Health policy reforms have dominated health systems in African countries for over three decades. However, the impacts of these policies on nurses’ work, as well as the extent to which the nurses are involved in the policy decisions, have not been well documented. As the largest group of health professionals in the workforce, nurses’ services are necessary to achieve population health outcomes. Thus, nurses’ work concerns related to the reform of national policies should be identified and addressed. This study was carried out to examine how the national policy reforms have impacted on nurses’ work in Kenyan district health care systems and how nurses have been involved in policy processes in the health care system. Critical theory and feminist critical policy analysis perspectives guided the study. The study was implemented in two phases. The first phase involved qualitative interviews with 32 decision makers and nurses in the public health care system. The second phase involved a comparative quantitative survey of nurses and nurse managers in two districts. A sample of 169 nurses was interviewed in two district hospitals to generate data for this second phase of the study. This thesis contains three manuscripts. The first manuscript presents a qualitative analysis of the impact of policies on nurses’ work (Chapter 2). The second manuscript presents qualitative results of how nurses were involved in policy processes at various levels of the health care system (Chapter 3). The third manuscript presents results of a quantitative survey of frontline nurses’ experiences with the policy reforms, comparing two districts (Chapter 4). An integrative discussion of key findings from all these manuscripts forms the last chapter of the thesis. The findings revealed that policies meant to enhance access to services like decentralization and primary health care were more enabling to nurses’ work while those aimed at enhancing efficiency like structural adjustment programs were more constraining. The constraints included poor work environments, unchanging work conditions, increased responsibilities and dilemmas in providing care. These constraints were experienced more by nurses in the district that was poorly resourced and had poor health indicators than the district that had better resources and better health indicators. The results suggest that inadequate involvement of nurses in policy processes is a reason why their work concerns have not been addressed. There are recommendations to improve nurses’ work in the context of policy reform and to improve nurses’ abilities to participate in policy processes.

A nurse-manager relationship plays a key role in a nurse’s practice environment. A nurse’s trust in one’s manager is the foundation for a supportive nurse-manager relationship and has crucial bearing upon the professional and personal lives of the nurse. However due to health care restructuring, nurses expressed little trust towards their leaders. To develop and implement strategies to help build healthy nurse-manager relationships, research is needed to more fully understand the factors that establish and enhance a nurse’s trust in one’s manager. This study tested a theoretical model that examined potential individual, managerial, relational and environmental attributes that impact a nurse’s degree of managerial trust. Employing a cross-sectional, descriptive design, a self-administered survey was completed by a random sample of 342 Registered Nurses employed in Ontario emergency departments. Structural equation modeling techniques tested and refined the hypothesized model. Final analysis showed adequate fit of data to theoretical model (χ 2 = 78.86, df = 20, SRMR = .02, CFI = .98, RMSEA = .09). In the final model, a manager’s perceived ability, benevolence, integrity and procedural justice had a strong, direct impact on managerial trust. Trust in one’s manager was indirectly influenced by procedural justice and ability as well as a manager’s facilitation of team work, communication accuracy, emotional availability and interaction frequency. Attributes of the individual RN, specifically job tenure and propensity to trust as well as self-determination, access to support and resources and span of control did not affect trust in one’s manager. Study findings suggest that creation and preservation of a nurse’s managerial trust is a complex process affected by manager’s competence and character as well as a fair decision-making process. Education programs that contribute to a manager’s ability, benevolence, integrity and procedural justice may help build and sustain nurses’ trust and healthy nurse-manager relationships.

The study was designed to compare and contrast responses of two groups of nurses to situational case studies relative to death and dying, with particular emphasis on euthanasia. One group of nurses was comprised of selected faculty of the 33 member universities of the Nurse Faculty Research Development in the Midwest. The second group of study participants was selected staff nurses of hospitals utilized by each of the universities in the Nurse Faculty Research Development in the Midwest. Special consideration was given to demographic data relative to age, highest level of education attained, marital status, number of classroom hours spent in the study of death, dying, and euthanasia during the basic nursing program, and present work assignment.The population of the study consisted of a total of 184 academic and staff nurses. Ninety of the nurses participating in the study were faculty members of institutions of higher education, and 94 nurses were staff nurses in hospitals utilized by the institutions of higher education.A search of the literature revealed no instrument dealing with euthanasia as it related to the nurse. An opinionnaire was designed specifically for the study because of a lack of an instrument in the area of euthanasia.The data collected from the opinionnaires were developed into a series of tables. The tables were designed to illustrate the number and percentage of academic and staff nurses responding to each situation in the opinionnaire. A comparison was made of the responses of the academic and staff nurses to determine similarities or dissimilarities in the response patterns.Conclusions based upon the review of the literature and findings of the study were:1. Staff nurses have more formal education relating to euthanasia than academic nurses.2. The number of classroom hours spent in the study of death and dying during basic nursing education has increased within the past ten years.3. Staff and academic nurses support the right of parents to make determinations regarding procedures utilized with infants that result in euthanasia.4. The greater number of nurses do not support the conclusion that the removal of life-support systems would be murder.5. A consensus of opinion does not exist between academic and staff nurses regarding the authority of a physician to determine which individual would have priority in the use of a hemodialysis machine. 6. There is an absence of agreement among academic and staff nurses regarding the allocation of scarce resources such as blood. 7. A majority of both academic and staff nurses agree that orders which would result in passive euthanasia could be followed, whereas few academic or staff nurses would follow an order which would result in active euthanasia.

Health policy reforms have dominated health systems in African countries for over three decades. However, the impacts of these policies on nurses’ work, as well as the extent to which the nurses are involved in the policy decisions, have not been well documented. As the largest group of health professionals in the workforce, nurses’ services are necessary to achieve population health outcomes. Thus, nurses’ work concerns related to the reform of national policies should be identified and addressed. This study was carried out to examine how the national policy reforms have impacted on nurses’ work in Kenyan district health care systems and how nurses have been involved in policy processes in the health care system. Critical theory and feminist critical policy analysis perspectives guided the study. The study was implemented in two phases. The first phase involved qualitative interviews with 32 decision makers and nurses in the public health care system. The second phase involved a comparative quantitative survey of nurses and nurse managers in two districts. A sample of 169 nurses was interviewed in two district hospitals to generate data for this second phase of the study. This thesis contains three manuscripts. The first manuscript presents a qualitative analysis of the impact of policies on nurses’ work (Chapter 2). The second manuscript presents qualitative results of how nurses were involved in policy processes at various levels of the health care system (Chapter 3). The third manuscript presents results of a quantitative survey of frontline nurses’ experiences with the policy reforms, comparing two districts (Chapter 4). An integrative discussion of key findings from all these manuscripts forms the last chapter of the thesis. The findings revealed that policies meant to enhance access to services like decentralization and primary health care were more enabling to nurses’ work while those aimed at enhancing efficiency like structural adjustment programs were more constraining. The constraints included poor work environments, unchanging work conditions, increased responsibilities and dilemmas in providing care. These constraints were experienced more by nurses in the district that was poorly resourced and had poor health indicators than the district that had better resources and better health indicators. The results suggest that inadequate involvement of nurses in policy processes is a reason why their work concerns have not been addressed. There are recommendations to improve nurses’ work in the context of policy reform and to improve nurses’ abilities to participate in policy processes.

Thesis (Ph.D.) -- University of Canberra, 2009. / Submitted in fulfillment of the requirements of the degree of Doctor of Philosophy in Government. Bibliography: p. 289-306.

Thesis (EdD)--Open University. BLDSC no. DX227620.

Thesis (Ph. D.)--Indiana University, 1974. / Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 100-105).

Thesis (Ph. D.)--Florida State University, 1974. / Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves [213]-215).

Thesis--St. Louis University. / Vita. Includes bibliographical references (leaves 43-45).

No description available.