Workplace empowerment, job satisfaction and job stress among Italian mental health nurses: an exploratory study

Aim  The purpose of the present study was to investigate the relationship between staff nurses' structural empowerment, work stress and job satisfaction in two health care settings in Italy using Kanter's Empowerment Theory.
Background  With the current scarcity of economic resources and shortage of nurses, it is essential to empower nurses to perform at a high level to ensure high-quality patient care. Structural empowerment is a process that can optimize use of nursing skills and professional expertise, thereby increasing job satisfaction among nurses.
Method  A convenience sample of 77 nursing staff employed in the Department of Mental Health in central Italy was used in this study (return rate 64%).
Results  Structural empowerment was significantly related to their job satisfaction ( r  = 0.506, P  < 0.001), as was global empowerment ( r  = 0.62). Empowerment also had a significant negative relationship to nurses' work stress ( r  = −0.28, P  < 0.05).
Conclusion  The results of this study support Kanter's theory of structural empowerment in an Italian nursing sample – a previously unstudied population.
Implications for nursing management  Organizational administration must make every effort to create organizational structures and systems that empower nurses to practice according to professional standards and optimize the use of their knowledge and expertise.     

Misconceptions Among Nurses About Evidence-Based Practice

Purpose: To delineate the origins and fundamental tenets of evidence-based practice (EBP) and to enhance understanding of this important term.
Methods: A critical review of the literature pertaining to evidence-based practice from the fields of medicine and nursing, including international reports.
Findings: The roots of EBP indicate this term is not a synonym for research utilization but rather is the rubric for a set of epistemologic assumptions. Key components of EBP include evidence hierarchies and systematic reviews. Differences were found between the views of EBP presented in papers published by nurses within the US compared to those published by nurses outside the US.
Conclusions: The literature shows incongruity in the interpretation of the basic tenets of the evidence-based paradigm. Additionally, nurses may underestimate implications of the evidence-based movement. These two problems impede nurses' participation as full partners in the advancement of evidence-based practice. They also represent a call to action to achieve a more standardized framework for advancing EBP in nursing.     

Workplace empowerment, incivility, and burnout: impact on staff nurse recruitment and retention outcomes

Aim  The aim of this study was to examine the influence of empowering work conditions and workplace incivility on nurses' experiences of burnout and important nurse retention factors identified in the literature.
Background  A major cause of turnover among nurses is related to unsatisfying workplaces. Recently, there have been numerous anecdotal reports of uncivil behaviour in health care settings.
Method  We examined the impact of workplace empowerment, supervisor and coworker incivility, and burnout on three employee retention outcomes: job satisfaction, organizational commitment, and turnover intentions in a sample of 612 Canadian staff nurses.
Results  Hierarchical multiple linear regression analyses revealed that empowerment, workplace incivility, and burnout explained significant variance in all three retention factors: job satisfaction ( R ² = 0.46), organizational commitment ( R ² = 0.29) and turnover intentions ( R ² = 0.28). Empowerment, supervisor incivility, and cynicism most strongly predicted job dissatisfaction and low commitment ( P  < 0.001), whereas emotional exhaustion, cynicism, and supervisor incivility most strongly predicted turnover intentions.
Conclusions  In our study, nurses' perceptions of empowerment, supervisor incivility, and cynicism were strongly related to job satisfaction, organizational commitment, and turnover intentions.
Implications for nursing management  Managerial strategies that empower nurses for professional practice may be helpful in preventing workplace incivility, and ultimately, burnout.     

Tensions and contradictions in nurses' perspectives of evidence-based practice

Aim  To explore nurses' understanding and interpretation of evidence-based practice (EBP).
Background  EBP has been welcomed into the nursing lexicon without a critical examination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning and application of EBP. Although work has been conducted on how EBP might be implemented, the general issue of how nurses understand and use EBP is largely unexplored. This paper seeks to examine in depth the understandings of EBP, to enable managers, educationalists and policy makers to implement it more effectively.
Methods  All registered nurses, midwives and health visitors in one UK National Health Service (NHS) Trust were asked to complete a questionnaire in October 2006.
Results  Despite a disappointing response rate (8.9%, 218/2438), the survey revealed interesting tensions and contradictions in nurses' understanding of EBP. National and local guidelines, practitioners' own experience and patients' preferences were the main influences on nurses' practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those who had not attended a study day on EBP.
Conclusions  The hierarchies of evidence propounded in local and national guidelines are not adopted by practising nurses, who use other sources of evidence, such as reflection on their own experiences, when making clinical decisions. However, subsuming published evidence to clinical judgement does not contradict the original tenets of EBP.
Implications for Nursing Management  Unless it is incorporated into national or local guidelines, research has relatively little impact on practice. To develop nursing practice and nursing knowledge, nurse leaders need to foster the synthesis of experiential knowledge and published research, in accordance with the founding principles of the EBP movement.     

Factors influencing the development of evidence-based practice: a research tool

AIM: The paper reports a study to develop and test a tool for assessing a range of factors influencing the development of evidence-based practice among clinical nurses. BACKGROUND: Achieving evidence-based practice is a goal in nursing frequently cited by the profession and in government health policy directives. Assessing factors influencing the achievement of this goal, however, is complex. Consideration needs to be given to a range of factors, including different types of evidence used to inform practice, barriers to achieving evidence-based practice, and the skills required by nurses to implement evidence-based care. METHODS: Measurement scales currently available to investigate the use of evidence in nursing practice focus on nurses' sources of knowledge and on barriers to the use of research evidence. A new, wider ranging Developing Evidence-Based Practice questionnaire was developed and tested for its measurement properties in two studies. In study 1, a sample of 598 nurses working at two hospitals in one strategic health authority in northern England was surveyed. In study 2, a slightly expanded version of the questionnaire was employed in a survey of 689 community nurses in 12 primary care organizations in two strategic health authorities, one in northern England and the other in southern England. FINDINGS: The measurement characteristics of the new questionnaire were shown to be acceptable. Ten significant, and readily interpretable, factors were seen to underlie nurses' relation to evidence-based practice. CONCLUSION: Strategies to promote evidence-based practice need to take account of the differing needs of nurses and focus on a range of sources of evidence. The Developing Evidence-Based Practice questionnaire can assist in assessing the specific 'evidencing' tendencies of any given group of nurses.     

Attitudes of nurse professionals and nursing students towards children with disabilities. Do nurses really overcome children's physical and mental handicaps?

Background:  Many health professionals and nurses, who are involved in the care of disabled children, do not exhibit the essential sensitivity and appropriate attitudes towards them, resulting in a poor quality of nursing care.
Aim:  The objective of this study was to investigate the attitudes of nurse professionals (paediatric nurses) and nursing students towards disabled children.
Patients and methods:  The present study is a comparative study. The sample consisted of 228 first-year nursing students, 90 post-diploma nurses attending MSc degree course and 123 nurse professionals who are employed in paediatric hospitals. After obtaining permission from the hospitals and the educational settings and informing about the subjects of the study, data were collected using the paediatric Attitude Towards Disabled Person Scale (ATDP).
Results:  Overall nurses' attitudes appeared to be poor (mean ATDP score 61.7 ± 14.2). However, the post-diploma nurses had significantly higher ATDP scores than first-year students and paediatric nurses ( P  < 0.001). In addition, first-year students had significantly higher scores than paediatric nurses ( P  = 0.047). Across the sample, females hold significantly more positive attitudes than males ( F  = 9.5, P  = 0.002), while age did not have any significant effect.
Conclusions:  Carefully designed curricula can influence the attitudes of nursing students towards children with disabilities. Special courses for treating disabled children should be integrated to the basic nursing studies. Moreover, continuing hospital education can change paediatric nurses' attitudes towards children with disabilities.     

Nurses' experiences of research utilization within the framework of an educational programme

This paper explores nurses' reflections on their experiences of disseminating and implementing research findings in clinical practice within the framework of an educational programme. Ten registered nurses, all in clinical practice, participated in a research-orientated educational programme with the aim of facilitating the dissemination and implementation of research findings in clinical practice. Thus, the programme contained different activities designed to disseminate and implement research findings in the participants' wards. Focus groups were used to collect data and a qualitative content analysis was performed. The main themes that were developed were: organizational and leadership issues; acquiring a new role; responses and reactions by others; and orientation to research. Organizational and leadership issues, nurses' interest in research, nurses' reading habits, and support and feedback from their head nurses and other managers and from their nursing colleagues and physicians were seen as important. This study confirms that research utilization and the change to research-based nursing practice are complex issues which require both organizational and educational efforts.     

Educational needs of nurses when nursing people of a different culture in Ireland

Background:  Over the last 10–15 years, there has been a dramatic change in the population of the Republic of Ireland (ROI). Because of strong economic growth, a buoyant economy and universal population migration, the ROI has moved from a mono to a multicultural society over a relatively short period of time. Therefore, nurses in this state have limited experience of caring for people of a different culture.
Aim:  To discuss registered nurses' experiences in the ROI of nursing people from a different culture.
Methods:  The study design was qualitative and participants were purposively sampled ( n  = 7). Data was collected through semi-structured interviews and thematically analysed.
Findings:  The main themes to emerge from the interviews were: dealing with cultural issues in practice; accessing and using the interpreter service; planning and taking action to improve nursing care for patients from a different culture.
Conclusion:  Support and education is needed by nurses to improve nursing care of people from a different culture.
Practice implications:  Recommendations for practice are to: develop transcultural nursing education; promote an ethos of providing culturally competent and culturally safe nursing to people of another culture; improve resources available to nurses; provide easier access to formal interpreter services with continuity of interpreters for patients and conduct further research into aspects of health care in multicultural Ireland.     

Evaluation of a transition to practice programme for mental health nursing

Title.  Evaluation of a transition to practice programme for mental health nursing.
Aim. This paper is a report of a study assessing nurses' satisfaction with a 12-month transition to practice programme into mental health nursing and its impact on their perceived knowledge, confidence and self-concept.
Background.  Transition to practice programmes are necessary to facilitate graduate nurses' professional adjustment into nursing and experienced nurses' movement from one clinical setting or speciality to another. Role transition can be a difficult process, and those who have realistic expectations may experience less stress during the actual transition.
Method. A quantitative evaluation design carried out in Australia, using questionnaires for data collection. The study began in 2005 and the participants were three groups ( n  = 45) of Registered Nurses who all completed the programme during 2006 and 2007.
Findings. Forty-four nurses (98%) completed pre- and postprogramme surveys. There was a relatively high level of satisfaction with the programme. Most participants found all aspects of the programme to be substantially positive, with the majority intending to continue to work in mental health nursing at programme completion. Data concerning knowledge of and confidence in undertaking a number of nursing tasks showed statistically significant gains postprogramme for most items. No differences were found in The Nurses' Self-Concept Questionnaire scores between pre- and post-test phases, apart from a trend towards improved communication and caring.
Conclusion. Transition programmes have the potential to make a positive contribution to the mental health nursing workforce. Continuing professional development opportunities are essential to ensure that skill development is maintained. Future longitudinal research could ascertain the benefits of the programme on staff retention.     

Predictors of nurses' perceptions of barriers to research utilization

AIM: To identify predictors of nurses' self-reported barriers to using research findings in clinical practice. BACKGROUND: Several studies have shown that nurses perceive barriers to research utilization but to our knowledge predictors of nurses perceptions of barriers to research utilization have not been identified before. METHODS: Three questionnaires were answered by 833 nurses: the Barriers Scale, the Quality Work Competence questionnaire and a questionnaire including questions on professional issues. RESULTS: Dissatisfaction with support from immediate superiors for participating in research and/or development projects, having no academic degree and unclear and unrealistic workplace goals were identified as factors increasing the risk of perceiving barriers to the use of research findings in clinical practice. CONCLUSIONS: The results imply that head nurses, nursing managers and other health care leaders should create strategies for supporting nurses' professional development and possibilities to implement research findings in clinical practice. IMPLICATIONS FOR NURSING MANAGEMENT: To support research utilization and evidence-based care health care leaders, head nurses and nurse managers should create clear and realistic goals for the work place including demands on evidence-based care. It is also important for head nurses and nurse managers to create strategies for supporting nurses' professional development and possibilities to implement research findings in clinical practice.     

The importance of work environment: evidence-based strategies for enhancing nurse retention

As the nation faces a growing nursing shortage, it is imperative that home care leaders implement evidence-based strategies to improve nurse recruitment and retention. Previous research indicates that characteristics of the work environment that support nursing practice enhance nurses' job satisfaction and reduce turnover. Yet, there is little evidence to assist in prioritizing initiatives to improve the work environment of nurses. In this nationwide survey, home care nurses were asked to rate the importance of specific agency work environment traits, as listed on the Nursing Work Index-Revised, in supporting their home care practice. The 10 agency traits rated as most important are presented, and evidence-based recommendations for creating a culture of nurse retention are discussed.     

Barriers to using research evidence in nursing practice

Barriers to using research evidence in nursing practice The nursing profession has long recognized the importance of research as an essential basis for its development. More recently, the movement supporting evidence-based practice has brought this point into focus. However, relatively little research has been conducted to identify factors that interfere with the ability of nurses to base their practice on research evidence. Using factor analysis procedures, barriers to the use of research evidence in practice which were perceived to be present by 400 registered nurses working in an Australian hospital, were grouped under four main factors. These were accessibility of research findings, anticipated outcomes of using research, organizational support to use research and support from others to use research. The most important factor was perceived to be organizational support, particularly in relation to providing time to use and conduct research.     

Comparing evidence-based practice of nurses and physiotherapists

Evidence-based practice has become an ubiquitous concept within nursing. However, there is little comparative data of nursing with other professions on attitudes to evidence-based practice. This article reports on a survey of nurses' and physiotherapists' sources of knowledge and perceived barriers to evidence-based practice within a large teaching hospital. A total of 324 questionnaires were sent to nurses and physiotherapists. The results showed that both physiotherapists and nurses accessed a wide variety of sources of knowledge. However, nurses were more likely than physiotherapists to use policy and procedure manuals and discussions with medical staff. Both professions have problems with overcoming the barrier of time. Nurses were more likely than physiotherapists to rate themselves as having poor evidence-based practice skills.