published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Kanter’s theory (1993) maintains that access to empowerment structure would lead to positive organizational behaviour and that individual differences are inconsequential. This study proposed that Chinese cultural value of social orientation needs to be considered when applying the theory to nursing practice in Hong Kong. Based on the perspective of person-situation interaction, it was also hypothesized that need for empowerment and self-esteem would act as moderators in the empowerment process. In this study, job satisfaction and psychological well-being were used as outcome measures to evaluate the empowerment process. A cross-sectional survey research was conducted to test the hypotheses formulated in this study. Reliability and validity of the measuring instruments were first established in a preliminary study. All measurements were incorporated in a standardized questionnaire which also contained items on sociodemographic characteristics. The participants were Chinese frontline nurses (N = 556) from different areas of practice in an acute hospital, of which 83% of them were aged between 25 and 39. Education of the participants ranged from hospital-based training to Master degree. A great majority (86%) of the respondents were females. Confirmatory factor analysis supported Kanter’s four-factor model (i.e., opportunity, information, support, and resources) of nursing empowerment. Availability of formal and informal power was found to facilitate access to empowerment structure. Measures of empowerment were of satisfactory reliability and construct validity. Access to empowerment structure was associated with subjective feelings of being empowered. This feeling of psychological empowerment mediated the impact of structural empowerment on outcome measures. Nurses with higher education or higher nurse rank reported greater access to empowerment structures. They also exhibited greater job satisfaction and better psychological well-being. Less experienced nurses reported greater access to opportunity and supports, whereas more experienced nurses exhibited greater job satisfaction and psychological well-being. The association of structural empowerment with job satisfaction was less significant among nurses who held stronger view of social orientation, but these nurses enjoyed better positive well-being with greater access to empowerment structures. Structural empowerment was associated with positive outcomes among nurses who reported high need for empowerment, but not among those whose need was low. With access to empowerment structure, nurses with high self-esteem reported a higher level of job satisfaction than did those with lower self-esteem. However, structural empowerment promoted positive well-being among nurses with moderate self-esteem, but not among those of high self-esteem. The impact of structural empowerment was negative among nurses of low self-esteem. This study confirmed the applicability of Kanter’s theory of structural empowerments among Hong Kong frontline nurses whose ecological culture was predominantly collectivistic. However, to implement structural empowerment effectively, the model needs to be expanded to include cultural-personality factors such as social orientation, need for empowerment, and self-esteem. In view of the substantial contribution of global empowerment to positive outcomes, an integration of structural and psychological empowerment was proposed. Findings of the present study were discussed with reference to relevant issues and compared with findings reported in the West. Limitations of the study were considered and suggestions for future research made. / published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

There is alleged to be a severe nursing shortage in Canada. While the shortage is attributed in large part to fiscal restraint in the hospital sector in the early 1990s, there are competing claims addressing why nursing employment levels changed over this period. Supply-side proponents argue that deteriorating working conditions and stagnant wages led nurses to voluntarily leave the profession, province, or country for better employment prospects. Demand-side proponents argue that hospitals reduced staff levels in response to a decline in inpatient utilization. There is also considerable disagreement on what impact, if any, reduced nursing employment levels had on access to hospital care. However, while there is no shortage of anecdotal evidence and plausible rhetoric, the debate is being carried out in a largely data-free environment. This thesis attempts partially to fill this void. Part I of this thesis examines trends in the nursing employment level in Canada over the hospital restructuring period. Results indicate that the number of nurses employed in hospitals decreased significantly during the cut-backs period and that the decrease was particularly severe among young nurses. The employment level is decomposed into three separate components for each age group: the change in the potential supply of nurses, the change in the employment rate of this group and the change in the likelihood that an individual will work in the nursing profession conditional on being employed. Results indicate that the third factor is most important. To determine whether the observed shift toward non-nursing employment was voluntary, an occupational sector choice model is developed and the pattern of nursing wages, non-nursing wages, and hospital expenditure (a proxy for demand) is examined. The evidence strongly suggests that the reduction in the nursing employment level in hospitals during the downsizing period was a result of a decrease in the demand for nursing labour and did not represent voluntary movement out of the nursing sector. That the decrease in demand primarily affected young nurses appears to reflect the influence of seniority in the highly unionized nursing sector.

Almost 40% of the Canadian workforce shows signs of progressive burnout. For a variety of reasons, stress within the workplace appears to be increasing. The popular press and academic journals suggest that chronic job stres, burnout, will be most significant workplace issue in the new millennium. Although both men and women suffer from stress and burnout, it appears that women are at a greater risk than men. Unfortunately, research on the relationship between women's stress and their heatlh has not kept pace with the popularization of the problem. We could understand this relationship better if we had more information about women, their health history (including phases of development over the life span), and occupational history. Relatedly, as the baby-boomer generation ages to mid-life, there appears to be a sea change on the horizon: one in which women are demanding answers and knowledge about the process of menopause and its effect on their lives, inside and outside the home. To fill this void, the proposed research will address the life change of women, and specifically, how their stages of development and occupational and health histories relate to the experience of burnout. / xv, 126 leaves ; 29 cm.

This ethnographic study of nurses at King Edward VIII Hospital in Durban, South Africa was designed to seek insights into the lives of women as nurses during the socio-political transition of the 1990's. It suggests that this period of dramatic political change in the country created spaces for redressing uneven social relations and chronic disparities faced by nurses in their personal and professional lives, particularly those constructed through the social engineering of apartheid policies. The study describes the particular evolution of nursing in South Africa, the process undertaken to unify the professional nursing associations formed through the 1980's and the national labour unrest that rippled through the health care system between 1994 and 1996. It considers the diverse locations of nurses as the backbone of the healthcare system, primarily in their capacities as professionals, managers, care-providers, team-players and colleagues and describes practices that operate to constrain nurses as women and health care practitioners. Feminist, post-structural perspectives framed the theoretical approach taken in this qualitative study. These were guided by Foucauldian theories of knowledge, power and discourse, and feminist contributions regarding resistance and agency. Over the course of four years in the field, methods of participant observation and in-depth interviews were employed to develop insights into the subject locations of nurses in their private and public lives. Twenty-six nurses of the professional and subprofessional categories contributed to the main narratives. In addition, a series of interviews were undertaken with key informants from the medical, paramedical, nursing and administrative services. The study illustrates the practices of patriarchal, institutional and organisational relations of power that intersected and dominated the realities of the nurses in all spheres of their day-to-day lives. Within the post-colonial moment in South Africa, these were conceptualized as subaltern institutional relations. The study found that as a consequence of their subjugation within the subaltern institutional relations, the realities of nurses were diverse, divergent, and fragmented. It argues that these relations imbued a lack of professional and personal coherence that impaired the capacity of nurses to contest the chronic professional and work place disparities. Often multiple and compounding in their manifestation, these relations and practices reinforced the isolation of nurses, compounding their incapacity to meaningful challenge professional and personal obstacles during the socio-political transition of the 1990's. / Thesis (Ph.D.)-University of Natal, Durban, 2000.

Aim: The purpose of this research was to explore and describe the hospital workplace experiences that had contributed to the resignations of Registered Nurses in the Durban Metropolitan Area. Methodology: The broad perspective governing this research is qualitative in nature. The researcher employed a phenomenological approach specifically because the researcher was interested in identifying, describing and understanding the subjective experiences of individual nurses at the two Private and two Provincial health care institutions selected to participate in the study - in respect of their decision (s) to resign from their employment, and lor to leave the nursing profession. Two semi-structured interviews were conducted with each participant by the researcher. The researcher applied the principle of theoretical saturation and a total of fifteen participants and thirty interviews were done. Experiential themes and sub-themes in the data were identified by a process of meaning condensation, and the data were managed by means of a qualitative software package - NVIVO (QSRNUD* IST). Findings: The resignations of registered nurses in the Durban Metropolitan Area were found to be linked to their respective hospital workplace experiences. These experiences related to their physical working conditions and environment and included the following: unsupportive management structures, autocratic and dehumanizing management styles, negative stereotypy of nurses and the nursing profession, lack of autonomy in the workplace, professional jealousies and fractures within the profession, sub-optimal physical working conditions and shortage of staff, equipment and lack of appropriate surgical supplies, concerns regarding occupational safety e.g. the increasing exposure of health care personnel to RIV and AIDS; lack of opportunities for promotion or continuing one's professional education, the experience ofworkplace violencepredominantly in the form of verbal and psychological abuse, inaccurate systems of performance assessment (Joint Performance Management, Reports, Personal Profile systems) - compounded by favouritism and racism; and inadequate remuneration. Conclusion: In terms of the findings of this study, the participants' lived experiences in terms of their respective hospital workplace experiences indicated that neither the maintenance factors nor the motivator factors were optimally represented, experienced or enjoyed in their respective workplaces. In terms of Rerzberg's Motivator-Maintenance theory, the registered nurses who participated in this study may be described as being 'not satisfied' and 'dissatisfied' with their hospital workplace experiences, physical conditions and environment. A number of recommendations pertaining to strategies for the retention of registered nurses were made for the consideration of both Provincial and Private health care authorities, hospital management structures and the nursing profession respectively. Recommendations for further nursing research were also made. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2005.

The present study, based on Lazarus' cognitive theory, identified coping strategies utilized by psychiatric nurses, and examined correlations between social support, perceived threat and coping effectiveness. The correlational design utilized a convenience sample of registered nurses holding membership in the Indiana State Nurses' Association Council on Psychiatric and Mental Health Nursing Practice. Subjects completed a demographic sheet, Interpersonal Support Evaluation List, Jalowiec Coping Scale, McNett Coping Effectiveness Questionnaire, and a one-item threat evaluation scale. Problem-focused coping was preferred by the sample. There was a statistically significant positive correlation between social support and coping effectiveness, a significant negative correlation between threat and coping effectiveness, and a non-significant negative correlation between social support and threat. Conclusions were psychiatric nurses utilize problem-focused coping strategies, there was a significant relationship betweeen social support and coping effectiveness, and threat and coping effectiveness, and a nonsignificant relationship between social support and threat. / School of Nursing

The purpose of the study was to examine the relationship between hardiness and burnout in medicalsurgical staff nurses at a midwestern hospital. The conceptual framework used in the study was hardiness, developed by Kobasa (1979).The population selected for the study was medicalsurgical staff nurses at a midwestern hospital. The convenience sample consisted of responding staff nurses (n=41). Subject confidentiality was maintained by indicating respondents by number instead of name.The research design for the study was a descriptive correlational design. The research question was analyzed using the Pearson Moment Correlation Co-efficient. Findings of the study indicated a negative, significant correlation between Emotional Exhaustion Burnout subscale and hardiness (p=.001). A positive significant correlation was supported-between the Personal Accomplishment Burnout subscale and hardiness (p=.000). The Depersonalization Burnout Subscale and the overall Burnout Score did not support significant correlations in sample subjects studied.Conclusions from the study were that nurses need opportunities for increasing personal development and decreasing exhaustion. The depersonalization of the environment did not seem to be a factor related to hardiness, and remains to be examined. The study was significant because it was determined that certain subscalBall State UniversityMuncie, IN 47306 / School of Nursing

Job-communication satisfaction and its importance to nursing staff and first-line supervisors is important because people in complex health care delivery systems tend to dehumanize communication (Duldt, 1989, 1990b). The purpose of the study is to determine the level of satisfaction first-line supervisors and staff nurses have of job-communication and interpersonal relationships, and the degree of importance staff members and first-line supervisors place on job-communication and interpersonal relationships within a mid-sized acute care facility in an urban area. The theoretical framework is Duldt's Humanistic Nursing Communication Theory (Hersey & Duldt, 1989).The population was all staff nurses and first-line supervisors employed in inpatient services at a midwest hospital. The sample was comprised of about 231 registered nurses and 61% first-line supervisors who volunteered to answer the Job-Communication Satisfaction Importance Questionnaire (JCSI). The JCSI was developed by B. W. Duldt (1990) based on the work of Downs, Hazen, and Thiry as cited in Duldt (1990a). The procedures for the protection of human subjects were followed.Findings revealed that supervisors and staff nurses were satisfied with aspects of job-communication. Supervisors and staff nurses rated six of the eight topics on the JCSI as important aspects of job-communication. Aspects of job-communication and interpersonal relationships were important to supervisors and staff nurses in the facility studied.The conclusions from the study were: (a) satisfaction with job-communication and interpersonal relationships can be improved, (b) aspects of job-communication and interpersonal relationships identified in the study were important to supervisors and staff nurses. Nursing supervisors are in key positions to influence job -communication satisfaction. Organizations undergoing rapid changes need to develop and maintain communication which is satisfactory to human beings working in the organization. / School of Nursing