Nursing Clinical Instructor Experiences of Empowerment in Rwanda: Applying Kanter's and Spreitzer's Theories.

The purpose of this study was to explore Rwandan nursing clinical instructors' (CIs) experiences of structural and psychological empowerment. CIs play a vital role in students' development by facilitating learning in health care practice environments. Quality nursing education hinges on the CI's ability to enact a professional role. A descriptive qualitative method was used to obtain an understanding of CIs empowerment experiences in practice settings. Kanter's Theory of Structural Power in Organizations and Spreitzer's Psychological Empowerment Theory were used as theoretical frameworks to interpret experiences. Interview data from 21 CIs were used to complete a secondary analysis. Most participants perceived the structural components of informal power, resources, and support while formal power and opportunity were limited, diminishing their sense of structural empowerment. Psychological empowerment for CIs stemmed from a sense of competence, meaning, impact and self-determination they had for their teaching roles and responsibilities in the practice setting.

Actor-Network Theory as a sociotechnical lens to explore the relationship of nurses and technology in practice: methodological considerations for nursing research.

Actor-Network Theory is a research lens that has gained popularity in the nursing and health sciences domains. The perspective allows a researcher to describe the interaction of actors (both human and non-human) within networked sociomaterial contexts, including complex practice environments where nurses and health technology operate. This study will describe Actor-Network Theory and provide methodological considerations for researchers who are interested in using this sociotechnical lens within nursing and informatics-related research. Considerations related to technology conceptualization, levels of analysis, and sampling procedures in Actor-Network Theory based research are addressed. Finally, implications for future nursing research within complex environments are highlighted.

Resilience in Nursing Education: An Integrative Review.

BACKGROUND: Resilience is a phenomenon known to buffer the negative effects of stress. Resilience is important in the lives of nursing students and nurse educators. METHOD: An integrative literature review was conducted to explore the current state of knowledge of resilience in the context of nursing education. Implications from the review findings were deduced for nursing education practice and research. RESULTS: Three theoretical papers and 16 empirical reports were included in the review. Three themes emerged from the analysis: (a) Resilience Is Important in Nursing Education, (b) Resilience Is Conceptualized as Either a Trait or a Process, and (c) Resilience Is Related to Protective Factors. CONCLUSION: The findings provide data to support interventions to enhance the resilience of nursing students and nurse educators and offer a foundation for further research of resilience in nursing education.

Nursing students' understanding and enactment of resilience: a grounded theory study.

AIM: The aim of this study was to explore nursing students' understanding and enactment of resilience. BACKGROUND: Stress is considered to be a major factor affecting the health, well-being and academic performance of nursing students. Resilience has been extensively researched as a process that allows individuals to successfully adapt to adversity and develop positive outcomes as a result. However, relatively little is known about the resilience of nursing students. DESIGN: A constructivist, grounded theory qualitative design was used for this study. METHOD: In-depth individual interviews were conducted with 38 nursing students enrolled in a four-year, integrated baccalaureate nursing degree programme at a university in Ontario, Canada. Face-to-face interviews were conducted from January to April 2012 using a semi-structured interview guide. FINDINGS: The basic social process of 'pushing through' emerged as nursing students' understanding and enactment of resilience. Participants employed this process to withstand challenges in their academic lives. This process was comprised of three main phases: 'stepping into', 'staying the course' and 'acknowledging'. 'Pushing through' also included a transient 'disengaging' process where students were temporarily unable to push through their adversities. The process of 'pushing through' was based on a progressive trajectory, which implied that nursing students enacted the process to make progress in their academic lives and to attain goals. CONCLUSION: Study findings provide important evidence for understanding the phenomenon of resilience as a dynamic, contextual process that can be learnt and developed, rather than a static trait or personality characteristic.

Nursing students' perceptions of clinical teachers' use of empowering teaching behaviours: instrument psychometrics and application.

The authors present findings of 2nd year nursing students' (N = 352) perceptions of their clinical teachers' use of empowering teaching behaviours (ETB) and to highlight steps undertaken to establish psychometric properties of the Empowering Teaching Behaviours Questionnaire-Student (ETBQ-S). The authors identify a) the process involved in the adoption of the ETBQ-S, b) ETBQ-S validity procedures completed prior to instrument implementation, c) results of nursing students' responses to the ETBQ-S, d) criterion validity, and e) ETBQ-S confirmatory factor analysis findings conducted after study completion. The ETBQ-S reliably measures five facets of empowering actions that clinical teachers can employ with nursing students in practice to enhance their confidence, involve them in decision-making and goal setting, make learning meaningful, and help them to become more autonomous nurses.

Understanding interprofessional relationships by the use of contact theory.

The importance and necessity of interprofessional collaboration (IPC) present challenges for educators as they determine how best to achieve IPC through interprofessional education (IPE). Simulation-based teaching has been shown to enhance students' understanding of professional roles and promote positive attitudes toward team members; yet, empirical evidence providing direction on the conditions necessary to promote these positive outcomes is lacking. This study used a quasi-experimental design with a pre-/post-test to examine changes in undergraduate healthcare students' perceptions and attitudes toward IPC following their participation in an interprofessional simulation program. Allport's (1954) intergroup contact theory was used to help understand the nature of this IPE workshop and its reported outcomes. Participants included students in the final year of their respective programs (n = 84) such as pharmacy technician, paramedic, nursing and occupational therapy assistant/physical therapy assistant programs. These students were engaged in simulation exercises with interactive contact opportunities. Using the interdisciplinary education perceptions scale, statistically significant increases in positive attitudes in three of four sub-scales were found. An analysis of the structure and format of the workshop suggests that this IPE initiative fulfilled the key conditions suggested by intergroup contact theory. Attention to the key conditions provided by Allport's theory in the context of successful intergroup relationships may help provide direction for educators interested in planning IPE initiatives with student groups enrolled in various health programs.

Effects of clinical practice environments on clinical teacher and nursing student outcomes.

The purpose of this study was to use a cross-sectional survey design, with an integrated theoretical perspective, to examine clinical teachers' (n = 64) and nursing students' (n = 352) empowerment, teachers' and students' perceptions of teachers' use of empowering teaching behaviors, students' perceptions of nurses' practice behaviors, and students' confidence for practice in acute care settings. In this study, teachers and students were moderately empowered. Teachers reported using a high level of empowering teaching behaviors, which corresponded with students' perceptions of teachers' use of such behaviors. Teachers' empowerment predicted 21% of their use of empowering teaching behaviors. Students reported nurses as using a high level of professional practice behaviors. Students felt confident for professional nursing practice. The findings have implications for practice contexts related to empowering teaching-learning environments and self-efficacy.

Structural and psychological empowerment and reflective thinking: is there a link?

Baccalaureate nursing education prepares students to become registered nurses in evolving health care systems. During their program, students' perceptions of empowerment in the nursing profession begin to form, and they are introduced to the process of reflective thinking. The purpose of this integrative literature review is unique in that three concepts are examined and linked-structural empowerment (as conceptualized by Kanter), psychological empowerment (as described by Spreitzer), and reflective thinking (as characterized by Mezirow)-and a theoretical model for testing is proposed. In examining the conceptual links, it is apparent that all three are required for learning and nursing practice. By preparing students to be empowered, reflective professionals, it is proposed that they will be more effective in their academic and future practice work. The conceptual links and proposed model described in this article provide the foundation for building a body of evidence to support or refute this contention.

Student perceptions of online participation in baccalaureate nursing computer-conferencing courses.

The purpose of this study was to examine baccalaureate nursing students' perceptions of their own and peers' online participation. The population included baccalaureate nursing students who have been or were recently involved in a computer-conferencing nursing course. Volunteer nursing students (n = 55) from three Canadian universities completed a Web-based questionnaire. The researcher-designed instrument was derived from a modified taxonomy of participation in online courses. The instrument measured three constructs of participation: interpersonal, content, and interface interactions. Overall, students perceived their participation to be at a high level with a reported mean of 3.94/5.00 (SD, 0.476). Students' perceptions of their group members' participation level were also reported as high (mean, 3.60; SD, 0.481). Significant correlations were found among each of the questionnaire's three subcomponents (ie, interpersonal, content, and interface). Results of the study lend support for the use of interface interactions to identify students who may not have the satisfactory computer skills to participate effectively in computer-conferencing courses.

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 first years of practise represent an important 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.

Clinical educators' empowerment, job tension, and job satisfaction: A test of Kanter's Theory.

Recruitment and retention of qualified nursing staff are vital to safe patient care and require the expertise of clinical educators to facilitate the nurses' professional development. However, organizational redesign has challenged clinical educators with role ambiguity, job stress, and decreased job satisfaction. This study used Kanter's Structural Theory of Organizational Behavior to examine the relationships between clinical educators' perceptions of empowerment, job tension, and job satisfaction. High levels of workplace empowerment were significantly related to low levels of job tension. In addition, the combination of high levels of empowerment and low levels of job tension was predictive of high levels of job satisfaction. Implications for staff development administrators are discussed.

Attention and restoration in Post-RN students.

BACKGROUND: The impact of a restorative intervention using the natural environment on capacity to direct attention and issues that contribute to attention fatigue for diploma-prepared nursing students (Post-RN students) enrolled in a baccalaureate nursing program was examined. METHODS: This study used a quasi-experimental comparison group design. Subjective (Attentional Functional Index) and objective (Finding A's Test and Symbol Digits Modalities Test) measures were employed. RESULTS: Thirty-two students at two universities participated. Results of the split-plot analysis revealed a within-subject effect on the Attentional Functional Index (p < .05), a significant within-subject effect on the Finding A's Test (p < .05), and a significant within- and between-subject effect on the Symbol Digits Modalities Test (p < .05). CONCLUSION: Recognizing and managing attention fatigue throughout the school year may enhance Post-RN students' abilities to direct attention and contribute to an enhanced academic experience.

The effect of classroom simulation on nursing students' self-efficacy related to health teaching.

The purpose of this descriptive study was to investigate the effect of classroom simulation on third-year baccalaureate nursing students' self-efficacy in health teaching. Bandura's self-efficacy model provided the conceptual framework. A nonprobability, convenience sample of 22 students completed the self-efficacy questionnaire before and after the simulation workshop sessions. Students' overall self-efficacy scores increased significantly (p = 0.001) following the two sessions of role-playing case studies, suggesting more perceived confidence in performing health teaching. Recommendations include continuing the use of simulation as a teaching-learning method, applying simulation as a strategy to enhance other learner behaviors, and cultivating faculty's use of simulation in their teaching.

The effects of a restorative intervention on undergraduate nursing students' capacity to direct attention.

PURPOSE: The purpose of this study was to examine the effects of a restorative intervention on undergraduate nursing students' capacity to direct attention. METHOD: Kaplan and Kaplan's attention restoration theory, which describes and links concepts of directed attention, attention fatigue, and restorative environments, formed the theoretical basis for this research. A convenience sample consisted of 33 students randomly assigned to nonintervention and intervention groups. The intervention was a 1-hr walk in natural surroundings. Both groups completed study instruments prior to and following the intervention. FINDINGS: Intervention group students scored higher on a measure of quality of life at posttest (p < .05). Differences in a measure of perceived attention were not observed between groups over time. Both groups improved on other measures of attention; however, the results did not provide support for the hypotheses. CONCLUSION: Students were a highly functioning group participating in many activities they considered restorative, prior to the study.

Codman Award Paper: self-efficacy of staff nurses for health promotion counselling of patients at risk for stroke.

The effect of nurses' confidence to counsel patients at risk of stroke in selected health promotion areas: smoking cessation, exercise and nutrition was examined. Bandura's (1986) self-efficacy and Knowles' adult learning theories provided the theoretical underpinnings for the study. This was a quasi-experimental design in which neuroscience nurses (N = 23) from a quaternary hospital completed questionnaires prior to, immediately after, and 2 months post completion of a self-directed learning manual (SDL). The researcher-designed manual was designed to enhance learning about the risk factors for stroke and the importance of stroke prevention. Along with reflective activities and pre-post test, strategies for counseling high-risk, stroke-prone individuals in the areas of smoking cessation, exercise, and nutrition were also integrated. The Health Promotion Counseling Self-Efficacy Scale (Tresolini, Saluja, and Stritter, 1995), consisting of 10 self-efficacy subscales relating to self-confidence in knowledge and ability to counsel in health promotion areas, was used to capture the nurses' self-report of self-efficacy. Using a 5-point Likert Scale, nurses also rated their amount of agreement or disagreement about health promotion counseling in practice. Overall, self-efficacy levels for both knowledge and counseling increased significantly (p < .01) from pre-to immediately post completion of the manual, and decreased slightly at two-month follow-up. This pattern was evident in all health promotion areas measured except for knowledge in exercise (p = .015). Nurses' attitudes about aspects of health promotion practices correlated significantly (p < 05) at two-month follow-up with all health promotion areas. Results of this study support the usefulness of a self-directed learning manual as a teaching strategy for health promotion counseling of individuals at risk of stroke.

The process of Master's education in nursing: evolution or revolution?

In this qualitative, descriptive study, the process of achieving change in knowledge and attitudes through Master's education in nursing is examined. Twenty-two recent graduates from three Ontario universities participated in semi-structured, taped interviews. Participants recounted personal and professional changes they attributed to completing a Master's program in Nursing and their experience of the process of change. After responding to questions about differences they perceived in themselves, participants reviewed Mezirow's (1991; 1994) 11 stages of perspective transformation and discussed whether these phases resonated for them. Some felt that the stages described their experience accurately; others reported their experience of the process was not as dramatic as Mezirow's description implied. Several who had taken degree completion baccalaureate programs perceived their baccalaureate experience to be more congruent with Mezirow's transformation process than the change process in their Master's program. At the Master's level, the majority felt the changes were evolutionary, not revolutionary. Most reported that rather than undergoing a perspective transformation, they were building on values and attitudes from the baccalaureate level. This study contributes to understanding the processes of change experienced by students in graduate education in nursing.

Effects of computer-based clinical conferencing on nursing students' self-efficacy.

A pretest-posttest, quasi-experimental, control group design and Bandura's theory of self-efficacy were used to examine the influence of computer conferencing on fourth-year baccalaureate nursing students' self-efficacy for professional nursing competencies and computer-mediated learning (CML) during a final clinical practicum. Descriptive analysis was also used to explore themes regarding strengths and challenges of online learning. The convenience sample included 42 direct-entry students (control group: n = 27; online intervention: n = 15). Within both groups, there was a significant difference in self-efficacy for nursing competencies from pretest to posttest. However, between-group posttest scores were not significantly different. Computer conferencing enhanced learning, and students' self-efficacy for CML increased at posttest. Strengths of CML included connection, support, learning, and sharing. Challenges involved time and Internet access. Insights gained may assist educators in curriculum development when considering how CML strategies support clinical courses and strengthen learning communities.