Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice

AIM

To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles.

BACKGROUND

Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services.

METHOD

A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces.

RESULTS

New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads.

CONCLUSIONS

The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

Occupational burnout, retention and health outcomes in nephrology nurses

Occupational burnout can have serious implications on productivity, nurses'health, service usage, and health care costs. This study examined the effect of burnout on nurses' mental and physical health outcomes and job retention. Randomly selected Canadian nephrology nurses completed surveys consisting of the Maslach Burnout Inventory and the Pressure Management Indicator. The nurses also completed questions related to job retention. After controlling for age and years of nephrology nursing experience, the multivariate results demonstrated that almost 40% of mental health symptoms experienced by nephrology nurses could be explained by burnout and 27.5% of physical symptoms could be explained by burnout. Twenty-three per cent of the sample had plans to leave their current position and retention was significantly associated with burnout, mental, and physical symptoms. Organizational strategies aimed at reducing perceptions of burnout are important, as a means to keep nurses healthy and working to their fullest potential.

Workplace empowerment and burnout in Canadian nephrology nurses

Nephrology nurses, like nurses in other areas, are impacted by the stress in their work environment. As recruitment and retention issues become more apparent, research in the area of conditions of work life for nephrology nursing has emerged, as an important area of study. Burnout has been reported as high as one in every three nephrology nurses (Flynn, Thomas-Hawkins, & Clarke, 2009). This cross-sectional study examined the influence of empowerment on burnout. Total empowerment was negatively correlated with emotional exhaustion in the bivariate analysis. Multivariate analysis demonstrated that access to resources and nursing education had an influence on burnout for nephrology nurses. Access to resources was a significant negative predictor of burnout for nephrology nurses. Degree-prepared nurses were more likely to experience burnout. Application of these results by providing access to resources for nephrology nurses may impact on occupational burnout.

Work environment, health outcomes and magnet hospital traits in the Canadian nephrology nursing scene

Nephrology, like others areas of health care, is confronting a nursing shortage. Unless action is taken to address nursing shortages, patient care may be negatively affected (American Nephrology Nurses' Association, 2007). Previous studies have been conducted on magnet hospital traits, quality of nursing worklife, empowerment, job satisfaction, burnout, health outcomes, and their influence on nursing retention in Canada. However, there is little research in this area specific to nephrology nursing. This descriptive study examined whether magnet hospital traits, empowerment, and organizational support contribute to Canadian nephrology nurses' job satisfaction, health outcomes, and perceived quality of patient care. A randomly selected sample of 300 nurse members of the Canadian Association of Nephrology Nurses and Technologists (CANNT) was asked to complete a survey consisting of four instruments: The Nursing Work Index (Lake, 2002), the Conditions of Work Effectiveness Questionnaire II (Laschinger, Finegan, Shamian, & Wilk, 2001), the Pressure Management Indicator (Williams & Cooper, 1998), and the Maslach Burnout Inventory (Maslach, Jackson, & Leiter, 1996). There was a 48.1% response rate. Results demonstrated that some aspects of the Canadian nephrology nursing environment were rated quite favourably (e.g., high standards of care are expected; good working relationships with peers), but areas requiring improvement were evident (e.g., assignments that foster continuity of care). Overall, the nurses felt empowered. The results of the Pressure Management Indicator and Maslach Burnout Inventory indicated that nephrology nurses are generally coping well, but that some of them are struggling. Strategies that improve work environments could promote the recruitment and retention of nephrology nurses. Further research in this area is warranted.

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.

The impact of workplace empowerment, organizational trust on staff nurses' work satisfaction and organizational commitment

A predictive, nonexperimental design was used to test Kanter's work empowerment theory in a random sample of 412 staff nurses selected from the professional registry list of a central Canadian province. Kanter argues that work environments that provide access to information, support, resources, and opportunity to learn and develop are empowering and influence employee work attitudes, productivity, and organizational effectiveness. Test results suggest that fostering environments that enhance perceptions of empowerment will have positive effects on organizational members and increase organizational effectiveness.

The antecedents and consequences of empowerment: a gender analysis

Kanter argues that empowerment has many positive consequences. Not only do empowered employees work more effectively, but they are more likely to express positive attitudes toward their organization. Although support for Kanter's model has been found in several studies of nurses, these studies have not explored the possibility of gender differences. Do men in nursing have the same access as women do to structures that lead to empowerment? Moreover, do men and women react differently to empowerment? To answer these questions, we sampled 412 nurses (195 men; 217 women) about their access to empowerment structures and their trust and commitment to their organization. We found no support for the suggestion that male nurses are less empowered because of their "token" status. Also, we found that the model predicted the responses of men and women equally. Our results suggest that empowerment provides an excellent way of enhancing organizational attitudes for both men and women.

Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model

OBJECTIVE

In this study, we tested an expanded model of Kanter's structural empowerment, which specified the relationships among structural and psychological empowerment, job strain, and work satisfaction.

BACKGROUND

Strategies proposed in Kanter's empowerment theory have the potential to reduce job strain and improve employee work satisfaction and performance in current restructured healthcare settings. The addition to the model of psychological empowerment as an outcome of structural empowerment provides an understanding of the intervening mechanisms between structural work conditions and important organizational outcomes.

METHODS

A predictive, nonexperimental design was used to test the model in a random sample of 404 Canadian staff nurses. The Conditions of Work Effectiveness Questionnaire, the Psychological Empowerment Questionnaire, the Job Content Questionnaire, and the Global Satisfaction Scale were used to measure the major study variables.

RESULTS

Structural equation modelling analyses revealed a good fit of the hypothesized model to the data based on various fit indices (chi 2 = 1140, df = 545, chi 2/df ratio = 2.09, CFI = 0.986, RMSEA = 0.050). The amount of variance accounted for in the model was 58%. Staff nurses felt that structural empowerment in their workplace resulted in higher levels of psychological empowerment. These heightened feelings of psychological empowerment in turn strongly influenced job strain and work satisfaction. However, job strain did not have a direct effect on work satisfaction.

CONCLUSIONS

These results provide initial support for an expanded model of organizational empowerment and offer a broader understanding of the empowerment process.

Testing Karasek's Demands-Control Model in restructured healthcare settings: effects of job strain on staff nurses' quality of work life

BACKGROUND

Job strain among staff nurses has become an increasingly important concern in relationship to employee performance and commitment to the organization in current restructured healthcare settings.

OBJECTIVES

The purpose of this study was to test Karasek's Demands-Control Model of job strain by examining the extent to which the degree of job strain in nursing work environments affects staff nurses' perceptions of structural and psychological empowerment, work satisfaction, and organizational commitment.

METHOD

A predictive, nonexperimental design was used to test these relationships in a random sample of 404 Canadian staff nurses. Karasek's Job Content Questionnaire, the Conditions of Work Effectiveness Questionnaire-II, Spreitzer's Psychological Empowerment Questionnaire, Meyer and Allen's Organizational Commitment Questionnaire, and the Global Satisfaction Scale were used to measure the major study variables.

RESULTS

Nurses with higher level of job strain were found to be significantly more empowered, more committed to the organization, and more satisfied with their work.

CONCLUSIONS

Support for Karasek's Demands/Control theory was established in this study.

Consortium approach for nurse practitioner education

In 1995, a 10-university consortium approach to deliver a post-baccalaureate primary care nurse practitioner programme funded by the Ontario Ministry of Health was launched throughout Ontario, Canada. A combination of traditional and distance teaching methods, in English and French, were used. A 5-year research project was initiated to evaluate the entire programme, the effect of nurse practitioners on patient and health-care system outcomes and examine practice patterns. Participants included deans and directors (n = 10), regional co-ordinators (n = 5) and course developers, some of whom were also course professors (n = 8). This article is a report of the evaluation of the consortium programme after the first year from the perspective of groups involved in implementation and delivery. Results of qualitative analyses of participant perceptions from researcher-led focus groups and asynchronous electronic interviews provided the framework for the evaluation, and revealed the rationale for the consortium method, strengths, limitations and recommendations. Sharing ideas, resources and delivery and increased student access in remote areas were perceived as positive outcomes. Limitations included the short time period to develop programme content, identify and plan for distance education resources, and too little communication between universities and students. Researchers concluded that the consortium approach was effective for nurse practitioner education. Key factors identified for programme planning were communication, resources, curriculum and workload. Included among the recommendations was to allow sufficient time for role and course development before beginning a similar programme.

Organizational trust and empowerment in restructured healthcare settings. Effects on staff nurse commitment

In today's dramatically restructured healthcare work environments, organizational trust is an increasingly important element in determining employee performance and commitment to the organization. The authors used Kanter's model of workplace empowerment to examine the effects of organizational trust and empowerment on two types of organizational commitment. A predictive, nonexperimental design was used to test Kanter's theory in a random sample of 412 Canadian staff nurses. Empowered nurses reported higher levels of organizational trust, which in turn resulted in higher levels of affective commitment. However, empowerment did not predict continuance commitment--that is, commitment to stay in the organization based on perceived lack of other job opportunities. Because past research has linked affective commitment to employee productivity, these results suggest that fostering environments that enhance perceptions of empowerment and organizational trust will have positive effects on organizational members and increase organizational effectiveness.

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.

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.

Leader behavior impact on staff nurse empowerment, job tension, and work effectiveness

OBJECTIVE

The authors tested a model linking specific leader-empowering behaviors to staff nurse perceptions of workplace empowerment, occupational stress, and work effectiveness in a recently-merged Canadian acute care hospital.

SUMMARY BACKGROUND DATA

An integration of Kanter's organizational empowerment theory and Conger and Kunungo's model of the leader empowerment process constituted the theoretical framework for the study. Few published studies were found in which specific leader behaviors were linked empirically to staff nurses' workplace empowerment.

METHODS

Staff nurses (n = 537) were surveyed shortly after a merger of two large tertiary hospitals. Structural equation modeling techniques were used to test the proposed model.

RESULTS

Leader-empowering behaviors significantly influenced employees perceptions of formal and informal power and access to empowerment structures (information support, resources, and opportunity). Higher perceived access to empowerment structures predicted lower levels of job tension and increased work effectiveness. The amount of explained variance in the final model was 42%.

CONCLUSIONS

Support for the model tested in this study highlights the importance of nurse managers' leadership behaviors within current turbulent healthcare organizations.

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.

Empowerment and staff nurse decision involvement in nursing work environments: testing Kanter's theory of structural power in organizations

Work redesign initiatives have transformed approaches to patient care that will require increased control of nurses over both the content and context of their practice. A secondary analysis of two studies linking perceived work empowerment with two aspects of staff nurse decisional involvement using Kanter's (1977, 1993) theory of structural power in organizations is described. In these studies, the pattern of relationships among variables in Kanter's theory and two different facets of work decisional involvement (control over the content and context of nursing practice) were examined using structural equation modeling techniques. Consistent with theoretical expectations, perceptions of formal and informal power significantly influenced perceived access to work empowerment structures. Informal power was found to mediate the relationship between formal power and access to work empowerment structures. Formal and informal power and access to empowerment structures, in combination, were found to be significant predictors of the extent of involvement in decisions related to the content and context of nursing practice, respectively. The results provide empirical support for propositions derived from Kanter's theory of work empowerment, and provide potential guidance for theory-based management practices to enhance nurses' involvement in professional and organizational decision making.

The effect of workplace empowerment on staff nurses' occupational mental health and work effectiveness

Occupational mental health has been linked to productivity and other desired organizational outcomes, such as commitment and satisfaction. Kanter's model of work empowerment was used to examine the relation between 62 staff nurses' perceptions of empowerment in their work settings and their occupational mental health. The authors discuss their findings and suggest organizational interventions that can be used by nurse administrators to ameliorate work stress and improve work effectiveness.

Nurse managers' perceptions of power and opportunity

This study used Rosabeth Kanter's (1977) structural theory of organizational behaviour to examine differences in the perceptions of access to job related power and opportunity of 91 nurse managers in first line and middle management positions. A convenience sample of nurse managers in three Canadian acute care urban hospitals was used to investigate the study questions. Consistent with Kanter's (1977) theory, middle managers perceived themselves as having significantly greater access to the empowerment structures than the first line managers (M = 14.66 and 12.82, respectively). Also, nurse managers in positions higher in the hierarchical structure reported having greater personal power in their organizational settings than those in lower positions.

Staff nurse work empowerment and perceived control over nursing practice, Conditions for work effectiveness

Nurse administrators are seeking ways to create organizational work environments that empower nurses to exercise more control over the content and context of their practice. This study used Rosabeth Kanter's Structural Theory of Organizational Behavior to examine relationships between staff nurses' perceptions of work empowerment, and control over nursing practice, and subsequently, job satisfaction and perceived work effectiveness. Implications for nurse administrators are discussed.

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.

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.

Staff nurses' perceptions of job empowerment and level of burnout: a test of Kanter's theory of structural power in organizations

Kanter's structural theory of organizational behavior was used as framework to explore the relationship between perceptions of power and opportunity and level of burnout in a sample of 87 hospital staff nurses. Data were collected using a modified version of the Conditions for Work Effectiveness Questionnaire (Chandler, 1986) and the Human Services Survey (Maslach & Jackson, 1986). Consistent with Kanter's theory, perceived access to power and opportunity was significantly related to the three aspects of burnout: level of emotional exhaustion and depersonalization (r = -.3419, p = .004; r = -.2931, p = .02), and personal accomplishments (r = .3630, p = .002). The results of this study are useful for nurse administrators positioned to create organizational structures than empower staff nurses and subsequently decrease burnout.

A theoretical approach to studying work empowerment in nursing: a review of studies testing Kanter's theory of structural power in organizations

Although work empowerment is a common theme in the current nursing systems literature, few systematic programs of research have studies the phenomenon from an explicitly theoretical framework. The author summarizes the results of a series of studies in a program of research designed to test Rosabeth Moss Kanter's Structural Theory of Organizational Behavior in the nursing population. Future directions for theory and research are proposed.

Applying the Stetler-Marram model to a nursing administration problem: a graduate student learning experience

Research utilization models have not commonly been used in attempts to solve workplace problems using the results of nursing administration research. This paper describes a graduate learning experience in which the Stetler-Marram Research Utilization Model was applied to a fictitious case in nursing administration. In this case, the model was used to develop a research-based intervention to improve job satisfaction in a hospital setting.

Community health nurses' HIV care behavior

The purpose of this study was to examine community health nurses' attitudes, subjective norms, and intentions to care for patients who are HIV positive using the theory of reasoned action. One hundred and forty-five participants completed a questionnaire developed according to guidelines described by Ajzen and Fishbein (1980). Consistent with the theory, nurses' attitudes and subjective norms were found to be significant predictors of intentions to care for persons who are HIV positive (R2 = .15). Personal beliefs found to discriminate between intenders and nonintenders were those related to possible consequences for self, family, and friends, but not to job-related consequences. In addition, qualitative data showed persistent concerns about occupational risk for contracting AIDS. Based on the results of this research, it is recommended that nurse educators in both clinical and academic settings target specific educational and training interventions to include transmission, prevention, and exploration of feelings, attitudes, beliefs, and behavioral intentions about HIV-related topics. Further theory-based research and testing of interventions to change community health nurses' attitudes and beliefs about HIV disease are advocated.

Staff nurse work empowerment and perceived autonomy. Testing Kanter's theory of structural power in organizations

Nurse executives have been striving for the means to equalize the power base in healthcare settings. They also have been seeking ways to overcome the perceived powerlessness of their staffs. Empowerment and increased autonomy in the work setting often are described as mechanisms to achieve these goals. This study, based on Kanter's theory of the structural determinants of behavior in organizations, examined formal and informal power as predictors of job-related empowerment and autonomy. Results of the study lend support to the use of the theory in healthcare settings as a way for nurse executives to develop increased access to the sources of job-related empowerment for their staffs.

The effect of a senior preceptorship on the adaptive competencies of community college nursing students

A pre-post design was used to examine the effect of a senior preceptorship experience on the adaptive competencies, environmental press perceptions and learning styles of 55 third-year community college nursing students. Kolb's experiential learning theory provided the framework for the study. Subjects rated their concrete and abstract competencies and the importance of divergent and convergent competencies significantly higher following the preceptorship. They also felt that the preceptorship experience contributed significantly more to their competency development than their weekly clinical experiences during the year. Contrary to expectations, administration of the Learning Style Inventory LSI-1976 and LSI-1985 produced inconsistent classifications of subjects' learning styles. Implications for nursing are described.

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.

Changes in student learning styles and adaptive learning competencies following a senior preceptorship experience

The purpose of this pre-post comparison study was to examine the effect of the preceptorship experience on the learning styles (the manner in which individuals process information from the environment), adaptive competencies (the congruences between personal skills and task demands) and environmental press perceptions (the subjects' perceptions of the importance of each adaptive competency to effective functioning in a designated environment) of 37 fourth-year baccalaureate nursing students. Using Kolb's theory of experiential learning as the theoretical framework for the study, it was found that the students' learning styles were inconsistently categorized by two versions of Kolb's learning style inventory. The preceptorship experience was perceived by students to have significantly (P < 0.05) improved the development of their adaptive learning competencies. Students perceived the importance of divergent, accommodative and convergent learning competencies to be lower after the preceptorship experience, with the only significant difference (P < 0.05) being between pre- and post-convergent competencies. The preceptorship experience, however, was found to contribute significantly more (P < 0.001) to the students' development of most adaptive competencies than their weekly clinical experiences. The findings support the notion that a senior preceptorship programme is a valuable and worthwhile learning experience to include in baccalaureate nursing curricula.

Staff nurses' and nurse managers' perceptions of job-related empowerment and managerial self-efficacy

Although much has been written about the importance of empowerment in nursing, few theoretical frameworks provide guidance for nurse administrators in their attempts to create empowered nursing work environments. The authors describe a study testing Kanter's Theory of Structural Power in Organizations in a nursing setting. They argue that the findings provide evidence of the usefulness of this model for increasing perceptions of job-related empowerment of both staff nurses and managers. Specific empowerment strategies derived from Kanter's theory are described.

Self-efficacy in caregivers of cognitively impaired elderly people: a concept analysis

Research with caregivers of cognitively impaired individuals has provided evidence which suggests that most caregivers experience at least some degree of burden. However, it has been postulated that it is the caregiver's subjective interpretation of the situation that is the primary factor responsible for mediating the degree of burden experienced. Caregivers who cope well with this type of stress may possess a high level of self-efficacy. The purpose of this paper is to analyse the concept of self-efficacy and its relationship to health care using Walker & Avant's concept analysis methodology. Uses of the concept of self-efficacy, as well as its defining attributes, antecedents, consequences and empirical referents, are discussed. Also, model, borderline, related, contrary and invented cases are constructed to illustrate the concept further. The relevance of the concept to nursing practice and areas requiring future investigation are noted.

Staff nurse perception of job empowerment and organizational commitment. A test of Kanter's theory of structural power in organizations

In this study, Rosabeth Kanter's structural theory of organizational behavior was tested in a nursing population by examining the relationship between 161 staff nurses' perceived job empowerment and their commitment to the organization. Data were collected using the Organizational Description Opinionnaire, the Organizational Commitment Questionnaire, a modified version of the Conditions for Work Effectiveness Questionnaire, and a demographic questionnaire. Consistent with Kanter's theory, a strong positive relationship was found between nurses' perceptions of power and opportunity and their commitment to the organization. In addition, overall empowerment was correlated positively with nurses' perceptions of their immediate managers' power. The results suggest that nurse administrators can empower their staff and improve organizational commitment by manipulating the structures in the work environment to allow greater access to the power and opportunity structures that Kanter maintains are important to overall work effectiveness.

Attitudes of practicing nurses as predictors of intended care behavior with persons who are HIV positive: testing the Ajzen-Fishbein Theory of Reasoned Action

The purpose of this descriptive correlational study was to examine practicing nurses' attitudes, subjective norms, and intentions to care for HIV positive patients, using the Theory of Reasoned Action. One hundred and forty-one subjects completed a questionnaire developed according to guidelines described by Ajzen and Fishbein (1980). Consistent with the theory, nurses' attitudes and subjective norms were found to be significant predictors of intentions to care for persons who are HIV positive (R2 = 0.27). Personal beliefs found to discriminate between intenders and nonintenders were those related to possible consequences for self, family, and friends, but not job-related consequences. Normative beliefs which discriminated between groups were also related to nonprofessional referents' expectations. In addition, qualitative data showed persistent concerns about occupational risk for contracting AIDS. Based on the results of this research, it is recommended that nurse educators in both clinical and academic settings, target specific educational/training interventions to include transmission, prevention, as well as exploration of feelings, attitudes, beliefs, and behavioral intentions about HIV-related topics. Further theory-based research and testing of interventions to change practicing nurses' attitudes and beliefs about HIV disease are advocated.

Theory-based practice: attitudes of nursing managers before and after educational sessions

In Canada, professional associations are mandating theory-based nursing as a standard of practice. Few systematic studies of nurses' attitudes toward, knowledge of, and exposure to theory-based nursing are in the literature. We used a convenience sample of nursing managers in a public health department to describe these aspects before and after an educational program, and to identify preferred ways of learning about nursing models. The managers had moderately positive attitudes toward theory-based nursing, which increased and were maintained six months after an educational program. Case studies and small group discussions were preferred over lectures and reading as methods of learning nursing theory. The significant increases in positive attitudes after the educational program suggest that knowledge and experience in applying nursing theory had an impact on the managers' attitudes. Managers identified a need to explore a variety of models before making a commitment to one. Leadership, commitment, and careful planning are required when the decision to introduce a model is made.

Research utilization in nursing administration. A graduate learning experience

The authors describe a graduate learning experience designed to increase understanding and encourage the use of research utilization models to solve problems in nursing administration. One student project is described, and the extension of research utilization projects to include nursing administration research findings as well as clinical research findings is discussed.

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.

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.

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.

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.

Attitudes of practicing nurses towards theory-based nursing practice

Theory-based nursing practice is a topic of current importance in Canadian nursing settings. Both the CNA and provincial regulating bodies have included the concept in their standards of practice. Current nursing education programs based on nursing models have produced a growing cadre of nurses familiar with formal nursing theory. However, practicing nurses' exposure to nursing theories varies and this population has not been systematically investigated. As part of a larger study, responses of 362 nurses from three Ontario cities to the Nursing Theories Questionnaire revealed a moderately positive attitude towards theory-based nursing practice. Attitudes were significantly more positive among nurses working in agencies which had implemented theory-based practice. Nurses believed that theory-based practice would help them collect useful data, plan comprehensive care, would result in better care, should not be left for nurse scholars and was important to the development of the nursing profession. Nurses were most familiar with theories of Neuman, Orem and Roy; least familiar with Parse and Rogers. Community nurses preferred Neuman's theory; hospital nurses preferred those of Roy and Orem. These findings provide information about factors associated with nurses' knowledge and attitudes towards theory-based nursing practice and may be useful for nurse administrators in planning strategies for implementing theory-based practice.

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 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.

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.

Learning styles of nursing students and career choices

Kolb's 'Learning Style Inventory' was used to examine learning characteristics of incoming nursing students (n = 166) which were then compared to those of more advanced nursing students (n = 102). A majority of students were found to have concrete learning styles. Advanced students had a greater incidence of concrete learning styles than first year students suggesting increasing concreteness with exposure to nursing education. Diploma students were found to have a higher incidence of concrete learning styles than university students. Students with concrete learning styles were more influenced by person-oriented factors in career choices than those with abstract learning styles. No relationship was found between learning style and preferred nursing specialty. Implications for nursing education are discussed.