st century and beyond: further validation of the Sieloff-King Assessment of Group Power within Organizations

How can strategies based on performance measurement and feedback support changes in nursing practice? A theoretical reflection drawing on Habermas' social perspective

Strategies based on performance measurement and feedback are commonly used to support quality improvement among nurses. These strategies require practice change, which, for nurses, rely to a large extent on their capacity to coordinate with each other effectively. However, the levers for coordinated action are difficult to mobilize. This discussion paper offers a theoretical reflection on the challenges related to coordinating nurses' actions in the context of practice changes initiated by performance measurement and feedback strategies. We explore how Jürgen Habermas' theory of Communicative Action may shed light on the issues underlying nurses' collective actions and self-determination in practice change and the implications for the design of strategies based on performance measurement and feedback. Based on this theory, we propose differences between communicative and functional coordination according to the nature of the actions and the purposes involved. The domains of action underlying these coordination processes, which Habermas referred to as the lifeworld and the system, are then used to draw a parallel with aspects of nursing practice. Further exploration of these concepts allows us to consider the tensions between the demands of the system and the self-determination of nurses within their practice.

AMPlifying metabolic screening for inpatients on antipsychotic medications with a nurse-driven protocol

INTRODUCTION

Patients on antipsychotic medications are at higher risk of developing metabolic syndrome; nevertheless, metabolic screening for patients on antipsychotics is suboptimal.

METHODS

This project developed and implemented AMP (Antipsychotic Metabolic screening Protocol), a nurse-driven protocol on inpatient psychiatric units that allowed nursing staff to collect all components of a metabolic screening. Nurses working on units with AMP were surveyed pre- and post-implementation on perception of AMP and empowerment.

RESULTS

AMP significantly increased overall metabolic screening as well as the most frequently missing component (lipid panel). The screening rates pre-intervention were similar to those found in the literature (on average, only two-thirds of patients were screened). However, AMP improved the rate such that nine out of every ten patients on the units were screened. Nurses had a negative perception and no change in empowerment from AMP implementation.

CONCLUSIONS

AMP can be used to increase metabolic screening for patients on antipsychotics. Further research is needed to better understand adoptability of nurse-driven protocols in the psychiatric inpatient setting as well as other applications, such as smoking cessation or safety sitters.

Perception of nursing in Primary Health Care about patients with hypertension: does King explain?

OBJECTIVES

to understand nurses' perceptions about Imogene King's concepts on CMIOS and its association with caring for patients with hypertension in Primary Health Care.

METHODS

a qualitative interventionist research with Family Health Strategy nurses who care for patients with hypertension at Primary Health Care in Maracanaú-CE. A focus group was held with seven nurses, in two audio-recorded and transcribed meetings, to analyze the production of meanings based on discursive practices.

RESULTS

the categories personal system, interpersonal system, and social system emerged referring to the potentialities and difficulties found both for understanding concepts, but also in the interaction with oneself, with hypertensive patients and health organization, with a view to adequate care for hypertensive patients.

FINAL CONSIDERATIONS

it was verified the understanding of nurses' knowledge in relation to King's concepts, associating its application in the context of care for patients with hypertension.

Effects of nursing power and organizational trust on nurse's responsiveness and orientation to patient needs

Aim

To assess the relationship among perceived nursing group power, organizational trust and patient orientation and identify patient orientation predictors.

Background

Nurses and nursing organizations should use all resources to give care.

Methods

Survey data were collected from 193 nurses at six acute care hospitals in South Korea. Characteristics of hospitals and nurses were analysed using t tests, one-way ANOVAs and regression models.

Results

The means for perceived nursing group power, organizational trust and patient orientation were 3.71 (SD± 0.58), 3.22 (SD± 0.83) and 3.94 (SD± 0.53), respectively. Multiple regression analysis revealed that 40% of the variance in patient orientation was explained by perceived nursing group power, organizational trust and work experience.

Conclusion

Hospitals should increase nursing group power and improve organizational trust to enhance patient orientation. Hospital executives and nurse managers should work to enhance nursing group power and positive perceptions of organizational trust, which could contribute to patient orientation.

A concept analysis of power

Using Walker and Avant's theory construction strategy, a concept analysis of power was conducted. Within the nursing literature, there exists a dialectic between types of power: power to vs. power over. This dialectic covers a wide range between goal attainment and powerlessness. The aim of this concept analysis was to examine power to for its potential fit with the phenomenon of nurses' lack of participation in professional organizations and on governing boards. The assumptions of this concept analysis are that power to is good, and that as humans with cognitive abilities, nurses have sufficient power to, whether they engage it or not. The Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, Business Source Elite, Google Scholar, ABI/INFORM Complete, Education Research Complete, Historical Abstracts, and PsychINFO were searched using the keywords power, nursing, and group. Peer-reviewed, scholarly journal articles from 1957 to 2019 were considered. The derived definition of power to is largely unchanged from its 17th century definition: the knowledge, freedom, and intention to do or to effect something. Self-assessing and nurturing knowledge, freedom, and intention, and identifying risk-preference among nurses may yield potential candidates for participation in professional nursing organizations and on governing boards.

Empowerment in Nursing Literature: An Update and Look to the Future

This review was conducted to describe empowerment theories that have influenced nursing practice, education, and research. Multiple perspectives of empowerment including structural, psychological, and group have contributed to the failure to consistently describe and measure this complex concept. The majority of empowerment literature originates from nonnursing theoretical frameworks. This review suggests that the nursing theory of work team/group empowerment, a midlevel nursing theory based upon King’s conceptual framework of nursing, may be used to better understand and improve nurses’ work team’s/group’s empowerment within healthcare organizations.

C-Suite Roles and Competencies to Support a Culture of Shared Governance and Empowerment

OBJECTIVE

The aim of this study was to examine C-suite executives' perspectives on empowerment early in shared governance implementation.

BACKGROUND

Leadership influences a workplace culture for empowerment. However, the literature lacks clarity regarding the specific roles of C-suite executives in fostering empowerment.

METHODS

A system's top 47 executives were invited to participate in a Delphi study. Two Delphi rounds identified leadership empowerment philosophies, plus techniques for (a) understanding staff needs, (b) embedding empowerment, and (c) ensuing leadership accountability. In round 3, leaders rated the 3 types of techniques for ease and impact.

RESULTS

Results revealed a passive C-suite culture regarding empowerment. However, C-suite executives recognized the need for active promotion of an empowering culture. Optimal techniques for understanding staff empowerment needs were identified.

CONCLUSIONS

Modeling empowerment by the C-suite executives enables alignment between councils and levels of nursing leadership, allowing organizations to achieve the goals for professional nursing practice and shared governance.

Nursing Group Empowerment: Instrument Revision

BACKGROUND AND PURPOSE

The Sieloff-King Assessment of Group Empowerment with Organizations (SKAGEO) has demonstrated consistent reliability and validity, although past participants reported the need for revisions to further improve its clarity and ease of use in research. The purpose of this research was to use focus groups to revise the SKAGEO.

METHODS

Two focus groups were held (seven RNs and one student nurse). Thematic analysis was used to analyze the focus group discussions.

RESULTS

Five major themes, and eleven subthemes, were identified as areas for future revisions to further improve the instrument's clarity and use in research.

CONCLUSIONS

Revisions in the SKAGEO, based on the areas identified by the focus groups, would result in an instrument that would more easily be understood and incorporated into research.

Content and factor validation of the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations

BACKGROUND AND PURPOSE

Nursing education programs have responsibilities to their stakeholders to prepare graduates who can provide safe, effective patient centered care while leading health care changes. Empowered nurses have been associated with low nurse turnover and higher patient satisfaction; however, less is currently known about group empowerment in nursing education. In order to examine group empowerment in schools of nursing, the Sieloff-King Assessment of Group Empowerment in Organizations (SKAGEO©) was adapted and tested for content validity and confirmatory factor analysis.

METHODS/RESULTS

The adapted instrument, the Sieloff-King-Friend Assessment of Group Empowerment within Educational Organizations (SKFAGEEO) was first reviewed by nurse experts who provided quantitative and qualitative data regarding each item. A total of 320 nurse deans and faculty comprised the final sample for the second order confirmatory 8 factor analysis. Findings revealed factor loadings ranging from .455 to .960.The overall fit of the propose model was Chi Square=1383. 24, df=566, p<.001; GFI=.786, RMSEA=0.69.

CONCLUSIONS

The study results indicated that the SKFAGEEO has acceptable psychometric properties.

Understanding Influence within the Context of Nursing: Development of the Adams Influence Model Using Practice, Research, and Theory

Acquiring influence, and knowing how to use it, is a required competency for nurse leaders, yet the concept of influence and how it works is not well described in the nursing literature. In this article, the authors examine what is known about influence and present an influence model specific to nurse leaders. The Adams Influence Model was developed through an iterative process and is based on a comprehensive review of the influence literature, expert commentary, multiple pilot studies, evaluation of nursing theories, and validation by an external data source. Rather than defining "how to" influence, the model serves as a guide for personal reflection, helping nurse leaders understand and reflect on the influence process and factors, tactics, and strategies they can use when seeking to influence others.

Is the first-line nursing managers’ power congruent with that of the nursing group?

Aim

This research examined the relationship between nursing managers’ power and nursing group power in public health service organizations.

Approach/Methods

A cross-sectional survey of first-line nurse managers ( n = 264) from 11 Finnish hospitals was conducted. The power of nurse managers and nursing groups was examined through two reliable instruments: the Nursing Managers’ Power instrument and the Sieloff-King Assessment of Group Power within Organizations instrument©.

Findings

The power of nurse managers was perceived to be moderate on a 5-point Likert scale. Managers reported that they gained the most power from their role and position as a nursing manager, and lastly, from their resources. The power of nurse managers correlated no more than moderately with nursing group power.

Implications for Nursing Management

Organizations need to ensure that nursing managers have the power and opportunity to influence nursing goals and outcomes.