An exploration of empowerment discourse within home-care nurses' accounts of practice

In this study, we explore how client and family caregiver 'empowerment' is interpreted by home-care nurses talking about their practice with palliative (and to a lesser extent, non-palliative) clients and families. We draw on secondary analysis of qualitative data collected through in-person interviews with 27 home-care nurses from a western Canadian health authority. First, we illustrate how the practice ideal of empowerment, in the sense of 'respecting autonomy and choices', can be understood as reflecting home-care nurses' needs to mitigate the emotional impact of feeling unable to effectively help palliative clients/families. Then, we illustrate how the practice ideal of empowerment, in the sense of 'promoting independence', can be understood to accomplish the need to shift responsibility for particular care tasks to clients and family members. Lastly, home-care nurses, talk about 'promoting choices' is also investigated. 'Choice' was framed narrowly with respect to allowing palliative clients and families to determine visit time and frequency. Findings are discussed in relation to the concept of 'responsibilization'.     

Effects of workplace incivility and empowerment on newly-graduated nurses' organizational commitment

smith l.m., andrusyszyn m.a. & laschinger h . (2010) Journal of Nursing Management 18, 1004–1015
Effects of workplace incivility and empowerment on newly-graduated nurses’ organizational commitment Aim The purpose of the present study was to test an expanded model of Kanter’s theory by examining the influence of structural empowerment, psychological empowerment and workplace incivility on the organizational commitment of newly-graduated nurses. Background The early years of practice represent a significant confidence-building phase for newly-graduated nurses, yet many new nurses are exposed to disempowering experiences and incivility in the workplace. Method A predictive non-experimental design was used to examine the impact of structural empowerment, psychological empowerment and workplace incivility on the affective commitment of newly-graduated nurses (n = 117) working in acute care hospitals. Results Controlling for age, 23.1% of the variance in affective commitment was explained by structural empowerment, psychological empowerment and workplace incivility [R² = 0.231, F_5,107 = 6.43, P = 0.000]. Access to opportunity was the most empowering factor, with access to support and formal power perceived as least empowering. Perceived co-worker incivility was greater than perceived supervisor incivility. Conclusion Results offer significant support for the use of Kanter’s theory in the newly-graduated nurse population. Implications for Nursing Management Without specific strategies in place to combat incivility and disempowerment in the workplace, attempts to prevent further organizational attrition of new members may be futile.     

Towards a comprehensive theory of nurse/patient empowerment: applying Kanter's empowerment theory to patient care

spence laschinger h.k., gilbert s., smith l.m. & leslie k. (2010) Journal of Nursing Management 18, 4–13
Towards a comprehensive theory of nurse/patient empowerment: applying Kanter's empowerment theory to patient care
Aim  The purpose of this theoretical paper is to propose an integrated model of nurse/patient empowerment that could be used as a guide for creating high-quality nursing practice work environments that ensure positive outcomes for both nurses and their patients.
Background  There are few integrated theoretical approaches to nurse and patient empowerment in the literature, although nurse empowerment is assumed to positively affect patient outcomes.
Evaluation  The constructs described in Kanter's (1993) work empowerment theory are conceptually consistent with the nursing care process and can be logically extended to nurses' interactions with their patients and the outcomes of nursing care.
Key issues  We propose a model of nurse/patient empowerment derived from Kanter's theory that suggests that empowering working conditions increase feelings of psychological empowerment in nurses, resulting in greater use of patient empowerment strategies by nurses, and, ultimately, greater patient empowerment and better health outcomes.
Conclusions  Empirical testing of the model is recommended prior to use of the model in clinical practice.
Implications for Nursing Management  We argue that empowered nurses are more likely to empower their patients, which results in better patient and system outcomes. Strategies for managers to empower nurses and for nurses to empower patients are suggested.     

Psychological empowerment and structural empowerment among nurse practitioners

Abstract
Purpose: Empowering workplaces provide practitioners with access to information, support, resources, and opportunities to learn and grow. Empowerment is also a psychological process, which occurs when one has a sense of motivation in relation to the workplace environment. There is no previous research on the relationship of psychological empowerment and structural empowerment in nurse practitioner (NP) practice.
Data Sources: Structural empowerment was measured using the conditions of work effectiveness questionnaire-II (CWEQ-II), and psychological empowerment was measured using Spreitzer's psychological empowerment scale. The sample consisted of 74 NPs in the state of Connecticut. The correlational scores for the instruments were derived with n = 72 as two subjects had extreme scores on multiple variables and were excluded. There were significant correlations between psychological and structural empowerment for total scores, and within 10 of these tools' subscales.
Conclusions: The NPs who participated in this study scored high on perceptions of structural empowerment and psychological empowerment. The results of the psychological empowerment instrument indicated that the NPs value their work and find meaning in what they do.
Implications for Practice: The relationships between psychological empowerment and structural empowerment have been linked to work effectiveness, quality patient care, cost-effectiveness, and retention. Study results support an implication that it is of critical importance for the organization or practice setting to facilitate both psychological and structural empowerment to the NP to ensure successful practice.     

Connection between organizational culture and climate and empowerment: The perspective of nurse managers

Health‐care organizations differ from other institutions due to their unique structure and management. Organizational culture and climate are the key constructs that compose the organizational social context, and might have an impact on employees, such as nurse managers, and the organization itself. The aim of this study was to analyze the connections between organizational culture and climate and work‐related empowerment, and also to present culture and climate profiles at team and organization levels. The research was carried out in Lithuania among 193 nurse managers in seven hospitals using a questionnaire that measured organizational culture and climate (Organizational Social Context instrument), and work‐related empowerment (Conditions for Work Effectiveness Questionnaire‐II and Work Empowerment Questionnaire). The findings showed that nurse managers were both structurally and psychologically empowered when the organizational culture was proficient and resistant, and the climate was engaged and functional. These results suggest that nurse managers are more likely to be empowered when there is an appropriate organizational culture and climate in the workplace. Creating an empowering work environment might have a positive impact on individual and organizational outcomes.     

层级护理管理模式提高ICU护士心理状态和护理质量的实践效果

目的探讨ICU护士实施分层管理对护理工作的影响。方法 2013年6月至2015年6月将层级护理管理模式应用于ICU护士护理管理中,观察比较实施前后ICU护士操作和理论考核成绩、心理状态、护理质量及满意度变化情况。结果层级护理管理实施后,ICU护士理论和操作技能考核成绩得分均较实施前提高(P0.01);抑郁评分低于实施前(P0.01);护理质量指标评分均显著高于实施前(P0.01);满意度评分高于实施前(P0.01)。结论层级护理管理模式能够改善护士心理状态和护理质量,提高护士工作满意度,有利于在护理管理方面推广应用。     

提升护士执行力的方法与效果

目的提升护士执行力,提高护理质量及患者的满意度。方法通过创建具有活力的护理团队执行力文化、建立有效沟通渠道、健全管理制度、明确质量标准、建立及健全激励机制、授权与及时跟进等方法提升护士执行力。结果实施提升护理执行力措施后,患者满意度及护理质量显著提高,差异具有统计学意义（P〈0．05）。结论提升护士执行力是提高护士综合素质、和谐护患关系、提高患者满意度及护理质量的有效措施.     

Organizational change and work-related empowerment

AIM: This study describes the views of multidisciplinary teams on work-related empowerment in a transitional organization. METHODS: The data were collected between September 2003 and January 2004 (n=115) and one year later (n=112) using a self-administered questionnaire consisting of verbal and behavioural items, empowerment outcomes, and factors promoting and impeding empowerment. The target population consisted of all members working in multidisciplinary teams at the Rheumatism Foundation Hospital in Finland. The response rate was 58% at both data collections. The data were analysed statistically using SPSS software. RESULTS: The multidisciplinary teams rated their work empowerment quite highly. The number of empowerment promoting factors was lowest for the category of future orientedness, consisting of continuity of work, opportunities for advancement, and access to information. The number of impeding factors was also highest for the same category of future orientedness, consisting here of organizational bureaucracy and hierarchy, authoritarian leadership, poor access to information, and short working periods. CONCLUSIONS: It is important not to underestimate the impacts of organizational changes: they have a direct effect on the work environment and may contribute to higher rates of dissatisfaction, burnout and absenteeism among health care workers.     

Kanter结构授能理论及其在护理领域中的研究进展

通过介绍Kanter结构授能理论的框架及其在护理领域的适用性,重点阐述了护理人员结构授能与身心健康、工作满意度、离职意向和护理质量的相关研究进展,并提出对我国护理领域结构授能研究的启示.     

Team inclusion and empowerment among nursing staff in long-term care

Team-based approaches to long-term care are increasingly part of the landscape in residential care facilities to improve staff performance and resident outcomes vis-à-vis empowering direct care staff. This study characterizes licensed and unlicensed nursing staffs’ (N = 95) perceptions of inclusion as care team members by co-workers, supervisors and non-nursing clinicians. Further, we explored whether inclusion was correlated with heightened empowerment and its related dimensions using the Perception of Empowerment Instrument. Linear regression analyses revealed that levels of total empowerment, autonomy, responsibility and participation were associated with how included team members felt and by which members of the care team. These findings shed light on the potential importance of tailoring staff training to target specific team members to increase a sense of empowerment that aligns with the specific dimension(s) for a targeted group.     

Patients' and nurses' experiences of perioperative dialogues

BACKGROUND: Previous research has shown that perioperative visiting can aid the planning and implementation of nursing care by giving patients an opportunity to express their expectation and to receive information. This is in turn can reduce anxiety and stress. However, patients and nurses' experiences of this process have not been studied before. AIM: The aim of the research was to describe and interpret the meaning of nursing care experienced by patients and nurse anaesthetists or operating-room nurses (referred to as perioperative nurses) through the pre-, intra- and postoperative dialogues. METHODS: A hermeneutic approach was used when interpreting text from interviews with 10 patients after the operation and 10 nurses who were asked to write down their experiences after having conducted pre-, intra- and postoperative dialogues with their patients. The interpretation of the whole was: the common quality of the pre-, intra- and postoperative dialogues was continuity and the distinguishing quality was how the patient and nurse experienced continuity. FINDINGS: Continuity in 'the perioperative dialogue' from the patients' point of view is expressed as sharing a story and the body is in safe hands. From the nurses' point of view continuity means that professional nursing care becomes visible and that continuity gives meaning to the work. CONCLUSION: If perioperative nurses used the perioperative dialogue they could create continuity for patients and for themselves in the pre-, intra- and postoperative phases. The nurse is, in this context, the continuity and continuity gives the possibility of establishing a caring relationship and caring for the patient in a dignified way.