Women's power in hospital-based nursing: A critical qualitative study

A dimensional analysis of nursing unit culture

AIM(S)

Organizational culture has been studied for over four decades among nurses, across countries and contexts. However, wide variation exists in how the concept has been defined and at what level of the organization it is measured. The aim of this study was to use a dimensional analysis to conduct a conceptual synthesis of unit culture from a nursing perspective.

DESIGN

Dimensional analysis, rooted in grounded theory methodology, was used to describe unit culture from a nursing perspective.

METHODS

A literature search was conducted in April 2022. Inclusion criteria were (1) peer review publications, (2) used the term 'unit culture' or 'ward culture', (3) references nurses' role in unit culture, (4) published in the last 20 years and (5) written in English. One hundred fifteen articles met inclusion criteria, but dimensional saturation was researched after coding 24 articles.

RESULTS

Findings were synthesized into four core dimensions and 10 subdimensions. Dimensions of unit culture included customs (practice norms, communication and prioritization), shared beliefs (assumptions, values and attitudes), hierarchy (social and informational) and atmosphere (emotional climate and collaboration). Conditions that shape unit culture include individual nurse characteristics, working conditions, unit policies/procedures and leadership. Unit culture impacts nurse work experiences and decision-making processes, which can affect outcomes including nurse wellbeing, practice behaviours and adherence to unit policies.

CONCLUSIONS

Identifying the dimensions of unit culture helps to bring clarity to a concept that is not well defined in existing literature.

IMPACT

This model of unit culture can be used to guide development of new instruments to measure unit culture or guide researchers in utilizing existing measures. Developing measures specific to unit culture are warranted to strengthen researchers' ability to assess how changing conditions of a unit (e.g. leadership, workload) changes unit culture and its related outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Public Health Nurses' Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study

OBJECTIVE

To address gaps in understanding the public health nursing workforce regarding competencies recognized as critical during an emergency response.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional observational study using data with information on local health department staff- and organizational-level characteristics collected from across the United States in 2021. We used logistic regression to estimate the association between 2 binary nurse-specific predictors-(1) whether the staff person was a nurse and (2) whether the staff worked in a local health department that was "nurse-led" (directed by a nurse)-and reported proficiencies important to the COVID-19 response. Models controlled for relevant local health department and community characteristics.

RESULTS

In the sample, 19% were nurses and 37% were at nurse-led health departments. Nurse versus nonnurse staff had higher odds of reporting proficiencies in skills related to Justice, Equity, Diversity, and Inclusion and in the skill "identifying/applying evidence-based approaches to address public health issues." However, nurses, compared with their nonnurse peers, had higher odds of reporting training needs in domains related to community engagement, policy engagement, and cross-sectoral collaboration. Conversely, staff at nurse-led health departments, compared with non-nurse-led staff, had higher odds of reporting proficiencies in many of these same areas, including "collaborating across the public health system" and "influencing policies external to the organization that affect community health." There were no areas in which nurse-led staff had lower odds of reporting proficiencies or higher odds of identifying training needs.

CONCLUSIONS

Findings from this study highlight areas of strength for public health nurses, particularly strengths related to diversity, equity, and inclusion, as well as areas where more training is needed. Such findings can help guide future public health nurse workforce development as well as underscore the value of public health nursing leadership and staff at local health departments for supporting community health.

Barriers to advancing women nurses in healthcare leadership: a systematic review and meta-synthesis

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.

Perceptions of Urban Father Support in Early Parenthood: A Critical Incident Analysis

Becoming a father is a common transitional event, however men are often not adequately prepared for their fathering role. The United States (U.S.) health care system does little to support fathers' parenting needs during the postnatal and infancy period. Moreover, father's support needs are often perceived as secondary to the mother's needs in the maternal-child system. It is important that fathers' social support needs be investigated in the first year of his newborn's life, especially in diverse populations. Therefore, the purpose of this study was to determine the social support needs of urban, African American fathers during early parenthood. Using the Critical Incident Technique (CIT), a descriptive, qualitative design was used to interview 35 fathers about their social support at 2-12 months after the birth of their baby. Using a semi-structured interview guide, fathers were asked to describe helpful and unhelpful events they experienced since the birth of their baby. Fathers reported 36 helpful events and 32 unhelpful events for an overall total of 68 events. Data was analyzed using House's Social Support Theory and the four social support categories: instrumental, informational, emotional, and appraisal. Using the CIT, main categories and subcategories were developed. The helpful categories included: 1) Helping father with infant care, 2) Providing information on infant care, 3) Receiving HCP assistance, 4) Managing relationships, and 5) Becoming a father. The unhelpful categories included: 1) Receiving unhelpful assistance, 2) Receiving unreliable or unwanted assistance, 3) Offering bad advice, 4) Conflicting relationships, 5) Conflicts with friends, 6) Unsatisfying HCP experience, and 7) Receiving no support from family/organizations. The results of the study validated House's Social Support Theory and served as an excellent framework for exploring social support needs in fathers. More research needs to be conducted on the social support needs of fathers during the first year of their infants' lives, especially with experienced African American fathers and nonresidential fathers, and how health care professionals (HCPs), specifically postnatal and child health nurses, can better support fathers during the infancy period.