empower assigment

NBNC 1204 CLINICAL PRACTICE 10 (PROFESSIONALISM AND ISSUES IN NURSING B )

BY SALMAH BT MD SHARIF

2010

Nursing Professionalism / Professionalisation in Malaysia

2.1 - Introduction

“ The Lady with the Lamp,”which it is address to Florence

Nightingale, is the most influential nurse in the history of modern

nursing.The first training school for nurses at Thomas’s Hospital,

London (1860) was founded by “The Lady with Lamp”. According to

Florence Nightingale learning a unique body of knowledge was

required to those wishing to practice professional nursing.

Nurses provide a variety of services to their patients. In general,

they help to prevent injury and disease, promote healthy living, and

care for the sick. They provide direct care for their patients through

administering medications, and assisting with convalescence and

rehabilitation. Nurses help people improve and maintain health by

creating and managing care plans for their patients. Nurses can

either choose to specialize in an area or many are general nurses

that perform a variety of duties as needed for the physician. Areas

of specialty include surgical, neonatal, anesthetist, gynecological,

and many others. Nurses often advance to become department

heads and supervisors, managing over other nurses, setting

standards of patient care, and even composing the department's

budget..

2.21 - Nursing professionalism

Professionalism refers to the conducts, goals or qualities that

characterize or mark of a profession of a professional person.

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Profession usually develops codes of ethic that describe the

expected behavior that reflect professionalism among its member.

Professionalism in nursing are set of rules, work ethics, ideologies,

work principles and dedication towards the service of a community,

that holistically gives a class and identity to this profession. In truest

sense, professionalism in nursing is more of an attitude of the

nurses towards the nursing profession.(Schwirian 1998)

2.22 - Nursing Professionlisation

Professionalisation is a process through which an occupation goes

through as it moves to the profession end of the occupation

profession continuum.(Schwirian 1998)

During the twentieth century, the nursing profession has under

gone immense change. Nursing has progressed from an

occupation to a fully licensed profession, with members that provide

a broad range of services independently, and in a variety of

professional relationship with other providers. This evolution has

changed how nurses are educated, clinically prepared, and how

they perceive their role.

According to Colyer,(2004) These changes can be characterized as

the professionalization of health care work, and also as moving

away from the tradiotional National Health Service (NHS) role

culture (where job titles denoted what people did and their place in

the hierarchy) towards greater role divertsity and a more

meritocratic system.

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Becoming a professional involves unique training, formal education,

achieving credentials,activity in continuing education opportunities,

joining and actively involving in professional association.

2.3. Nursing issue in Higher Education

Nursing issue in Higher Education is identify relating in clinical

practice , which may effect nursing professionalism in Malaysia.

In this paper, I will try to highlight the need of higher education in

nursing profession. The changes in medical education have been

proposed earlier by Flexner report. The Report (also called

Carnegie Foundation Bulletin Number Four) called on American

medical schools to enact higher admission and graduation

standards, and to adhere strictly to the protocols of mainstream

science in their teaching and research. Flexner, Bixler’s & Bixler’s

and Kelly believed that practitioner needs to educate in Institution of

Higher Learning to become a peer profession. Perhaps no issue in

nursing has been more controversial than the education of its

practitioners. Nursing’s heritage, like that of medicine, was founded

in apprenticeship. Students were assigned to experienced

practitioners who taught the skills with which they were familiar.

Once those skills were acquired, the student moved into the world

of employment. Earliest programs of education were located in

hospitals rather than colleges or universities.

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2.4 Aim

To highlight the need of higher education in nursing profession.

2.5 Discussion

2.5.1 A Day In Nursing Life. Nurses work in many different

settings, including hospitals, clinics, nursing homes, schools,

corporations and even patient homes. Home health and public

health nurses travel more than other nurses, to patients' homes,

schools, and other sites. Nurses generally work eight hour shifts,

but some hospitals have nurses work ten and twelve hour shifts for

three or four days a week. Nurses in hospitals, and nursing and

residential homes tend to work weekends, nights, and even

holidays, and are often on-call. Nurses are on their feet a lot at

work and therefore must be in relatively good physical shape. They

must also have good communication skills in order to deal

effectively with patients by practicing good listening and giving clear

directions to both patients and aides. A positive disposition and

mental strength is essential to this position as it can be stressful

and emotionally challenging to deal with human suffering and

emergency situations on a day-to-day basis. A nurse should have a

caring and sensitive nature in order to best care for patients.

2.5.2 Education and training.

Over time, the settings in which nurses are educated have

changed. Today, most nursing programs preparing Registered

Nurses are located in institutions of higher education or

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collegiate settings. But, not all nurses today are educated in

colleges and universities. There are four main educational

programs available for nursing. To become a licensed practical

nurse you must complete a state-approved practical nursing

program, which are usually offered through community and

technical colleges, and last for two years. There are three programs

available for registered nurses, including the Associate Degree in

Nursing( A.D.N), the Bachelor of Science in Nursing( B.S.N.) and

the diploma program. The associate degree in nursing (A.D.N.)

program is a two to three year program offered at junior and

community colleges and combined with hospital training. The

Bachelor of Science degree in nursing (B.S.N.) program is offered

at colleges and universities, and normally takes four to five years to

complete. And lastly, diploma programs are offered at hospitals,

and typically last from two to three years. Students are required to

graduate from an approved nursing program and pass a national

licensing examination to practice nursing. Periodic licensing

renewal is required, and usually involves continuing education and

additional training. It is important that nurses pursue higher

education in order to be eligible for promotions to supervisory and

higher paying roles. Also, a bachelor's degree is required to pursue

a career as an advanced practice nurse such as a nurse

practitioner or certified nurse anesthetist.

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2.6 The Transformation Factors To Commit Higher Education

In Nursing Profession.

2.6.1 The Need To Become Professional Profession.

Over time, the settings in which nurses are educated have

changed. Today, most nursing programs are located in institutions

of higher education or collegiate settings (at either colleges or

universities). Controversy over the length of nursing education

programs (associate degree versus baccalaureate degree) and the

“technical” aspects of patient care continues. Additionally, not all

nurses today are educated in colleges and universities. In

Malaysia, hospital based programs still provide an avenue to

nursing education for prospective nursing students but now we are

moving towards higher education such as minimum diploma and

now degree and even do master’s and doctoral in local and private

university. Even do there is growing numbers of master’s and

doctoral programs in nursing but its small compared with others

health profession. The legitimate question is ’How can nursing

take its place as a peer among the professions when the most

nurses currently in practice hold less than a baccalaureate

degree?’. The professional status and power comes and increase

with postgraduate education. Education of nurses needs to change

to accommodate the increased expectations of nurses as

practitioners, educators, researchers, managers and administrators

as well as policy shapers. Flexner, Bixler’s & Bixler’s and Kelly

believed that practitioner needs to educate in Institution of Higher

Learning to become a peer profession.

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2.6.2 The Growth Of Science And Technology. With the growth

of science and technology and the increase in complexity of

modern society, new fields of study have opened up to the

community via universities. Although nursing could not be seen as

a new science, technological advances and the explosion of

nursing and care models throughout the world has led to an

extraordinary increase in nursing knowledge and complexity. This

has resulted in the transfer of nurse preparation to higher education

with the view to ensuring nurses are prepared adequately to

guarantee safe practice. Preparation to degree levels is seen by the

nursing profession as a minimum standard. The requirement of

nurses to keep abreast with advancing technology and treatments

will increase the demand on the provision of higher education for

the profession.

2.6.3 Expectation of Community. A community should expect

that basic rights will be afforded it by its government. One of these

basic rights is access to quality health care. This can only be

provided in a system that is not only adequately funded but is

provided by health professionals well grounded in knowledge and

skills required to provide that health care.

2.6.3 The Attributes Required By Nurses. These skills and

attributes can no longer be provided in an apprenticeship type

system, hence the transfer of nurse education to the higher

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education sector. The attributes required by nurses to operate

effectively in their professional lives are:

a. Knowledge of clinical treatments for specific illnesses.

b..Awareness of and competence in emerging health

technology.

c. Skilled in counseling both patients and other nurses and

members of the health care team.

d. Ability to supervise other members of the health care team

in the care of patients.

e. An understanding of multiculturalism and the ability to

relate to people of many differing cultural backgrounds.

f. Ability to effectively manage both human and material

resources.

g. The capacity to observe, act and interact appropriately

with a whole person, not just the illness or condition they

exhibit.

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2.7 Implication of Higher Education to Nursing Profession

2.7.1 The Need of Health Industry. The health care industry is

one that is experiencing considerable growth, and as the population

continues to age, the need for provision of health care will expand.

It's been widely reported that there is a nursing shortage in the

United States, and it is expected to grow worse as the population

increases and ages and new medical procedures are developed.

Hospitals, nursing homes, adult-care facilities and home-care

services will suffer increasingly, industry experts say, as the current

trend seems likely to continue. Nursing faculties within Australian

universities have not kept pace with the health industry’s demand

for registered nurses and this has resulted in a shortfall of adequate

nursing numbers at both general and specialist level. This will

continue to have significant impact on workforce needs. A recent

workforce survey undertaken in Victoria, Australia shows a shortfall

of 516 effective full time positions in 412 facilities, this figure if

translated across the state results in one thousand unfilled nursing

positions. The major areas noted in the study as experiencing

particular difficulty in recruitment of nurses are operating theatres,

critical care, accident and emergency, renal dialysis, rehabilitation,

midwifery and general medical and surgical units. Although some

of the nursing workforce shortages in Victoria can be attributed to

specific cuts to the health budget, Victorian nurses are also

extremely concerned at the significant cost of undertaking post

graduate studies in specialist nursing domains.

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2.7.2 In Malaysia, we face two problems that is shortage of nurses

that we need to import foreign nurses and shortage of graduate

nurses. We have about 75,000 nurses nationwide, less than five

per cent of whom are graduates. The percentage of graduates we

need is actually about 10 per cent. Currently there is about one

nurse to care for 500 people but the industry is hoping to narrow

the gap to one nurse to 200.

2.7.3 Nursing as a Lifetime Commitment. Bixler and Bixler

(1945) emphasized in their list of criteria for professions that a

profession should attract people of certain intellectual and personal

qualities, who exalt service above personal gain and who consider

their chosen occupation to be their life work. Shortage of people

chooses these professions are increase. The higher education is

the one that can ensure the better pay, promotion, hierarchy in

upper position and other great career benefits. With these benefits,

the recruitment can be easier. The need of higher education brings

the changes in nursing curriculum. Today in Malaysia, hospital

based programs still provide an avenue to nursing education for

prospective nursing students but now we are moving towards

higher education such as minimum diploma and now degree and

even doing master’s and doctoral in local and private university.

The nursing profession in Malaysia has also seen remarkable

progress over the years. In 1992, the nursing curriculum in our

colleges was upgraded from certificate to diploma levels. In the

same year the University of Malaya introduced the tertiary-level,

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nursing degree programme. Today, we have 6 local universities

and 4 privately-owned colleges conducting the degree programme

for nurses. They are planning to expand its contribution to produce

more graduate nurses by offering a nursing degree through Long

Distance Learning and e - Learning. With all the programme will

allow Ministry of Health to retain its workforce while at the same

time upgrading their knowledge and skills . In 1994, the conversion

programme for the upgrading of assistant nurses to staff nurses

was introduced.Malaysia .

2.7.4 In terms of career development, nurses in Malaysia have

now been upgraded from being a support group to a professional

group with the creation of the degree scheme for nurses from U41

to U54 grades. This shows that the government acknowledges the

significant contribution of nurses (the higher education and

professional level) to the health of the nation. The good support

from government in Malaysia for nursing profession have

encourage and attract people of certain intellectual and personal

qualities, who exalt service above personal gain and who consider

their chosen occupation to be their life work

2.7.5 Responsibility of Nursing Autonomy Body And

Authority. One of the responsibilities of nursing autonomy or

authority body is to promote and maintain the honors, interest and

the advancement of nursing as a profession. The bodies need to

double up their contribution to encourage nurse to grab the

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opportunities with continuing studies up to graduate level. Others

policy they should remains and highlighted are:

a. To serve as the vehicle of integrated voice of the whole

profession to express its opinion and to acquaint the

government and other bodies with the policy and aspirations

of the nursing profession.

b..To promote nursing education, a high standard of nursing

practice and nursing research.

2.8 Recommendation

For this paper, I have three recommendation to be register, they

are:

2.8.1 Education Of Nurses Needs To Change To

Accommodate The Increased Expectations Of Nurses.

Education of nurses needs to change to accommodate the

increased expectations of nurses as practitioners, educators,

researchers, managers and administrators as well as policy

shapers. The requirement of nurses to keep abreast with

advancing technology and treatments will increase the

demand on the provision of higher education for the

profession. Skills and attributes can no longer be provided

in an apprenticeship type system, hence the transfer of

nurse education to the higher education sector.

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2.8.2 Government Policy Should Be Remaining. The

good support from government for nursing profession have

encourage and attract people of certain intellectual and

personal qualities, who exalt service above personal gain

and who consider their chosen occupation to be their life

work.

2.8.3 Responsibility of Nursing Autonomy Body And

Authority. The bodies need to maintain their contribution to

promote and encourage nurses to grab the opportunities

with continuing studies up to graduate level. Remain the

requirements to qualify for the higher level such as

applicants should have a diploma in nursing or equivalent

with a minimum of two years working experience, is currently

practising as a registered nurse.

2.9 Conclusion

Nurses practice in the interest of public safety and provide a service

to society equally with other essential services such as the police

and army. The transfer of nurse education to the higher education

sector has provided a much needed stimulus to nursing research.

The continued availability of nurse researcher preparation through

the university process is essential for the continual addition of

nursing knowledge and evidence to nursing practice. As the

conclusions, I can say that the professional status and power

comes and increase with postgraduate education.

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References:

1.Creasia, L. C., & Parker, B. (2001) The bridge to professional

nursing practice, conceptual foundations (3rd ed.). St Louis,

Sydney: Mosby.

2.Chan.M.C.,& Elicebat,P.L (2010) .NBBS 1203,Professionalism

and issues in Nursing B (Version March). Malaysia. Kuala Lumpur.

3..Malaysian Nursing Board website[Online][2010,July.01]

4.Trossman, S. (2002). The global reach of the nursing shortage. American Journal of Nursing,102(3):85,87,89

5.Nafsiah Shamsudin. 30th Anniversary Invited Editorial Reflecting

on Smith J.P (1978) Higher education and nursing.Journal of

Advanced Nursing 3(3),219-220.

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3.0 Empowerment in Nursing - the Malaysian context

3.1 Introduction

In Malaysia the registered nurses represent the greatest number of

professional in a health care environment. In a world of ever

increasing technology advancement and economic constrains, the

need for solid rationale on which the base nursing interventions

cannot be ignored. Nurses need power to make their optimum

contribution and conclude with a discussion on the current state of

nursing empowerment related to nursing intervention.

Empowerment seems likely to provide for an umbrella concept of

professional development in nursing.

3.2 What is meant by empowerment in nursing

3.2.1 Defination of power

From The Oxford English Dictionary power is define as “the ability

to do or effect something or anything, or to act upon a person or

thing”. Power as define by Grant(1994) is the capability of acting or

producing some sort of and effect, usually associated with the

ability to influence the allocation of scarce resources.

However, the use of power in nursing occurs as a phenomenon of

interpersonal relationships. Power is a central factor in

interpersonal communication.

Manojlovich(2007) give two definition for power in nursing. Power is

defined as having control, influence or domination over someone or

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something and power is ability to mobilize resources in order to

attain the intended goals.

3.2.2 Defination of empowerment

From The Oxford English Dictionary empower defines as “to

invest legally or formally with power or authority”. Kramer and

Schmalenberg (1990) Empower defines as giving

Individuals the authority, responsibility, and freedom to act on what

they know and instilling in them belief and confidence in their own

ability to achieve and succed. The concept of empowerment are

wide - ranging: the term has been used to describe the essence of

human existence of and development, but also aspects of

organizational effectiveness and quality. The empowerment

ideology is rooted in social action where empowerment was

associated with community interests and with attempts to increase

the power and influence of oppressed group (such as workers,

women and ethnic minorities). Later there was also growing

recognition of the importance of the individual’s characteristics and

actions.

3.2.3 Nurses’ Power over Nursing Practice

A historical review of nurses’ power over nursing practice should

include social, cultural, and education factors that influence nurses’

power over their practice. Social and cultural factors that influence

nursing power have their roots in the view of nursing as women’s

work(Wuest 1994). Nursing remain in a low status in the health

care hierarchy even in other profession can bring women on an

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equal footing with men. Education factors contribute to this situation

where most of our nurses in Malaysia today are diploma graduate

and yet the multiple entry level into nursing practice further

dissipate whatever influence nursing may be able to generate.

From this educational factors may still be contributing to nursing’s

powerless.

Ongoing research on empower in nursing has demonstrated that

empowered nurses are “highly motivated and are able to motivate

and empower others by sharing the sources of power”(Laschinger

& Havens,1996).

3.3 Type of empowerment.

There are two Form of Empowerment :

3.3.1 Structural Empower

Structural power - oriented individuals sacrifice their own self -

interest for the good organization, feel a responsibility to build up

the organization, and have a strong sence of fairness and justice.

Employees with a high need for power tend to be superior

perfomers, managers with a need for institution power tend to be

managing work groups that are productive and satisfied.(Steers &

Porter,1987)

Structural empowerment can be described as the structures (e.g.

policies, councils, and processes) within an organization that

empower nurses to practice in a professional and autonomous

manner to achieve the highest degree of clinical excellence and

professional fulfillment. With structural empowerment, the

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organization has a commitment to continual learning and

educational and career advancement.

The theory of structural empowerment states that opportunity and

power in organizations are essential to empowerment, and must be

available to all employees for maximal organizational effectiveness

and success. The theory of structural empowerment was

developed by Kanter(1993) who saw employees’ work behavior as

arising from conditions and situations in the work place, and not

from personal attributes(Laschinger & Havens,1993). When

nurses have high level of power and opportunity that allow them to

complete their work in meaningful ways.

Structural sources of power have been used to explain power in

organization. Three main structural sources of power in

organizations have been identified as(Hoelzel):

1. Centerality: being central to the major function of the

organization and interconnected with the major systems.

2. Control of uncertainty: influencing organizational goal attainment

by being able to cope with organization’s uncertain environment.

3. Control over resources, information, and other critical

organizational resourses

3.3.2 Psychological Empowerment

Psychological empowerment is seen as a process of personal

growth and development, which is influenced by individual beliefs,

views, values and perceptions and relationships with the

environment (Kuokkanen & Leino - Kilpi 2000)

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Thus empowerment, as provided by the environment, tells part of

the story, but alone it is not enough. Some environments are

empowering because they allow workers to do what it is the worker

feel is necessary to get the job done. In other words, these

environments provide the sources of power. Other work

environments may not be as empowering, yet there will still be a

few hardy individuals who manage to do whatever it take to be

effective on the job. It may be that these people are able to

recognize what few empowering social structures can be used.

Manojlovich(2007).

Psychological power consists of the extent to which people believe

that they can influence even through personal effort. This means

knowing who they are, where they are going, what they want to

accomplish, as well as packaging themselves as person with power

and being adaptable.In a giving situation ,psychological power is

ability to assess the situation in managerial and political sense and

discern the degrees of decision freedom and the chances of being

successful given any specific power strategy or leadership style. It

is also has been described as the extent to which followers respect,

are committed to, and are willing to follow a leader(Hersey et al.,

1996).Trust is the foundation of psychological empowerment.

3.4 Why Empowerment is needed

To be able to make their optimum contribution nurses need at least

three types of power.

3.4.1 Control Over the Content of Nursing Practice.

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Power is an attribute that nurses must cultivate in order to practice

more autonomously because it is through power that members of

an occupation are able to raise their status, define their area of

expertise, and achieve and maintain autonomy and influence(Hall,

1982). One of the characteristics of profession is that professionals

have power over the practice of their discipline which is often

refered to as professional autonomy(Laschinger, Sabiston &

Kutszcher,1997). To identify the appropriate course of action and

effectively function, professionals must have understanding and

control over the entire spectrum of activities associated with the job

at hand (Manojlovich2005). However, it may be that nurses are

frequently unable to use their professional prepareation, which

focuses on autonomous practice and independent decision making,

because they are powerless relative to organizational

administrators and medical staff (Manojlovich).

3.4.2 Control Over the Context of Nursing Practice

Besides control over the content of nursing practice, which

represents one type of power, a related type of control is known as

control over the context of practice, and represents another type of

power that nurses need (Laschinger et. Al.1997).

The positive findings of the magnet hospital research may be

attributed to empowering organizational social structures, although

they were not identified as such. Hospital characteristics which

were found to attract and retain qualified staff nurses included

decentralization and participatory decision making. :Although

relatively little attention has been paid to how a magnet work

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environment contributes to nurses’ sense of power Upenieks,

2003).Professional practice models, shared governance models,

and collaborative governance all use similar processes to increase

nurses’ participation in decision making, thereby increasing their

control over the context of nursing practice and promoting power.

There is strong empirical justification for promoting nurses’ power

through control over both the content and context of nursing

practice. In multiple studies, patient outcomes were improved when

the hospital organization was supportive of autonomous nursing

practice(Aiken et. Al 1999; Aiken, Clarke, & Sloane, 2000).

3.4.3 Control Over the Competence of Nursing Practice

A necessary precursor for both autonomy and power is

competence , which has its foundation in education al preparation.

Power is maintained through knowledge development , which is

acquired through education and expertise. Educational preparation

and expertise represent two additional type of power nurses need

to make their optimal contribution to patient care.

To increase nursing empowerment may lie in understanding

workplace sources of power, expanding the view of empowerment

to include the notion of empowerment as a motivational construct,

and finally making more explicit growth fostering relationships

which also contribute power. The importance of a positive work

environment for ensuring patient safety in hospital settings.

Creating and sustaining trust throughout the organization was

identified as a critically important leader activity. Structural

empowerment is identified as important for retaining nurses,

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including job satisfaction, participant in organizational decision

making, job autonomy or control over practice and organizational

commitment.

3.5. AIM

Aiming for painless experience for hospitalization patients

“Any failure to relive pain is both morally and ethically

unacceptable”.

“All patients have a RIGHT to pain relief, creating a duty of

care”

(Royal College of surgeons and Anaesthetists .1990)

Pain is a very common symptom in hospitalize patients. Acute pain

is pain that associated with a distinct disease or injury. The aim

hospital organization and health care provider is to ovoid pain or

reduce pain to all the patient. In recent years, there has been an

increasing trend for anaesthesiologist to take over the management

of acute pain. As a results ‘Acute Pain Services’ (APS) have been

set up in hospitals all over the world. This has resulted in better

management of postoperative and other form of acute pain.

In 1992 a survey was done in Hospital Kuala Lumpur and it

revealed that 55% of patient who had laparotomies had moderate

to severe pain post operatively with the management of surgeons

eg. Intra muscular pethedine 50mg 6 hourly. In Malaysia APS

service started in July 1993 by Department of Anaesthesiology to

manage postoperative and other forms of acute pain. APS has

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evolved into a more organized service where it have Specialist

Anaesthetist, a medical officer and specialized APS nurses.

3 6. Disscussion

3.6.1 On Going Development of The Nursing Role

Health care professionals work within a system of

interdependent roles and collaborate with each other for the

common goal of quality health care. Effective management of

acute pain depends on close liaison with and education and

training of all staff, and involvement and education of the

patient and their care.

Empowering the APS nurse who was educated to make decisions

that provide effective around- the-clock pain management to

patient base on medication or technique for pain as prescribe by

doctor.

Task and responsibilies undertaken by the APS nurse is to advise

on acute pain management to other nurses or patient if pain

control analgesia is indicated. APS also undertake regular review

of acute pain problem to ensure all the patient well manage and all

the machine in used are working eg. PCA machine, perfussor.

During round APS nurse need to assess the patient regarding vital

sign, pain assessment, sedation score and side effect of

medication.

APS nurse need to give bed side teaching of ward staff nurses and

supervise in the care of patient under acute pain management.

APS nurse must stress on pain assessment, sedation score, side

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effect of the follow The Nursing Protocol that I attached at Appendix

1 to 6.

APS nurse need to deliver formal education for all disciplines with

medical colleagues and other health care professional.

In my hospital setting APS nurse have to liaise with consultant

anaesthetist with overall responsibility for acute pain management

such as to increase or decrease the dose of medication, advise to

change the route of medication, or to stop the medication.

When the nurses are empowered as a APS Nurse, it will improve

the management of acute, particularly post operative pain. This

will result in more comfortable patients, less post operative

complications and shortened hospital stay. With successful

empowerment for APS Nurse increasing their knowledge, skill,

confidence and competence.

3.6.2. Empowerment is a an effective tool

The delivery of effective pain management has become a pressing

national issue in health care. Pain management is important

because it lessens pain experienced by the patient and reduces the

likelihood of physiological and psychological sequelae. In addition,

pain management may improve patient outcomes and increase

patient satisfaction.

Empowering the APS Nurse will lead to improving the patient care

with a good pain management or pain relief.

Beside having extensive professional knowledge ,nurses are

expected to be independent decision - makers engage in

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continuous development of both themselves and their work. Other

consequences of nurses’ empowerment are accountability,

responsibility, willingness to see beyond the bedside, and the

pursuit of advocacy skills for patient.

Empowerment make APS Nurse co - ordinate the activities of ward

teams to ensure the highest standard of assessment, planning,

implementation and evaluation of individual patients encouraging

an environment of empowerment through coaching, teaching and

facilitating managing Acute Pain Service in the absence of the APS

Nurse.

Collecting data is part of APS Nurse responsibility to perform a

statistic as a imformation as knowledge about work goals, plans,

organization decisions, and change in policies. Nurse felt that

structural empowerment in their workplace resulted in higher levels

of psychological empowerment. These heightened feelings of

psyhological empowerment in turn strongly influenced job strain

and work satisfaction.

For individual patients and their families, empowerment produces a

trusting, respectful, and nurturing nurse - patient relationship that

supply support, encouragement and imformation, but patients and

their families must accept responsibility for health care choices of

modilitis pain management.

3.6.3. Concepts of managing with empowerment

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Structural empowerment states that opportunity and power in

organizations are essential to empowerment, and must be available

to all employees for maximal organizational effectiveness and

success.

The empowerment concept is a communcation concept bacause

the process of empowerment includes a connection with

individuals. .Although empowerment entail an individual needs,it is

nurtured by the outcome of mutual efforts(Kieffer,1984).Wallerstein

and Bernstein (1988) said that the empowerment includes more

environmental modification too. Team building and developing

human capacity are two key elements of achieving employee

empowerment. Nurses need opportunities for growth and

development. Nurses confidence and capability increase as people

gain additional experience in management and organization,as

well as develop new skills and knowledge, including the ability to

effectively pass on this knowledge. It’s an ongoing process that

requires effort and dedication to improve working relationships,

thereby improving the overall effectiveness of the organization.

Leader or Specialist Anaesthetist need to recognize and believe in

the ability of their team members to utilize their good judgment and

expertise to act independently. At the same time, they must also

serve as a mediator and coach. Empowering APS Nurse is about

more than just participation, it also involves autonomous analysis,

decision making, and action. APS Nurse will have authority to

make independent decisions in their own expertise.

This is why true empowerment requires a great deal of respect,

trust and transparency.

26



2010

Authority and enhancing self - confidence of the nurses also help

them to apply their knowledge in practice. Unification of the nurses

and their mutual support play the key roles in development of their

collective power and provide a base better working conditions,

professional independence and self regulation.

If the nurses getting empowered, the productivity and effectiveness

of nursing health care services will increase. Empowerment can

improve nurses skills, motivation, and they will creates comparative

advantage for the organization. The aim is to identify the

relationship between effective management by objective practices,

organizational productivity and nurses performance of the

organization.

3.6.4. Working in a positive, empowered atmosphere

Organization support and trust has significant relationship with

psychological empowerment.. Supportive team is required to carry

out the mission of the organization or department. Organization

needs to provide subordinates with enough information about

organization goals, so that they understand how their efforts and

those are their manager are to contributing to goal attainment.

When the APS Nurse get the support, information, resources,

opportunities and autonomy made them feel empowered,

While this psychological empower occur the nurse feel empowered

to contribute to achieve organization goal.

Through careful manipulation of the hospital environment, both

structural and psychological empowerment can be increase,

27



2010

resulting in greater job and patient satisfaction and ultimately

improve patient outcome.

Positive working atmosphere will lead the APS Nurse to self-

development by maximize on opportunities to continue education.

Positive work environment will be able to ensure patient safety in

hospital settings such as getting enough pain relief whenever they

got the pain. Good pain management given by APS Nurse will

reduces respiratory complication eg. Increase ability for deep

breathing and coughing, co - operate with chest physiotherapy,

decreased cardiovascular complication eg. Reduce tachycardia.

vasoconstriction, reduce incidence of DVT and pulmonary embolus

an reduce anxiety, anger and frustration.

Effort to improve nursing working conditions will be able to retaining

nurses and reduce shortage of staff problem.

3.6.5. Implications to nursing profession

Empowerment to the nurses will develop confidence and

competencies in order to undertake responsibilities, of APS Nurse

jobs. The standard of care is effecting ongoing pain assessment

and pain management. The concept used as theorecal framework

is empowerment, which has widely been found useful not only in

developing patient care but also in education and also upgrade

personnel knowledge. Empowerment seems likely to provide for an

umbrella concept of professional development in nursing.

3.7 Recommendation

28



2010

Pain is a very common symptom in hospitalizes patients. In order

to ovoid this empowering of APS nurse to manage the acute pain is

the recommended way. Effective relief of acute pain has been

shown to be important contributor to the rapid restoration of normal

functions, reduced incidence of complications and earlier discharge

from hospital. APS also will be able to promote doctor, patient and

nurse interaction which is provide better communication and better


Empowered APS nurse also able to provide better patient care with

individualized carer’ priority to pain assessment, better awareness

of pain, better management of pain and early ambulation.

In general, the smart concept building such as putting up posters,

pamphlets and reading materials regarding the importance of pain

management and the agents of choice both for pediatrics and

adults for the patient’s information can be used in these areas. By

increasing the awareness of the public regarding this matter, their

cooperation during the procedure can be achieved to get the

expected outcome.

The staff involved in acute pain management either APS nurses or

ward nurses have to be more sensitive when dealing with the pain.

Beside pharmacology approach, psychology approach is very

crucial to develop rapport with patient. Simple approaches such as

gentle handling of the patient, eye contact and good communication

skills can be implemented to arrive at the objectives in reducing the

anxiety and suffering. Caring attitude shown by staff towards the

care of the patients help a lot in relieving pain.

29



2010

Training and education in the pain assessment and management

should provided to all nurses in Intensive Care Unit, High

Dependency Unit, surgical ward and medical ward.

4.0 Conclusions:

These findings suggest that nursing organizations' efforts to create

empowering work environments can influence nurses' ability to

practice in a professional manner, ensuring excellent patient care

quality and positive organizational outcomes.

Nursing once again faces a serious shortage of nurses as

experienced nurses approach retirement and fewer individuals

enter the profession. Recent downsizing initiatives have often

resulted in heavier workloads for nurses, and reports of poor

working conditions, particularly in hospitals, abound in the media.

Patient safety is a major concern in this context in which fewer

nurses are available to care for patients with much higher acuity

than in the past. To address this problem, efforts must be made to

improve nurses' working conditions to retain nurses in the system

and encourage new recruits to the profession.

30



2010

References



2.McDonald .S et al (2010).Relationship Between Staff Nurses In

Organization Structures and Perception of Empowerment.Volume

33.148-162.

3.Rawal,N. Understand Component 11:Structural empowerment

[Online]Available:http://www.hcpro.com/NRS-228670-3238/

(1)Inside-the-program-Understand-Component-II-Structural-

empowerment.html.[20hb. June.2010]

4.Monojlovich.M.(2010).Power and empower in nursing.Journal of

issues in nursing.[Online] Available:http://www.nursing

world.org/Main menu Categories/ANA Market place

(2010,June,10].

5. Creasia, L. C., & Parker, B. (2001) The bridge to professional


Sydney: Mosby.

31



2010

3.1 Introduction

In Malaysia the registered nurses represent the greatest number of

professional in a health care environment. In a world of ever

increasing technology advancement and economic constrains, the

need for solid rationale on which the base nursing interventions

cannot be ignored. Nurses need power to make their optimum

contribution and conclude with a discussion on the current state of

nursing empowerment related to nursing intervention.

Empowerment seems likely to provide for an umbrella concept of

professional development in nursing.

32



2010

3.2 What is meant by empowerment in nursing

3.2.1 Defination of power

From The Oxford English Dictionary power is define as “the ability

to do or effect something or anything, or to act upon a person or

thing”. Power as define by Grant(1994) is the capability of acting or

producing some sort of and effect, usually associated with the

ability to influence the allocation of scarce resources.

However, the use of power in nursing occurs as a phenomenon of

interpersonal relationships. Power is a central factor in

interpersonal communication.

Manojlovich(2007) give two definition for power in nursing. Power is

defined as having control, influence or domination over someone or

something and power is ability to mobilize resources in order to

attain the intended goals.

3.2.2 Defination of empowerment

From The Oxford English Dictionary empower defines as “to

invest legally or formally with power or authority”. Kramer and

Schmalenberg (1990) Empower defines as giving

Individuals the authority, responsibility, and freedom to act on what

they know and instilling in them belief and confidence in their own

ability to achieve and succed. The concept of empowerment are

wide - ranging: the term has been used to describe the essence of

human existence of and development, but also aspects of

organizational effectiveness and quality. The empowerment

33



2010

ideology is rooted in social action where empowerment was

associated with community interests and with attempts to increase

the power and influence of oppressed group (such as workers,

women and ethnic minorities). Later there was also growing

recognition of the importance of the individual’s characteristics and

actions.

3.2.3 Nurses’ Power over Nursing Practice

A historical review of nurses’ power over nursing practice should

include social, cultural, and education factors that influence nurses’

power over their practice. Social and cultural factors that influence

nursing power have their roots in the view of nursing as women’s

work(Wuest 1994). Nursing remain in a low status in the health

care hierarchy even in other profession can bring women on an

equal footing with men. Education factors contribute to this situation

where most of our nurses in Malaysia today are diploma graduate

and yet the multiple entry level into nursing practice further

dissipate whatever influence nursing may be able to generate.

From this educational factors may still be contributing to nursing’s

powerless.

Ongoing research on empower in nursing has demonstrated that

empowered nurses are “highly motivated and are able to motivate

and empower others by sharing the sources of power”(Laschinger

& Havens,1996).

3.3 Type of empowerment.

There are two Form of Empowerment :

34



2010

3.3.1 Structural Empower

Structural power - oriented individuals sacrifice their own self -

interest for the good organization, feel a responsibility to build up

the organization, and have a strong sence of fairness and justice.

Employees with a high need for power tend to be superior

perfomers, managers with a need for institution power tend to be

managing work groups that are productive and satisfied.(Steers &

Porter,1987)

Structural empowerment can be described as the structures (e.g.

policies, councils, and processes) within an organization that

empower nurses to practice in a professional and autonomous

manner to achieve the highest degree of clinical excellence and

professional fulfillment. With structural empowerment, the

organization has a commitment to continual learning and

educational and career advancement.

The theory of structural empowerment states that opportunity and

power in organizations are essential to empowerment, and must be

available to all employees for maximal organizational effectiveness

and success. The theory of structural empowerment was

developed by Kanter(1993) who saw employees’ work behavior as

arising from conditions and situations in the work place, and not

from personal attributes(Laschinger & Havens,1993). When

nurses have high level of power and opportunity that allow them to

complete their work in meaningful ways.

35



2010

Structural sources of power have been used to explain power in

organization. Three main structural sources of power in

organizations have been identified as(Hoelzel):

1. Centerality: being central to the major function of the

organization and interconnected with the major systems.

2. Control of uncertainty: influencing organizational goal attainment

by being able to cope with organization’s uncertain environment.

3. Control over resources, information, and other critical

organizational resourses

3.3.2 Psychological Empowerment

Psychological empowerment is seen as a process of personal

growth and development, which is influenced by individual beliefs,

views, values and perceptions and relationships with the

environment (Kuokkanen & Leino - Kilpi 2000)

Thus empowerment, as provided by the environment, tells part of

the story, but alone it is not enough. Some environments are

empowering because they allow workers to do what it is the worker

feel is necessary to get the job done. In other words, these

environments provide the sources of power. Other work

environments may not be as empowering, yet there will still be a

few hardy individuals who manage to do whatever it take to be

effective on the job. It may be that these people are able to

recognize what few empowering social structures can be used.

Manojlovich(2007).

Psychological power consists of the extent to which people believe

that they can influence even through personal effort. This means

36



2010

knowing who they are, where they are going, what they want to

accomplish, as well as packaging themselves as person with power

and being adaptable.In a giving situation ,psychological power is

ability to assess the situation in managerial and political sense and

discern the degrees of decision freedom and the chances of being

successful given any specific power strategy or leadership style. It

is also has been described as the extent to which followers respect,

are committed to, and are willing to follow a leader(Hersey et al.,

1996).Trust is the foundation of psychological empowerment.

3.4 Why Empowerment is needed

To be able to make their optimum contribution nurses need at least

three types of power.

3.4.1 Control Over the Content of Nursing Practice.

Power is an attribute that nurses must cultivate in order to practice

more autonomously because it is through power that members of

an occupation are able to raise their status, define their area of

expertise, and achieve and maintain autonomy and influence(Hall,

1982). One of the characteristics of profession is that professionals

have power over the practice of their discipline which is often

refered to as professional autonomy(Laschinger, Sabiston &

Kutszcher,1997). To identify the appropriate course of action and

effectively function, professionals must have understanding and

control over the entire spectrum of activities associated with the job

at hand (Manojlovich2005). However, it may be that nurses are

frequently unable to use their professional prepareation, which

37



2010

focuses on autonomous practice and independent decision making,

because they are powerless relative to organizational

administrators and medical staff (Manojlovich).

3.4.2 Control Over the Context of Nursing Practice

Besides control over the content of nursing practice, which

represents one type of power, a related type of control is known as

control over the context of practice, and represents another type of

power that nurses need (Laschinger et. Al.1997).

The positive findings of the magnet hospital research may be

attributed to empowering organizational social structures, although

they were not identified as such. Hospital characteristics which

were found to attract and retain qualified staff nurses included

decentralization and participatory decision making. :Although

relatively little attention has been paid to how a magnet work

environment contributes to nurses’ sense of power Upenieks,

2003).Professional practice models, shared governance models,

and collaborative governance all use similar processes to increase

nurses’ participation in decision making, thereby increasing their

control over the context of nursing practice and promoting power.

There is strong empirical justification for promoting nurses’ power

through control over both the content and context of nursing

practice. In multiple studies, patient outcomes were improved when

the hospital organization was supportive of autonomous nursing

practice(Aiken et. Al 1999; Aiken, Clarke, & Sloane, 2000).

3.4.3 Control Over the Competence of Nursing Practice

38



2010

A necessary precursor for both autonomy and power is

competence , which has its foundation in education al preparation.

Power is maintained through knowledge development , which is

acquired through education and expertise. Educational preparation

and expertise represent two additional type of power nurses need

to make their optimal contribution to patient care.

To increase nursing empowerment may lie in understanding

workplace sources of power, expanding the view of empowerment

to include the notion of empowerment as a motivational construct,

and finally making more explicit growth fostering relationships

which also contribute power. The importance of a positive work

environment for ensuring patient safety in hospital settings.

Creating and sustaining trust throughout the organization was

identified as a critically important leader activity. Structural

empowerment is identified as important for retaining nurses,

including job satisfaction, participant in organizational decision

making, job autonomy or control over practice and organizational

commitment.

3.5 The issue related to empowerment in nursing in my

workplace.

The related issue which I interested to highlight is to create

empowering work environments which can influence nurses' ability

to practice in a professional manner, ensuring excellent patient care


39



2010

It is being increasingly recognized that the solution to the problem

of inadequate postoperative and acute pain relief liaise not so

much in development of new techniques but in development of a

formal organization for better use of existing techniques. Acute

Pain Services (APS) are being increasingly established to provide

good quality postoperative analgesia.

3,5.1 Defination of pain

Merskey (1964) define pain as “An unplessant sensory and

emotional experience associated with actual or potential tissue

damage, or described in term of such damage”.

i) Sensory – feeling and sensation

ii) Emotional – psychological aspect

iii) Pathophysiology – tissue damage – actual, potential

Pain is a very common symptom in hospitalize patients. Acute pain

is pain that associated with a distinct disease or injury. Traditionally,

surgeons have been treating acute pain, particularly postoperative

pain.With increased awareness about detrimental effect of pain and

a better understanding of pain physiology has led to

recommendatios of early, aggressive analgesic intervention for

post-surgical.

“Any failure to relive pain is both morally and ethically

unacceptable”.

“All patients have a RIGHT to pain relief, creating a duty of

care”

(Royal College of surgeons and Anaesthetists .1990)

40



2010

In recent years, there has been an increasing trend for

anaesthesiologist to take over the management of acute pain. As a

results ‘Acute Pain Services’ have been set up in hospitals all over

the world. This has resulted in better management of postoperative

and other form of acute pain.

In 1992 a survey was done in Hospital Kuala Lumpur and it

revealed that 55% of patient who had laparotomies had moderate

to severe pain post operatively with the management of surgeons

eg. Intra muscular pethedine 50mg 6 hourly. In Malaysia APS

service started in July 1993 by Department of Anaesthesiology to

manage postoperative and other forms of acute pain. APS has

evolved into a more organized service where it have Specialist

Anaesthetist, a medical officer and specialized APS nurses. Our

nurse - based anesthesiologist - supervised model is base on the

concept that postoperative pain relief and acute pain relief can be

greatly improved by provision of in - service training for surgical

nursing staff, optimal use of systemic opiods and use of regional

analgesia techniques and Patient Control Anaesthesia in selected

patients.

3.5.2 Personnel of Acute Pain Service (APS)

The staffing of an APS should be based upon the following

considerations:

a. Consultant anaesthetist, who is responsible for provision of the

service. The job of consultant is in pain management.

41



2010

b. The APS nurse to advise on pain management and to undertake

a program of regular review of acute pain problems. The APS nurse

should also be responsible for the day to day organization of the

APS.

c. The provision of effective acute pain management can be

optimized by collaboration with colleagues from pharmacy

department.

3.5.3 Modilities of analgesia

1.Conventional methods

a. Oral analgesic : Opiod eg. Morphine. Codine, pethidine

Non steroidal anti imflammatory drugs (NSAIDs) eg. Ponstan,

Synflex.

b. Intramuscular : Opiod

: Non steroidal anti imflammatory drugs

(NSAIDs)

c. Per ractal

d. Transdermal

2. Newer techniques

a. Subcutaneous opiod

b. Patient control analgesia (PCA)

c. Epidural analgesia

42



2010

3.5.4 Why treat pain?

1.Early return to normal function.

2.Humanitarian aspect of relieving pain.

3.Reduces respiratory complication eg. Increased ability for deep

breathing and coughing, co - operate with chest physiotherapy.

4.Decreased Cardiovascular complication eg. Reduced

thachycardia, vasoconstriction, afterload & myocardial workload.

5.Increased mobility, reduce incidence of DVT and pulmonary

embolus.

6.Early oral intake.

7.Reduced anxiety, anger & frustration.

3.5.5 The role of the Acute pain Service

1.To improve the management of acute, particularly postoperative

pain by introducing new methods and improving old methods of

pain relief. This will result in more comfortable patients, less

postoperative complications and shortened hospital stay.

2.To organize the monitoring necessary for patients, including pain

and sedation scores.

3.To train hospital staff in the management of acute pain - this

includes ward nurses, surgeons, anaesthetists, medical and house

officers and trainee paramedic staff.

43



2010

4.To provide standardized protocols in various techniques of acute

pain management including the early detection and management

of complications. This will minimize the adverse sffects

associated with the provision of good pain relief.

5.To provide standardized protocols in postoperative pain

management.

3.5.6 APS nurse responsibility

1. Advice on acute pain management.

2. Undertake regular review of acute pain problems.

3. Undertake education of ward nurses by supervision in the care of

patient under APS

4. Deliver formal education for all disciplines with medical

colleagues and other health care professional.

5. Liaise with consultant anaesthetist with overall responsibility for

acute pain management.care.

3.5.7 Modilities of analgesia for APS in my work place

1. Subcuteneous morphine

G 23 or 22 butterfly needle cannula insert at infraclavicular or

outer aspect of the

Aim. Dosage 2.5 mg - 10 mg Morphine undiluted 4 hourly.

a. Advantage

i. Reasonable good pain relief

ii. Less pain on injection

iii. Easy to give and no needle

iv. Patient can be mobile

44



2010

v. Cheap

b. Disadvantage

i. Onset slow

ii. Over - sedation

iii. Nausea and vomiting

iv. Occasional pain on injection ( esp. Pethidine)

2. Patient control analgesia (PCA)

Morphine 1mg/ml or pethidine 10mg/ml given intravenously and

control by patient using PCA mechine. Only patient can press

the button and patient should mentally alert and able to comply

with instruction. PCA delivered by a dedicated IV line or a

one way ‘Anti - Reflux’ valve is used if the IV line is shared. PCA

mechine must be locked and lockout interval at least 5 minutes.

a. Advantages

i. Effective for severe pain

ii. Involves patient participation

iii.Safe and reliable technique

iv. Dose according to patient’s need

v. Nursing is easier

b. Disadvantages

i. High cost of PCA machine and tubing

ii. Need to educate patients and relatives

iii. Still need regular monitoring

iv. Not suitable for all patients

c. Contraindication

i. Patient refuse PCA

ii. Patient does not know how to use it e.g. Senile, small children

45



2010

iii. Unable to use PCA mechine e.g. Head injured, both hand

plastered

iv. Untrained staff

3. Central neuraxial (epidural & intrathecal) analgesia

-Epidural - Intruducing analgesic drug (opioid, local

anaesthetic,combined opiod and local anaesthetic) into the

epidural space(use cateter).

-Intrathecal - Intruducing analgesic drug into subarachnoid(single

shot).

Epidural opioid commonly used in my hospital. Opioid will diffuse

through the dura into the CSF and act on specific opioid

receptors in the spinal cord.

a. Advantage

i. Very effective for severe pain

ii. Less problems with nausea/vomiting

iii.Little central sedation effect

b. Disadvantage

i. Not for all type of surgery

ii. High cost of equipment

iii.Need skill in inserting epidural

iv.Risk of infection

v. Risk of delayed respiratory depression

vi.Required skilled nurses.

3.6 Nursing observation

46



2010

It is very important for early detection of serious side effects and to

make sure patient is effectively treated.

3.6.1 What to observe?

i. Vital sign (BP/ pulse) hourly for the first 4 hours then 4 hourly.

ii. Respiration rate - to observe for side effect of opioid respiratory

depression.

iii. Sedation score

0 = None (awake/alert)

1 = Mild ( occasionally drowsy)

2 = Moderate (frequent drowsy but arousable)

3 = Severe (difficult to arouse)

4 = Sleeping

iv. Pain score

a. Verbal numerical pain score

0 = None

1 = Slight pain

2 = Tolerable pain

3 = Severe pain

4 = Worst pain imaginable

b. Visual analogue score

Using the ruler with the whole scale is 10 cm.

c. Verbal analogue score

Patient gives a number for her pain on a scale from zero to

ten. The number is recorded as a pain score.

d. Functional score

To assess what function the patient can do with the pain.

47



2010

Can you cough?

Can you breathe deeply?

Can you sit?

e. Observation pain score

Usually used for paediatrics. Observation of respiratory

rate, heart rate, crying, calm/restless, sleeping or trashing.

v. Side effect e.g. urine retention, post operative nausea and

vomiting, pruritis, motor blockade, hypotension.

vi..Check the injection site: not inflamed, swelling, painful, catheter

insitu and clearly labeled.

Nursing Procedure Protocol

Attached at Appendix 1 - 6

Recommandition

Pain is a very common symptom in hospitalises patients.In order to

ovoid this empowering of APS nurse to manage the acute pain is

the recommended way.Effective relief of acute pain has been

shown to be important contributor to the rapid restoration of normal

funcition, reduced incidence of complications and earlier discharge

from hospital. APS also will be able to promote doctor, patient and

nurse interaction which is provide better communication and better


48



2010

Empowered APS nurse also able to provide better patient care with

individualized carer’ priority to pain assessment, better awareness

of pain, better management of pain and early ambulation.

In general, the smart concept building such as putting up posters,

pamphlets and reading materials regarding the importance of pain

management and the agents of choice both for pediatrics and

adults for the patient’s information can be used in these areas. By

increasing the awareness of the public regarding this matter, their

cooperation during the procedure can be achieved to get the

expected outcome.

The staff involved in acute pain management either APS nurses or

ward nurses have to be more sensitive when dealing with the pain.

Beside pharmacology approach, psychology approach is very

crucial to develop rapport with patient. Simple approaches such as

gentle handling of the patient, eye contact and good communication

skills can be implemented to arrive at the objectives in reducing the

anxiety and suffering. Caring attitude shown by staff towards the

care of the patients help a lot in relieving pain.

Training and education in the pain assessment and management

should provided to all nurses in Intensive Care Unit, High

Dependency Unit, surgical ward and medical ward.

4.0 Conclusions:

These findings suggest that nursing organizations' efforts to create

empowering work environments can influence nurses' ability to

practice in a professional manner, ensuring excellent patient care


49



2010

Nursing once again faces a serious shortage of nurses as

experienced nurses approach retirement and fewer individuals

enter the profession. Recent downsizing initiatives have often

resulted in heavier workloads for nurses, and reports of poor

working conditions, particularly in hospitals, abound in the media.

Patient safety is a major concern in this context in which fewer

nurses are available to care for patients with much higher acuity

than in the past. To address this problem, efforts must be made to

improve nurses' working conditions to retain nurses in the system

and encourage new recruits to the profession.

Magnet hospital research has shown that nurses are attracted to

hospital work environments that promote autonomy and control

over the practice environment and that foster good nurse-physician

relationships.

Hospital nurses who perceive themselves to be structurally and

psychologically empowered are more likely to feel respected in the

workplace.

Changing workplace structures is within the mandate of nurse

managers in their roles as advocates for and facilitators of high-

quality care. Nurse managers have the influence and resources to

facilitate empowering work conditions that can increase nurses'

feelings of being respected. In addition, promoting collaborative

inter-professional and intra-professional relationships and assuring

continuous support to nurses are particularly important strategies

for building respect.

50



2010

References



2.McDonald .S et al (2010).Relationship Between Staff Nurses In

Organization Structures and Perception of Empowerment.Volume

33.148-162.

3.Rawal,N. Understand Component 11:Structural empowerment

51



2010

[Online]Available:http://www.hcpro.com/NRS-228670-3238/

(1)Inside-the-program-Understand-Component-II-Structural-

empowerment.html.[20hb. June.2010]

4.Monojlovich.M.(2010).Power and empower in nursing.Journal of

issues in nursing.[Online] Available:http://www.nursing

world.org/Main menu Categories/ANA Market place

(2010,June,10].

5. Creasia, L. C., & Parker, B. (2001) The bridge to professional


Sydney: Mosby.

52

empower assigment

Documents