Investigating the Psychological Empowerment of Nurses in Educational Hospitals: A Study in Ahvaz Jundishapur University of Medical Sciences in Southwest Iran

Abdolreza Gilavand^* and Pardis Hosseinpour

^*Correspondence: Abdolreza Gilavand, Musculoskeletal Rehabilitation Research Center, Iran, Email:

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Introduction

Empowerment is the process of giving power to individuals to strengthen their sense of self-esteem and overcome their inability and helplessness feelings, leading to mobilization of their inner motivations [1]. Empowerment involves development and extension of the capabilities and competencies of individuals in order to achieve continuous improvement in the performance of the organization [2]. Thomas et al. [3] argue that empowered staff are more flexible in controlling and fulfilment of their tasks and start new tasks in response to problems and opportunities and remove barriers. As a result, their motivation is strengthened in dealing with issues and problems [4]. In general, empowerment means giving power to staff to do a work assigned to them. It should be noted that empowerment does not mean disorder and chaos or managers' refusal to accept a responsibility. It is not also limited to empowerment of staff, but it should help staff improve their performance by acquiring knowledge, skills and motivation [5]. Empowerment has been considered from different perspectives. One of the most important perspectives is psychological empowerment. Psychological empowerment is an intrinsic job motivation that includes four dimensions of meaning, impact, competence, and selfdetermination [6]. According to studies by Mishra [7] and Cameron et al. [8] added the dimension of confidence to above-mentioned dimensions. The psychological empowerment of staff means releasing of the forces, the internal power of individuals as well as providing opportunities for flourishing of talents, abilities and competencies of staff. In fact, it includes one's perceptions of his role in the job and organization [4]. Conger et al. [9] investigated empowerment from a psychological point of view for the first time and considered psychological empowerment as the ability or to increase individual efficiency in performing job tasks [4,10]. In a research conducted to examine the status of psychological empowerment among the nurses of teaching hospitals of Birjand in northeastern Iran, psychological empowerment of the nurses was at moderate level and the meaning dimension had the highest mean and the impact dimension had the lowest mean. In addition, in the mentioned study, the mean of empowerment scores in men was higher than that of women and there was a significant relationship between the psychological empowerment score and age, employment history, job satisfaction, and service sector, and satisfaction with superiors [11].

In the study conducted by Mok et al., it was found that teamwork has the highest relationship with the empowerment of nurses [12]. In a study conducted with the aim of evaluating the psychological empowerment of nurses in the educational hospitals of Sabzevar in northeastern Iran, psychological empowerment of the nurses was at the moderate level [13]. Studies have shown a positive and significant relationship between psychological empowerment, organizational learning and organizational trust [14]. In a study conducted by Gilavand et al. with the aim of investigating the status of the different components of the psychological empowerment of faculty members in Dezful University in southwest of Iran, the mean score of the areas of impact, sense of competence and self-determination was at the lower level, but the mean score of the meaning was evaluated at the moderate level. Individual characteristics of the subjects did not have a significant effect on their empowerment [2]. In the health system, nurses are the largest group of health service providers and their professional ability plays a key role in fulfilling the mission of the health system. Unskilled nurses are ineffective and are less satisfied with their jobs, which may have a negative impact on patient care. For various reasons, less attention is paid to empowerment of the nurses in different hospital wards. The empowerment of nurses by medical science universities and nursing managers can increase their active participation in solving healthcare and medical education systems and make them effective and creative members in medical and educational teams [15].

Therefore, as medical education system is integrated with the health and therapeutic services system in Iran, investigating the empowerment status of nurses working in teaching hospitals is crucial. Hence, this research was conducted to evaluate the psychological empowerment of nurses in teaching hospitals. Accordingly, the Ahvaz Jundishapur University of Medical Sciences in southwest of Iran was selected as a statistical sample.

Materials and Methods

This cross-sectional descriptive study was conducted in 2019 at Ahvaz Jundishapur University of Medical Sciences, southwest of Iran. The research population included all nurses working in the teaching hospitals of this university (including Imam Khomeini, Golestan, Shafa, Abuzar, Razi, Taleghani and Sina hospitals). The questionnaires were distributed by census sampling method. Finally, 235 of them were completed by the subjects. The data collection method was a questionnaire. The questionnaire included two sections of demographic characteristics (age, level of education, employment history, and type of employment) and Spreitzer empowerment questionnaire. This questionnaire was developed in 1995 based on the Thomas et al. [3] empowerment model and consists of 12 items [2] assessing four dimensions of psychological empowerment from the Spreitzer point of view. These dimensions include meaning (3 items), including consistency between work requirements and beliefs, values and behavior, feeling competence (3 items) which is a personal belief that a person feels that he will successfully perform the assigned tasks, selfdetermination (3 items) which is having a sense of choice or autonomy at the sense of freedom of action and independency in determining the activities necessary to perform the job tasks, and impact (3 items) which is the degree to which a person can influence the strategic, administrative, and operational results of a job. These questions have been designed on the 5-point Likert scale (including "strongly disagree" takes the Score 1, "disagree" takes the Score 2, "I have no idea" takes the Score 3, "agree" takes the Score 4 and "strongly agree" takes the Score 5). Based on the classification, 3-7 is evaluated as low limit, 7-11 is evaluated as moderate limit, and 11-15 is evaluated as high limit. Validity and reliability of this questionnaire have been confirmed in numerous domestic and foreign studies [2]. Descriptive statistics (mean, standard deviation, percentage) and inferential statistics (independent t-test and analysis of variance) were used for data analysis. SPSS 22 was also used in this regard.

Results

A total of 235 nurses finally completed questionnaires. Their demographic characteristics are shown in Table 1. According to this table, 37.3% of them were under 30 years old and 62.7% of them were over 30 years of old. In addition, 86.2% of the nurses had a bachelor level of education and 13.8% had a master level of education, 43.5% of them had an employment history of less than 10 years and 56.5% of them had an employment history of more than 10 years. Moreover, 56.8% of the nurses had official type of employment, 18.6% had treaty type of employment, 2.5% had contractual employment, and 22.1% of them had project type of employment (2 years). In terms of living place, 27.6% of nurses were working at Golestan teaching hospital, 9.5% of them were working at Abuzar teaching hospital, 8.7% of them were working at Shafa teaching hospital, 10.8% of them were working at Razi teaching hospital, 8.9% of them were working at Taleghani teaching hospital, and 34.5% of them were working at Imam Khomeini teaching hospital.

Table 1: Demographic characteristics of nurses

According to Table 2, variables including employment history, level of education, age, type of employment and the teaching hospital where nurses were working did not have a significant effect on their psychological empowerment (p<0.05).

Table 2: Investigating the effect of demographic characteristics of faculty members on their empowerment score

According to Table 3, the mean scores of domains of sense of competence (12.89 ± 2.50), self-determination (12.87 ± 2.48), and impact (12.22 ± 2.15) and meaning (11.48 ± 3.19) were evaluated at the highest level.

Table 3: Mean and standard deviation of empowerment components score

Discussion

In general, the psychological empowerment status of nurses in teaching hospitals of Ahvaz Jundishapur University of Medical Sciences was evaluated at high level. Among the four dimensions of psychological empowerment, sense of competence had the highest score, followed by self-determination, impact, and meaning, respectively. In a research conducted with the aim of assessing the psychological empowerment of nurses in Zanjan hospitals in Iran, the psychological empowerment of the nurses was at high level [14]. Moreover, in a research conducted to evaluate the status of psychological empowerment of nurses in Shahrekord teaching hospitals in southwest of Iran, the psychological empowerment of nurses participating was reported at moderate to high level [16]. In a study conducted by Nasiripour et al., the psychological empowerment of nurses at Qom hospitals in central Iran was reported at high level [17]. In addition, the study conducted by Friend examined the empowerment among the faculty members at the nursing faculties in the United States and empowerment in the two studied groups were reported at high level, but the capability level of the managers was higher. It was also concluded that capable managers have a positive effect in empowerment of the staff [5]. Stewart et al. examined the psychological empowerment of the nurses in the US and reported their psychological empowerment of at desirable level [18]. Another study conducted in this regard to evaluate the relationship between aggression and psychological empowerment and the individual characteristics of nurses in intensive care units in the United States reported the psychological empowerment of nursing staff at the high level [19]. The results of all these studies are consistent with those of our study. Tourani et al. examined the relationship between empowerment atmosphere and empowerment perception among the staff in teaching hospitals in Kerman and reported that staff did not have a good status in terms of psychological empowerment [20]. Their results are not consistent with those of our research.

Our research also revealed that variables such as employment history, education, age, type of employment and nursing teaching hospitals had no effect on psychological empowerment of them, which is in line with the result of study conducted by Gilavand et al. [2]. Various studies have been conducted to improve and enhance the psychological empowerment of nurses, indicating that some factors can play role in this regard. For example, studies have shown that there is a positive and significant relationship between psychological empowerment, organizational learning and organizational trust [14]. A study also showed that change in managers' behaviors led to an increase in the ability of nursing staff [21].

Conclusions

Thus, it can be concluded that retraining leadership and management skills programs will lead to organizational and psychological empowerment of nursing staff and an improvement in their professional performance by improving the knowledge of managers. Given the importance of psychological empowerment in nursing staff, it is suggested that managers of teaching hospitals provide conditions for staff to consider their job valuable and have an intrinsic interest in it, believe in their ability to perform their tasks, duties and have a freedom of action in the work environment, participate in the decision makings and have sense of trust and interest in each other. Studies in which questionnaire is used to collect the data suffer from specific problems and limitations. One of the most important limitations of this research is the conservatism of staff in answering the questions, especially questions related to management factors, which may have an impact on the results. Another limitation of this study is its external validity, which might make it impossible to generalize the obtained results to similar populations. In the present study, the target group was only nurses of teaching hospitals and other nursing groups such as room technician and anesthesiologists were not included in the study. This issue could affect the generalizability of the present study results on the entire nursing population of Ahvaz Jundishapur University of Medical Sciences. The psychological conditions and individual characteristics of the subjects, the differences in attitude of the individuals towards the nursing profession, as well as the rules and regulations governing the hospital and the work conditions can affect the view of nurses in completing the questionnaires. Identifying these factors was out of the control of the researcher and he tried to do sampling in stable conditions of the hospital wards to minimize these factors.

Acknowledgments

This article is extracted from a research granted by Ahvaz Jundishapur University of Medical Sciences, Iran Numbered PHT-9640 and the ethical code of IR.AJUMS.REC.1396.1127.

Conflict of Interest

The authors declare that there is no conflict of interest regarding the publication of this article.

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