This study tested the ability of work relationships and work empowerment to predict nursing expertise in experienced acute care nurses.
With high patient acuity, constant system changes, and multiple changing members of the healthcare team, expert nurses are increasingly important to ensure positive patient outcomes in acute care settings.
This study was an exploratory, predictive correlational design with a stratified random sample of 115 staff nurses from a large tertiary care center. Data were collected on work empowerment, work relationships, and nursing expertise.
A modified study model was supported in this sample of acute care nurses (R = 0.258, P = .000) and explained 26% of nurses' reported expertise.
Work relationships explained the largest portion of the variance in nurses' reported expertise (16%), more than experience in the specialty (9%) with an indirect link between work empowerment and nursing expertise.
"By building significant networks, people connect to each other, create opportunities to test new ideas, or discuss matters of professional concern, depending on culture, traditions, habits, and workplace structures   . The PICU context requires that nurses react instantly and precisely in situations of suspected pain, in a surrounding full of lights and sound signals, with colleagues having different priorities, during complicated medical treatments  . This raises a concern that the context contributes to the difficulty of recognizing children's pain, and influences what is learned as well as the learning process  . "
[Show abstract][Hide abstract] ABSTRACT: Background: Vulnerable children undergoing intensive care might still experience pain when they should not, due to nurses and pediatricians insufficient knowledge about how critical illness affects childrens' signs of pain. How signs of pain are learned in clinical practice might be one of the remaining aspects in nurses insufficient pain alleviation. In the workplace learning is directed by what the units shared meaning finds as significant and meaningful to learn. However, what it is viewed as meaningful to learn about pain from the nurses' perspective might not be meaningful from the child's perspective. When working together in the PICU, nurses rely on each other and interact in many ways, and their understanding is related to situated knowledge and facilitated by a personal reference group of colleagues. Professional concern, depending on culture, traditions, habits, and workplace structures forms the clinical learning patterns in the PICU. However little is known about nurses' clinical learning patterns or collegial facilitation within the PICU. These assumptions lead to the aim of the study: to elucidate patterns in clinical knowledge development and unfold the role of facilitator nurses in relation to pain management in the PICU. Method: The study had a qualitative interpretive design approach using semi-structured interviews, analyzed with qualitative content analysis to elucidate both manifest and latent content. Results: The findings elucidates that the workplace culture supports or hinders learning and collaboration. Knowledge development within practice is closely connected to the workplace culture and to nurses' significant networks. The findings also clarify that nurses needs to feel safe in the workplace and on an individual level to build and rely on significant networks that facilitates their own personal knowledge development. There is an ongoing interaction between the learning patterns and the facilitation the significant networks offer. Conclusions: Nurses need to embrace effective learning about children's pain from day one. Lack of a facilitating structure for learning, lack of assessment within clinical practice, and the focus on the individual nurses' learning are remaining considerable problems when it comes to alleviating the vulnerable child's pain. To increase the possibility of pain alleviation in the clinical setting, it is of importance to attend to the caring culture and build a safe collaborative www.sciedu.ca/jnep Journal of Nursing Education and Practice, May 2012, Vol. 2, No. 2 ISSN 1925-4040 E-ISSN 1925-4059 108 culture that is patient centered. This requires an environment that allows for open discussion, where questioning and reflecting is a natural part of the culture within the group. These factors need highlighting and thorough examination from the organization. Nurses focus on learning, and interact in a learning community of practice that is furthered when they experience a safe environment and find that their questions are taken seriously. Approaches to promote a scholarship of nursing care are needed to develop clinical learning and, consequently, raise the quality of pain care.
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