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Pincha Baduge MSDS, Garth B, Boyd L, Ward K, Joseph K, Proimos J, Teede HJ. Barriers to advancing women nurses in healthcare leadership: a systematic review and meta-synthesis. EClinicalMedicine 2024; 67:102354. [PMID: 38314055 PMCID: PMC10837541 DOI: 10.1016/j.eclinm.2023.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/06/2024] Open
Abstract
Background Women comprise the majority of the nursing profession, yet nurses are underrepresented in healthcare leadership. We aimed to explore barriers for women nurses to advance in healthcare leadership to inform organisational interventions for career advancement. Methods In this systematic review and meta-synthesis, studies examining advancing women nurses and midwives in leadership within healthcare and academia in the international literature were included. Six databases (MEDLINE, EMCARE, EMBASE, PsycINFO, PubMed, and CINAHL PLUS) were searched for studies published in English between January 1 2000 and October 17 2023. The Grading of Recommendations Assessment, Development, and Evaluation tools (GRADE) was followed to assess confidence in the findings. Retrieved full texts were assessed for methodological rigour using the Critical Appraisal Skill Programme Qualitative Studies checklist and the Joanna Briggs Institute Cross-sectional and Prevalence Studies checklists. Reported barriers for women nurses' leadership attainment were identified and generated themes were mapped to the Abilities, Motivation, and Opportunities (AMO) framework. Findings There were 32 eligible studies; 18 qualitative, 11 quantitative, and 3 mixed-methods. Studies included high-income countries (n = 20), middle-income countries (n = 7) and across countries (n = 3) with two unspecified. Samples included registered nurses, nurse academics, executives, and leaders. The key barriers highlighted were related to: role modelling and leadership development (ability); multiple complex and interacting factors, including gender stereotyping, perception of professionalism, human relations policies, and gender bias (motivation); and systemic issues, such as organisational setting, structure, and support (opportunity). Interpretation The prevailing belief in the literature is that caregiving is a feminine occupation and along with societal expectations of women's subordinate position, these present substantial obstacles that limit women nurses from advancing into healthcare leadership. Ultimately, these factors restrict women nurses in career advancement and need to be addressed at a systems and organisational level. Funding The National Health and Medical Research Council (NHMRC), Australia.
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Affiliation(s)
| | - Belinda Garth
- Monash Centre for Health, Research and Implementation, Monash University, Melbourne, VIC, Australia
| | | | - Kylie Ward
- Australian College of Nursing, Australia
| | - Kathryn Joseph
- Monash Centre for Health, Research and Implementation, Monash University, Melbourne, VIC, Australia
| | - Jenny Proimos
- Monash Centre for Health, Research and Implementation, Monash University, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Helena J Teede
- Monash Centre for Health, Research and Implementation, Monash University, Melbourne, VIC, Australia
- Endocrine and Diabetes Units, Monash Health, Melbourne, VIC, Australia
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de Kok E, Schoonhoven L, Lalleman P, Weggelaar AM. Understanding rebel nurse leadership-as-practice: Challenging and changing the status quo in hospitals. Nurs Inq 2023; 30:e12577. [PMID: 37408336 DOI: 10.1111/nin.12577] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
Some nurses are responding rebelliously to the changing healthcare landscape by challenging the status quo and deviating from suboptimal practices, professional norms, and organizational rules. While some view rebel nurse leadership as challenging traditional structures to improve patient care, others see it as disruptive and harmful. These diverging opinions create dilemmas for nurses and nurse managers in daily practice. To understand the context, dilemmas, and interactions in rebel nurse leadership, we conducted a multiple case study in two Dutch hospitals. We delved into the mundane practices to expand the concept of leadership-as-practice. By shadowing rebel nurse practices, we identified three typical leadership practices which present the most common "lived" experiences and dilemmas of nurses and nurse managers. Overall, we noticed that deviating acts were more often quick fixes rather than sustainable changes. Our research points to what is needed to change the status quo in a sustainable manner. To change unworkable practices, nurses need to share their experienced dilemmas with their managers. In addition, nurse managers must build relationships with other nurses, value different perspectives, and support experimenting to promote collective learning.
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Affiliation(s)
- Eline de Kok
- Dutch Nurses' Association, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Pieterbas Lalleman
- Research Group for Person-Centeredness in an Ageing Society, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Anne M Weggelaar
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Autonomy in Japan: What does it Look Like? Asian Bioeth Rev 2022; 14:317-336. [PMID: 36203709 PMCID: PMC9530074 DOI: 10.1007/s41649-022-00213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/04/2022] Open
Abstract
This paper analysed the nature of autonomy, in particular respect for autonomy in medical ethics/bioethics in Japan. We have undertaken a literature survey in Japanese and English and begin with the historical background and explanation of the Japanese word Jiritsu (autonomy). We go on to identify patterns of meaning that researchers use in medical ethics / bioethics discussions in Japan, namely, Beauchamp and Childress’s individual autonomy, relational autonomy, and O’Neill’s principled autonomy as the three major ways that autonomy is understood. We examine papers discussing these interpretations. We propose using the term ‘a form of autonomy’ first used by Edmund Pellegrino in 1992 and examine the nature of ‘a form of autonomy.’ We finally conclude that the crux of what Pellegrino calls ‘something close to autonomy,’ or ‘a form of autonomy' might best be understood as the minimization of physician paternalism and the maximization of respect for patient preference. Simultaneously, we introduce a family-facilitated approach to informed consent and respond to criticism by Laura Sullivan. Finally, we discuss cross-cultural approaches and global bioethics. Furthermore, we use the term ‘Bioethics across the Globe’ instead of ‘Global Bioethics’, calling for international scholars to write works to provide an in-depth understanding of each country. We conclude that deep understanding of others is pivotal for dialogue to be of value. We hope this article will deepen the reader’s understanding of Japan and will contribute to the progress of bioethics worldwide.
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de Kok E, Weggelaar‐Jansen AM, Schoonhoven L, Lalleman P. A scoping review of rebel nurse leadership: Descriptions, competences and stimulating/hindering factors. J Clin Nurs 2021; 30:2563-2583. [PMID: 33955620 PMCID: PMC8453833 DOI: 10.1111/jocn.15765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 12/17/2022]
Abstract
AIMS To (1) give an overview of rebel nurse leadership by summarising descriptions of positive deviance, tempered radicals and healthcare rebels; (2) examine the competences of nurse rebel leadership; and (3) describe factors that stimulate or hinder the development of rebel nurse leadership. BACKGROUND Research shows nurses have lower intention to leave their jobs when they can control their work practices, show leadership and provide the best care. However, organisational rules and regulations do not always fit the provision of good care, which challenges nurses to show leadership and deviate from the rules and regulations to benefit the patient. Three concepts describe this practice: positive deviance, healthcare rebels and tempered radicals. DESIGN Scoping review using the Joanna Briggs Institute methodology and PRISMA-ScR checklist. METHODS Papers describing positive deviance, healthcare rebels and tempered radicals in nursing were identified by searching Scopus, CINAHL, PubMed and PsycINFO. After data extraction, these three concepts were analysed to study the content of descriptions and definitions, competences and stimulating and hindering factors. RESULTS Of 2705 identified papers, 25 were included. The concept descriptions yielded three aspects: (1) positive deviance approach, (2) unconventional and non-confirmative behaviour and (3) relevance of networks and relationships. The competences were the ability to: (1) collaborate in/outside the organisation, (2) gain and share expert (evidence-based) knowledge, (3) critically reflect on working habits/problems in daily care and dare to challenge the status quo and (4) generate ideas to improve care. The factors that stimulate or hinder the development of rebel nurse leadership are as follows: (1) dialogue and reflection, (2) networking conditions and (3) the managers' role. CONCLUSIONS Based on our analysis, we summarise the descriptions given of rebel nurse leadership, the mentioned competences and provide an overview of the factors that stimulate or hinder rebel nurse leadership. RELEVANCE TO CLINICAL PRACTICE The descriptions produced in this review of rebel nurse leadership and the stimulating or hindering factors listed should help nurses and managers encourage rebel leadership.
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Affiliation(s)
- Eline de Kok
- Dutch Nurses’ Association UtrechtUtrechtThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
| | | | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary CareUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
- School of Health Sciences, Faculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonUnited Kingdom
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Omura M, Stone TE, Levett-Jones T. Cultural factors influencing Japanese nurses' assertive communication: Part 2 - hierarchy and power. Nurs Health Sci 2018; 20:289-295. [PMID: 29570923 DOI: 10.1111/nhs.12418] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/20/2017] [Accepted: 01/29/2018] [Indexed: 11/29/2022]
Abstract
Hierarchy and power characterize health-care relationships around the world, constituting a barrier to assertive communication and a risk to patient safety. This issue is more problematic and complex in countries such as Japan, where deep-seated cultural values related to hierarchy and power persist. The current paper is the second of two that present the findings from a study exploring Japanese nurses' views and experiences of how cultural values impact assertive communication for health-care professionals. We conducted semistructured interviews with 23 registered nurses, following which data were analyzed using directed content analysis. Two overarching themes emerged from the analysis: hierarchy/power and collectivism. In the present study, we focus on cultural values related to hierarchy and power, including differences in professional status, gender imbalance, seniority/generation gap, bullying, and humility/modesty. The findings from our research provide meaningful insights into how Japanese cultural values influence and constrain nurses' communication and speaking up behaviors, and can be used to inform educational programs designed to teach assertiveness skills.
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Affiliation(s)
- Mieko Omura
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Teresa E Stone
- Faculty of Nursing, Chiang Mai University, Muang Chiang Mai, Thailand
| | - Tracy Levett-Jones
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Fontenot HB, Fantasia HC. Understanding feminism: considerations for nurses working to end violence against women. JOURNAL OF FORENSIC NURSING 2011; 7:27-31. [PMID: 21348931 DOI: 10.1111/j.1939-3938.2010.01092.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Violence against women is a pervasive and serious human rights and public health problem worldwide. As interdisciplinary research teams try to address the effects of this health problem of which the effects transcend all women, nurses are at the forefront. Using a feminist philosophy and methodology to explore violence against women is one way to uncover new knowledge to address this health epidemic. In this paper, we will review the basic concepts of feminism and provide examples of viewing violence research and forensic nursing practice through this theoretical lens. These perspectives provide a foundation for understanding feminism and facilitating nurses' awareness as they consider careers in research and practice. Through this lens, nurses who are helping to ease the burden of violence in our global society may affect change in women's lives.
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Affiliation(s)
- Holly B Fontenot
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA.
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Abstract
Despite an increasing number of feminist studies in nursing, few reviews on current trends in feminist nursing research have been published. This article aims to explore the current trends in feminist nursing research and provide recommendations for future feminist studies in nursing. In multiple database searches, 207 articles were retrieved. These were reviewed based on 5 criteria: (1) epistemological background, (2) research questions, (3) research participants, (4) research methods, and (5) implications for changes. The review indicated that feminist nurse researchers with diverse epistemological backgrounds adopted new research methods to ask new questions; expanded their focus to include differences in ethnicity, class, sexual preference, and disability; and incorporated these diversities among women in a global context in their research. Based on these findings, recommendations for future feminist research in nursing are outlined.
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Affiliation(s)
- Eun-Ok Im
- The University of Texas at Austin, School of Nursing, 1700 Red River St., Austin TX 78701, USA.
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Turale S, Ito M, Murakami K, Nakao F. Nursing scholarship in Japan: Development, facilitators, and barriers. Nurs Health Sci 2009; 11:166-73. [DOI: 10.1111/j.1442-2018.2009.00447.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Methodological challenges in cross-language qualitative research: a research review. Int J Nurs Stud 2008; 46:277-87. [PMID: 18789799 DOI: 10.1016/j.ijnurstu.2008.08.006] [Citation(s) in RCA: 325] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 08/05/2008] [Accepted: 08/05/2008] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Cross-language qualitative research occurs when a language barrier is present between researchers and participants. The language barrier is frequently mediated through the use of a translator or interpreter. The purpose of this analysis of cross-language qualitative research was threefold: (1) review the methods literature addressing cross-language research; (2) synthesize the methodological recommendations from the literature into a list of criteria that could evaluate how researchers methodologically managed translators and interpreters in their qualitative studies; (3) test these criteria on published cross-language qualitative studies. DATA SOURCES A group of 40 purposively selected cross-language qualitative studies found in nursing and health sciences journals. REVIEW METHODS The synthesis of the cross-language methods literature produced 14 criteria to evaluate how qualitative researchers managed the language barrier between themselves and their study participants. To test the criteria, the researcher conducted a summative content analysis framed by discourse analysis techniques of the 40 cross-language studies. RESULTS The evaluation showed that only 6 out of 40 studies met all the criteria recommended by the cross-language methods literature for the production of trustworthy results in cross-language qualitative studies. Multiple inconsistencies, reflecting disadvantageous methodological choices by cross-language researchers, appeared in the remaining 33 studies. To name a few, these included rendering the translator or interpreter as an invisible part of the research process, failure to pilot test interview questions in the participant's language, no description of translator or interpreter credentials, failure to acknowledge translation as a limitation of the study, and inappropriate methodological frameworks for cross-language research. CONCLUSIONS The finding about researchers making the role of the translator or interpreter invisible during the research process supports studies completed by other authors examining this issue. The analysis demonstrated that the criteria produced by this study may provide useful guidelines for evaluating cross-language research and for novice cross-language researchers designing their first studies. Finally, the study also indicates that researchers attempting cross-language studies need to address the methodological issues surrounding language barriers between researchers and participants more systematically.
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SURAKKA TIINA. The nurse manager's work in the hospital environment during the 1990s and 2000s: responsibility, accountability and expertise in nursing leadership. J Nurs Manag 2008; 16:525-34. [DOI: 10.1111/j.1365-2834.2008.00901.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Trotta RL. Quality of Death: A Dimensional Analysis of Palliative Care in the Nursing Home. J Palliat Med 2007; 10:1116-27. [DOI: 10.1089/jpm.2006.0263] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rebecca L. Trotta
- Hartford Center of Geriatric Nursing Excellence, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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