Bakgrund: Första linjens chefers stöd och förståelse för distriktssköterskor är viktigt för att befrämja en god arbetsmiljö och tillfredsställelse på arbetsplatsen. Faktorer som kan påverka: resurser, att känna sig delaktig, att veta vad som händer, utvecklingsmöjligheter. Syfte: Syftet var att beskriva erfarenheter och reflektioner första linjens chefer vid hälsocentraler hade kring sitt arbete med strukturella förutsättningar till distriktssköterskor. Metod: Studien hade en kvalitativ ansats med beskrivande design. Semistrukturerade intervjuer, med åtta första linjens chefer inom primärvården, utfördes och bearbetades genom kvalitativ innehållsanalys utifrån en induktiv ansats. Resultat: Information framhölls som svårt. Vanligast sättet att föra ut information på var mail. Vikten av att distriktssköterskorna gavs förutsättningar att själva söka information påtalades. Cheferna höll olika möten, vilket tog mycket tid. Cheferna gjorde sitt yttersta för att det skulle finnas tillräckligt med personal. Cheferna litade på distriktssköterskornas bedömningar vad gällde material, utrustning och att planera sin tid. Cheferna uttryckte att distriktssköterskornas tid var knapp. Cheferna kände att de hade en hög närvaro och tillgänglighet. Feedback gavs på olika sätt, flera chefer ville förbättra sig på detta. Cheferna var positiva till utbildning och ansåg att möjligheter till utveckling fanns. Slutsats: Första linjens chefer inom primärvård upplevde att de var ett gott stöd till distriktssköterskor och avsikterna var att ge möjlighet till strukturella förutsättningar. De upplevde ibland att de var styrda uppifrån. De upplevde att vissa distriktssköterskor inte hade samma intresse som organisationen, vilket kunde försvåra anpassning av exempelvis utbildning på individuell nivå. / Background: First line managers' support and understanding for district nurses is important to promote good work environment and satisfaction at the workplace. Factors that may affect: resources, feeling involved, knowing what's happening, development opportunities. Aim: The aim of this study was to describe experiences and reflections first-line managers’ had concerning their work on structural empowerment for district nurses in primary care. Method: The study had a qualitative approach with descriptive design. Semi-structured interviews, with eight first-line primary care managers, were performed and analyzed through qualitative content analysis based on an inductive approach. Result: Information was highlighted as difficult. Most common way to convey information were by mail. It was important to give district nurses opportunity of seeking information themselves. The managers held different meetings, which took a lot of time. The managers did their utmost to ensure that there were enough staff. The managers trusted the district nurses' assessments regarding materials, equipment and planning their time. The managers expressed that the time of district nurses was scarce. The managers felt they’d high attendance and availability. Feedback was given in different ways, managers would like to improve on this. The managers were positive about education and felt that opportunities for development were available. Conclusion: First-line managers in primary care experienced themselves as good support to district nurses and their intentions were to provide opportunities for structural empowerment. Sometimes they experienced being controlled from top. They found that some district nurses didn’t share the same interest as the organization, which may make it difficult to adjust at individual level.

The purpose of the study was to investigate the perceived lack of empowerment of registered nurses in the Mpumalanga Province. To determine the reasons for the perceived lack of empowerment and the effect thereof on professional conduct after which empowerment guidelines would be developed which managers can apply in order to enhance the empowerment of registered nurses in their service, and in turn cultivate confident nurse leaders. The main study objectives were to describe what empowerment entails, and its effect on professional conduct in the workplace; explore the level of empowerment among nurse managers and registered nurses; ascertain the effect of perceived powerlessness on the professional conduct and behaviour of nurse managers and registered nurses; establish the reasons for the perceived lack of empowerment among nurse managers and registered nurses; determine if there is a difference in the way in which nurse managers and registered nurses perceive the existing empowerment in their public hospitals and to develop empowerment guidelines for nurse managers and registered nurses. Kanter’s Theory of Structural Empowerment formed the basis of the study and guided the structure of the report. This theory contains three components, each with several dimensions resulting in 14 factors to be tested. A quantitative research approach, with an exploratory and descriptive design was used. Using a researcher-developed questionnaire as the data collection instrument. The site population consisted of one randomly selected district containing eight public hospitals in the Mpumalanga Province. All nurse managers and registered nurses in these hospitals were invited to participate in the study. The researcher delivered the questionnaires to the respondents of the eight hospitals that met the inclusion criteria. Two hundred and sixty seven (267) completed questionnaires were collected upon completion resulting in a response rate of 30.2%. Descriptive and inferential statistics were used to analyse the data. Generally, the results indicated that the majority of the respondents felt empowered with the dimensions contained under the structural empowerment, psychological empowerment and positive work behaviours and attitudes components of Kanter’s Theory. However the respondents noted that they had limited resources. According to the results those nurse managers and registered nurses who felt empowered, scored strongly in the areas of structural and psychological empowerment. The empowerment guidelines were developed for dimensions which were found to be non-empowering to assist nurse managers and registered nurses in creating workplace environments that could enhance the empowerment of registered nurses in their hospitals. / Health Studies / D. Litt. et Phil. (Health Studies)

In hospitals of Addis Ababa, there is a high turnover of leaders while patient and health workers’ satisfaction is low, and safety and quality are in dire situations. The purpose of this study was to explore and propose strategies to improve effectiveness of hospital leadership in order to enhance the quality of health care provided in hospitals through improving health workers’ empowerment, job satisfaction and patient safety culture. Thus, a sequential explanatory mixed method research design was used. The research had three phases, in which the first phase used five structured questionnaires explored leadership styles, the health workers’ satisfaction and empowerment, patient safety culture, and the patient experience of quality of health care; while the second involved a qualitative study (content analysis); and third phase focused on the preparation of a strategy document. Data in the form of interview responses was gathered from 75 leaders, 542 health workers, 532 patients and 11 key informants. The analysis shows that, overall, hospital leaders considered themselves more transformational (M=2.98, SD=0.41) than transactional (M=2.85, SD=0.46). Job satisfaction of private and public hospital health workers were 70.8 % and 57.1 % respectively (P-value<0.001). In addition, private hospital workers had a higher score in structural and psychological empowerment than their pubic hospital counterparts; the difference was statistically significant in all dimensions (P-value <=0.03). The analysis reveals that public and private hospitals’ mean total patient safety scores were 3.58 and 3.77 respectively (P-value=0.02). Finally, the “overall rating of hospital” was better for private hospitals: 84.8% and 88.4 % respectively (P-value=0.03). The study makes a number of observations. It notes that, firstly, transformational leadership has direct and strong correlation with structural and psychological empowerment (r=0.70, P-value=0.04 and r=0.83, P-value=0.01 respectively). Secondly, structural empowerment has a direct and significant effect on psychological empowerment (β=0.28, P-value=<0.01); and minimal indirect effect on patient safety culture through psychological empowerment (β=0.05, P-value=<0.05). Thirdly, health worker job satisfaction also has had a direct effect on patient safety culture (β=0.44, Pvalue=< 0.01. The fourth and final observation is that psychological empowerment has had a direct and statistically significant effect on patient safety culture (β=0.19, Pvalue=< 0.01). These observations indicate that, although private hospitals are better in every dimension of this study, the current hospitals situation in Addis Ababa needs urgent attention. Hence, the identification and recommendation for the preparation of eight strategic priority areas along with key interventions seeking to improve the hospital leaders’ effectiveness. / Health Studies / D. Litt. et Phil. (Health Studies)