Development and Testing of an Explanatory Model of Registered Nurse Empowerment

Recent innovations in patient care delivery and nursing governance require an empowered workforce. However, little is known about what combination of organizational, leadership, and personal characteristics maximize the prediction of registered nurse empowerment. The purpose of this study was to develop and test an explanatory model of registered nurse empowerment. The predictor variables included personal characteristics of registered nurses (age, experience, organizational tenure, education, and position level of clinical and/or management responsibility), perceptions of organizational culture, and connective leadership. The study was conducted in a tertiary-care hospital in Southern California. A total of 113 registered nurses completed the Organizational Culture Inventory (Cooke & Lafferty, 1989), the connective leadership measure (Achieving Styles Inventory (Lipman-Blumen, 1991)), the Klakovich Reciprocal Empowerment Instrument (Klakovich, 1994b), and a demographic questionnaire designed to elicit personal characteristics. Regression analysis was performed to identify the variables which significantly predicted registered nurse empowerment. Constructive organizational culture (Beta =.47), connective leadership (Beta =.29), and defensive organizational culture (Beta = -.30) combined to explain 45% of the variance in empowerment, with each of the variables making a statistically significant (p \u3c.001) contribution to the regression equation. Although there were no significant relationships between the personal characteristics and organizational culture or empowerment, there was a relationship between position and connective leadership (r =.27, p =.002) and between highest educational level and connective leadership (r =.27, p =.002). The results support previous studies which have emphasized the important relationships of organizational culture and leadership to empowerment. Implications for professional practice and education are addressed. Further theoretical development, empirical testing, and refinement of the Registered Nurse Empowerment Model is recommended. It is proposed that, with further refinement, this model can assist nurses to deal effectively with the major changes challenging them in the rapidly transforming health care delivery system

Ethical Decision-Making among Critical Care Unit Nurses

The health care business has created complex relationships between consumers and health care institutions. Rising health costs, rationing of health care and medical technology have put critical care unit (CCU) nurses in complex environments where they must face ethical conflict. CCU nurses find themselves ill equipped to make sound decisions concerning ethical dilemmas. Nurses must ensure the patient\u27s choices are respected and honored due to the duties inherent in the nurse-patient relationship. The purpose of this study was to explore the process of ethical decision making (EDM) as it is experienced by CCU nurses. Gaining an understanding of this process may assist nursing education programs, and provide a basis for ethical nursing practice in the critical care setting. The grounded theory method described by Glaser (1967) and Strauss (1978) guided data collection and analysis. The sample was comprised of 10 full-time critical care nurses. Data were collected over the course of two academic semesters using methods common to field research. The constant comparative method of data analysis was used. Results indicated that critical care nurses identified ethical conflict in four major areas: professional values versus personal values, respect for patient autonomy versus duty to do no harm, professional standards versus institutional policies, caring versus controlling. Constraining intervening conditions that inhibited resolution of ethical conflicts were: legal issues, professional relationships, paternalism, medical futility, and physician burnout. The intervening conditions that facilitated resolution of ethical conflicts were: cultural perspectives, open communication, and caring. Strategies for responding to the ethical conflicts evolved from the data: opening up, getting people to talk, and supporting the patient. Consequences of these strategies were described as: reaching understanding, and sensing harm. The inter-relationship of these categories resulted in a core category of facilitating resolution. Facilitating resolution, the basic social process, describes the linking of action/interactional sequences as they evolved over time. The major implications of this study are that shared decision making in ethical conflict will result in positive outcomes for patients and nurses involved in ethical dilemmas. Relationship enhancement methods increase perceptual abilities in EDM. Further nursing research should include inquiry into the use of power in interactions, therapeutic empathy, and permeability of nurses\u27 internal and external boundaries in the opening up phase of EDM

Rural and urban differences in metabolic profiles in a Cameroonian population

Introduction: The difference between modern lifestyle in urban areas and the traditional way of life in rural areas may affect the population’s health in developing countries proportionally. In this study, we sought to describe and compare the metabolic (fasting blood sugar and lipid profile) profile in an urban and rural sample of a Cameroonian population, and study the association to anthropometric risk factors of obesity. Methods: 332 urban and 120 rural men and women originating from the Sanaga Maritime Department and living in the Littoral Region in Cameroon voluntarily participated in this study. In all participants, measurement of height, weight, waist circumference, hip circumference, blood pressure systolic (SBP) and blood pressure diastolic (DBP), resting heart rate (RHR), blood glucose and lipids was carried out using standard methods. Total body fat (BF%) was measured using bio-impedancemetry. Body mass index (BMI) and waist to hip ratio (WHR) were calculated. Low Density Lipoprotein-cholesterol (LDL-c) concentrations were calculated using the Friedwald formula. World Health Organization criteria were used to define high and low levels of blood pressure, metabolic and anthropometric factors. Results: The highest blood pressure values were found in rural men. Concerning resting heart rate, only the youngest women’s age group showed a significant difference between urban and rural areas (79 ± 14 bpm vs 88 ± 12 bpm, p = 0.04) respectively. As opposed to the general tendency in our population, blood glucose was higher in rural men and women compared to their urban counterparts in the older age group (6.00 ± 2.56 mmol/L vs 5.72 ± 2.72 mmol/L, p = 0.030; 5.77 ± 3.72 vs 5.08 ± 0.60, p = 0,887 respectively). Triglycerides (TG) were significantly higher in urban than rural men (1.23 ± 0.39 mmol/L vs 1.17 ± 0.64 mmol/L, p = 0.017). High Density Lipoprotein-cholesterol (HDL-c) levels were higher in rural compared to urban men (2.60 ± 0.10 35mmol/L vs 1.97 ± 1.14 mmol/L, p < 0.001 respectively). However, total Cholesterol (TC) and LDL-c were significantly higher in urban than in rural men (p<0.001 and p=0.005) and women (p <0.001 respectively. Diabetes’ rate in this population was 6.6%. This rate was higher in the rural (8.3%) than in the urban area (6.0%). Age and RHR were significantly higher in diabetic women than in non-diabetics (p=0.007; p=0.032 respectively). In a multiple regression, age was an independent predictor of SBP, DBP and RHR in the entire population. Age predicted blood glucose in rural women only. BMI, WC and BF% were independent predictors of RHR in rural population, especially in men. WC and BF% predicted DBP in rural men only. Anthropometric parameters did not predict the lipid profile. Conclusion: Lipid profile was less atherogenic in rural than in urban area. The rural population was older than the urban one. Blood pressure and blood glucose were positively associated to age in men and women respectively; this could explain the higher prevalence of diabetes in rural than in urban area. The association of these metabolic variables to obesity indices is more frequent and important in urban than in rural area.Key words: Adults, anthropometry, lipid profile, blood glucose, blood pressure, diabetes, urban, rural, Cameroo

Measuring nurse workload in ambulatory care

Nurses and adequate nurse staffing are critical to the delivery of safe, cost-effective, and quality patient care in every health care setting. This has been proven time and again through various research studies and recognized by various accrediting bodies such as JCAHO. However, the information available on required or optimal ambulatory care nurse staffing is limited and varies across ambulatory care settings. An overview of instruments for measuring nursing workload in ambulatory care, a critical prerequisite when identifying best nurse staffing models for diverse ambulatory care settings, is provided

Linking nursing workload and performance indicators in ambulatory care

More and more ambulatory care organizations are using nursing report cards to monitor and evaluate the quality and effectiveness of nursing care in the ambulatory setting. Nurse staffing levels is usually one of the items included in a nursing report card and the one most scrutinized by ambulatory care administrators. One strategy employed by the nursing leadership at the South Texas Veterans Healthcare System to justify nurse staffing levels is linking administrative staffing monitors with nurse-sensitive outcomes via workload and performance indicators. Through this approach, nurse leaders are able to justify nurse staffing level changes, needed technology changes, process improvements, and/or workflow needs to administrators with positive results and support