Eliciting e-leadership style and trait preference

among nurses via conjoint analysis

Authors: Christian Jay S.Orte and Michael JosephDiño

Significance / Statement of the problem

With the advent of changes in technology, a style of leadership with the use of the internet is
now viewed as a creative way in executing motivation direction and influence to others this is
known as a leadership style. The general purpose of the study is to elicit and identify
characteristic trait and style preferences of their nurse leaders who uses advanced information
technology hands this will answer the central questions:

1. What is the profile of the clients in terms of

Age?
Gender?
Educational attainment?
Organizational involvement?
Area of practice?

2. Which is the most important factor of an e- leader of the respondents in terms of

Leadership style?
Leadership trait?
Leadership characteristics?

3. Which is the more preferred virtual leadership style of the respondents between

Transformational?
Transactional?

4. which is the most preferred virtual leadership trait of the respondents in terms of
Authentic?
Emphatic?
Artistic?
Strategic?

5. Which is the more preferred vehicle leadership characteristic of the respondents

between

Gender?
Physique?
Research design
 Conjoint analysis via card sort was employed to capture the responses of 174 purposely
selected nurses in the Philippines with prior interaction with a virtual nursing leader. Ten (10)
orthogonal combination cards grounded from literature reviews were used as study tools. Data
was collected online for about two months and was analyzed using SPSS version 21.

Locale/population

Inclusion criteria are as follows:

- Registered nurse in the philippines

- Active member of the following nursing organizations ( i.e. PNA, MCNAP)
- Who experience virtual leadership through social media
- Who are willing and has the capacity to participate

Population n= 174 selected nurses in the Philippines with prior interaction with a virtual
nursing leader. Ten (10) orthogonal combination cards grounded from literature reviews were
used as study tools.

Statistical Treatment

Data collection was conducted from april 13 2018 to june 13 2018 via online Questionnaire
Statistical package for social sciences ( sp ss) version 21 and microsoft 2010 software was
utilized for its data analysis

Ethical considerations

This study has been approved by the institutional ethics review committee. This an institutional
review board (IRB), also known as an independent ethics committee (IEC), ethical review
board (ERB), or research ethics board (REB), is a type of committee that applies research ethics
by reviewing the methods proposed for research to ensure that they are ethical. Such boards are
formally designated to approve (or reject), monitor, and review biomedical and behavioral research
involving humans.

Conclusion

1. Leadership style was the most important e- leadership factor as perceived by the
respondents
2. transformational leadership style was the more preferred virtual leadership style as
perceived by the respondents
3. authentic and artistic leadership where the most preferred virtual leadership traits as
perceived by the respondents
 4. physique attribute was more preferred was the more preferred virtual leadership
characteristic as perceived by the respondents

Recommendation

1. The leaders of the organizations should execute a transformational leadership style with an
authentic trait for them to lead and motivate their followers in order to achieve and attain their
organizational goals and objectives.
2. The leaders of different professional organizations in the country are encouraged to fully
utilize the digital and virtual spaces as platforms of communications among its members in
order to identify their concerns, suggestions and even issues that are needed to address that
probably affect the nursing practice. In addition, since physical attractiveness matters when
it comes to virtual leadership, leaders must be always presentable in communicating and
leading their followers.
3. For nurses it is imperative that they will vote their professional organization leaders who are
technologically savvy and have the capacity to transform, enhance and influence the
nursing field either in the clinical practice or the academic since the result shows that
respondents preferred a transformational leader as e- leadership style of nursing
Leaders.
4. Since there is a concrete finding with regards to the attributes of preferred e- leadership
Style for nurses, this can serve as a reference or basis in creating a model for nurse-
leaders who utilize the virtual spaces as an approach in nursing leader and management.
5. For nurse-educators the concept of e- leadership attributes can now be introduced in the
lessons among aspiring nurses in the undergraduate students as well as among the
professional nurses in the graduate level to be incorporated or adopted with regards to their
actual leadership practices.
6. Likewise, another study is recommended among professions with regards to their preferred
e- leadership style of the followers to their leaders. They may use the same variables
employed in this study or may identify new variables grounded on literature reviews.
7. To generalize the findings a qualitative research is also recommended to identify the ideal e-
leaders of nurses based on their lived experiences.
8. For future researchers they may employ innovative research designs such as structural
equation modeling path analysis or multiple regression models to assess the different
strengths of variables that may affect the execution of e- leadership among leaders.

Experiences and perceptions of the theory‐practice

gap in nursing in a resource‐constrained setting: A
qualitative description study
Authors:

David Abdulai Salifu1 | Janet Gross2,3 | Mohammed Awal Salifu4 | Jerry PK Ninnoni5
Significance

The aim of the study was to describe the experiences and perceptions of strategic stakeholders
in nursing education and practice of events associated with TPG (Theory-practice Gap) in a
resource‐constrained setting.

Statement of the problem

● Theory‐practice gap is a reverberative theme in nursing education and practice

with the potential to impede advances in nursing practice and patient safety.
● The professional and bureaucratic work conflict has been proposed as an
explanatory model for the existence of the theory practice gap
● Poor support for student learning in the clinical learning environment can occur
when the community of learning is poorly constituted
● Varying levels of the TPG exist in various settings based on the degree of
misalignment between learning outcomes, learning activities and the learning
environment (consisting of the community of learning)

Research design

Maximum variation sampling based on role in the events of theory‐practice gap was
used to recruit student nurses, nurse faculty and clinicians from two study sites for focus
group discussions. Data were analysed using conventional content analysis.

A qualitative description methodology of the naturalistic paradigm was adopted to describe the
common, everyday experiences and perceptions of events contributing to the phenomenon of
theory practice gap in a way specifically relevant for improving practice, education, research and
policy decisions (Sandelowski, 2000).

Locale/population

1. Clinicians with a minimum of a bachelor's degree in nursing and at least three years clinical
working experience and acting as a preceptor, or a clinician with a minimum of diploma in nursing
and five years working experience and acting as a preceptor in site A.
2. Only full‐time nurse faculty of site B with at least three years teaching experience and a minimum
qualification of a master's degree.
3. Level 400 postsecondary nursing students of site B

The study took place at two sites situated in the poorest region of the country (Ghana) with a poverty
level of 50.4%, representing 1.3 million poor individuals (Cooke, Hague, & McKay, 2016). Site A was
a teaching hospital and the main referral point in the region. Site B was a university which had been
in existence for more than three decades but only started offering a baccalaureate nursing
programme about a decade ago. The Nursing Department of site B had an average class size of 176
and an average student population of 704 at the time of the study. The Department depended on the
services of adjunct faculty to help augment the staff shortage. The Department was faced with a
myriad of challenges. Educational resources were limited. Nursing faculty and students do not have
access to the wealth of data available online to benefit from the learning process. The school does
not have an electronic library system and their wireless connection was erratic. The Department
does not have its own library and the simulation room was poorly supplied and some equipment was
outdated. Disposable nursing supplies were simply inadequate or not available to facilitate teaching.
Students at site B were mainly assigned clinical placements at site A but also used other smaller
clinical placement areas in the region and across the country. Typically, only a few of the clinicians
acting as preceptors in site A possessed a postgraduate level education in nursing and did so with
minimal to no training for the role.

Statistical Treatment

Data sources for this study were triangulated to ensure a holistic coverage of the phenomenon
from perceptions of stakeholders with extensive experience of the events of TPG. The topic
guide for focus group discussions was reviewed by two expert nurse educationists and piloted
with student nurses, nurse faculty and clinicians at two sites similar to the study sites but in a
different region. Minor revisions were made to wording of the topic guide to enhance clarity.
Data analysis was also triangulated, and the analytical process peer reviewed by one of the co‐
authors.

Ethical considerations

Ethical approval for the study was granted by the University Institutional Review Board.
Approval was also given by both sites A and B prior to data collection. Participants were
comprehensively informed about the aims and procedures of the study before a written informed
consent was obtained from each of the participants. The confidentiality and anonymity of
participants were ensured by assigning a code to each participant; known only to the participant
and researchers. The study process did not entail any manipulations or potentially harmful
effects on participants.

Conclusion

Findings of this study confirmed the existence of the TPG in the context of nursing education
and practice in the country of interest in sub‐Saharan Africa and add to the growing literature
acclaiming TPG as a global phenomenon. Stakeholders of nursing education and
practice in the research setting are yet to realize the realities of the implications of the TPG and
its associated challenges on contemporary nursing education and practice. In the context of the
research setting, the existence of TPG revolved around system inadequacies;
resource constraints; challenges of the clinical learning environment; clinical placement and
supervision; and nurse faculty factors. Inadequate establishment of a community of learning
with a shared mental model of learning outcomes aligned with learning activities and sessions
was largely accountable for the theory practice gap in this setting.

Recommendation

1. The recognition of the complexity of healthcare delivery systems and the need for
parallel improvements in nursing roles prompted the introduction of major
reforms in nursing education in some parts of the world.
2. A full‐time clinical coordinator, probably employed by university, may be needed
to address issues of clinical sequencing, communication and collaboration and
clarification of student learning objectives.
3. If learning outcomes are constructively aligned with learning activities which
occur within a well established community of learning, the authors hold the view
that the professional and bureaucratic work conflict could be minimized. Reduced
conflict will provide ample opportunities for students to activate existing
knowledge, engage new information, demonstrate competence and apply skills in
the real world

Nurses’ perspectives on readiness of

organizations for change: a comparative
study
Author: Basil Hameed Amarneh

Significance

The purpose of this study is to evaluate readiness for change perceived by nurses at
Jordanian hospitals according to the hospital type and the gender of nurse.

Statement of the problem

There are misconceptions about readiness for change, and only a few health care
and nursing studies about organizational readiness for change have been conducted. Nurses’
perceptions of their organizations’ readiness for change are important; they help in introducing,
managing, and maintaining the change.

Research design

Using a quantitative comparative research design and a validated survey, data were
collected in 2010 from a convenience sample of 130 nurses from four government and three
private hospitals with a response rate of 59%.

Locale/population

This study involved four government and three private hospitals. Nurses were recruited
using a convenience sampling technique. In this study, from a possible 220 participants,
only 130 nurses responded, 43 males and 87 females, who were employed in hospitals
located in the capital Amman and two other large governorates, resulting in a response
rate of 59%. For a full understanding of change and the ability to manage it, the
inclusion criterion was set as “RNs who have worked in hospitals for at least 1 year”.
The exclusion criteria were based on the educational level and experience. Practical
nurses and those RNs who had less than 1 year of experience were excluded.

Statistical Treatment

This was a quantitative comparative research design that used a structured questionnaire to
collect data in 2010 over 2 weeks. Statistical Package for the Social Sciences (version 20) was
used to analyze data,25 considering 0.05 as the significance level. Descriptive statistics for
sample variables including means, frequencies, and standard deviations were calculated.
The demographic variables of the sample were categorical; accordingly, chi-square tests were
used to perform comparisons. Items of the “readiness for change in organizations” instrument
were treated as continuous variables, and thus,independent t-tests were used to compare
different types of hospitals. The readiness of organizations for change scores were compared
based on gender using the t-test. Correlations were found between the organizational readiness
for change and sample demographics.

Ethical considerations

Before data collection, the Institutional Review Board of Jordan University of Science and
Technology approved the study protocol, the methodology of the research, anonymity of the
participants, the protection of identity, privacy, and handling of the data. The participants were told
that completing and submitting the survey automatically meant that they gave consent.

Conclusion

Government hospitals were more ready to change than private hospitals, particu-
larly in supporting collaborative and multidisciplinary team approaches to patient care. More
than male nurses, female nurses perceived that their organizations were ready to use or plan to
use advanced practice nurses. In general, Jordanian nurses perceived that their hospitals were
not ready for change. Perceptions about organizational readiness for change varied according
to the type of hospital and the gender of nurse. Government hospitals were more ready to
change than private hospitals, particularly in supporting collaborative and multidisciplinary team
approaches to patient care. More than male nurses, female nurses perceived that their
organizations were ready to use or plan to use advanced practice nurses.

Recommendation

One of the recommendations is a need for targeted intervention to improve readiness for
change. Assessing readiness for change is generally the first step in any change project. Until
participants are ready for change, little can be done to bring about the change.

The classical change theory is commonly used in research about change and readiness for
change.28 The researcher identified three phases through which the change agent must
proceed before a planned change becomes a part of the system. Results of this study have
implications for practice, research, and education. For practice, regardless of type of hospital,
Jordanian nurses perceived that their hospitals were not ready for change, suggesting that
nurses and nursing administrators should work in a collaborative manner to introduce and adapt
to change.

Exploring implementation of the Careful Nursing

Philosophy and Professional Practice Model in
hospital-based practice
Authors: Sinéad Murphy RGN, MSc|Raphael Mc Mullin RGN, MSc| Sinéad Brennan
RGN|Therese Connell Meehan RGN,PhD

Significance

To explore the effectiveness and feasibility of implementing the two clinical dimensions
of the Careful Nursing Philosophy and Professional Practice Model© (Careful Nursing)
in an acute care hospital.

A professional practice model is a conceptual framework of inter-related nursing care

delivery structures, relational processes and values that are meaningful to nurses in
clinical practice and support their control over their practice and practice environment
(Slatyer et al., 2016). Most PPMs incorporate an external theoretical foundation, often a
caring theory. Jacobs (2013) emphasizes that PPMs are different from conceptual
models and theories in that their concepts are a combination of commonly recognized
human values, such as compassion, and practice aims, such as evidence-based
practice. Professional practice models do not identify the type of
statements about concepts, or relationships among them, that are
necessary for theory development.

Statement of the problem

The study aimed to determine if the modified form of Careful Nursing described above would
increase nurses’ control over their practice, increase nurses’ adherence to hospital nursing
documentation standards, positively influence nurses’ perception of their practice, and be
feasible to implement.

Research design

A mixed methods exploratory design was used, employing quantitative and qualitative methods.
Quantitative data were collected on nurses’ control over and documentation of their
practice. Qualitative data were collected on nurses’ perceptions of their practice.

Locale/population

The study was conducted over 16 months during 2012–2013 in a 26-bed acute medical ward at
a 544-bed urban hospital in Ireland. Patients were aged 65 years and older and their medical
diagnoses were mainly stroke and dementia.

Statistical Treatment

Nurses’ control over practice was measured using the Control Over Nursing Practice Scale
(CONP) (Parsons & Murdaugh, 2007), designed to measure hospital-based nurses’ freedom to
evaluate and modify their practice. The CONP is composed of 16 statements, each with a 7-
point Likert scale. Scores range from 1, minimal to 7, maximum control. The CONP includes two
subscales: Clinical Autonomy (CA) including eight items measuring nurses’ freedom to practise
patient care using independent clinical decision-making and Control Over

Unit Operations (COUO) including eight items measuring nurses input and engagement in
decision-making about patient care operations. Parsons and Murdaugh demonstrated good
internal consistency,using Cronbach’s α, for the total scale (α = 0.94) and each subscale
(α = 0.92). They examined construct validity using confirmatory factor analysis within structural
equation modelling. The CONP loaded at 0.87 on both CA and COUO; CA loaded between 0.61
and 0.86 on its eight indicators and COUO loaded between 0.59 and 0.84 on its eight indicators.

Ethical considerations

Ethical approval was obtained through the hospital ethics and research committee expedited
review. Nurses gave their informed consent to participate and focus group participants were
assured in writing that audio-taped data would be kept confidential.

Conclusion

Despite the inherent limitations of a small study, the results of this study suggest that Careful
Nursing, as implemented, could have a positive overall influence on nurses’ practice.
Implementation of Careful Nursing is feasible.

Recommendation

Careful Nursing offers a distinctive nursing framework for professional practice. This study can
provide a strategy for implementing Careful Nursing-guided changes in hospital-based practice
on an exploratory level. Exploratory evidence suggests that Careful Nursing could influence
nurses’ practice and overall perception of practice positively; its implementation is feasible.

Goal Attainment Theory-Based Empowerment

for Chronically Ill Older Persons in the
Community

Authors: 1) Paul Froilan Garma RN, MAN 2) Letty G. Kuan EdD, RN

Significance

The aim of the study was to test the effects of the goal attainment theory-based empowerment
(GATE) on self-efficacy and health empowerment among chronically ill older persons in the
community. This is a quasi-experimental with non-equivalent control group pre-test post-test
study.

The Goal Attainment Theory-based Empowerment (GATE) intervention is a patient-centered

nursing intervention that facilitates chronically ill older persons in taking control of their health by
purposeful participation in setting and attaining their health goals. In addition to the routine care,
the GATE integrates health goal-setting and phone-assisted follow-up for four weeks
Statement of the problem

Chronically ill older persons suffer from multiple unmet needs, role transitions, poor quality of life
and increased demand for health services (Cheng, 2012). Their self-efficacy to manage the
demands of their health condition is poor, due to the lack of participation in their treatment
regimen and limited health choices (Chan et al., 2015). Poor self-efficacy and lack of control on
personal health increase the risk of comorbidities, frequent hospitalizations, decline in functional
ability and well-being (Lorig & Ritler, 2014). Empowerment is one of the innovative approaches
that fosters a sense of control in decision making and goal-setting, thereby, increasing the level
of self efficacy and perception of being empowered (World Health Organization, 2012).

The increasing prevalence of chronic diseases in the growing aging population stimulates
discussion regarding ways to empower older persons. The Department of Health (2012)
identified diseases of the heart and vascular system (i.e., coronary artery disease, hypertension)
and diabetes mellitus as the leading chronic conditions affecting older persons age 60 years
and above.

Research design

The study utilized a quasi-experimental with a non-equivalent control group pre-test

post-test design. Participants in the intervention group were the recipients of the GATE
intervention for a four-week period in addition to routine care. The control group had
routine care that includes health education, curative aspect and referrals. Data were
collected at baseline and four weeks after the intervention from June to August 2016.

Locale/population

A convenience sampling technique was utilized. Inclusion criteria for participation were:
(1) a community-dwelling individual aged 60 years or older; (2) seeking out-patient
consultation in a health center; (3) must have a medical diagnosis of at least one
chronic condition namely hypertension, diabetes mellitus and coronary artery disease
for the past six months at the time of the interview as indicated in the medical record; (4)
ability to read and speak Filipino; (5) has access to a cellular phone at home; and (6)
intact cognitive functioning (minimum cut-off score 3-4 errors) as evaluated by a Short
Portable Mental Status Questionnaire. Exclusion criteria were those who were severely
ill (i.e., on dialysis, chemotherapy), diagnosed with acute, life threatening comorbidities,
have sensory deficits in hearing/speaking and psychomotor impairment, and known
psychiatric problems. The study was conducted in two (2) health centers in the National
Capital Region, which were conveniently selected.
Statistical Treatment

The G*Power software (Germany; version 3.1.9.2) was used to estimate the required
sample size. The effect size was based on a previous study on empowerment program
that reported a value of 0.72 (Chen, 2014). To reach 80% power and a 0.72 effect size
with an alpha value of 0.05, a minimum sample size of 32 participants in each group
was required. A total of 59 participants completed the study. Attrition rates were 14%
and 16.67% in the control and intervention group, respectively. The study has a power
of 77.58%.

Descriptive statistics was used to report the participants' sociodemographic and clinical
characteristics. The homogeneity of participant characteristics between the control and
intervention groups was analyzed using Levene's test and chi-square test for categorical
variables. Normality test was verified using ShapiroWilk's test. Self-efficacy between the
groups were compared using independent t-test.

Ethical considerations

The ethics review board of University of the Philippine Open University - Faculty of Management and
Development Studies granted ethical clearance to conduct the study. Written informed consent was
obtained from all study participants. A risk-benefit assessment was also conducted. The intervention
protocol was deemed as a low-risk, empowerment-based clinical feedback intervention. Likewise,
permission to use the research instruments was obtained from their respective authors.

Conclusion

The study demonstrated preliminary evidence on the effectiveness of goal-setting as an integral

component of an empowerment intervention delivered through phone calls. The GATE
intervention significantly improved the health empowerment of chronically ill older persons.
Although self efficacy did not differ between the groups, it must be noted that there was a
significant increase in the intervention group. It is recommended that goals of chronic disease
management for older persons living in the community should neither be shaped by the health
care professionals nor restricted to generic medical outcomes, but rather be discussed and
personalized with every patient, according to their own particular health goals, priorities and life
situation. Further studies are needed to explore the use of nursing theory, empowerment
framework and technology in caring for older persons with chronic illness.

Recommendation
The improved self efficacy in the intervention group likely resulted from skill mastery, use of
problem solving strategy, and verbal and social persuasion as integral components of the
intervention protocol. The finding was congruent with similar empowerment programs tested on
chronic diseases such as diabetes and renal disease that increased the self-efficacy of patients
(Chen et al., 2014).

This study is the first to give evidence on the effect of an empowerment intervention using a
nursing theoretical framework delivered through phone calls on behavioral outcomes among
older persons in the local context.

Empowerment interventions promote positive physical, psychosocial and behavioral health

outcomes (Anderson & Funnell, 2010). Drawing from a nursing theoretical perspective, this
study that highlighted goal attainment as an empowerment strategy for older persons with
chronic conditions living in the community significantly improved the study participants' self
efficacy and health empowerment in managing their health condition