Staff Nurses' Perceptions and Experiences about Structural Empowerment: A Qualitative Phenomenological Study

Exploring Nurse perceptions of structural empowerment in midwifery practice in Saudi Arabia: A qualitative study

Perceptions and experiences of midwives regarding structural empowerment during practice in Saudi Arabia were explored using a qualitative, constructive, descriptive design. Data was gathered using individual semi-structured interviews with ten midwives employed in delivery rooms, and prenatal and postnatal units of governmental hospitals in Saudi Arabia's eastern province. Data was analyzed with assistance of NVivo software, Version 12. Five themes emerged from our study: the meaning of structural empowerment, ambiguous hospital policies, the insufficient numbers of midwives, midwife-physician dynamics, and continuing education and training. Structural empowerment of midwives in maternity units may be useful in improving midwifery services in Saudi Arabia and worldwide.

Data-driven clinical improvement: Oncology nurse leaders' perceptions and experiences of organisational data reports

AIM

To elicit oncology nurse leaders' perceptions and experiences of accessing, using and interpreting report data at the unit level, and their suggestions for future reports.

BACKGROUND

Nurse leaders are expected to use data reports for decisions about unit-level operations, yet data may be inaccessible, unavailable and lack relevance for improving patient care and unit-level outcomes.

METHODS

A purposeful sampling was used to recruit 12 unit-level nurse leaders. Qualitative data were collected through semi-structured interviews and analysed using thematic content analysis.

RESULTS

Consistent themes included the lack of accurate, useful and meaningful data specifically related to patient care. Accessibility Challenges, Limits to Applicability and Suggestions for Improvement were the main themes.

CONCLUSION

Nurse leaders require real-time data to effectively implement clinical interventions and practice changes for improving unit-level patient care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders emphasized that their insight into the development of customizable reports is crucial for obtaining meaningful data relevant to the varied unit-level health care setting. Reports targeting unit-level outcomes would provide meaningful data to facilitate clinical improvement where patient care is provided. Improved reports increase the likelihood of their use and the potential for enhancing the quality and safe care outcomes.

Original Research: 'It Would Be Nice to Think We Could Have a Voice': Exploring RN Involvement in Hospital Staffing Policymaking

BACKGROUND

Hospitalized patient and nursing outcomes improve when nurses are involved in decision-making practices through shared governance structures. Yet there has been little research investigating how staff nurses are involved in hospital staffing policymaking and how they perceive this process.

PURPOSE

The study's primary aims were to increase understanding of staff nurses' perceptions of factors that hinder or support nurse involvement in hospital nurse staffing policymaking and to learn more about how nurses are, or would like to be, so involved. We also collected nurses' work environment and demographic information to further inform our understanding.

METHODS

This study used a qualitative descriptive approach. Using QuestionPro software, we solicited open-ended responses to semistructured questions to explore the topics of interest. The online form was distributed via social media. Results were analyzed using conventional content analysis. Multiple-choice questions related to demographics and nurse work environments were also included, and these results were analyzed using descriptive statistics.

RESULTS

Thirty-two staff nurses completed the online form between April 5 and May 24, 2021. Identified themes include "We aren't asked": structural barriers to staff nurse involvement; "No one cares": workplace culture barriers to staff nurse involvement; and "'They' versus 'we'": lack of power sharing for staffing decision-making. Participants described feeling powerless with regard to, and having little to no involvement in, hospital staffing policymaking. Yet they also expressed their desire to be engaged in this process and offered suggestions for how nurse involvement in such policymaking could be improved.

CONCLUSION

Our findings provide crucial insight into how organizations can address existing structural barriers to nurse involvement, offer more equitable opportunities for nurse involvement, foster more inclusive workplace cultures, and recognize the value of nurse input and autonomy regarding staffing decisions.

What fuels suboptimal care of peripheral intravenous catheter-related infections in hospitals? A qualitative study of decision-making among Spanish nurses

Background

Peripheral intravenous catheters (PIVC) are commonly used in hospital worldwide. However, PIVC are not exempt from complications. Catheter-related bloodstream infections (CRBSI) increase morbidity and mortality rates, and costs for the healthcare organization. PIVC care is shaped by the complex mix of professional and organizational culture, such as knowledge gaps, low perception of impact of PIVCs on patient safety, or lack of hospital guidelines.

Aim

To explore determinants of decision-making about the prevention of PIVC-BSI among nurses in Spanish hospitals.

Methods

We conducted a descriptive qualitative study with semi-structured interviews in three public hospitals, the Balearic Islands Health Care Service in Spain. We considered hospital ward nurses working routinely with inpatients at any of the three hospitals for enrolment in the study. We approached relevant informants to identify suitable participants who recruited other participants through a ‘snowball’ technique. Fourteen inpatient nurses from the hospital took part in this study between September and November 2018. We employed several triangulation strategies to underpin the methodological rigour of our analysis and conducted the member checking, showing the information and codes applied in the recording of the interviews to identify the coherence and any discrepancies of the discourse by participants. We used the COREQ checklist for this study.

Findings

We identified four major themes in the analysis related to determinants of care: The fog of decision-making in PIVC; The taskification of PIVC care; PIVC care is accepted to be suboptimal, yet irrelevant; and chasms between perceived determinants of poor PIVC care and its solutions.

Conclusion

The clinical management of PIVCs appear ambiguous, unclear, and fragmented, with no clear professional responsibility and no nurse leadership, causing a gap in preventing infections. Furthermore, the perception of low risk on PIVC care impact can cause a relevant lack of adherence to the best evidence and patient safety. Implementing facilitation strategies could improve the fidelity of the best available evidence regarding PIVC care and raise awareness among nurses of impact that excellence of care.

Empowerment Predicting Nurses' Work Motivation and Occupational Mental Health

Introduction

Empowering nurses is essential for improving work outcomes, and understanding the role of structural and psychological empowerment in supporting nurses' work motivation and occupational mental health are essential to stimulate nurses' productivity and preserve their mental health.

Objectives

To evaluate nurses' perspectives about the levels of structural and psychological empowerment in their working areas. Additionally, to evaluate nurses' motivation and occupational mental health, and to predict the nurses' motivation and occupational mental health through structural and psychological empowerment.

Methods

A descriptive correlational design and quota sampling were used. Two hundred registered nurses were recruited from two hospitals in Jordan. Data were collected using four valid and reliable self-report questionnaires.

Results

Nurses who participated in this study were young and have an average total experience in nursing of fewer than 10 years. Nurses in this study reported a moderate level of structure empowerment and a low level of psychological empowerment. Significant positive relationships were documented between both structural, psychological empowerment, and nurses' work motivation (r = 0.85), (r = 0.83) respectively. A significant negative relationship found between both structural, psychological empowerment, and nurses' occupational mental health (r = -0.31), (r = -0.29) respectively.

Conclusions

The levels of nurses' work motivation and occupational mental health can be predicted through the levels of structural and psychological empowerment. The higher workplace empowerment was associated with increased work motivation, as well as reduced the feeling of occupational stress among nurses. Thus, administrators should invest in fostering structural and psychological empowerment in the work environment.

Predicting positive organizational behavior based on structural and psychological empowerment among nurses

BACKGROUND

Positive Organizational Behavior (POB) as an application of positive psychology provides the opportunity to nurses to deliver an effective and high-quality service. This study aims to predict positive organizational behavior based on structural and psychological empowerment among Nurses.

METHOD

In this descriptive-analytical study, the selected population was the nurses working in university hospitals affiliated to Kermanshah University of Medical Sciences, of which 152 people were selected using quota sampling strategy and according to the set entry criteria. The research data were collected using the standard questionnaires of Kanter's Structural Empowerment, Spreitzer's Psychological Empowerment, and Luthans' Positive Organizational Behavior, and were then entered into SPSS16 software.

RESULTS

There are significant and direct relationships between the elements of structural empowerment with positive organizational behavior (r = 1.496), and psychological empowerment with positive organizational behavior (r = 1.379). Overall structural and psychological empowerment criteria predict 29% of variance in positive organizational behavior among nurses.

CONCLUSION

This study highlights the importance of structural and psychological empowerment as strong predictors for positive organizational behavior.

Exploring the dark side of Lean: a systematic review of the lean factors that influence social outcomes

Purpose

Lean has shifted over the years from a set of tools to implement to a human-centric approach concerning both hard and soft factors. However, there is a limited research on these soft factors and how they influence companies performance and social outcomes on the one hand and how they enable the hard factors on the other hand. Taking this as a valuable opportunity, the purpose of this paper is to present the key motivating factors and key gaps in the literature as an agenda for future research.

Design/methodology/approach

A systematic methodology to identifying the literature on social outcomes and factors in Lean is presented. Web of Science, EBSCO, Emerald, Science Direct, Google Scholar and the top journals were searched, and 158 papers were identified.

Findings

The systematic review helped the authors to identify the evolution, current trends, research gaps and an agenda for future research for exploring social outcomes in Lean and the factors mediating them. These factors are grouped and presented.

Practical implications

The implications of this work include understanding for managers and professionals how both soft and hard factors in Lean are related and that for a sustainable implementation, the whole system must be observed. This work could serve as a valuable resource that depending on the execution of Lean, either positive outcomes will emerge or even negative outcomes, referred to as “The Dark Side”.

Originality/value

This paper presents an extended survey on the factors in Lean mediating both companies’ performance and social outcomes. The authors also believe that this is possibly the most comprehensive systematic literature review on the topic and will set the foundation for various research avenues based on the key findings of this study.

Structural empowerment of nurses in the hospital setting

OBJECTIVE

to measure the level of structural empowerment of nurses working in a university hospital.

METHOD

a descriptive, analytical, and cross-sectional study, carried out with 237 nurses, who developed care and management activities. Data collection took place through a self-administered questionnaire with questions on the personal and professional characterization and the Work Effectiveness Conditions Questionnaire II. Data analysis used descriptive and inferential statistics.

RESULTS

it was identified that nurses have a moderate level of structural empowerment (18.06±SD 0.9). The greatest value was obtained in the Opportunity dimension (4.08±SD 0.8), followed by the Resources (3.17±SD 0.8) and Informal power (3,04±SD 0.9) dimensions; while the scores of Support (2.67±SD 1.0), Formal power (2.59±SD 0.9), and Information (2.51±SD 0.9) were lower.

CONCLUSION

the level of structural empowerment of the nurses was moderate, which means partial access to opportunities, resources, support, and information of the institution.

Reconsidering the nursing role in antimicrobial stewardship: a multisite qualitative interview study

OBJECTIVES

This study responds to calls for greater focus on nursing roles, and the need for nursing integration within the antimicrobial optimisation agenda. The objective of this study was to explore Australian hospital nurses' views on antimicrobial resistance and antimicrobial stewardship (AMS) in a hospital setting, in order to better understand the opportunities for and challenges to integration of nursing staff in antimicrobial optimisation within hospital settings.

DESIGN

Qualitative one-on-one, semistructured interviews. Interview transcripts were digitally audio-recorded and transcribed verbatim. Data were subject to thematic analysis supported by the framework approach and informed by sociological methods and theory.

SETTING

Four hospitals (three public and one private), across metropolitan, regional and remote areas, in two Australian states.

PARTICIPANTS

86 nurses (77 females, 9 males), from a range of hospital departments, at a range of career stages.

RESULTS

Findings were organised into three thematic domains: (1) the current peripheral role of nurses in AMS; (2) the importance of AMS as a collaborative effort, and current tensions around interprofessional roles and (3) how nurses can bolster antimicrobial optimisation within AMS and beyond.

CONCLUSION

Nursing staff are central to infection management within the hospital and are thus ideally located to enhance antibiotic optimisation and contribute to AMS governance. However, without increased interprofessional cooperation, education and integration in the AMS agenda, as well as addressing organisational/resource constraints in the hospital, the nursing role in stewardship will remain limited.

Nurses' intention to stay: The impact of perceived organizational support, job control and job satisfaction

AIM

To propose a theoretical model of intention to stay (ITS) and examine the effects of perceived organizational support, job control and job satisfaction on ITS.

DESIGN

Cross-sectional multicentre survey.

METHODS

The survey was conducted from January 2017-July 2017 and comprised 3,240 clinical nurses from nine tertiary hospitals in eastern, central and western China, with 2,352 effective responses. Structural equation modelling was used to analyse the relationship between ITS and its correlative factors.

RESULTS

The hypothesized model was supported. Job control, perceived organizational support and job satisfaction significantly and directly affected nurses' ITS. Furthermore, job control and perceived organizational support showed indirect effects on ITS, which was mediated by job satisfaction. Perceived organizational support could positively influence job control to have a further impact on job satisfaction and ITS.

CONCLUSION

Based on a large sample of Chinese tertiary hospital nurses, this study proposed and verified a theoretical model of nurses' ITS, revealing that organization characteristics, work characteristics and affective response to work can have an impact on ITS.

IMPACT

This study was the first to examine the relationships among perceived organizational support, job control, job satisfaction and ITS, enriching the theoretical model of ITS. Nurse managers can improve nurses' ITS by enhancing their perceived organizational support, job control and job satisfaction.

Registered nurses' perceptions of factors influencing nursing care quality: A structural equation modeling study

Cambodia, like many other countries, is working to raise nursing care standards, including improving nurse work environments and nurse education. This descriptive, cross-sectional study examined the factors influencing nursing care quality among 375 registered nurses from 12 government hospitals in Cambodia. The conceptual framework was modified from the Nurse Work Environment, Nurse Staffing, and Outcome Model, and five questionnaires were used. The hypothesized model fitted the empirical data and explained 12% of the variance in nursing care quality. Structural equation modeling revealed that nurse work satisfaction negatively affected nursing care quality, while the nurse practice environment and burnout had no effect. Nurse staffing had a positive direct effect on nurse work satisfaction, while nurse work satisfaction did not directly affect burnout. The results indicate that the highest impacting factors influencing nursing care quality were nurse work satisfaction and the indirect effect of nurse staffing on nursing care quality. Therefore, leaders and policymakers in government, health systems, and nursing across the country need to consider these results to enhance nursing care quality.

Research paradigms and the politics of nursing knowledge: A reflective discussion

A standard view would suggest that research is a neutral apolitical activity. It neutralizes external pressures by its fidelity to robust scientific methods. However, politics is an inevitable part of human knowledge. Our knowledge of the world is always mediated by human priorities. What matters is therefore a contested and political debate rather a neutral accumulation of factual data. How researchers manage this varies. Research paradigms are one way in which research engages with knowledge. They frame knowledge within epistemological and ontological philosophies. In this paper, I will explore this view in relation to neo-positivism, qualitative research, Foucault and critical realism. I will argue that if nursing knowledge is to be effective it needs to acknowledge the political, particularly in the context of neoliberalism. Healthcare systems are having to cope with a social world increasingly dominated by market fundamentalism, extreme levels of inequality and a rise in xenophobia. These forces are undermining the provision of ethically sound health care, misdirecting research practice and contributing to a discourse of dehumanization. These forces need to be challenged politically and I will argue that epistemologically diverse approaches, alongside a realist ontology can provide a way forward for nursing research.

Staff empowerment and engagement in a magnet® recognized and joint commission international accredited academic centre in Belgium: a cross-sectional survey

Background

A substantial number of studies linked aspects of a balanced, healthy and supportive nurse practice environment with quality and patient safety. To what extent balanced work characteristics such as social capital, decision latitude and workload are relevant for all staff engaged in patient care including healthcare and medical staff in a Magnet Recognized and Joint Commission International accredited academic centre is unclear. The study aim is to investigate associations between work characteristics such as social capital, decision latitude and workload, work engagement and feelings of burnout as explanatory variables and job satisfaction, turnover intentions and perceived quality of care as dependent variables in a study population of nursing, healthcare and medical staff taken in account generation differences.

Methods

Hierarchical regression analysis estimated strength of associations with demographic characteristics (block-1), professional category (block-2), work characteristics (block-3) and work engagement or burnout dimensions (block-4) as explanatory variables of job satisfaction and turnover intention and quality of care as outcome variables.

Results

The study confirmed and extended previous study findings demonstrating positive impact on staff’ job outcomes and assessed quality of care by balanced work characteristics such as social capital, decision latitude and workload in nursing staff (N = 864), healthcare staff (N = 131) and medical staff (N = 241). Generational characteristics and professional category were associated with turnover intentions and less favorable assessed quality of care, respectively. Explained variances of studied models ranged from 14.4 to 45.7%.

Conclusion

Engaging and committing staff to promote excellent patient outcomes in daily interdisciplinary practice works through clear frameworks, methods and resources supported by governance and policy structure that makes outcomes visible and accountable.

Intercountry master's degree in nursing: policy implications for the Mozambican health system

PURPOSE

Within an overarching evaluation framework, this study explored the experiences of course participants and administrators of an intercountry master's degree in nursing between South Africa and Mozambique. The lessons learnt were used to inform nursing and health policy for the Mozambican health system.

METHODS

Kirkpatrick's four levels of training evaluation and a results-oriented approach to capacity change were integrated to form a hybrid evaluation framework to capture information about course implementation and the context/environment within which it was delivered. The study used quantitative and qualitative methods including a self-administered survey of course participants, document review, in-depth, semi-structured interviews with course administrators and two focus group discussions with course participants.

FINDINGS

Participants enrolled in the course primarily to gain new knowledge and to improve health outcomes; course participants and administrators responded positively to the course design, course implementation and the quality of teaching. Knowledge and skills gained help to build graduates' confidence and boost their attitude towards nursing. Paradoxically, graduates felt powerless to transfer knowledge and effect change in practice.

CONCLUSION

This collaborative, capacity development project produced postgraduate nurses in two areas of specialization, namely, critical care and trauma nursing and maternal and neonatal health. While course participants gained significant benefits in new skills and knowledge and a higher degree qualification, the rewards available to them in the public health system remain unclear.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Lessons learnt may serve to influence policy decisions about the role of the Ministry of Health and other stakeholders in sustaining the output and quality of postgraduate nurses for the Mozambican health system. A strategic approach informed by multilevel policies at government, organizational and managerial levels should be adopted to systematically minimize and remove barriers to the transfer and utilization of knowledge and skills in the workplace.

Measuring patient safety culture in maternal and child health institutions in China: a qualitative study

INTRODUCTION

Patient safety culture (PSC) plays a critical role in ensuring safe and quality care. Extensive PSC studies have been undertaken in hospitals. However, little is known about PSC in maternal and child health (MCH) institutions in China, which provide both population-based preventive services as well as individual care for patients.

OBJECTIVES

This study aimed to develop a theoretical framework for conceptualising PSC in MCH institutions in China.

METHODS

The study was undertaken in six MCH institutions (three in Hebei and three in Beijing). Participants (n=118) were recruited through stratified purposive sampling: 20 managers/administrators, 59 care providers and 39 patients. In-depth interviews were conducted with the participants. The interview data were coded using both inductive (based on the existing PSC theory developed by the Agency for Healthcare Research and Quality) and deductive (open coding arising from data) approaches. A PSC framework was formulated through axial coding that connected initial codes and selective coding that extracted a small number of themes.

RESULTS

The interviewees considered patient safety in relation to six aspects: safety and security in public spaces, safety of medical services, privacy and information security, financial security, psychological safety and gap in services. A 12-dimensional PSC framework was developed, containing 69 items. While the existing PSC theory was confirmed by this study, some new themes emerged from the data. Patients expressed particular concerns about psychological safety and financial security. Defensive medical practices emerged as a PSC dimension that is associated with not only medical safety but also financial security and psychological safety. Patient engagement was also valued by the interviewees, especially the patients, as part of PSC.

CONCLUSIONS

Although there are some common features in PSC across different healthcare delivery systems, PSC can also be context specific. In MCH settings in China, the meaning of 'patient safety' goes beyond the traditional definition of patients. General well-being, health and disease prevention are important anchor points for defining PSC in such settings.