Abstract
BackgroundWhile the Iranian nursing profession tries to reach to its full capacity for participating in the maintenance of public health, its desire to develop is strongly influenced by cultural, economic, and religious factors. The concept of empowerment is frequently used in nursing and the health services, particularly in relation to the quality of care, since the mission of nursing is to provide safe and quality nursing care thereby enabling patients to achieve their maximum level of wellness. When considering the importance of nursing services in any health system, the 54th World Health Assembly recommended that programs be designed to strengthen and promote the nursing profession. Since empowerment is crucial to the role of nurses, a qualitative study was conducted and aimed at designing a model for empowering nurses in Iran.MethodsA grounded theory approach was used for analyzing the participants' experiences, their perceptions and the strategies affecting empowerment. Data collection was done through Semi-structured interviews and participant observation. Forty-four participants were interviewed and 12 sessions of observation were carried out.ResultsThree main categories emerged from the data collected; these are "personal empowerment", "collective empowerment", and "the culture and structure of the organization." From the participants' perspective, empowerment is a dynamic process that results from mutual interaction between personal and collective traits of nurses as well as the culture and the structure of the organization. Impediments, such as power dynamics within the health care system hinder nurses from demonstrating that they possess the essential ingredients of empowerment.ConclusionA model was designed for empowering the nursing profession in Iran. Implementing this model will not only define nursing roles, identify territories in the national healthcare system, but it will restructure nursing systems, sub-systems, and services. Currently no such model exists; therefore, restructuring of the nursing system, including its services, education and research subsystems is recommended.
Highlights
While the Iranian nursing profession tries to reach to its full capacity for participating in the maintenance of public health, its desire to develop is strongly influenced by cultural, economic, and religious factors
Category 1: personal empowerment According to the participants, personal empowerment is dependent on three variables, these are "having authority" and "professional self-confidence" for the "application of professional knowledge and skills." According to two nurses, "A powerful nurse is one who has good knowledge and can use it well" and "The power of a nurse depends on his knowledge and skills as well as his self-confidence in application of his knowledge in the provision of care for their clients." participants pointed out that the culture and structure of organization negatively impacts nurses' self-confidence and authority and it is one that emphasizes "physician centeredness"
Two participants noted that "I must have the right to do nursing care based on my diagnosis, but I haven't this authority," "a person can be powerful only when he/she can decide on his/her own." Others pointed out that "the public hasn't an appropriate view on the nursing profession," "nurses cannot provide their own services to the public directly and people go to the doctor first," "nurses are only expected to do the doctors orders," "their workloads are high," and "there isn't any system for nurses' continuing education." Collectively all these variables have a negative effect on nurses' self-confidence and minimized their ability to exercise authority or power in the practice setting
Summary
While the Iranian nursing profession tries to reach to its full capacity for participating in the maintenance of public health, its desire to develop is strongly influenced by cultural, economic, and religious factors. The concept of empowerment is frequently used in nursing and the health services, in relation to the quality of care, since the mission of nursing is to provide safe and quality nursing care thereby enabling patients to achieve their maximum level of wellness. A country of sixty eight million has a national health service which employs over 70,000 nursing personnel (including operating room technicians) who provide nursing care in general and specialty hospitals. Iran like other countries is faced with a nursing shortage. The impact of this nursing shortage lead nurses to work more than their required shift of 192 hours per month; with potentially 150 hours of overtime in some parts of the country. Because the people of Iran have a poor image of nursing, those who choose nursing as a profession do experience low self-esteem. The combination of poor image and questions regarding quality of patient care, one would find it hard to believe that these nurses are graduates with a Baccalaureate Science in Nursing (BSN) from either a nursing school or medical science university
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