Bradbury Jones Study

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Are nursing students empowered in clinical practice

Empowerment: an illusion or reality for Irish nursing students?This study proposes to explore the concept of empowerment in clinical practice on final year nursing students.This study proposes to explore the concept of empowerment combined with the clinical experience on final year nursing students .

I was drawn to this topic as I frequently heard stories of how nursing students are disempowered, lacking in motivation, confidence and find it difficult to empower them selves during clinical practice experience. In Ireland clinical practice comprises of 81 weeks of a four year honours degree programme. 1

What happens when a student goes on placement?

The ripples that an empowered practitioner in the clinical environment affect all nursing students and the ripples of the disempowered affect all equally. Are students empowered through their interactions with other professionals and patients?2

In the Lourdes Hospital Enquiry into peri-partum hysterectomies of young mothers, Judge Clark noted the midwives response was that their training did not facilitate questioning. Others simply wept and said that they had not got the confidence to question (p.316). Judge Clark noted obedience was part and parcel of the training of nurses (Government of Ireland, 2006 p. 187).

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Cultural and Historical Context

Nursing has evolved from being perceived as being handmaidens to the doctors to that of health professionals (Jinks & Bradley, 2003). What is the relevance of this cultural context?

Historical legacy emerged as a key theme in an Irish national study of registered nurses views on empowerment (DOH & DCU, 2003).

As Ireland is leading the way in nurse education with degree only entry in place for last ten years it is timely that the nursing students of today are the focus of a study to explore their views on the empowering /disempowering factors at play in the clinical learning environment

How do we empower our nursing students?

Empowerment is a process it is not a state of mind or personality disposition. It is fluid and ever changing, it is impacted by the environment and culture. Empowerment of registered nurses is much researched however there is a dearth of literature on nursing student empowerment. Empowerment is simply defined by Chandler as to enable to act and is impacted by many factors in our environment and culture.

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Empowerment a definitionElusive, difficult to define and complex concept can fluctuate and change (Bradbury- Jones et al. 2010) Keiffer (1984) suggests it is easier to define in its absence.Rappaport (1984) suggests it is like obscenity we might not know what it is but we know when we see it.Working definition for the study is that empowerment is viewed as a desirable and positive concept that incorporates energy and impetus to do good for ones self and others within a nursing context.

Literature on Nursing Students EmpowermentBradbury Jones et al. (2007) suggests that nursing students can be empowered or disempowered depending on context. In this study critical incidents were provided by 66 nursing students relating to incidents of empowerment /disempowerment.

Bradbury Jones et al. (2010) in a longitudinal phenomenological study found that students were both empowered and disempowered in clinical practice.

In Bradbury- Jones et al. (2010) phenomenological study of third year nursing students found that empowerment of students is multifaceted and involves the following-Knowledge and Confidence-Being Valued-Mentorship and Placements-Cultural and Structural Influences

Nursing students used strategies to promote their own empowerment (Bradbury Jones et al., 2010). The study did not describe what the strategies were.

Bradbury-Jones et al. (2010) not clear whether or not these students were undertaking a degree or diploma course.

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Promotion or Prevention of Empowerment- Behaviours that matterPromotional Behaviours

-Moral Principles-Personal Integrity-Expertise/Competence-Future Orientation-Sociability

Kuokkanen & Leiono-Kilpi (2000)

Preventing Behaviour

-Conflicting Values-Distrust-Resistance to innovation-Lack of information-Hierarchy-Short working periods-Lack of openness-Nullification

Can we measure empowerment?Laschinger measured organisational empowerment in several studies in Canada using Conditions for Work Empowerment Questionnaire (CWEQ-11)

Spreitzers (1995) questionnaire measures psychological empowerment Psychological Empowerment Scale (PES).

Ibrahim (2011) found nursing students moderately empowered in a study that used Spreitzers PES in a study of nursing students level of self esteem. Corbally et al. (2007) noted that all measurement of empowerment found that registered nurses were moderately empowered

Empowerment MeasurementsConstructsStructural Empowerment(Access to Opportunity, Support, Information and Resources )Psychological Empowerment(Meaning, Competence, Self-determination and Impact).

Critical Social Theory Empowerment (Being listened to, Being recognised as professional by Multidisciplinary teams, Being Involved in decision making process)

MeasuresStructural Empowerment is measured using Conditions for Work Empowerment Questionnaire (CWEQ-11) (Laschinger et al., 2010)

Psychological Empowerment is measured using Psychological Empowerment Scale. PES (Spreitzer, 1995).

Critical Social Theory Questionnaire (Casey et al., 2010)

Theoretical FrameworkThis study will use Adaptive theory which is based upon a critical realist ontology and epistemology as a theoretical framework to explore empowerment.Adaptive theory is applied within a social realist ontology namely Layders Social Domains Theory (social ontology informed by realism).This theory acknowledges the macro (organisational and institutional) and the micro (individual) factors that impact our social reality (Layder, 2006).Casey et al. (2010) Irish study of 306 nurses supports the importance of macro and micro factors in her study of empowerment and job satisfaction in Ireland.

Adaptive Theory (Derek Layder)

Objective Social World Domains: Contextual ResourcesSocial Settings DomainsSubjective DomainsPsychobiographySituated Activity Domain12

Adaptive TheoryThis study's framework will acknowledge the complexities of the students social world in clinical practice and their perception of that world in relation to empowerment.

Adaptive theory facilitates the use of existing theoretical frameworks and acknowledges possibility of generating new knowledge that will help in understanding this complex phenomenon.

Methodology

How this study will contribute to the literature on empowerment?Focus Groups will provide an opportunity for the students to discuss and agree/disagree on what empowers/disempowers themData from this study will contribute to how educationalists and preceptors view clinical placements in nursing programmes.This study will augment literature from previous studies on nursing empowerment (Bradbury-Jones et al. 2008; 2009).It is envisaged that this study will contribute to the development of future policy on nursing education.

Thank you for your attention

ReferencesBradbury-Jones, C. Sambrook, S. Irvine, F. (2007) The meaning of empowerment for nursing students: a critical incident study. Journal of Advanced Nursing 59(4), pp. 342-351.

Bradbury-Jones, C., Irvine, F., Sambrook, S. (2010) Empowerment of Nursing students in clinical practice: spheres of influence. Journal of Advanced Nursing 66(9), pp. 20661-2070.

Casey, M., Saunders, J. & O Hara, T. (2010). "Impact of critical social empowerment on psychological empowerment and job satisfaction in nursing and midwifery settings." Journal of Nursing Management 18 (1), 24-34.

Department of Health and Children/Dublin City University (2003) Nurses and Midwives Understanding and Experiences of Empowerment in Ireland. Final Report. Stationary Office, Dublin.

Government of Ireland (2006) The Lourdes Hospital Enquiry: An Inquiry into the Peripartum Hysterectomy at Our Lady of Lourdes Hospital, Drogheda. Stationary Office, Dublin.

Ibrahim, S. (2011) Factors affecting assertiveness among student nurses. Nurse Education Today, 31(4), pp. 356-360.

Jinks, A.M. & Bradley, E. (2003) Angel, handmaiden, battleaxe, or whore? A study which examines changes in newly recruited student nurses attitudes to gender and nursing stereotypes. Nurse Education Today 24, pp. 121-127.

References Kanter, R. M. (1997) Men and Women of the Corporation. Basic Books, New York, NY.

Keiffer, C. (1984) Citizen empowerment: a development perspective. Prevention in Human Services 3, pp. 9-36.

Laschinger, S., Gilbert, S., Smith, L., Leslie, L. (2010) Towards a comprehensive theory of nurse/patient empowerment: applying Kanters theory to patient care. Journal of Nursing Management 18 (1), 4-13.

Layder, D. (2006) Understanding Social Theory. 2nd ed. Sage Publications, London.Rapport, J. (1984) Studies in empowerment: introduction to the issue. Prevention in Human Services 3, pp. 1-7.

Spreitzer, G. M.(1995). Psychological empowerment in the workplace: Dimensions, measurement, and validation. Academy of Management Journal 38 (5), 1442-1465.