Evaluating physical therapists' perception of empowerment using Kanter's theory of structural power in organizations.

BACKGROUND AND PURPOSE: Little is known about physical therapists' perceptions of empowerment. In this study, Kanter's theory of structural power in organizations was used to examine physical therapists' perceptions of empowerment in a large Canadian urban teaching hospital. Kanter's theory, which has been studied extensively in the nursing profession, proposes that power in organizations is derived from access to information, support, resources, opportunity, and proportions. SUBJECTS AND METHODS: A convenience sample of physical therapists who had been working in the hospital longer than 3 months was used to determine the scores for the physical therapists' ratings of empowerment using the Conditions of Work Effectiveness Questionnaire. RESULTS: Physical therapists' scores were similar to reported staff nurses' scores for access to support, information, resources, and opportunity (mean=2.89, 2.91, 2.62, 3.25, respectively). Physical therapists' scores were higher than the majority of reported staff nurses' and nurse managers' scores for access to sources of informal and formal power structures (mean=2.81 and 3.29, respectively). There was a relationship between the empowerment score and the physical therapists' global rating of empowerment. Unlike studies of nurses, there were no relationships when demographic attributes and empowerment scores were examined. DISCUSSION AND CONCLUSION: Evidence for the validity of Kanter's theory of empowerment was found. Kanter's theory can provide physical therapists and their managers with a useful framework for examining critical organizational factors (access to information, support, opportunity, and resources) that contribute to employees' perceptions of empowerment. A baseline measure for comparing future empowerment scores of this sample is available. Further work to examine the application of Kanter's theory to other samples of physical therapists appears to be warranted.

Intraclass correlations as estimates of interrater reliability in nursing research.

Intraclass correlation coefficients are useful statistics for estimating interrater reliability. The ICC provides a means for quantifying the level of rater agreement as well as rater consistency. The ICC is easier to use than the Pearson r when more than two raters are involved and can be computed when data are missing on some subjects (Haggard, 1958). Use of this statistic allows the researcher to decide whether or not to include rater effects in estimating IRR and to determine the precision of the reliability estimate. Information about the various types of intraclass correlations and their use is frequently absent from psychometric references commonly used by nurse researchers, resulting in confusion about correct usage and interpretation. Because different values are obtained depending on which ICC formula is selected, ICC formulae reported in the literature can have varying interpretations. For this reason, it is important for researchers to become familiar with the various forms of intraclass correlations and to report the version used in their calculations and the rationale for their choice.

A hospital-level analysis of the work environment and workforce health indicators for registered nurses in Ontario's acute-care hospitals.

The purpose of this study was to explore the relationship between hospital-level indicators of the work environment and aggregated indicators of health and well-being amongst registered nurses working in acute-care hospitals in Ontario, Canada. This ecological analysis used data from a self-reported survey instrument randomly allocated to nurses using a stratified sampling approach. Multivariable linear regression models were used to examine hospital-level associations for burnout, musculoskeletal pain, self-rated general health, and absence due to illness. The unit of analysis was the hospital (n = 160), with individual nurse responses (n = 6,609) aggregated within hospitals. After controlling for basic differences in nurse workforces, including mean age and education, higher (better) work-environment scores were found to be generally associated with higher health-indicator scores, while a larger proportion of full-time than part-time nurses was found to be associated with lower (poorer) health scores. This study may provide direction for policy-makers in coping with the recruitment and retention of nursing staff in light of the current nursing shortage.

Effect of pregraduate preceptorship experience on development of adaptive competencies of baccalaureate nursing students.

Kolb's (1984) theory of experiential learning was used as a framework to study 50 baccalaureate nursing students' perceptions of the contributions of a senior preceptorship experience to the development of adaptive competencies. Nursing learning environments were thought to contribute most to divergent and convergent competencies, reflecting the importance of both people-oriented and scientific skills in nursing. The preceptorship had a significant impact on most learning competencies. Significant increases occurred in competencies considered not important for nursing by students prior to the experience, e.g., assimilative competencies such as testing theories and ideas, and accommodative competencies such as leading and influencing others. These results support the notion of further research of nursing learning environments from the experiential learning perspective.

The effects of family nursing and family medicine clinical rotations on nursing and medical students' self-efficacy for health promotion counseling.

The effects of community-based family nursing and medicine clinical rotations on students' confidence in their knowledge and ability to counsel clients in selected health promotion areas were examined from the perspective of Bandura's (1986) self-efficacy theory. Nursing students (n=66) enrolled in a community family nursing course and medical students (n=71) enrolled in a 6-week family practice clerkship rotation completed questionnaires at three points: prior to, at completion of, and 3 months following their clinical rotations. Nursing and medical students' self-efficacy levels at pretest were similar. At-posttest, nursing students' self-efficacy was significantly higher than that of the medical students. This difference was sustained at 3 months follow up. Students' conception of health (clinical vs. nonclinical) did not have an effect on posttest self-efficacy levels. Self-efficacy scores accounted for 63% of the variance in the nursing students' self-reported use of health promotion principles in their daily practice; but only 11% of the variance in medical students' daily practice. The results of this exploratory study provide information to guide theory-informed curricular decisions to design clinical learning activities that foster the development of health promotion counseling skills in both nursing and medical students.

Impact of nursing learning environments on adaptive competency development in baccalaureate nursing students.

Kolb's experiential learning theory (ELT) was used as a framework to study 179 generic baccalaureate students' perceptions of the contributions of different types of nursing learning environments to development of adaptive competencies described in the theory. In addition, students in each of the 4 years of the program were asked to describe their perceptions of the importance of Kolb's adaptive competencies for successful functioning in nursing settings as well as to rate their personal levels of skill on each competency. Nursing learning environments were thought to contribute most to divergent and convergent competencies, reflecting the importance of both people-oriented and scientific skills in nursing. Clinical experiences and the senior preceptorship experience contributed significantly more to the development of these competencies than typical nursing classes and nonnursing classes. Students considered assimilative competencies--such as testing theories--and ideas and accommodative competencies--such as leading and influencing others--relatively unimportant to successful functioning in nursing learning environments. Implications for nursing education are discussed.

Learning styles of baccalaureate nursing students and attitudes toward theory-based nursing.

The purpose of this study was to investigate personal and environmental factors related to undergraduate and post-RN nursing students' attitudes toward theory-based nursing from Kolb's experimental learning theory perspective. The study is part of a larger project designed to test aspects of Kolb's theory in the nursing population. Hypotheses about relationships among learning styles, perception of environmental press, experience in nursing, attitudes toward theory-based nursing, preferred nursing theory, and preferred method of learning theory were proposed for investigation. Seventy-six post-RN and 121 upper-level generic baccalaureate nursing students each completed two measures of personal learning style, a measure of perception of environmental press of nursing learning environments, and a nursing theories questionnaire. Learning style and environmental press perceptions were found to be significantly related to attitudes toward theory-based nursing. Concrete learners and subjects who perceived nursing environments to be predominantly concrete were significantly less positive toward theory-based nursing than abstract learners. Experience in nursing was found to be related to perception of environmental press. Learning style was not found to be significantly related to preferred method of learning nursing theories nor to preferred nursing theory for practice. Implications for nursing education are discussed.

Role perceptions of freshman and senior nursing and medical students and attitudes toward collaborative decision making.

David Kolb's (1981) experiential learning theory was used to examine differences between first- and fourth-year nursing and medical students' perceptions of competencies important for nursing and medicine. A convenience sample of nursing (n = 109) and medical (n = 108) students from a large Canadian research university was surveyed. Respondents completed the Environmental Press Questionnaire, the Adaptive Competency Scale, and a 6-item measure of attitudes toward collaborative nurse-physician patient care decision making. Nursing students' perceptions of competencies important for medicine were found to be more congruent with medical students' perceptions of these competencies than were medical students' perceptions of competencies important for nursing as seen by nursing students. Gaps in perceptions of each others' roles were significantly negatively related to attitudes toward collaborative patient care decision making.

Helping students use nursing models to guide research.

This article describes a teaching-learning strategy that was used to help third-year undergraduate BSN students understand the importance of situating nursing research questions within a nursing theoretical framework. Examples of student-generated research questions and their transformation into questions that reflect explicit nursing frameworks are provided. Common difficulties encountered by the students are also discussed.

An exploratory study of nursing and medical students health promotion counselling self-efficacy.

Self-efficacy of nursing and medical students for client health promotion counselling was examined in an exploratory study using Bandura's (1977) self-efficacy theoretical perspective. Third-year nursing students (n = 41) and fourth-year medical students (n = 60) were compared on their self-efficacy for engaging in clients health promotion activities within 5 areas: smoking, exercise, nutrition, sexually-transmitted diseases and injuries. Their self-efficacy about their knowledge levels in the same 5 areas of health was also compared along with their perceptions of the relative impact of various curricular learning experiences on building health promotion counselling self efficacy. Self-efficacy scores were high for both groups. Nursing students scored significantly higher on both knowledge and ability to counsel patients in the areas of exercise, nutrition and injury prevention. In both groups, confidence in knowledge for health promotion activities was higher than ability to counsel patients. Learning specific health promotion strategies in class and actual practice were strongly associated with nursing students' self-efficacy while practice, feedback on performance, and role modelling were strongest for medical students.

Voices from the trenches: nurses' experiences of hospital restructuring in Ontario.

Nurses, the largest occupational group in health care, have been disproportionately affected by health care restructuring initiatives. A survey of registered nurses in Ontario was conducted in the fall of 1998 to examine factors influencing their work life quality in hospital settings. As a part of this survey, respondents were provided with an opportunity to share their concerns about work conditions in an open ended section of the questionnaire. Almost sixty percent of the nurses chose to respond to the open ended question (n = 230), divided equally between males and females. The purpose of the qualitative component of the study was to obtain a more in depth analysis of the effects of hospital restructuring initiatives on staff nurses' working conditions. All geographic areas of the province were represented in the responses. A content analysis of the data was conducted to determine major themes. Similar themes were found across all geographic areas. The four major categories of concerns that emerged from the qualitative analysis were quality of worklife, quality of patient care, relations with management, and cumulative impact of work conditions on feelings and attitudes. Nurses' perceptions of their quality of work life, concern for the quality of patient care and their emotional and attitudinal responses were very similar to those reported in a recent study of hospital staff nurses in the United States. The decade of the 1990's has been characterized as one of constant change bordering on chaos within the health care system in Canada and the United States. In Canada, government fiscal policies have resulted in less money being directed toward health care forcing the system to reorganize in order to meet new financial realities. Many of the organizing efforts have been directed toward the acute care sector of the health care system. Nurses, as the largest occupational group within the health care system, have been disproportionately affected by these efforts. The purpose of this study was to tap nurses concerns about the effects of these changes on their personal and work experiences.

The effects of teamwork on staff perception of empowerment and job satisfaction.

Rosabeth Moss Kanter's model of organizational empowerment was used to examine the effects of a multidisciplinary teamwork project initiated in preparation for a 1995 Canadian Council on Health Services Accreditation survey. Kanter maintains that work structures such as teams foster opportunities to learn and grow, provide access to information, support and resources, empower employees, and result in increased work satisfaction and effectiveness. Staff who participated on multidisciplinary teams to prepare for the accreditation survey (n = 210) and a random sample of staff who did not participate on the teams (n = 348) were surveyed to ascertain their perceptions of work-related empowerment and job satisfaction. Consistent with Kanter's propositions, members participating on teams had higher empowerment scores and perceived access to empowerment structures to be more important than members not participating on these teams. Overall, perceived access to empowerment structures was found to be significantly lower than perceived importance of access to the empowerment structures. The results of this study support the use of multidisciplinary teams as one work redesign strategy for enhancing work effectiveness in the health care environment.

Work empowerment and organizational commitment.

As organizations struggle to deliver the same level and quality of services with fewer resources, administrators are challenged with redesigning workplaces to maximize nurses' commitment. This study used Kanter's Structural Theory of Organizational Behavior to examine the relationship between job-related empowerment perceptions of staff nurses and their commitment to the organization. Strategies for creating more empowered work environments are discussed.

Review of experimental learning theory research in the nursing profession.

In this paper, Kolb's theory of experimental learning theory is briefly outlined. This overview is followed by a summary of research on the theory in nursing populations. Moderate support for various propositions of the theory suggests that further research is warranted and that Kolb's model may be useful as a basis for developing instructional activities in professional nursing education programmes.

Learning styles of nursing students and environmental press perceptions of two clinical nursing settings.

Kolb's Learning Style Inventory and Environmental Press Questionnaire were used to study 68 third-year baccalaureate nursing students' learning styles and perceptions of environmental press differences in medical-surgical and psychiatric nursing settings from the experiential learning theory perspective. Evidence for a hypothesized match between predominating student learning styles and predominating environmental press was sought. As hypothesized, student learning styles were found to be predominantly concrete as was the predominating environmental press in both nursing settings. Medical-surgical and psychiatric nursing settings did not differ significantly from environmental press. A profile of competencies felt to be important in nursing emerged with concrete people-oriented competencies rating higher than abstract competencies.

Undergraduate nursing students' health promotion counselling self-efficacy.

In this study, undergraduate nursing students' self-efficacy for carrying out health promotion activities with clients in nursing settings was examined. Students in the first, second and fourth year of a baccalaureate programme felt moderately efficacious about their knowledge and abilities for health promotion counselling in the three content domains measured (smoking cessation, nutrition and exercise). Senior nursing students had the highest self-efficacy scores, suggesting a positive impact on health promotion, regardless of year in their educational programme, students reported significantly lower efficacy for their ability to engage clients in an educational programme for behavioural change. Educational directions from Bandura's theory are described.