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Pincha Baduge MSDS, Garth B, Boyd L, Ward K, Joseph K, Proimos J, Teede HJ. Barriers to advancing women nurses in healthcare leadership: a systematic review and meta-synthesis. EClinicalMedicine 2024; 67:102354. [PMID: 38314055 PMCID: PMC10837541 DOI: 10.1016/j.eclinm.2023.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/06/2024] Open
Abstract
Background Women comprise the majority of the nursing profession, yet nurses are underrepresented in healthcare leadership. We aimed to explore barriers for women nurses to advance in healthcare leadership to inform organisational interventions for career advancement. Methods In this systematic review and meta-synthesis, studies examining advancing women nurses and midwives in leadership within healthcare and academia in the international literature were included. Six databases (MEDLINE, EMCARE, EMBASE, PsycINFO, PubMed, and CINAHL PLUS) were searched for studies published in English between January 1 2000 and October 17 2023. The Grading of Recommendations Assessment, Development, and Evaluation tools (GRADE) was followed to assess confidence in the findings. Retrieved full texts were assessed for methodological rigour using the Critical Appraisal Skill Programme Qualitative Studies checklist and the Joanna Briggs Institute Cross-sectional and Prevalence Studies checklists. Reported barriers for women nurses' leadership attainment were identified and generated themes were mapped to the Abilities, Motivation, and Opportunities (AMO) framework. Findings There were 32 eligible studies; 18 qualitative, 11 quantitative, and 3 mixed-methods. Studies included high-income countries (n = 20), middle-income countries (n = 7) and across countries (n = 3) with two unspecified. Samples included registered nurses, nurse academics, executives, and leaders. The key barriers highlighted were related to: role modelling and leadership development (ability); multiple complex and interacting factors, including gender stereotyping, perception of professionalism, human relations policies, and gender bias (motivation); and systemic issues, such as organisational setting, structure, and support (opportunity). Interpretation The prevailing belief in the literature is that caregiving is a feminine occupation and along with societal expectations of women's subordinate position, these present substantial obstacles that limit women nurses from advancing into healthcare leadership. Ultimately, these factors restrict women nurses in career advancement and need to be addressed at a systems and organisational level. Funding The National Health and Medical Research Council (NHMRC), Australia.
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Affiliation(s)
| | - Belinda Garth
- Monash Centre for Health, Research and Implementation, Monash University, Melbourne, VIC, Australia
| | | | - Kylie Ward
- Australian College of Nursing, Australia
| | - Kathryn Joseph
- Monash Centre for Health, Research and Implementation, Monash University, Melbourne, VIC, Australia
| | - Jenny Proimos
- Monash Centre for Health, Research and Implementation, Monash University, Melbourne, VIC, Australia
- Royal Children's Hospital, Melbourne, VIC, Australia
| | - Helena J Teede
- Monash Centre for Health, Research and Implementation, Monash University, Melbourne, VIC, Australia
- Endocrine and Diabetes Units, Monash Health, Melbourne, VIC, Australia
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Mustafa ZU, Manzoor MN, Shahid A, Salman M, Hayat K, Yasmin K, Baraka MA, Mathew S, Kanwal M, Parveen S, Jamal I, Khan AH, Godman B, Saleem F, Bashaar M. Nurses' Perceptions, Involvement, Confidence and Perceived Barriers Towards Antimicrobial Stewardship Program in Pakistan: Findings from a Multi-Center, Cross-Sectional Study. J Multidiscip Healthc 2022; 15:2553-2562. [PMID: 36388630 PMCID: PMC9642086 DOI: 10.2147/jmdh.s376664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose Antimicrobial resistance (AMR) is leading to greater therapeutic cost, length of hospital stays, adverse events, morbidity and mortality. Hospital-based antimicrobial stewardship programs (ASPs) engaging physicians, pharmacists, microbiologists and nurses are considered as effective way to ensure appropriate use of antimicrobial agents. The aims of our study were to assess nurses' perception, involvement, confidence and barriers towards hospital-based ASPs, and use the findings to provide future guidance. Methods A web-based, cross-sectional study was conducted among the nurses serving at eleven hospitals of Punjab province of Pakistan during a period of two months (December 2021-January 2022). Data were collected using a validated self-administered questionnaire. All data were analyzed using SPSS version 22. Results A total of 583 nurses participated in the study (response rate = 77.7%). All the participants were female staff nurses and 86% had a minimum of 3 years of working experience. The overall median score on the perception towards ASPs among the nurses was 18 (IQR: 16, 19) on a 0 to 20 scale whereas median score on the involvement in ASPs was 18 (IQR: 15, 37) on a 0 to 64 scale. Median perception and involvement score were statistically significantly differed by age (p < 0.001) and years of experience (p < 0.001). The overall median score on the confidence to perform ASP activities was 22 (IQR: 14, 24) on a 0 to 28 scale. Lack of knowledge, insufficient support from administration, and heavy workload were found to be the common barriers to perform ASP. Conclusion Our study concluded that Pakistani nurses have positive perception but limited involvement in ASPs. Moreover, they are confident to perform ASP besides many barriers.
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Affiliation(s)
- Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan54700, Pakistan
| | | | - Arfah Shahid
- Department of Medicine, Rawalpindi Medical University, Rawalpindi46000, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Khalida Yasmin
- Lahore School of Nursing, The University of Lahore, Lahore, Pakistan
| | - Mohamed A Baraka
- Clinical Pharmacy Program, College of Pharmacy, Al Ain Campus, Al Ain University, Al Ain, Abu Dhabi, United Arab Emirates
- Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Nasr city, Cairo, Egypt
| | - Smitha Mathew
- Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Mahpara Kanwal
- Department of Pharmacy Services, District Headquarter Hospital, Okara South City, Pakistan
| | - Samina Parveen
- Department of Pharmacy Services, District Headquarter Hospital, Chakwal, Pakistan
| | - Irsa Jamal
- Department of Pharmacy Services, District Headquarter Hospital, Kasur, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Fahad Saleem
- Faculty of Pharmacy & Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Mohammad Bashaar
- SMART Afghan International Trainings and Consultancy, Kabul, Afghanistan
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