Decisional involvement of registered nurses in a tertiary hospital in Saudi Arabia

Schoombie, Tracy (2013-03)

Thesis (MCurr)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Literature suggests that job satisfaction and retention of nurses can be improved by empowering nurses in decision making (Mark, Lindley & Jones, 2009:120; Mangold, Pearson, Schmitz, Scherb, Specht & Loes, 2006:266; Manojlovich, 2007; and Scherb, Specht, Loes & Reed, 2010:2). Positive work environments such as those found in Magnet® accredited hospitals and those where management models have flat hierarchical structures, support the decisional involvement of registered nurses. Decisional involvement is described as “the pattern of distribution of authority for decisions and activities that govern nursing practice policy and the practice environment” (Havens & Vasey, 2005:377). The purpose of this study was to explore the decisional involvement of registered nurses in a tertiary hospital in Saudi Arabia. It is hypothesized that an empowering shared governance structure will result in a high level of decisional involvement of registered nurses who provide direct patient care. A quantitative study with a descriptive exploratory design was chosen to answer the research objectives. Through simple random sampling, n=140 registered nurses who provide direct patient care (target population N=672) and through non-probability purposive sampling n=18 nurse managers (target population N=21), participated in the study. A self-administered questionnaire was designed which included a validated tool, namely the Decisional Involvement Scale (Havens & Vasey, 2003:333). A pilot study was completed to test the validity of the self-designed sections of the questionnaire. Numerical data was analysed using STATISTICA v. 11.5 while the open-ended questions were analysed and placed into themes. It was found that registered nurses who provide direct patient care have low levels of actual and preferred decisional involvement, implying that the authority for decisional involvement lies with managers. The hypothesis that empowering shared governance structures will result in a high level of decisional involvement is not supported. There was no statistical difference identified between bedside Registered Nurses (bedside RNs) and nurse managers in the overall perception of decisional involvement. Factors that were identified to impact on decisional involvement included educational level, experience, leadership styles, the work environment and a culture of shared decision making. It is recommended that the focus to improve the decisional involvement of registered nurses who provide direct patient care should be on addressing those activities where more decisional involvement is preferred, while concurrently addressing those factors that were identified which would impact on the decisional involvement of all registered nurses.

AFRIKAANSE OPSOMMING: Literatuurstudies dui aan dat bemagtiging van verpleegkundiges in die proses van besluitneming tot meer werksbevrediging en retensie sal lei. Positiewe werksomgewings soos die by Magnet geakkrediteerde hospitale en die met plat hiërargiese bestuursmodelle dra by tot betrokkenheid van geregistreerde verpleegkundiges in besluitneming. Betrokkenheid by besluitneming word beskryf as ‘die wyse waarop outoriteit versprei is sodat besluite en akwiteite wat verpleegpraktykbeleid en die praktykomgewing bepaal, uitgevoer kan word’ (Havens & Vasey, 2005:377). Die doel van die studie was om die betrokkenheid te bepaal van geregistreerde verpleegkundiges by besluitneming in ‘n tersiêre hospitaal in Saoedi-Arabië. Die hipotese is dat ‘n bemagtigende, gedeelde bestuurstruktuur sal lei tot ‘n hoë vlak van deelnemende besluitneming by geregistreerde verpleegkundiges verantwoordelik vir direkte verpleegsorg. Die navorsingsdoelwitte is beantwoord deur middel van ‘n kwantitatiewe studie met ‘n beskrywende, ondersoekende ontwerp. Geregistreerde verpleegkundiges (n=140) wat direkte verpleegsorg lewer (teikengroeppopulasie N=672) is gebruik as deelnemers in die studie. Verpleegdiensbestuurders (n=18) is ook gebruik as deelnemers en gekies deur nie-waarskynlike, doelbewuste steekproefneming (teikenpopulasie N=21). ’n Self-toegepasde vraelys is ontwerp, met insluiting van ‘n geldig verklaarde Besluitnemende Betrokkenheidskaal (Havens & Vasey, 2003:333). ‘n Loodsstudie om die geldigheid van die selfontwerpte deel te bepaal, is voltooi Numeriese data is ontleed deur middel van STATISTICA v. 11.5. Oop-einde vrae is ontleed en in kategorieë georganiseer. Daar is gevind dat geregistreerde verpleegkundiges wat direkte pasiëntsorg lewer, laer vlakke van werklike en verkose betrokkenheid het in besluitneming, wat aandui dat die outoriteit vir besluitnemende betrokkenheid by bestuurders lê. Die hipotese dat bemagtigende gedeelde bestuurstrukture tot ‘n hoë vlak van deelneming in besluitneming sal lei, word nie ondersteun nie. Daar was nie ‘n beduidende statistiese verskil tussen geregistreerde verpleegkundiges wat by die bed betrokke is en verpleegdiensbestuurders met algehele waarnemingsbetrokkenheid by besluitneming nie. Geïdentifiseerde faktore wat ‘n rol speel by betrokkenheid by besluitneming behels opvoedkundige vlak, ondervinding, leierskapstyle, die werkomgewing en ‘n kultuur van gedeelde besluitneming. Daar word aanbeveel dat aktiwiteite waarby geregistreerde verpleegkundiges wat direkte pasiëntsorg lewer, verkies om meer betrokke by te wees tydens besluitneming, aangespreek word. Terselfdertyd moet geïdentifiseerde faktore wat ‘n rol speel in die betrokkenheid van besluitneming van alle geregistreerde verpleegkundiges ook aangeroer word.

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