published_or_final_version / Public Health / Master / Master of Public Health

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

South African nurses are emigrating for greater prospects abroad – a weakening of the healthcare system. Nurses play a critical role in health care globally as well as in South Africa. Work engagement or lack thereof may be the reason why so many nurses decide to emigrate. This study aimed to get a better understanding of whether nurses working more specifically with mentally and physically challenged ‘children’ experience work engagement. The focus will be on the resources and demands that nurse’s face in their work environment and whether these contribute to feelings of work engagement. A qualitative research design was used to collect data in this study. The study took the form of a cross sectional survey design with a sample of 8 nurses from a home for physically and mentally challenged individual’s in the Durban, KwaZulu-Natal region. The data was collected with the use of a biographical questionnaire and an interview schedule. The resulting data was analysed using thematic content analysis with the aid of NVIVO 9. The study found that the nurse’s do experience work engagement despite the circumstances they are exposed to. The study also found the resources the nurses were presented with aided in them experiencing work engagement. A love for their job contributed to feelings of work engagement. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

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.

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.

Stress among nurses is still perceived as a challenge experienced by the nursing profession. Several studies have shown the negative impact of stress on both nurses and patients. However, little is known about the factors influencing stress among nurses in Rwanda. Aim: The overall aim of the study was to explore the factors contributing to nurses’ stress and related coping strategies used by nurses in the University Teaching Hospital of Butare (UTHB), Rwanda. Methods: The researcher used a non-experimental, descriptive study to explore the factors contributing to nurses’ stress and related coping strategies used by nurses in the University Teaching Hospital of Butare, Rwanda. This study was informed by a stress and coping theoretical framework. A questionnaire was used to collect the demographic characteristics of participants, while nurses’ stressors were assessed using the questionnaire of nurse’s stressors previously developed by Bianchi. The ways of coping were evaluated using the ways of coping elaborated by Folkman & Lazarus. A convenient sampling of 85 registered nurses, working at UTHB, participated in this study. Permission to conduct the study was requested and obtained from the University of KwaZulu-Natal Ethics Committee, the Kigali Health Institute -Institutional Review Board and the management of UTHB. The data was analysed using the Statistical Package for Social Sciences (SPSS), version 15, and was summarized using descriptive statistics. The results were presented in tables and graphs. Results: The findings of the study revealed that registered nurses at UTHB face a variety of stressors such as shortages of staff and materials, facing death and dying, dissatisfaction with the work environment, work overload and time spent on bureaucratic activities. It was shown that consequences of stress vis-à-vis registered nurses could be low quality of care, job dissatisfaction and burnout syndrome. Among the major strategies of coping with stress, registered nurses have indicated problem solving, social support and accepting responsibility. This study indicates that stress can be prevented and managed by using vi nursing strategies such as team work, effective communication improving work conditions and fostering the managerial nursing strategies in working unit. Conclusion: Drawing from these findings, it can be inferred that nurses’ stressors need to be addressed in order to create a working environment conducive to high quality of care and also to enhance nursing staff morale, satisfaction, motivation and retention. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

America's health care industry is in a state of crisis. Nursing administrators are in the position to facilitate change in institutions. One aspect of nursing which has remained constant is high turnover rates. The high turnover rates have been linked to job dissatisfaction. One method of reducing turnover is to provide greater job satisfaction to staff nurses. Job satisfaction has been connected with management style (Lucas, 1991; Price & Mueller, 1981; Volk & Lucas, 1991).This study described the impact of head nurse management style on staff nurse job satisfaction. Likert's (1967) System 4 management theory was utilized as the framework in the study. All staff nurses and head nurses from three Central Indiana hospitals were given the opportunity to participate in the study. Participants completed two questionnaires, one from Price and Mueller's (1981) work on turnover to determine job satisfaction and one from Likert and Likert's (1976) work to determine management style.Data analysis was conducted to describe any variations between staff nurse experience of head nurse management style and staff nurse job satisfaction. Differences between head nurse and staff nurse description of management style were also examined. There were no identified risks as participation was voluntary and did not affect the employment status of any individual.Results of the study demonstrated agreement with previous research findings. When management style is closer to participative (system 4), greater job satisfaction is expressed. Recommendations are to provide management training and training in communication and self-awareness for head nurses, and to form unit based committees designed to achieve greater staff input in decisions affecting the unit functioning.Benefits of the study include identification of the management style which leads to improved staff nurse job satisfaction. Equipping nurse administrators with information regarding desirable management style to employ for staff nurses to experience greater job satisfaction, and training present managers in that management style are also possible benefits from the study. / School of Nursing

The recruitment, hiring, and retention of registered nurses (RNs) is of critical concern for nursing home administrators. Many times, nursing homes unsuccessfully compete with hospitals and staff relief agencies for available RNs (Braddy, Washburn, & Carroll, 1991). Understanding the factors that influence nurses to seek a particular employer is significant in recruitment and hiring. Factors related to nursing decisions to choose employment in nursing homes were identified in this descriptive study.Price and Mueller's (1981) Causal Model for Turnover (CMT) provided a conceptual framework for the study. The investigator used a revised form of an instrument developed by Price and Mueller for a 1981 study of hospital turnover. The instrument contained 67 items presented in a combination of 59 multiple choice items and 8 five-point Likert-type items. The reliability for each of the seven subscales was equal to or greater than .70.A sample of 300 full-time RNs with tenure of at least 6 months employment with a large for profit corporation was selected for this study. Questionnaires were mailed to participants with a letter of introduction from the investigator and the divisional vice president of the corporation. Subjects were provided with a self-addressed, stamped envelope to be used to return completed questionnaires. A follow-up call was done one week after the mailing requesting return of all completed questionnaires.There were no risks or ill effects from participating in this study. Respondents were free to ask any questions during the study. The agency and respondents were not identified in the sampling and the results of the study. Completion of the questionnaire was interpreted as the respondent's agreement to participate in the study.Results should help administrators understand the factors that influence registered nurses to seek employment in nursing homes. The results of the study should be utilized in reviewing current recruitment, hiring, and retention strategies. / 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

The nursing home industry has low registered nurse retention rates. Low retention rates can be related to job satisfaction. The nursing home industry needs qualified registered nurses (RNs) who are satisfied with all aspects of their jobs. The purpose of this study was to examine factors affecting job satisfaction of RNs currently employed in nursing homes using Herzberg's (1968) Dual Factor Theory.Herzberg (1968) has identified internal factors that motivate employees on the job. If intrinsic factors are met, the employee is satisfied. Extrinsic factors, if present, will not satisfy the employee, but will prevent dissatisfaction (Herzberg, 1968). The Minnesota Satisfaction Questionnaire - Short Form, was used to determine the intrinsic, extrinsic and general satisfaction scores of 48 (480) RNs currently employed in ten nursing homes from the midwest. Confidentiality and anonymity of the subjects were maintained as questionnaires contained no identifying information.Findings supported previous studies on job satisfaction of RNs employed in nursing homes. Participants did not identify intrinsic factors as being fully satisfactory, but responses were closer to satisfied than dissatisfied. Extrinsic factors were not sources of dissatisfaction, but responses were closer to dissatisfied than satisfied. General satisfaction scores determined respondents were not fully satisfied, but were closer to neutral scores. Responses were closer to being satisfied than not. Conclusions were that extrinsic and intrinsic factors influence job satisfaction.Implications call for examination of factors effecting job satisfaction. Managers should increase job security, social services, activites, independence and variety. Human relations, company policies and technical supervision should be open to input from staff as to how the extrinsic motivational factors can be improved. Recommendations include replication of this study with a large sample size; assuring nurses under 40 years of age participate in further studies and the need for nursing home administrators to address intrinsic and extrinsic factors that affect job satisfaction. / School of Nursing